10th July 2008
[QUOTE=rockyryan;3641756]I am a 52 yo fitness instructer and went for a routine health check. They found my psa to be 16. After a biop the results were right side clear, left side 2 cores 5%, volume 24.6cc. Gleason 3+3, MRI and Bone scan clear, I have no symptems.
I have a younger partner and a great and active life. Do I realy need to go ahead with treatment that will stop me enjoying my life ?? I believe I will not die from PC and treatment will wreck my whole life. I would rather another 10 good years than the posibility of a bag on my hip and Erectile Dysfunction plus all the treatment implications.
Hello Rocky,
daff covered key points. It's important for prostate cancer patients to be informed or to be very lucky.
Several of your thoughts indicate you don't know much about prostate cancer, which is typical for new patients, including me, back in 1999. For starters, having to have a bag on your hip is extremely unlikely. Likewise, having treatment wreck your whole life is also unlikely, but that's the way most of us feel for a while after we learn we have the disease. Erectile Dysfunction is a possibility, but many patients still enjoy an active sex life, depending on the circumstances of their cases and treatment outcomes. Even some of us with challenging cases are able to enjoy a fine quality of life. (My own QOL is very good in my ninth year since diagnosis for a challenging case (PSA 113.6, GS 7, etc.) - basically like what I had before diagnosis, allowing for being older.) For many patients, active surveillance without conventional treatment is a sound option, though in your case that PSA of 16 is a large caution flag that you should not ignore.
Here's my layman's/experienced survivor's view (no enrolled medical education) of your case information: the volume of cancer and Gleason total of 6 are both favorable, but the PSA is not and deserves further explanation. (The MRI and bone scans are almost always favorable and don't add much unless the case is well advanced.)
Here are a couple of key additional, related facts you may have or may be able to develop about the PSA: (1) the PSA doubling time, especially whether the PSA rose by more than 2.0 in the year before you were diagnosed, and (2) whether infection or inflammation may have boosted the PSA in addition to the cancer. (Having sex within a day or so of the test can also boost the result, but only by about 10% according to Dr. Gary Onik.)
A rise by more than 2.0 has been recognized in just the past several years as an additional risk factor, based on research by the D'Amico team. Even if you don't know whether yours did so rise, you can get an additional PSA(s) at least three months from the last one(s) and with the necessary healing time after the biopsy disturbed the prostate; you can calculate the doubling time from just two PSAs, though it is more reliable with three, ideally with a spacing of 18 months. With that, you can calculate whether your PSA would have gone up by more than 2.0 in the year before diagnosis. (But I wouldn't wait 18 months just to get an accurate doubling time figure.)
Do you know that infection or inflammation of the prostate can boost the PSA as high as 50, even higher in some cases? Even though you don't have symptoms, you might still have an infection. Of course, if you do, that would throw off doubling time calculations, and it would also mask the value of PSA in determining the risk of your case. If your true PSA, undisturbed by infection, were 10 or below, and your true PSA would not have exceeded an increase of 2.0 in the year prior to diagnosis, your case would be "low risk." Active surveillance could be an option, especially aided by nutrition, exercise and stress reduction (probably no issue for you with your yoga work), and perhaps mild medication like finasteride or Avodart. If the true PSA is higher than 10, then you would probably have your best outcome by choosing some kind of treatment.
One other key point - the Gleason score. Most of us have our first Gleason score assigned by a general pathologist who spends his days looking at a stream of tissue samples for cancers and many other diseases from men, women, and children. Frequently general pathologists will undergrade (more often) or overgrade the Gleason. It is very important to have a pathologist who is expert in prostate cancer review the Gleason score, if an expert did not do the first grading. That's because the Gleason is so critical in sound treatment decision making and case management. The excellent book "A Primer on Prostate Cancer - The Empowered Patient's Guide," gives a list of some experts in the US on page 50, and shipping the biopsy sample could work. I don't know what expertise there is in Bangkok, but Singapore is emerging as a major player on the global medical scene and probably has some expert prostate cancer pathologists.
Many of the conventional therapies offer at least a fair shot at the quality of life you are looking for, plus a good shot at a cure, especially if the case is truly low-risk and you have an expert doctor. There is also an option that offers a good shot at long-term control, but not a cure, and an almost sure return to your pre-treatment quality of life following a year of triple hormonal blockade therapy. (I know about the latter because I had limited options, and that's the one I chose.) If it were me and I had a truly low-risk case, I would get in a sound active surveillance program or choose a treatment that emphasized going for a cure even if risking the QOL, but each of us has to work out how to balance these priorities for himself, and it's not an easy task.
I join daff in wishing you good luck in researching your situation and deciding what to do.
Take care,
Jim
I have a younger partner and a great and active life. Do I realy need to go ahead with treatment that will stop me enjoying my life ?? I believe I will not die from PC and treatment will wreck my whole life. I would rather another 10 good years than the posibility of a bag on my hip and Erectile Dysfunction plus all the treatment implications.
Hello Rocky,
daff covered key points. It's important for prostate cancer patients to be informed or to be very lucky.
Several of your thoughts indicate you don't know much about prostate cancer, which is typical for new patients, including me, back in 1999. For starters, having to have a bag on your hip is extremely unlikely. Likewise, having treatment wreck your whole life is also unlikely, but that's the way most of us feel for a while after we learn we have the disease. Erectile Dysfunction is a possibility, but many patients still enjoy an active sex life, depending on the circumstances of their cases and treatment outcomes. Even some of us with challenging cases are able to enjoy a fine quality of life. (My own QOL is very good in my ninth year since diagnosis for a challenging case (PSA 113.6, GS 7, etc.) - basically like what I had before diagnosis, allowing for being older.) For many patients, active surveillance without conventional treatment is a sound option, though in your case that PSA of 16 is a large caution flag that you should not ignore.
Here's my layman's/experienced survivor's view (no enrolled medical education) of your case information: the volume of cancer and Gleason total of 6 are both favorable, but the PSA is not and deserves further explanation. (The MRI and bone scans are almost always favorable and don't add much unless the case is well advanced.)
Here are a couple of key additional, related facts you may have or may be able to develop about the PSA: (1) the PSA doubling time, especially whether the PSA rose by more than 2.0 in the year before you were diagnosed, and (2) whether infection or inflammation may have boosted the PSA in addition to the cancer. (Having sex within a day or so of the test can also boost the result, but only by about 10% according to Dr. Gary Onik.)
A rise by more than 2.0 has been recognized in just the past several years as an additional risk factor, based on research by the D'Amico team. Even if you don't know whether yours did so rise, you can get an additional PSA(s) at least three months from the last one(s) and with the necessary healing time after the biopsy disturbed the prostate; you can calculate the doubling time from just two PSAs, though it is more reliable with three, ideally with a spacing of 18 months. With that, you can calculate whether your PSA would have gone up by more than 2.0 in the year before diagnosis. (But I wouldn't wait 18 months just to get an accurate doubling time figure.)
Do you know that infection or inflammation of the prostate can boost the PSA as high as 50, even higher in some cases? Even though you don't have symptoms, you might still have an infection. Of course, if you do, that would throw off doubling time calculations, and it would also mask the value of PSA in determining the risk of your case. If your true PSA, undisturbed by infection, were 10 or below, and your true PSA would not have exceeded an increase of 2.0 in the year prior to diagnosis, your case would be "low risk." Active surveillance could be an option, especially aided by nutrition, exercise and stress reduction (probably no issue for you with your yoga work), and perhaps mild medication like finasteride or Avodart. If the true PSA is higher than 10, then you would probably have your best outcome by choosing some kind of treatment.
One other key point - the Gleason score. Most of us have our first Gleason score assigned by a general pathologist who spends his days looking at a stream of tissue samples for cancers and many other diseases from men, women, and children. Frequently general pathologists will undergrade (more often) or overgrade the Gleason. It is very important to have a pathologist who is expert in prostate cancer review the Gleason score, if an expert did not do the first grading. That's because the Gleason is so critical in sound treatment decision making and case management. The excellent book "A Primer on Prostate Cancer - The Empowered Patient's Guide," gives a list of some experts in the US on page 50, and shipping the biopsy sample could work. I don't know what expertise there is in Bangkok, but Singapore is emerging as a major player on the global medical scene and probably has some expert prostate cancer pathologists.
Many of the conventional therapies offer at least a fair shot at the quality of life you are looking for, plus a good shot at a cure, especially if the case is truly low-risk and you have an expert doctor. There is also an option that offers a good shot at long-term control, but not a cure, and an almost sure return to your pre-treatment quality of life following a year of triple hormonal blockade therapy. (I know about the latter because I had limited options, and that's the one I chose.) If it were me and I had a truly low-risk case, I would get in a sound active surveillance program or choose a treatment that emphasized going for a cure even if risking the QOL, but each of us has to work out how to balance these priorities for himself, and it's not an easy task.
I join daff in wishing you good luck in researching your situation and deciding what to do.
Take care,
Jim