13th November 2007
[QUOTE=BooMan;3252119]Harry, ...those like me with a Gleason sum of 6 or less, no more than 2 cores involved, no more than 50% involvement in any one core (mine are both less than 5%), and a low PSA (2.5). The diagnosis and tissue analysis of this disease are the questionable areas for those of us on this end of the scale. I believe studies have been done indicating that most of us by age 57 (like me) would have cancerous cells found in our prostate if examined during an autopsy if no cancer was previously suspected. Determining the aggressiveness and extent of disease before treatment is an area that needs a lot of study. ... A urologist I saw at Johns Hopkins told me that with my numbers I would not miss the window of opportunity for curative treatment by taking this path. Of course, no one can guarantee that. I'm comfortable with it for now. I'll let you know how the biopsy goes next month.
BooMan
You seem very well informed for a new patient, or have you been on active surveillance for years?
Active surveillance sure would not have fit my challenging case, but I have been learning about it for friends. I've been amazed at the number of major, very well known cancer centers in the US, in Canada, and in the Netherlands that have vigorous active surveillance programs in progress, at least two of them involving some of the leading prostate cancer surgeons in the world.
I have been very impressed with the effectiveness of these programs in selecting appropriate patients, maintaining diligent surveillance, and moving them to hopefully curative therapy if their cancers show unacceptable signs of aggressiveness. :) By the way, I think using color Doppler ultrasound for a biopsy is a great tactic for someone on active surveillance, especially to ensure that an otherwise mild cancer does not chance to be located in a strategic location that makes it dangerous. I hope the active surveillance programs will start emphasizing CDU; at the moment, I don't think any of them emphasize or even use it. You mentioned Johns Hopkins, and I recall that a leading doctor in that program recently said or published that about half or more than half of patients in their active surveillance program were still on active surveillance, and he also said that for those whose cancer proved too aggressive and who had elected surgery, none had cancers that penetrated the prostate capsule. :)
We are under tight restrictions here on what we can cite on the web, so I will just mention general locations for leading programs that I have learned about: Toronto, Baltimore, New York City, the Netherlands, Houston, and San Francisco.
It is also worth mentioning that active surveillance has been a major emphasis in some of the key medical association conferences this year. The conference for the medical oncologists association had three presentations/papers on active surveillance of just twelve total papers in the section of their Education Book on genitourinary cancers this year for their annual meeting. The Education Book is the key information that medical associations want to communicate to their members. Vu-graphs and audio recordings of the talks are on the web.
The IMPaCT conference, involving about 600 researchers sponsored by the Prostate Cancer Research Program arm of the Congressionally Directed Medical Research Program over the past ten years, as well as other leading researchers and about 100 survivors who had served for two years or more on proposal evaluation panels, was held in Atlanta in September. Many renowned researchers were there; it was a premier event. It too devoted a plenary session to leaders of active surveillance programs, including a panel member who had also given a presentation I found highly informative and encouraging at the medical oncologists conference. (I did not attend the latter, but I studied the material on the many pages of material from his talk and heard the talk on the web.) I don't believe material from the IMPaCT conference has made it to the web yet, but that is in the works. (IMPaCT: Innovative Minds in Prostate Cancer Today)
Active surveillance also came up at this year's National Conference on Prostate Cancer 2007, held in September in Los Angeles. (A couple of years ago, a leader of the Johns Hopkins active surveillance program had given a presentation to the 2005 national conference in Washington, DC. He might have been the doctor you mentioned.)
It's encouraging that the major centers are homing in on the best way to select, monitor and support patients on active surveilliance. Some are emphasizing diet/nutrition/supplements, exercise, stress reduction, and mild medication in support. For instance, at least one or two of the programs are now or are about to use one of the mild 5-alpha reductase drugs (finasteride or Avodart) to help prevent progression of the cancer and to improve monitoring results.
My hat is off to you for having the guts to follow this course and be comfortable (more or less) with it. :cool: It's certainly not for everyone or even most of us, but it looks very promising for a large group of patients with a priority for preserving quality of life and avoiding side effects of major treatment, as well as gaining time for additional treatment breakthroughs to occur or a cure to be found, while still maintaining high confidence that the cancer does not escape the potential for cure should it prove aggressive.
Take care and good luck,
Jim
BooMan
You seem very well informed for a new patient, or have you been on active surveillance for years?
Active surveillance sure would not have fit my challenging case, but I have been learning about it for friends. I've been amazed at the number of major, very well known cancer centers in the US, in Canada, and in the Netherlands that have vigorous active surveillance programs in progress, at least two of them involving some of the leading prostate cancer surgeons in the world.
I have been very impressed with the effectiveness of these programs in selecting appropriate patients, maintaining diligent surveillance, and moving them to hopefully curative therapy if their cancers show unacceptable signs of aggressiveness. :) By the way, I think using color Doppler ultrasound for a biopsy is a great tactic for someone on active surveillance, especially to ensure that an otherwise mild cancer does not chance to be located in a strategic location that makes it dangerous. I hope the active surveillance programs will start emphasizing CDU; at the moment, I don't think any of them emphasize or even use it. You mentioned Johns Hopkins, and I recall that a leading doctor in that program recently said or published that about half or more than half of patients in their active surveillance program were still on active surveillance, and he also said that for those whose cancer proved too aggressive and who had elected surgery, none had cancers that penetrated the prostate capsule. :)
We are under tight restrictions here on what we can cite on the web, so I will just mention general locations for leading programs that I have learned about: Toronto, Baltimore, New York City, the Netherlands, Houston, and San Francisco.
It is also worth mentioning that active surveillance has been a major emphasis in some of the key medical association conferences this year. The conference for the medical oncologists association had three presentations/papers on active surveillance of just twelve total papers in the section of their Education Book on genitourinary cancers this year for their annual meeting. The Education Book is the key information that medical associations want to communicate to their members. Vu-graphs and audio recordings of the talks are on the web.
The IMPaCT conference, involving about 600 researchers sponsored by the Prostate Cancer Research Program arm of the Congressionally Directed Medical Research Program over the past ten years, as well as other leading researchers and about 100 survivors who had served for two years or more on proposal evaluation panels, was held in Atlanta in September. Many renowned researchers were there; it was a premier event. It too devoted a plenary session to leaders of active surveillance programs, including a panel member who had also given a presentation I found highly informative and encouraging at the medical oncologists conference. (I did not attend the latter, but I studied the material on the many pages of material from his talk and heard the talk on the web.) I don't believe material from the IMPaCT conference has made it to the web yet, but that is in the works. (IMPaCT: Innovative Minds in Prostate Cancer Today)
Active surveillance also came up at this year's National Conference on Prostate Cancer 2007, held in September in Los Angeles. (A couple of years ago, a leader of the Johns Hopkins active surveillance program had given a presentation to the 2005 national conference in Washington, DC. He might have been the doctor you mentioned.)
It's encouraging that the major centers are homing in on the best way to select, monitor and support patients on active surveilliance. Some are emphasizing diet/nutrition/supplements, exercise, stress reduction, and mild medication in support. For instance, at least one or two of the programs are now or are about to use one of the mild 5-alpha reductase drugs (finasteride or Avodart) to help prevent progression of the cancer and to improve monitoring results.
My hat is off to you for having the guts to follow this course and be comfortable (more or less) with it. :cool: It's certainly not for everyone or even most of us, but it looks very promising for a large group of patients with a priority for preserving quality of life and avoiding side effects of major treatment, as well as gaining time for additional treatment breakthroughs to occur or a cure to be found, while still maintaining high confidence that the cancer does not escape the potential for cure should it prove aggressive.
Take care and good luck,
Jim