14th June 2008
Hello again lowan,
It's good that you have gotten some more advice from a different doctor and have had some thoughtful responses on this board. Taking the time and effort to see that second opinion specialist also seems like a sound thing to do.
Active surveillance is generally not favored in the major programs now practicing and researching it for men with a PSA over 10, as has been noted on the board and by the doctor, but you might want to get the specialist's opinion about it. As daff noted, your very large prostate would account for quite a bit of PSA produced by healthy cells, leaving a relatively small amount that is produced by the cancer. The rule of thumb, based on research, is that each cc of prostate will produce about .066 units of PSA. Using the rule, a prostate of 111 cc would account for about 7.3 units of PSA produced by healthy cells, with about 4.3 produced by the cancer. Of course, that rule of thumb, though helpful, is not a guarantee for a specific, individual case. The research cite is given in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide," page F4.
Two major active surveillance programs would not have any problem with your age of 63: the U. of Toronto, Sunnybrook, Canada, under Dr. Klotz (no limit on age), and the Erasmus Medical Center in the Netherlands, under Dr. Fritz Schroder (likes to see patients on AS that are at least age 55). I'm not advocating AS, just raising it as a possibility. As shs50 has noted, there are risks.
About radiation - my knowledge is second hand, but I've heard a number of presentations where leading doctors have commented that radiation's effectiveness can be adversely affected if the prostate or cancer is large. That would be something to check with your specialists.
One option is to reduce the prostate with a drug in the class known as 5-alpha reductase inhibitors - finasteride or Avodart.
Take care,
Jim
It's good that you have gotten some more advice from a different doctor and have had some thoughtful responses on this board. Taking the time and effort to see that second opinion specialist also seems like a sound thing to do.
Active surveillance is generally not favored in the major programs now practicing and researching it for men with a PSA over 10, as has been noted on the board and by the doctor, but you might want to get the specialist's opinion about it. As daff noted, your very large prostate would account for quite a bit of PSA produced by healthy cells, leaving a relatively small amount that is produced by the cancer. The rule of thumb, based on research, is that each cc of prostate will produce about .066 units of PSA. Using the rule, a prostate of 111 cc would account for about 7.3 units of PSA produced by healthy cells, with about 4.3 produced by the cancer. Of course, that rule of thumb, though helpful, is not a guarantee for a specific, individual case. The research cite is given in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide," page F4.
Two major active surveillance programs would not have any problem with your age of 63: the U. of Toronto, Sunnybrook, Canada, under Dr. Klotz (no limit on age), and the Erasmus Medical Center in the Netherlands, under Dr. Fritz Schroder (likes to see patients on AS that are at least age 55). I'm not advocating AS, just raising it as a possibility. As shs50 has noted, there are risks.
About radiation - my knowledge is second hand, but I've heard a number of presentations where leading doctors have commented that radiation's effectiveness can be adversely affected if the prostate or cancer is large. That would be something to check with your specialists.
One option is to reduce the prostate with a drug in the class known as 5-alpha reductase inhibitors - finasteride or Avodart.
Take care,
Jim