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To IMRT or not IMRT

hochbob
Posts: 10
Joined: Jun 2010

My Brothers,
While I have just joined this site and am grateful to have found it, I am no stranger to prostate cancer. I would sincerely appreciate any input regarding my situation, but first, my history.
PSA of 4.1 led to RP six years ago at age 57; T1C; Gleason 3+3=6; seminal vesicles, vasa, apex, and base all free of involvement; margins and lymph nodes (5) negative; AJCC pathologic stage T2, NO, MX.
PSA of .42 3 months ago; PSA of .85 1 month ago; CT and bone scans both negative; referred to radiation oncologist for possible IMRT.
I continue to read all I can find regarding my history and so far have discovered the following:
• 25-40% of men who have a RP will have a biochemical failure/recurrence.
• IMRT should be considered for all with biochemical failure especially those with positive margins.
• Only half of patients treated with SRT have a long term PSA response to SRT.
• One study says that 60% of patients will have an undetectable PSA post SRT.
• SRT initiated more than two years after recurrence provided no significant increase in prostate specific survival.
• Patients with positive surgical margins are more likely to benefit from SRT.
• PSA doubling time is significantly associated with CSS, however, the risk of dying is not fully explained by PSADT.
• According to the Sloan Kettering nomogram predicting response to SRT, I have 1 chance in 3 of being progression free after 6 years.
Given the above, I am struggling with moving forward with SRT. It is aggressive, expensive (I have a high deductible insurance plan), not without significant risk of both incontinence and impotence (I have neither), and it is without a proven survival benefit. Yes, I can choose to zap my prostate bed and pelvis with 37 blasts of radiation, however, the question is should I. I must also add that while my oncologist (MD/PhD) might be brilliant, he has absolutely no personality and spent the better part of my consult trying to “sell” me on going forward to the point of asking me to sign a document to begin treatment. He was taken aback when I said I wanted to think about it. I realize health care is a business and I have enormous respect for the medical profession, however, I wonder what would happen to these guys if we found a cure for cancer?
If you would share your experience and thoughts, I would be extremely grateful.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Hochbob,

So sorry that you're having to go through this whole process all over again after your RP six years ago. As you know from the PSA doubling time associated with your recent rise in PSA it is likely that your cancer is back and growing fairly rapidly.

I had an almost identical pathology and after reading the same statistics you have cited, I chose to have radiation as a first choice treatment because of the nearly identical long term survival statistics with RP. I chose CyberKnife but I don't believe that is an appropriate follow-on treatment following cancer recurrance following RP.

I too would be hesitant to go forward with another treatment that may increase the side effects of ED and incontinence which you seem to have avoided to date without an optimistic long term prognosis in terms of long term survival. The other thing you have to weigh is your personal choice regarding quality of life over quantity of life. To me, quality trumps quality every time, but that's an intensely personal decision and I know other men who regularly post on this forum would take an opposite view.

The first thing I would do is consult with some other doctors who not only might have a more agreeable personality but may have different options that you would be more comfortable with.

I believe there are some advanced CT scans / MRI technologies that may be able to better pinpoint the location of your cancer today and that might be a tool that could help you better gauge the liklihood of success.

As you know, once the prostate is removed the return of detectable PSA readings is pretty conclusive for PCa but I have read recently that there are other sources of PSA and that even some women have had a detectable PSA reading.

In the absence of any better tool, the trend in PSA readings following treatment is about the only measure of the efficacy of treatment. Although I am not proposing that you abandon your radiologist/oncologist team, I believe there is a growing body of evidence that diet can dramatically affect PSA. Also, statins (like Crestor) also tend to lower PSA. In my own case, I eliminated all dairy products (everything from milk including butters, cheeses, milks, yougurts, ice cream, and so on) and replaced it with a diet of soy products and rice milk. My PSA dropped from 4.3 at diagnosis in March 2010 to 2.8 prior to treatment in June. Unlike saw palmetto and other supplements, the elimination of dairy does not mask PSA...it seems to lower it by removing the IGF (insulin growth factors) which seem to be like candy to cancer. I know of many other antecdotal cases where a complete elimination of dairy has had similar effects on both prostate and breast cancer and you might wish to read some of Professor Jane Plant's books on the subject. Although there are no large studies that I am aware of that compares non dairy users in the West with dairy users for prostate cancer, there are some compelling individual stories. (Although I am sure the American Dairy Industry would dispute this strongly). As you may know, the rate of PCa in rural areas of China that have no dairy in the diet is about 1 in 100,000 versus about 1 in 6 in the West where dairy how comprises about 40% of our diet. While researching other potential alternatives, I would try eliminating dairy...it can't hurt and might stabilize or reverse your PSA readings.

In any event, best of luck as you deal with this dilemma.

hochbob
Posts: 10
Joined: Jun 2010

Kongo,

I sincerely appreciate your prompt and thorough response. Everything you say makes a lot of sense. You have armed me with additional questions for my physicians. I will get results from a 3rd. PSA tomorrow and will keep you posted.

mrspjd
Posts: 693
Joined: Apr 2010

hochbob
You've probably already read this article on whether to do SRT after RP, but in case you haven't, here is the link (It's from a well respected nationally known open RP doctor and has some good info):
http://www.drcatalona.com/quest/quest_winter08_2.htm

Certainly there are quality of life issues in your choices, but just curious and wondering if I might ask--if you decide not to do IM/IGRT w/ or w/o hormones, what options are you considering, if any--will you do nothing as far as tx now or consider chemo later or ?
mrs pjd

hochbob
Posts: 10
Joined: Jun 2010

I did not mean to offend or exclude you by reaching out to my "brothers". I had not read the Catalona article which is very relevant to my situation. Thanks for posting the link. Still, because of my minimal adverse pathology and the thought that those with more aggressive factors seem to benefit most, I am not yet convinced that the "benefits" of IMRT outweigh the risks. I should have the results of my 3rd. PSA tomorrow. Don't know if this will move me to treatment, however, IMRT would be that treatment as I don't believe that my disease, at this point, is aggressive enough for hormone therapy.

Thanks.

ezra99
Posts: 18
Joined: May 2010

I'm kind of in same situation. I've been told that if I do SRT it will be about a 1 out of 3 chance of being progression free after 6 years. They claim I can increase my chances to about 1 out of 2 if I do ADT for 2 months prior to SRT, 2 months during and 2 months after. Guess it would be a 3 month injection two months before starting and a second injection half way through. I'm trying to make an informed decision on what to do. My last PSA was .38 with doubling rate of 18.5 months so they say I have a little time to decide. I'm leaning toward just SRT but haven't really made up my mind. Are you considering ADT with SRT?

Thanks for information on your post. I have been lucky to have a set of 3 MD's that are all very personable and not pressuring me to make a decision before I'm ready.

hochbob
Posts: 10
Joined: Jun 2010

Ezra,

If your adverse pathology is minimal like mine, than I would suspect that your PSA doubling rate is driving your physicians to have you consider additional treatment(s). Unlike my rapidly doubling PSA, yours seems to be one that would put you in a "watch and wait" category again assuming minimal pathology. I believe you are in good hands as it appears that your physicians have adopted this strategy and are providing options. Should you decide to move forward with additional treatment, do so with a thorough risk benefit analysis. I am continent and potent which compounds my decision to risk that for an aggressive therapy that at best offers me a 33% chance of being progression free 6 years out. Again, not knowing your history, I'm concerned that concurrent ADT and SRT might be overkill. If and when I go forward, it will be with IMRT only as I don't believe my disease is aggressive enough to warrant ADT, which also, as you know, is not without risk. Treatment wise, I would like to believe that less may be more given our situations. Regretably however, this remains unproven. Thanks for your input. Best of luck and stay in touch.

BRONX52
Posts: 156
Joined: Apr 2010

DON'T KNOW IF THIS WILL HELP YOU BUT MY JOURNEY WITH PC TOOK ME THROUGH A RP AND ADJUVANT RADIATION THERAPY. AT THE TIME OF SURGERY MY PSA WAS 5.1 AND I WAS STAGED AS T1C WITH A GLEASON 7 (3+4). AFTER SURGERY HOWEVER, I WAS STAGED AT T3A WITH A GLEASON 7 (3+4), POSITIVE MARGIN AND EXTRAPROSTATIC EXTENSION.LYMPH NODES AND SEMINAL VESICLES WERE NOT INVOLVED. MY PROSTATE TURNED OUT TO BE 75% INVOLVED. THAT'S A FAR CRY FROM THE CLINICAL STAGING AND BIOPSY WHICH SHOWED VERY LITTLE CANCER IN 2 OUT OF 10 CORES TAKEN!! I GUESS THEY JUST TOOK SAMPLES FROM GOOD AREAS ! ANYWAY, AFTER SEVERAL CONSULTS I CHOSE TO HAVE ADJUVANT RADIATION EVEN THOUGH MY PSA AT 6 WEEKS WAS UNDETECTABLE.I JUST WANTED TO DO EVERTHING POSSIBLE AS SOON AS POSSIBLE TO ZAP THE CANCER. I CHOSE NOT TO HAVE HORMONE THERAPY IN CONJUNCTION WITH THE RADIATION. ALTHOUGH HORMONE THERAPY CAN SHRINK TUMORS AND SLOW PROGRESSION IT DOES NOT KILL CANCER CELLS AND SOME CANCER CELLS ARE IMMUNE TO THE HORMONES ANYWAY. AND THE SIDE EFFECTS OF HORMONE THERAPY DIDN'T PAINT A PRETTY PICTURE FOR ME. THE IMRT WASN'T BAD AS FAR AS SIDE EFFECTS WERE CONCERNED. I WAS CONTINENT BEFORE TREATMENT AND THE SAME AFTER TREATMENT. HAD SOME FREQUENCY AND URGENCY ISSUES TOWARD THE END OF TREATMENT BUT THAT HAS SUBSIDED SINCE I FINISHED 38 SESSIONS THE FIRST WEEK OF JUNE. LONG TERM SIDE EFFECTS ARE POSSIBLE AND I WILL JUST HAVE TO WAIT AND SEE WHAT THE FUTURE HOLDS.AS FAR AS THE DIET IS CONCERNED I BELIEVE THERE IS NOT A CONCENSUS ON THIS EVEN AMONG THE MEDICAL COMMUNITY. BUT AS KONGO SAID, IT CAN'T HURT AND LIMITING YOUR INTAKE OF DAIRY AND RED MEAT CERTAINLY HELPS IN OTHER AREAS BESIDES CANCER. I HAVE ANOTHER PSA IN AUGUST AND I'LL LET YOU KNOW HOW I MAKE OUT. YOU SOUND LIKE YOU ARE DOING ALL OF THE RIGHT THINGS BEFORE MAKING A DECISION THAT IS RIGHT FOR YOU. GOOD LUCK AND I WISH YOU THE BEST----ALOHA, DAN.

hochbob
Posts: 10
Joined: Jun 2010

Dan,

Thanks for increasing my confidence in IMRT. I suspect that I will reluctantly roll the dice and head in that direction. I believe Kongo is on to something, like you say, that may not be totally embraced by the medical community. However, it just makes a lot of sense. Let me know about your next PSA. I am awaiting results of my 3rd. test today. All the best and keep in touch.

The Naturalist's picture
The Naturalist
Posts: 6
Joined: Jun 2010

Hochbob: First, I take it that you had Radical Prostatectomy 6 years ago. Without trying to analyze the details, I just want to tell you now that many cancer patients today have RP, which is ten followed by IMRT - just to eliminate cancer cells that may have remained after RP, but they are too small and undetectable.

For the record, I had a PSA 4.1 in 2007, Gleason 3+3, and a biopsy showed 1 of 6 cores was positive - but only 40%. My doctor, and a specialist suggested "watchful waiting," since pelvic and bone scans were clear, an the cancer was microscopic and was contained in the prostate. But I wanted out, and I chose IMRT. 8 weeks by 5 treatments each, 40 X 2 GY =
80 GY of radiation. All follow ups, the latest in March 2010 good. PSA 0.5 No incontinence,
no other bowel or rectal irritation, but some sexual dysfunction.

To IMRT or not to IMRT? Yes, in my opinion. I have a bad opinion about RP, and I have a bad opinion about doctors as well, as most of them try to sell you what they do, urologists
RP, and oncologists or radiologists IMRT. But after a lot of research, I believe IMRT was better for me because I knew that the center of IMRT is pointed at the prostate area, but a lower portion of radiation also radiated adjacent areas of the prostate, and probably killed microscopic cancer cells that might have been undetected in the CT scan that was clear.
It is a "GO FOR" from me, and good luck!

hochbob
Posts: 10
Joined: Jun 2010

Naturalist,

Yes, I had my RP 6 years ago. I appreciate the time you took to share your history, however, I'm not sure whether your post RP pathology indicated positive or negative margins. I believe this, as well as, PSA doubling time are the determinants of one's decision to move forward with IMRT, at least in my case. Your decision to receive adjuvant radiation appears to have served you well. With more research, RP and adjuvant radiation may become the standard of care. I also very much appreciate your candor regarding physicians who choose to "sell" what can be done vs. what should be done. Today, the result of my 3rd. PSA was .8...down from .85 three months ago. This result has prompted me to further research other non-CA variables that I can control that may lower my PSA.
I'm sure the "psychic income" provided by knowing you have done all you can is very comforting. I hope to get there soon. All the best and please keep in touch.

The Naturalist's picture
The Naturalist
Posts: 6
Joined: Jun 2010

I would not see your 3rd PSA change from .85 to .8 as a decrease. I am glad you have a positive attitude, but small fractional numbers may be the result of variation among testing
laboratories. Also, I have a 86 years old cousin in Michigan whose PSA is 17, and he has no
prostate cancer. PSA rise with age is normal, and it doesn't indicate cancer. Cancer is indicated in a "sudden rise" in PSA, as it was in my case. It rose from 1.8 to 4.1 in one
year. My suggestion? Don't worry about small fractional PSA levels.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Hochbob, I would tend to agree with Naturalist that there isn't much statistical difference between .85 asnd .8 given the variability of the testing process and laboratory technique. The good news is that the PSA isn't continuing to increase which may mean nothing at all (just a random data point that doesn't fit into a long range trend) or it may well mean that the rate of PCa growth is such that it may not be a threat or at least give you some time to ponder alternatives.

I've often wondered whether the process of RP itself (or even a needle biopsy) might cause the spread of cancer that would otherwise have been contained within the prostate in an indolent form. It seems to me that the state of cancer in your original diagnosis at the time you did RP could very well have been indolent and slow growing and if some cancer cells leaked during the surgical process. It has taken six years for them to show up in a PSA rise. If you had a slow growing, indolent cancer before, maybe it's the same and a watchful waiting approach is appropriate. Of course all of that is pure speculation on my part and I haven't read anything that would shed any light on that one way or the other but it's a question you might want to pose to your doctor.

Keep us advised as you go forward.

hochbob
Posts: 10
Joined: Jun 2010

Kongo,

I continue to be amazed by and grateful for your tremendous incite into this incidious disease. That you would take time to help me while on a plane is clearly above and beyond. The article you referenced was one I stumbled upon a couple of weeks ago and I must say, it appears to be the definitive publication regarding my dilemma. I will pose your thesis, regarding the spread of cancer, when I meet with my urologist next week.

Like you, I continue to seek answers that may not exist. Best we can hope for are healthcare professionals who can truly separate what might be best for their patients vs. what might be best for their bank accounts.

My M.S. in Healthcare Management and long career in the medical device business have armed me with enough clinical and business knowledge to qualify me as a bonefide skeptic.

Your expertise is greatly appreciated. Stay tuned.

hopeful and opt...
Posts: 1364
Joined: Apr 2009

I read about needle biopsy and the possible spread of cancer. I don't have the documentation available, however needle biopsies don't spread cancer. Prehaps one of the posters has this information readily available.

Ira

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Ira, I am not sure about your comment that needle biopsies don't spread cancer. I think the jury may still be out on this subject. When I consulted with my oncologist during my research phase he mentioned that he felt that in post RP pathologies, he noted cancer growing in the areas where the needle biopsies were done. If you google the subject about spreading PCa through biopsy or surgery there is a lot of information that makes you wonder if we really know what we're doing in this area.

While I believe that the value of a biopsy probably outweighs any risk to spreading the cancer, I wish there was another way of positively ascertaining the presence and extent of prostate cancer without a biopsy. Another thing my oncologist said, this time in relation to breast cancer which he termed a "brother/sister" disease with PCa...is that he seldom saw metasasis of breast cancer until after surgery or biopsy...

My opinion, and its more of a gut feel than anything else, is that cutting around a tumor capillary risks launching cancer cells into the bloodstream.

hopeful and opt...
Posts: 1364
Joined: Apr 2009

I am very interested in this subject since the protocol for my active treatment is to have a 3.0 tesla , a high definition MRI and then three dimension transrectal directed biopsy based the information obtained in the MRI.......the biopsy is the main diagnostic tool that is being used , PSA's are a low second in measuring any disease progression, so the plan is to stick a lot of needles in my biopsy over time.

I haar talk from various people that a needle biopsy causes disease progression.

The surgeon that I had seen at UCLA stated in a lecture that attended with him that the needle biopsy does not spread the disease.

Needle biopsies are the standard.

There had been a discussion at this site several months ago. There was some good information that was stated......the conclusion was --does not spread cancer.......I am unable to find this discussion.

Today I checked the internet for information. There is a site that I go to often called pubmed.com . This site is medically oriented and is a great site...I really did not see a discussion about this topic.

I also looked outside the pubmed site......there were various institutions that were biased since they were selling some other diagnostic tool, that mentioned the ill effects of needle biopsies. Since these organizations have a different agenda I did not believe the informationto be valid.

I am interested in hearing scientifically valid and unbiased information that shows or not shows that needle biopsies spread cancer.

Thanks

Ira

tarhoosier
Posts: 189
Joined: Aug 2006

Bob:

Factors in your favor: G 3+3, several years from surgery before psa rise (suggests local recurrence), health.
Factors against: cost, likely side effects plus possible side effects, negative margin status (suggests cancer is outside of treatment area), psa is above 0.5 (point of best results), recent rapid psa doubling time.
Also factor against, IMO, are attitude and practices of doctor.

I also agree that Avodart, vitamin D, and other low cost efforts could bear fruit.

The Naturalist's picture
The Naturalist
Posts: 6
Joined: Jun 2010

Hochbob: With an M.S. in Healthcare Management, I suggest you check this one: After I had my IMRT radiation, and my anxiety has been reduced considerably, I was still searching and
reading any message board I could find online. And one of them, which I did not "save" in my computer, and I cannot find now had this information:

A prostate diagnosed patient decided to go on a "watchful waiting" period before any treatment. During that time he -somehow- obtained information that "Capsicum" (hot pepper
powder" sold in tablets online - and almost impossible to find in a local store- were effective in shrinking cancer. He told his doctor that he would take those for 6 months,
and go in for his next check up. I am not sure, but if memory serves, he was taking 600mg
4 times a day, before food because with food that stay in the stomach until digestion, it burnt his stomach, but before it passed to the small intestine faster. At 6 months check up,
the tests came inconclusive - if he had cancer or not! He continued, and at 12 months, no cancer was detected!

The posting looked like an "old wives tales," but then two doctors posted requests to that man, and posted their e-mails to contact them. The last I remember, he said that he was willing to take Capsicum the rest of his life, rather than go through RP or any traditional therapy. I tried to find that message board for you, but I am running into the selling gamut of websites, and had no luck. But I suggest you look for -under Capsicum and cancer, capsicum sellers and testimonials, etc. You may find something that most people believe do not exist.

Can something like this exist? Am I an illiterate sucker, or one of those "herbs cure everything" believer? Not, at all! For the record, I am a retired social sciences professor, and I know the medical industry - both medical equipment manufacturers, the pharmaceutical industry, hospitals, and doctors - will not allow hot pepper to wreck their industries. I believe high levels of "Capsicum" may be effective to block cancer cells from replicating, and it may have to be taken for life. I would, therefore, suggest that you pursue this lead, and if you find that source, let us know. Remember: Sometimes something
comes out of nowhere and change our lives. Take this lead and see. You have got nothing to lose. Just re-direct you search and see if you hit something! Good luck!

hochbob
Posts: 10
Joined: Jun 2010

Naturalist,

I am intrigued by your post and have no doubt that there are non-medically endorsed alternatives to conventional therapy. Your concern for the many "cures" and your expertise in separating fact from fiction means a lot to me. I will certainly research this lead to get a handle on its efficacy. I will report back. Many, many thanks for your efforts on my behalf.

mrspjd
Posts: 693
Joined: Apr 2010

A quick google search produced the following info from the source cited below. Not necessarily the most reliable source, but a good place to start. I have not read the related PCa medical studies cited in the source, but if someone wants to pick up the lead, go for it, as I've posted the links from the source below! btw, this is not an endorsement nor a pan, just trying to keep an open mind, since capsaicin has been in the news recently related to other medical issues.

source: http://en.wikipedia.org/wiki/Capsaicin
Capsaicin (pronounced /kæpˈseɪ.ɨsɪn/) (8-methyl-N-vanillyl-6-nonenamide, (CH3)2CHCH=CH(CH2)4CONHCH2C6H3-4-(OH)-3-(OCH3)) is the active component of chili peppers, which are plants belonging to the genus Capsicum. It is an irritant for mammals, including humans, and produces a sensation of burning in any tissue with which it comes into contact. Capsaicin and several related compounds are called capsaicinoids and are produced as a secondary metabolite by chili peppers, probably as deterrents against certain herbivores and fungi.[1] Pure capsaicin is a hydrophobic, colorless, odorless, crystalline to waxy compound.

The American Association for Cancer Research reports studies suggesting capsaicin is able to kill prostate cancer cells by causing them to undergo apoptosis.[31][32] The studies were performed on tumors formed by human prostate cancer cell cultures grown in mouse models, and showed tumors treated with capsaicin were about one-fifth the size of the untreated tumors. There have been several clinical studies conducted in Japan and China that showed natural capsaicin directly inhibits the growth of leukemic cells.[33]

31
^ Mori, A; Lehmann S, O'Kelly J et al. (March 2006). "Capsaicin, a component of red peppers, inhibits the growth of androgen-independent, p53 mutant prostate cancer cells". Cancer Research (American Association for Cancer Research) 66 (6): 3222–3229. doi:10.1158/0008-5472.CAN-05-0087. PMID 16540674. http://cancerres.aacrjournals.org/cgi/content/full/66/6/3222. Retrieved 2008-07-22.

32
^ American Association for Cancer Research (2006). "Pepper component hot enough to trigger suicide in prostate cancer cells". http://www.eurekalert.org/pub_releases/2006-03/aafc-pch031306.php. Retrieved January 27, 2007.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

The company I currently work for uses Capsaicin in several of the products we manufacture and I have eaten extremely hot food my entire life starting at probably 12 years old to 52 now.

I wish the capsaicin I consumed in all the Hot peppers I've injested stopped my cancer but it did not. I continue to eat hot foods/spices/sauces which in include cayanne, habenero, jalepeno, cerito and any other hot pepper you can find...the brown ones in Chinese food. I believe that all these peppers have capsaicin - I need to look into this to confirm.

If hot food stopped my cancer from growing or progressing...then I would have been long gone years ago had I not been injesting the delectable scorchers. Having my Davinci 12/29/09 I have fully returned to eating the same (large volume) and intensely hot foods about two months or so ago.

Here's my fairly detailed path for anyone not yet aquainted with it:

52 years old
PSA 9/09 7.25
PSA 10/09 6.125
Diagnosis confirmed Oct 27, 2009
8 Needle Biopsy = 5 clear , 3 postive
<20%, 10%, 10%
Gleason Score (3+3) 6 in all positive cores

11/09 Second Opinion on Biopsy slides from Dr. Koch
(4+3) = 7 5%
(3+4) = 7 10%
(3+4) = 7 10%

Endorectol MRI with Coil - Indicated the Palpal tumor was Organ confined

Da Vinci performed 12/29/09 - Dr. Hollensbee & Scott
Sling installed at time of Da Vinci – not sure what name of it is but not the 800 that is causing all the problems. Attached to Coopers Ligament.

Post Surgery Pathology:
Prostate size 5 x 4 x 3.5 cm Weight: 27 g
Gleason: Changed to (3+4) = 7
Primary Pattern 3, 80%
Secondary Pattern 4, 18%
Tertiary Pattern 5, 2%
Tumor Quantitation:
Greatest Dimension, Largest tumor focus: 19 mm
Additional Dimension 18 x 15 mm
Location, largest tumor focus: Right posterior quadrant
Multifocality: Yes
Greatest dimension second largest focus 10 mm
Location: second largest focus: Left Posterior quadrant
Extraprostatic extension: Yes
If yes, focal or non-focal: Nonfocal
If yes: location(s) right and left antero-lateral
Seminal vesicle invasion: No
Cancer at surgical margin: No
If no, closest distance with location: less than 1 mm, right posterior quadrant
Apex involvement: No
Bladder involvement: NO
Lymph-vascular invasion: No
Perineural invasion: Yes
Lymph nodes: 9 from right pelvic 0/9 positive
Stage: pT3a, pNo, pMX
All nerves sparred - found two additional pudendal arteries

FIRST PSA TEST 2-11-10 <0.1 NON-DETECTABLE

Virtually Pad free 2-20-10

SECOND PSA TEST 5-26-10 <0.1 NON-DETECTABLE

Notes on Recovery: Was at my desk working (from home office – sales) 6 days following my surgery. No pain to speak of (very lucky as many have some pain) I think because I took the Tramadol they gave religiously and found it to be the best drug in the world. BM’s where the trickiest part and most uncomfortable in the early stages but improved with time – follow the diet they give you!...I strayed off and the next BM helped to get me back on track – I like food very hot and spicy - don’t recommend that for at least a month following surgery. Cream soups, mushroom, celery, and chicken worked great the first week following surgery. Mashed Potatoes…Ah the first time following surgery it was heaven!...the first really solid food I ate…..you will learn to appreciate food all over again as you add back your favorites following surgery when the time is right. Take all the help from everyone around you…it might be a while you get that opportunity again to be waited on hand and foot. Liquids are a concern but some affect people differently it seems reading through the discussion board…I found anything carbonated would cause much leaking…alcohol was not good either…but I justified doing it thinking It’s my training method to work on my bladder control!...lol I love homebrewed beers too much! And am an admitted hop head.

ED path:
Early on started on Viagra 100mg pills cut into 4ths so 25mg per day dose then a full 100mg on every 7th day.
Also bought pump and used sporadically to get blood flow to member. Within about three weeks or 5 weeks from surgery (cannot remember but probably posted on CSN somewhere) had usable erections.

Currently only need ¼ pill to get usable . Day 150 am starting to get semi hard without any drug.

Day 163 had usable erection without any drug!!!

Not finding I can go drugless permanently yet day 169 post surgery.

Still hit and miss on drugless on day 194 July 11, 2010

Randy in Indy

hopeful and opt...
Posts: 1364
Joined: Apr 2009

Has there been a study that validates this?

Also, the person who was tested, I guess a biopsy that did not show cancer in the six and one year period....very frequent testing. Well there still is cancer even though it was not dectected.

I had a second biopsy which did not show cancer, but I still have cancer. I did not take any Capsicum.

Frankly I would rather stay with medical expertise. I have confidence in the medical profession..

Ira

mrspjd
Posts: 693
Joined: Apr 2010

I, for one, am not in any way suggesting that any one food might be a cure for cancer, and anyone considering rushing out to try a particular food to "cure" their cancer should be cautioned/warned to discuss this with their doctor and do their own research...that is why I posted a few scientific studies. Any other poster on this discussion board is welcome to do the research and post studies posing opposite or contrary findings...medical science does not base their research findings on individual personal stories, i.e., "I eat/ate lots of capsaicin, tomato sauce, green tea, chili peppers (whatever), etc. and it did not cure MY cancer (or--'I still got cancer'), and, therefore, it does not work!"

From the many posts on this discussion board related to diet and PCa, and all cancers for that matter, I think we can agree that a healthy diet, and some foods in particular, may have some cancer prevention benefits, or at the very least, heart health benefits.

If you're not already familiar with TED, it is a symposium for the best and brightest that science has to offer. Here is some food for thought (no pun intended) from a recent TED presentation on this very subject, but a WORD OF CAUTION: ONLY VIEW THIS IF YOU HAVE AN OPEN MIND...

http://www.wimp.com/starvecancer/

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Mrs,

Thanks for posting this information about angiogenesis and its application to cancer. The video made a lot of sense and the charts in the video which compared angiogenesis effects of some prescription medications to certain food types was quite compelling. I think this is a "must see" for all men with PCa who are considering AS or are wondering about potential recurrence after treatment.

Like any new approach, leveraging recent insights into genes, and what is going on at the molecular level will have its share of skeptics, nay-sayers, and critics and there will be those who will wait for the ten year studies before making decisions about what to eat or not eat in their personal life but the clear and cogent presntation in the video you referenced made a great deal of sense to me.

The Naturalist's picture
The Naturalist
Posts: 6
Joined: Jun 2010

Since I mentioned the Capsicum in this forum after Hochbob said "I am looking for something that may not exist, or doesn't exist," I feel that some members here believe that anything outside the medical establishment is probably outlandish. And that prostate cancer patient who posted that was taking high "concentrated" doses of Capsicum - certainly much more than my ex-Mexican wife who had never had a meal without Jalapeno peppers - was probably exxagerating his results. Well, maybe. But Capsicum in high doses may keep cancer cells "Inactive" -assuming the proper dose is established, then "watchful waiting" may become a standardized future therapy.

Does the scientific chemotherapy that costs hundreds of thousands of dollars do better? No.
Cancer relapses occur later in most cases. But because that therapy is done by the medical/pharmaceutical industry, it is considered valid because the industry producers brochures, testimonials from doctors with shares in those industries or research grants, etc. And the chemical used in "chemotherapy wreck many body organs, and no doubt shorten lives considerably, something that Capsicum surely doesn't do. It is not corrosive, and there is no overdose. Does it kill cancer? No, and no other therapy does. They only kill
the cancerous cells temporarily, but the person has cells with the same genetic disposition to change other healthy cells to cancerous. What we all get in prostate cancer treatment is a temporary reprieve - not a cure-
in most cases. And if Capsicum can do that, why not try it?

But there are no patents on Cayenne, Red Hot Chili peppers, and Capsicum. And, based on supply and demand, and if Capsicum can keep cancer cells dormant for life, that will bring the extinction of the medical/ pharmaceutical industry. Our cancers, therefore, support billion dollar companies on Wall Street, and executives make millions in bonuses from our suffering. I have written articles about the excesses in the Health Industry in the major newspapers of the U.S. and Europe under my name, and some of those were re-published in Thailand, India and Singapore, as proof that Americans who cannot afford the exorbitant profit
laden therapies and surgeries here go to the above countries and have their operations there for only 15% of what it would have cost them here, and with the same quality care. Singapore's is actually better of what we have here. Our health-care system, therefore, is profit-driven - not a compassionate system to help us! We get a lease on life at astronomical costs, and we must think what affect that has on the recommendations on our medical decisions.

Back in the 70's and 80's doctors here laughing out at Acupuncture as the hedge hog therapy. Now it is part of most major hospitals. I believe Capsicum has potential, but hot peppers are in oversupply, and nobody will
invest in any therapy from them because there are no profit margins to match the chemo of Wall Street chemical giants . But for those who feel that their survival is at stake, they should go for it, as well as for any medical trial that they can be accepted. The point: Keep our mind open, and don't invest all our trust about your health on those who will become rich selling you hope as science. I believe only in science that comes without a profit motive attached. Period. And I speak here both as a cancer survivor, and as an academic who has followed the medical trends, and the growth of the health industry into a mechanical and chemical golden plated production line.

142
Posts: 169
Joined: Dec 2009

An early life of hot peppers burned a number of holes in my stomach and intestines, and caused a lifetime of spastic colon.

I got PCa anyway at 56.

I don't see evidence of a good result to having torched my gut.

hopeful and opt...
Posts: 1364
Joined: Apr 2009

There may be something out there that will benefit us, however I do not wish to spend any of my time and effort on anything that is unproven or not scientifically based. Instead I want to put my full effort in finding the best treatment based on scientific information.

For example, what if I said that I had jelly bean soup which I think accounted for better biopsy results......would you start drinking this soup with capiscum sprinkled on it.

Ira

bdhilton
Posts: 759
Joined: Jan 2010

The “facts” you state are about what I see with the statistics with guys with negative margins getting Salvage after surgery….More importantly, how do you feel about the pending IMRT? Does your gut tell you it is a good choice? My 2 cents is that if you feel like this is a good or bad process for you then it is…Quality of life is certainly an important items for me today…. I had surgery 19 weeks ago and based on my pathology both the surgeon and my urologist (at first) told me to get Adjunct radiation (positive margin and seminal invasion)…. My first 2 PSAs have been 0 and it would be nice to have 0’s the next 30 years or so (I am 55)….After a long talk with my urologist oncologist he agreed with me that he would not have radiation unless he had a reoccurrence and told me that IMRT for Adjunct or salvage had better statics results for guys with positives margins….Now my spiritual adviser told me at the beginning of this journey to throw all statistical data out the window and go with my gut as you can be on either side of statics….So again what does your “gut” tell you? Go with it….. What I have changed in my life is what I can control and that is my diet, exercise and how I deal with stress in general….I believe these things can extend your “quality” of life…. Best to you in your journey….

The Naturalist's picture
The Naturalist
Posts: 6
Joined: Jun 2010

I had IMR myself 3 years ago, and the way it was explained to me, and the way I believe it is, it works this way: Human cells have a span of life, and then die. But the body replenishes them with new cells. During IMRT radiation therapy, healthy human cells die along with cancerous cells. But our body continues to produce healthy cells to replace those that were killed by radiation, but the cancerous human cells cannot reproduce and replenish
those killed by radiation. After 8 weeks x 5 treatments of 2 Gy each day, for a total of 40 treatments, and a total delivery of 80 Gy of radiation on the prostate gland, all the cancerous cells are gone, while the body has reproduced and replaced the healthy cells destroyed by radiation. PSA levels should come down progressively, as PSA hormones still in the bloodstream would die off.

What is the future holds after radiation therapy? Nobody knows, as some people are genetically more prone to have a recurrence than others. Some people who had and treated prostate cancers may not have a recurrence, but they may develop other cancers, or may remain
healthy and have a long life afterward.

On a personal basis, I have become a mostly vegetarian person to avoid the hormone and antibiotic laden meat and poultry, live mostly on homemade food, jog 2.5 miles almost daily, and do other gym exercises to maintain body muscle. I avoid high pollution areas -like downtown, have top air cleaners in my living space, and keep a positive attitude of life.
And if there is a recurrence, I will have another IMRT. I don't believe that there is any natural remedy for cancer now, but for those who had other therapies but they may found themselves on the fence, other therapies and a strong belief may produce a body reaction that
may work. The mind may be at times a powerful inhibitor. And that may explain some medical
healing mysteries that I have seen on various documentaries in my life. People who fight deseases bravely win more battles than those who just give up!

gkoper's picture
gkoper
Posts: 174
Joined: Apr 2009

Naturalist-----you appear to be making many healthy choices-----but when you say you would do IMRT again if needed--------is that possible? I had surgery & IMRT and was told the IMRT could not be repeated. Hormones & or chemo would be next. Did your doc say something different?
George

tdorman
Posts: 21
Joined: Jun 2010

My situation was very similar to yours. Had a RP in 1996. Had non detactable PSA for 7 years. In 2003 psa went to .4. My surgeon told me to have radiation asap. I had 43 hits of IMRT radiation. IMRT had no impact on erections or incontinence. Just had a PSA last week and PSA still non detectable. My surgeon did not recomend IMRT. I chose IMRT after some research. In 1996 IMRT was not as available as today. There were only 2 places offering IMRT in the entire Tampa Bay area.

Good Luck

hochbob
Posts: 10
Joined: Jun 2010

T,

Thanks for sharing your experience. Did you have positive or negative margins post RP?After much thought and another consult with my Urologist, I/we have decided to wait and watch. I am scheduled for another PSA in 3 months. Hopefully your PSA will remain undetectable. I grew up in St. Pete, BA - UF (go Gators!), MS - USF (go Bulls!). All the best.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

hochbob,

I know what a tough decison this was for you but you've made it and that should give you some relief. I think if I were in your situation I would wait awhile too but I'm sure you realize that your cancer is back somewhere. I've recently read that it can take up to six years or longer (or never) for PCA that recurs to metastise so keeping an eye on it with PSA checks every three months is a good idea.

Since you're going AS on this turn, I'm wondering if you chose to make any dietary changes that might help slow or reverse the cancer. I think mentioned in an earlier post eliminating dairy led to a quick and dramatic drop in my own PSA scores. MRSPJD had an intriguing post about capsaicin and it's helpfu effect. I think there are likely plenty of natural products that can help...all drugs that treat PCa don't have to come from a laboratory.

There is a test called a Prostacint scan where they inject you with a radioactive isotope with a short half life and let it sit for a few days and then scan you for where it has attached itself to cancer. Sort of like the bone scan but different. Anyway, it is supposed to help identify if there are any spots where the PCa has metastasised and that could be helpful as your ponder future treatment options.

Best of luck and keep us informed of how things go.

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