New To The Fight

beau1020
beau1020 Member Posts: 5
edited March 2015 in Prostate Cancer #1

I am a 62 year old male and as the topic states I have just been diagnosised with early stage Prostate cancer and am doing my homework!  Over the past few years there has been a steady rise in my PSA ... 3.6 (9/10); 4.0 (12/11); 6.74 (11/12) with biospy sampled (12 samples) all negative for cancer; 7.2 (11/13) with second biospy (12 samples) all negative; 11.8 (11/14); and finally 13.3 (2/15) with third biospy (18 samples) with 2 positive cores of 30% each.  Clinical T Stage is T1c with a Gleason score of 3+3=6 and Prolaris Biopsy Test Score being -0.9 and consistenty with Average AUA being an Intermediate Risk.  Present course of treatment is AS with repeat Free PSA to be conducted in early June.   I currently am taking .8 mg of Tamsulosin HCL daily as well as 5 mg Cialis daily.  Additionally I generally work ut 4-6 times per week on an elliptical machine for between 30 - 90 minutes per session.

 

In speaking with my urologist (with whom I am extremely comfortable and have a high level of confidence) he has explained to me potential courses of treatment (AS, radiation, chemo, surgery) and since my figures are still low (except the PSA) we are following AS protocols.  However, my urologist has suggested that if my Free PSA is higher in June he is recommending that the prostate be revomed surgically, as chemo is not an option for me (the cancer is not that progressed and is confined to the Prostate) and that if radiation does not work as a first option then surgery is not an option later on down the road.  In researching the side effects of any treatment plan (other than AS) the potential side effects are not very pleasant and with surgery, from what I can tell, the effects can be life long.  While it is too early to be taking action other than AS I want to be prepared to respond in June should my PSA continue to rise ... any feedback would be appreciated.

 

 

Comments

  • Old Salt
    Old Salt Member Posts: 1,530 Member
    #2
    Surgery versus Radiation

    In debates of radiation vs surgery, it is often stated that surgery is not an option after radiation therapy. Whereas this is generally true, surgery is a more serious course of action with a greater frequency of, sometimes serious, side effects; an issue that you are aware of. What is often not entered into the initial (radiation/surgery) discussion by a urologist is that if radiation fails, there are several other treatment modalities available and newer ones are coming along as well. Hence, I highly recommend that you seriously consider radiation type treatments. There are at least three that are frequenstly used (in the USA):

    Brachytherapy (implanted seeds; either low dose or high-dose), IMRT/IGRT (Intensity Modulated Radiation Therapy/Image Guided Radiation Therapy) and Stereotactic Body Radiation Therapy (SBRT/CyberKnife).

    To get more info on these radiation therapies, and how they might (or might not) be suitable for your specific situation, please consult with a radiation oncologist, sooner rather than later, because I do find your PSA results worrisome.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #3
    Evaluating where you stand

    Beau1020,

    I am sorry for your diagnosis.

     

    When one has an enlarged prostate, there is pressure on the uretha that secretes more PSA in the blood so the numbers are higher.

    When a biopsy is done, the size of the prostate is calculated. What is the size of your prostate?

    Generally to be in an active surveillance program one looks for a PSA of 10 or less ( with a normal szie prostate) Also the ratio of PSA to prostate size should be under 0.15

    Aslo the PSA trend can be higher due to a urinary infection, or cancer. 

    ........................................

    There is an MRI scan for prostate cancerthat  may show evidence of extracapular extension, that is show if the cancer is outside the prostate, show the extensiveness of disease within the prostate; it will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. There are certain major hospitals that have MRI machines with a 3.0 Tesla magnet. 

    If there are suspicious lessions, there are directed MRI biopsies that can target these lessions. This is more effective than the random biopsy that you had.

    Basically the MRI provides fine resolution , and is pretty effective in determining if the cancer is outside the prostate.

    In my layman’s opinion it is advisable for you  to have a multiparametric MRI T3

    Questions, comments?

    best,

    H

     

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #4
    Controversy or misunderstanding

    B

    Welcome to the board. I am thinking that your PCa case has been followed in a European country because of the Polaris test, though I am curious about your doctor’s comment in regards of using the free-PSA to trigger treatment.
     In fact the free-PSA is typically used to identify cancer in a benign case (BPH), and as higher as the free-PSA values (%) are the lesser chances one has in having cancer. Maybe you misunderstood his comment and took the free-PSA word for the PSA itself.

    Gleason score6 and cell cycle progression score (CCP) of -0.9 are identical and these refer to low risk not intermediate as you comment. The PSA is high and the doubling (PSADT) is very short and worrisome however, the increase could be due to other factors such as sex or pressing of the prostate (etc.) the day before drawing blood for the test or the use of certain steroids that many taken for physical improvements (body-building style). I am not aware of but the elliptical machine could be a cause if it stresses the abdominal muscles affecting the prostate.

    Can you tell the reason for taking Tamsulosin (Flomax)? Is it due to an enlarged gland? How big is it?
     Enlarged glands produce higher levels of PSA and make it difficult to “find” cancer. Your failed initial two sets could be a cause of the above. The last 18 needles may have been done aiming at specific targets with a successful result. Two positive cores of 30% each. Can you share the contents of the pathologists’ report? Which region of the prostate did those positive needles found cancer? Were there BPH identified?

    Old Salt is providing you with the treatments that cure, but all of them have risks and side effects that you should know before any decision. If you consider to continue on AS you could try a palliative way with a 5 alpha reductase inhibitor that works against BPH and fights low aggressive types of cancer. This makes part of hormonal treatments preferred by many because it has little side effects and allows continuous quality of living.

    I would recommend you to get second opinions from specialists. The majority of doctors are biased through their trade so that one should be careful with their proposals. I see it rather surprising that an urologist will know in detail the radiologist’s work or oncologist’s chemo choices, so that they are able to advice a patient properly.

    You may also investigate other lipids level and exams that could trigger conditions interfering with the possibility of certain treatments. Bone and heart health, ulcerative colitis, etc, are matters of aging that we do not “recognise” at young ages in the 60th. Testosterone levels are also indicative but important in PCa cases.

    Best wishes in your journey.

    VGama

  • beau1020
    beau1020 Member Posts: 5
    #5
    hopeful and optimistic said:

    Evaluating where you stand

    Beau1020,

    I am sorry for your diagnosis.

     

    When one has an enlarged prostate, there is pressure on the uretha that secretes more PSA in the blood so the numbers are higher.

    When a biopsy is done, the size of the prostate is calculated. What is the size of your prostate?

    Generally to be in an active surveillance program one looks for a PSA of 10 or less ( with a normal szie prostate) Also the ratio of PSA to prostate size should be under 0.15

    Aslo the PSA trend can be higher due to a urinary infection, or cancer. 

    ........................................

    There is an MRI scan for prostate cancerthat  may show evidence of extracapular extension, that is show if the cancer is outside the prostate, show the extensiveness of disease within the prostate; it will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. There are certain major hospitals that have MRI machines with a 3.0 Tesla magnet. 

    If there are suspicious lessions, there are directed MRI biopsies that can target these lessions. This is more effective than the random biopsy that you had.

    Basically the MRI provides fine resolution , and is pretty effective in determining if the cancer is outside the prostate.

    In my layman’s opinion it is advisable for you  to have a multiparametric MRI T3

    Questions, comments?

    best,

    H

     

    Thanks for your Input

    Very much appreciate your input.  If only I could have an MRI it would be an exrtra tool in the fight.  However, I have a pacemaker and as such cannot go near a MRI!  Did have a CAT scan done so at least that is on record!  

     

    Thank you  for taking the time to comment!

  • Old Salt
    Old Salt Member Posts: 1,530 Member
    #6
    VascodaGama said:

    Controversy or misunderstanding

    B

    Welcome to the board. I am thinking that your PCa case has been followed in a European country because of the Polaris test, though I am curious about your doctor’s comment in regards of using the free-PSA to trigger treatment.
     In fact the free-PSA is typically used to identify cancer in a benign case (BPH), and as higher as the free-PSA values (%) are the lesser chances one has in having cancer. Maybe you misunderstood his comment and took the free-PSA word for the PSA itself.

    Gleason score6 and cell cycle progression score (CCP) of -0.9 are identical and these refer to low risk not intermediate as you comment. The PSA is high and the doubling (PSADT) is very short and worrisome however, the increase could be due to other factors such as sex or pressing of the prostate (etc.) the day before drawing blood for the test or the use of certain steroids that many taken for physical improvements (body-building style). I am not aware of but the elliptical machine could be a cause if it stresses the abdominal muscles affecting the prostate.

    Can you tell the reason for taking Tamsulosin (Flomax)? Is it due to an enlarged gland? How big is it?
     Enlarged glands produce higher levels of PSA and make it difficult to “find” cancer. Your failed initial two sets could be a cause of the above. The last 18 needles may have been done aiming at specific targets with a successful result. Two positive cores of 30% each. Can you share the contents of the pathologists’ report? Which region of the prostate did those positive needles found cancer? Were there BPH identified?

    Old Salt is providing you with the treatments that cure, but all of them have risks and side effects that you should know before any decision. If you consider to continue on AS you could try a palliative way with a 5 alpha reductase inhibitor that works against BPH and fights low aggressive types of cancer. This makes part of hormonal treatments preferred by many because it has little side effects and allows continuous quality of living.

    I would recommend you to get second opinions from specialists. The majority of doctors are biased through their trade so that one should be careful with their proposals. I see it rather surprising that an urologist will know in detail the radiologist’s work or oncologist’s chemo choices, so that they are able to advice a patient properly.

    You may also investigate other lipids level and exams that could trigger conditions interfering with the possibility of certain treatments. Bone and heart health, ulcerative colitis, etc, are matters of aging that we do not “recognise” at young ages in the 60th. Testosterone levels are also indicative but important in PCa cases.

    Best wishes in your journey.

    VGama

    Urologists recommend what they do best!

    After thinking about your situation a bit more, I was also going to recommend high-resolution magnetic resonance imaging of your prostate. But in the meantime, you wrote that that technique is out of the window for you. Too bad!

    In my first post I suggested consultation with a radiation oncologist and VGama agreed:

    I would recommend you to get second opinions from specialists. The majority of doctors are biased through their trade so that one should be careful with their proposals. I see it rather surprising that an urologist will know in detail the radiologist’s work or oncologist’s chemo choices, so that they are able to advice a patient properly.

    In the meantime, best wishes!

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #7
    VascodaGama said:

    Controversy or misunderstanding

    B

    Welcome to the board. I am thinking that your PCa case has been followed in a European country because of the Polaris test, though I am curious about your doctor’s comment in regards of using the free-PSA to trigger treatment.
     In fact the free-PSA is typically used to identify cancer in a benign case (BPH), and as higher as the free-PSA values (%) are the lesser chances one has in having cancer. Maybe you misunderstood his comment and took the free-PSA word for the PSA itself.

    Gleason score6 and cell cycle progression score (CCP) of -0.9 are identical and these refer to low risk not intermediate as you comment. The PSA is high and the doubling (PSADT) is very short and worrisome however, the increase could be due to other factors such as sex or pressing of the prostate (etc.) the day before drawing blood for the test or the use of certain steroids that many taken for physical improvements (body-building style). I am not aware of but the elliptical machine could be a cause if it stresses the abdominal muscles affecting the prostate.

    Can you tell the reason for taking Tamsulosin (Flomax)? Is it due to an enlarged gland? How big is it?
     Enlarged glands produce higher levels of PSA and make it difficult to “find” cancer. Your failed initial two sets could be a cause of the above. The last 18 needles may have been done aiming at specific targets with a successful result. Two positive cores of 30% each. Can you share the contents of the pathologists’ report? Which region of the prostate did those positive needles found cancer? Were there BPH identified?

    Old Salt is providing you with the treatments that cure, but all of them have risks and side effects that you should know before any decision. If you consider to continue on AS you could try a palliative way with a 5 alpha reductase inhibitor that works against BPH and fights low aggressive types of cancer. This makes part of hormonal treatments preferred by many because it has little side effects and allows continuous quality of living.

    I would recommend you to get second opinions from specialists. The majority of doctors are biased through their trade so that one should be careful with their proposals. I see it rather surprising that an urologist will know in detail the radiologist’s work or oncologist’s chemo choices, so that they are able to advice a patient properly.

    You may also investigate other lipids level and exams that could trigger conditions interfering with the possibility of certain treatments. Bone and heart health, ulcerative colitis, etc, are matters of aging that we do not “recognise” at young ages in the 60th. Testosterone levels are also indicative but important in PCa cases.

    Best wishes in your journey.

    VGama

    second opinion pathology; reduce study prostate cancer; A. S.

    Determining the pathology of your biopsy is subjective, so it is very important to have a second opinion of the pathology by a world class pathologist so tthat you are not under or over treated.

    Vasco wrote to you, "If you consider to continue on AS you could try a palliative way with a 5 alpha reductase inhibitor that works against BPH and fights low aggressive types of cancer. This makes part of hormonal treatments preferred by many because it has little side effects and allows continuous quality of living."  Validation for this statement is the REDUCE Study Prostate Cancer. Basically the cancer may be slowed while the prostate is reduced in size. Also PSA numbers are approximately cut in half by those who take this...there are two drugs Proscar and Avodart, Avodart is the preferred.

    So if your prostate is enlarged discuss this option with your doc.

     

    I am starting the seventh year of "Active Surveillance with Delayed treatment protocol"  Click my name to the left. You will see what I have done, and some sources for management of those who are on Active Surveillance.

     

    Vasco asked you some very valid questions , please get back to us with what you can answer.

     

    Best

    H

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,819 Member
    #8
    Welcome

    With everyone else I'd like to welcome you, beau. I hope the guys here assist you in your treatment decisions -- they certainly did me. I am 58, and last month had a t2a, 55 oz gland surgically removed.  

     

    I will only mention two things: As Vasco noted, your results so far indicate a mild, early disease, except for your PSA Doubling Rate, which is at roughly 2/yearly, and pretty consistent from year-to-year.

     

    Second, as several noted, you will find that each form of specialist will have a tendency to recommend what they themselves do. I would not say that this overwhelmes their judgement, but it is a factor to keep in mind.  Surgery is a big deal.  Study all options in detail. I did way over a month's study. "Take your time" is a recommendation that I think everyone here agrees upon. 

     

    max

  • beau1020
    beau1020 Member Posts: 5
    #9
    Max Former Hodgkins Stage 3 said:

    Welcome

    With everyone else I'd like to welcome you, beau. I hope the guys here assist you in your treatment decisions -- they certainly did me. I am 58, and last month had a t2a, 55 oz gland surgically removed.  

     

    I will only mention two things: As Vasco noted, your results so far indicate a mild, early disease, except for your PSA Doubling Rate, which is at roughly 2/yearly, and pretty consistent from year-to-year.

     

    Second, as several noted, you will find that each form of specialist will have a tendency to recommend what they themselves do. I would not say that this overwhelmes their judgement, but it is a factor to keep in mind.  Surgery is a big deal.  Study all options in detail. I did way over a month's study. "Take your time" is a recommendation that I think everyone here agrees upon. 

     

    max

    Thank you to all who have responded.  It can be difficult learning new medical technologies and meanings ... a discussion and support avenue is greatly appreciated.

     

    OK .. not in any order ... 

     

    Vasco, my Prolaris was NOT conducted in a European country but rather right here in USA ... I live in Uptsate NY.  Additionally, while I feel my risk is low the Prolaris people themselves identified my condition as being "Intermidate".  As i explained to my Urologist "it is all relative" ... so while I am not a physician I tend to believe mine is a slow growing cancer and my risk is actually low.  Again, need to keep it in perspective.  As indicated I do exercise quite a bit (although you couldn't tell my looking at my body)  AND have taken steroids for gout (but only on a PRN basis).  Unfortunately I did not tract the use of the steroid but I will be reviewing it and the exercise with my doctor.

     

    In the past I utilized Proscar and one other medication (can't remember) for enlarged prostate but then switched to Jalin .. did not like the side effects of Jalin so then went to Flomax and Cialis; Flomax is to assist with urination; Cialis, which I recently restarted, is for the BPH.  I am told my prostate is the size of an orange (not walnut) but the surfuace is smooth (ie, no tumors which was confirmed by a CAT scan).  Urination is not a problem unless I have a full bowel and once evacuated urine flow returns to good!

     

    The latest biopsy was 18 samples, prostate "divided" in half and then thirds again (six section .. top and bottom right showed one sample in each third with 30% core.  While this was my thrid biopsy (previous two being 12 samples and all negative) I am uncertain where exactly these cancerous samples were drawn other then the segments theelves (ie, did these 2 cancerous come from previously tested areas.)  Biosphsy results (from John Hopkins) stated frollowing results ... "Prostatic Adenocarcinoma, Gleason Score 3+3=6 Involving 30% of one (1) core. ... Small Foci of Prostatic Adenocarcinoma, Gleason Score 3+3=6 Discontinuously Involving 30% of one (1) core".

     

    I will be discussing these points as well as others when I see my uirologist ... in the meantime I am gaining very helpful information and getting on with my life ... be damned if this is going to stop me from living my life as i had planned!  Thank you all for your input and "keep those cards and letters coming"!

     

    Ross

     

     

     

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #10
    Second opinion on gene test results

    Ross (Beau1020)

    Please note that we are just survivors with no medical enrolment. You should consider the advice of the specialist and follow your instincts.
     The information you shared regarding your past BPH (and present) case is now very comprehensive. It seems that your PSA has been increasing while taking Finasteride and that is not good. This drug is known to halve the PSA and yours has gone the other way; it increased. Doctors usually make considerations to this fact when judging a PCa case. In other words, in a typical Gs6 case the PSA should have gone down not up, probably indicating the presence of a more aggressive type of cancer, yet to be found.
     Your doctor may have changed to Dutasteride (another 5-ARI) to try decreasing the size of the prostate while fighting the cancer. Big size prostates are difficult to treat and difficult to dissect. Radiation therapies also need “special” care (detailed isodose planning).

    I think you better get additional testing as Hopeful above recommends getting a more precision diagnosis of cancer location. I am not sure if an AS regimen is recommendable for you. Though, your choice in postponing a treatment because of your age and loss of quality living is proper, but worrisome.

    I wonder why the Polaris specialists have diagnosed you as intermediate. The CCP=-0.9 is low. Intermediate starts at CCP=0. Maybe you could request a second reading of the data with the number of strains (genes) analysed, because their conclusion is crucial in postponing a radical approach. Moreover, DRE is negative but the case seams to be still unclear. Ask for the complete “scale” their laboratory uses and a copy of the report. I would like to know its details.

    Hope for the best.

    Best wishes,

    VG

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #11
    VascodaGama said:

    Second opinion on gene test results

    Ross (Beau1020)

    Please note that we are just survivors with no medical enrolment. You should consider the advice of the specialist and follow your instincts.
     The information you shared regarding your past BPH (and present) case is now very comprehensive. It seems that your PSA has been increasing while taking Finasteride and that is not good. This drug is known to halve the PSA and yours has gone the other way; it increased. Doctors usually make considerations to this fact when judging a PCa case. In other words, in a typical Gs6 case the PSA should have gone down not up, probably indicating the presence of a more aggressive type of cancer, yet to be found.
     Your doctor may have changed to Dutasteride (another 5-ARI) to try decreasing the size of the prostate while fighting the cancer. Big size prostates are difficult to treat and difficult to dissect. Radiation therapies also need “special” care (detailed isodose planning).

    I think you better get additional testing as Hopeful above recommends getting a more precision diagnosis of cancer location. I am not sure if an AS regimen is recommendable for you. Though, your choice in postponing a treatment because of your age and loss of quality living is proper, but worrisome.

    I wonder why the Polaris specialists have diagnosed you as intermediate. The CCP=-0.9 is low. Intermediate starts at CCP=0. Maybe you could request a second reading of the data with the number of strains (genes) analysed, because their conclusion is crucial in postponing a radical approach. Moreover, DRE is negative but the case seams to be still unclear. Ask for the complete “scale” their laboratory uses and a copy of the report. I would like to know its details.

    Hope for the best.

    Best wishes,

    VG

    alpha 5 inhibitors, diasgnostic tests

    Since Ross did not mention how long proscar was used, it may not be a factor in the PSA readings.

    Avodart will reduce the prostate size and may slow cancer growth,  if AS is choosen. Ross, you will be able to pee, and in the future can consider a radiation treatment, since you will have a smaller prostate. NOw if you choose a radiation treatmetn, due to inflamation,  you will probably need a  catheter in order to be able  to pee.

    .....................

    I wonder what diagnostic test(s) Ross can have that will be helpful to diagnosis his situation Any thoughts? PET Scan? 

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #12
    Exams with restrictive "wearing" devices

    Ira,

    Patients “wearing” restrictive metal devices such as pacemakers, prostheses or other implants (including penile devices), and those in medication for a particular long term illness, can be examined in multiparametric techniques with the use of PET, CT, gamma and X-ray machines, etc. However, some contrast agents react causing sort of localized inflammatory which may interfere in the interpretation of the results by the specialist that may not be aware of the presence of the device. In prostate cancer the traditional FDG PET/CT scan that uses F18 fluoro- D-glucose, is a typical case. The patient must fill up a report initially indicating what they are “wearing”, however, in “busy” clinics nurses tend to forget to request those fill-ups. One must be attentive.

    Ross should discuss in detail with the doctor that is “sending” him for the tests.

    Best

    VG

  • beau1020
    beau1020 Member Posts: 5
    #13
    Updated Replies

    As Hopeful and Opt has suggested the Proscar was not a factor in my PSA socres as I have not taken Proscar for at least three years now.  I have however, based upom my research and information posted above, asked my urologist if i should go back on Proscar AND to stop the elliptical for the next two months; at that point i would have a new PSA and perhaps the addition of Proscar and reduction in "heavy" exercise will have a postive effect on my PSA results.  I am told I am in a very early stage and while it is a concern to me I am not 'freaking out"!  My present understanding is that if the PSA stays the same or goes down my urologist will not suggest removal of the prostate and continue with AS.  At some point I will need to consult an oncologist but I feel I have some time before I need to go that route.

     

    Again my thanks to all .. "keep those cards and letters coming!"

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #14
    beau1020 said:

    Updated Replies

    As Hopeful and Opt has suggested the Proscar was not a factor in my PSA socres as I have not taken Proscar for at least three years now.  I have however, based upom my research and information posted above, asked my urologist if i should go back on Proscar AND to stop the elliptical for the next two months; at that point i would have a new PSA and perhaps the addition of Proscar and reduction in "heavy" exercise will have a postive effect on my PSA results.  I am told I am in a very early stage and while it is a concern to me I am not 'freaking out"!  My present understanding is that if the PSA stays the same or goes down my urologist will not suggest removal of the prostate and continue with AS.  At some point I will need to consult an oncologist but I feel I have some time before I need to go that route.

     

    Again my thanks to all .. "keep those cards and letters coming!"

     

    Advodart vs Proscar,
    Avodart(Dutasteride)

    As I understand, this drug has been used to reduce the size of the prostate. It is an Alpha 5 Inhibitor . In some cases there can be side effects from the drug, to include problems with sexuality, enlarged breasts, etc. so one has to be viligent. This Avodart goes to two inhibitors. There are also studies that show that this drug retards the growth of prostate cancer. The retardation of prostate cancer has been studied for about 7 years, however the results are not clear cut as yet. Some docs are concerned about side effects.

     

    In my case since I do not have an enlarged prostate I have made the decision not to take this drug, but my decision might  be different if my prostate was enlarged as yours is, and as I hope, you qualify for an Active Surveillance Protocol . 

     

    There is also another drug , Proscar that goes to one inhibitor.

     

    I had  collected information about Avodart,  up to about two years ago, so there may be new information available.

    ...................................

    Avodart discussion pro and con jan 2012

    pro

    Lancet. 2012 Mar 24;379(9821):1103-11. Epub 2012 Jan 24.

    Dutasteride in localised prostate cancer management: the REDEEM randomised, double-blind, placebo-controlled trial.

    Fleshner NE, Lucia MS, Egerdie B, Aaron L, Eure G, Nandy I, Black L, Rittmaster RS.

    Source

    Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. neil.fleshner@utoronto.ca

    Abstract

    BACKGROUND:

    We aimed to investigate the safety and efficacy of dutasteride, a 5α-reductase inhibitor, on prostate cancer progression in men with low-risk disease who chose to be followed up with active surveillance.

    METHODS:

    In our 3 year, randomised, double-blind, placebo-controlled study, undertaken at 65 academic medical centres or outpatient clinics in North America, we enrolled men aged 48-82 years who had low-volume, Gleason score 5-6 prostate cancer and had chosen to be followed up with active surveillance. We randomly allocated participants in a one-to-one ratio, stratified by site and in block sizes of four, to receive once-daily dutasteride 0•5 mg or matching placebo. Participants were followed up for 3 years, with 12-core prostate biopsy samples obtained after 18 months and 3 years. The primary endpoint was time to prostate cancer progression, defined as the number of days between the start of study treatment and the earlier of either pathological progression (in patients with ≥1 biopsy assessment after baseline) or therapeutic progression (start of medical therapy). This trial is registered with ClinicalTrials.gov, number NCT00363311.

    FINDINGS:

    Between Aug 10, 2006, and March 26, 2007, we randomly allocated 302 participants, of whom 289 (96%) had at least one biopsy procedure after baseline and were included in the primary analysis. By 3 years, 54 (38%) of 144 men in the dutasteride group and 70 (48%) of 145 controls had prostate cancer progression (pathological or therapeutic; hazard ratio 0•62, 95% CI 0•43-0•89; p=0•009). Incidence of adverse events was much the same between treatment groups. 35 (24%) men in the dutasteride group and 23 (15%) controls had sexual adverse events or breast enlargement or tenderness. Eight (5%) men in the dutasteride group and seven (5%) controls had cardiovascular adverse events, but there were no prostate cancer-related deaths or instances of metastatic disease.

    INTERPRETATION:

    Dutasteride could provide a beneficial adjunct to active surveillance for men with low-risk prostate cancer.

    FUNDING:

    GlaxoSmithKline.

    Copyright © 2012 Elsevier Ltd. All rights reserved

    ……………………………………………………………………………………………………………………..

    ……………………………………………………………………………………………………………..

    pro

    1. Urology. 2010 Nov;76(5):1067-71. Epub 2010 May 15.

    The effect of short-term dutasteride intake in early-stage prostate cancer: analysis of 148 patients who underwent three-dimensional prostate mapping biopsy.

    Barqawi AB, O'Donnell CI, Siomos VJ, Hou AH.

    Source

    Department of Surgery, Division of Urology, University of Colorado Denver, Aurora, CO 80045, USA. al.barqawi@ucdenver.edu

    Abstract

    OBJECTIVES:

    The effect of dutasteride on existing prostate cancer volume is largely unknown. In this study, we assessed the impact of dutasteride on tumor burden and Gleason score.

    METHODS:

    A retrospective review of patients from our institution was performed, examining men interested in surveillance for prostate cancer, who underwent transperineal three-dimensional mapping (TP-3DM) biopsy within 3-6 months after their initial cancer diagnosis. The criteria to qualify for TP-3DM biopsy included prostate-specific antigen < 10 ng/mL, Gleason score ≤ 7, ≤ 2 positive cores out of 12. There were 2 cohorts of men--those who took dutasteride daily before the TP-3DM biopsy and those who did not receive any 5ARIs. Upstaging of prostate cancer diagnosis was defined as an increase in one or more positive cores or a change from unilateral to bilateral disease.

    RESULTS:

    From 2006-2008, a cohort of 148 men underwent TP-3DM biopsy of the prostate. Ninety-one men received a treatment regime of dutasteride at least 3 months before TP-3DM biopsy. Fifty-seven men did not receive dutasteride or any other 5ARI. Approximately 74% of men who did not take dutasteride were upstaged and/or upgraded compared with 49.4% of men who received dutasteride (P = .0038).

    CONCLUSIONS:

    We observed a 24.3% decrease in the proportion of upstaging and/or upgrading of prostate cancer in men who received dutasteride at least 3 months before 3D prostate TP-3DM biopsy. Thus, the effect of dutasteride on prostate cancer may have implications for its potential use as a secondary chemoprevention agent.

    Copyright © 2010 Elsevier Inc. All rights reserved.

    PMID: 20472268 [PubMed - indexed for MEDLINE

    .....................................................................

    con

    1. BJU Int. 2012 Jan 30. doi: 10.1111/j.1464-410X.2011.10875.x. [Epub ahead of print]

    Effect of treatment with 5-α reductase inhibitors on progression in monitored men with favourable-risk prostate cancer.

    Ross AE, Feng Z, Pierorazio PM, Landis P, Walsh PC, Carter HB, Trock BJ,Schaeffer EM.

    Source

    James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins Medicinal Institutions, Baltimore, MD, USA.

    Abstract

    Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Finasteride (Proscar) and dutasteride (Avodart) are 5-α reductase inhibitors (5-ARIs) used to treat LUTS in men with benign prostatic enlargement. Because these drugs suppress androgens, the theory has been put forward that 5-ARIs might prevent the development of prostate cancer. Careful analysis of two randomized controlled trials, however, showed that, in the clinical setting, this was not the case, and that these drugs can increase the occurrence of more aggressive high-grade disease. Because of this, the U.S. Food and Drug Administration did not approve 5-ARIs for the primary prevention of prostate cancer and notified healthcare professionals about a change in the 'Warnings and Precautions' for these drugs. Interest remains among some for using 5-ARIs in men diagnosed with very low-risk prostate cancer to delay the progression from clinically indolent disease to clinically significant disease requiring treatment. The present study investigated whether 5-ARI use among men with very low-risk prostate cancer in an active surveillance (AS) programme would reduce the number of cancers reclassified to clinically significant disease on surveillance biopsy. Our results do not support the use of 5-ARIs for slowing or preventing cancer progression in men with low-risk prostate cancer, but do suggest that men with very low-risk prostate cancer who take 5-ARIs for LUTS are unlikely to be at increased risk for the development of high grade disease during AS.

    OBJECTIVE:

    •  To determine whether 5-α reductase inhibitor (5-ARI) use delays cancer reclassification in an active surveillance (AS) cohort.

    PATIENTS AND METHODS:

    •  We performed a retrospective study of 587 men enrolled in an AS programme, who had no history of 5-ARI use. •  Chi-squared and t-tests were used to compare characteristics of 5-ARI users and non-users. •  Univariable and multivariable proportional hazards models, treating 5-ARI use as a time-dependent covariate, were used to evaluate the influence of 5-ARIs on the risk of a subsequent biopsy no longer meeting criteria for continued AS (i.e. reclassification).

    RESULTS:

    •  5-ARI use was initiated in 47 men while on AS. •  Men using 5-ARIs had larger prostates and higher PSA levels at diagnosis. •  During 5-ARI use, PSA levels and prostate volume deceased by mean values of 47% and 11%, respectively. •  Men using 5-ARIs had a mean of 2.5 surveillance biopsies while on the drug. Reclassification occurred in 17% of 5-ARI users compared with 31% of non-users (P= 0.04). •  Multivariable models (adjusting for age, α-blocker use, PSA level, %free PSA, PSA density, prostate volume and number/percent biopsy core involvement at diagnosis) showed nonsignificant risk reductions for reclassification in 5-ARI users as determined by either tumour extent (hazard ratio [HR]= 0.37 (95% confidence interval [CI] 0.12 to 1.13), P= 0.08) or grade (HR = 0.8 (95% CI 0.25-2.59), P= 0.7).

    CONCLUSION:

    •  Treatment with 5-ARIs did not significantly alter the outcome of biopsy reclassification by grade in men with very low-risk prostate cancer.

    © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

    PMID: 22289613 [PubMed - as supplied by publisher]

    Treatment options with diagnosis at relatively young age. ›

     

     

    …............................................................................................

    Dihyydrotesterone is ten times more powerul than testosterone at stimulating prostate growth, so a dihydrotestosterone of 30ng/dL is potentially as powerful as testosterone of 300.


    Dishydortestosterone formation can be blocked in most patients with either Proscar or Avodart, with Avodart being more consistently effective.......But again we have to measure dihydrotestosternone levels to see if the Proscar or Avodart is in fact suppressing dihydrotestosterone.

     

    …..................................

    Ross...you mention that you took Proscar over three years ago...can you tell what length of time this was for, the start and finish date.

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #15
    beau1020 said:

    Updated Replies

    As Hopeful and Opt has suggested the Proscar was not a factor in my PSA socres as I have not taken Proscar for at least three years now.  I have however, based upom my research and information posted above, asked my urologist if i should go back on Proscar AND to stop the elliptical for the next two months; at that point i would have a new PSA and perhaps the addition of Proscar and reduction in "heavy" exercise will have a postive effect on my PSA results.  I am told I am in a very early stage and while it is a concern to me I am not 'freaking out"!  My present understanding is that if the PSA stays the same or goes down my urologist will not suggest removal of the prostate and continue with AS.  At some point I will need to consult an oncologist but I feel I have some time before I need to go that route.

     

    Again my thanks to all .. "keep those cards and letters coming!"

     

    PSA rise

    There are various factors that may cause the PSA to rise, a hard still, sex before the blood test, and exercise, especially bike riding.........it is NOT necessary to stop exercising two months before the test....a day or two is sufficient.

    Other factors that may contribute are, infection which can be treated with an antibiotic

    An enlarged prostate that places pressure on the urethra, and secretes larger amounts ofPSA in the blood.

    Many of us who have been diagnosed have change our eating habits to be heart healthy, since heart healthy is prostate healthy.......

    A couple of years ago there was a study by Dr. Dean Ornish who measured PSA , pre and post, of a small number of men who followed a veggie diet, limited stress and exercise regularly.  The PSA numbers of this group  declined some.

    Suggest you read , The China Study by T. Colin Campbell, or see the movie that may be available at your library or net flicks..........FORKSoverKNIVES  

    Also suggest that you read Eat to LIve by Joel Furman

    ..........................

    Now some nutritionist promote veggie diet for PCa, other promote Mediterranean diet Do your research

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #16
    beau1020 said:

    Updated Replies

    As Hopeful and Opt has suggested the Proscar was not a factor in my PSA socres as I have not taken Proscar for at least three years now.  I have however, based upom my research and information posted above, asked my urologist if i should go back on Proscar AND to stop the elliptical for the next two months; at that point i would have a new PSA and perhaps the addition of Proscar and reduction in "heavy" exercise will have a postive effect on my PSA results.  I am told I am in a very early stage and while it is a concern to me I am not 'freaking out"!  My present understanding is that if the PSA stays the same or goes down my urologist will not suggest removal of the prostate and continue with AS.  At some point I will need to consult an oncologist but I feel I have some time before I need to go that route.

     

    Again my thanks to all .. "keep those cards and letters coming!"

     

    PSA, prostate size ratio

     PSA 13.3 , prostate size 60 so the proportion is .222...Generally doctors look for a proportion of  0.15 or less

    My layman opinion only is that the most critical information for diagnosis comes from the biopsy, and in your case, probably the PET Scan...........I suggest that you discuss this with your doc.

    Above I mentioned reasons for PSA increase that you may also wish to discuss with your doc.

     

  • beau1020
    beau1020 Member Posts: 5
    #17
    hopeful and optimistic said:

    PSA, prostate size ratio

     PSA 13.3 , prostate size 60 so the proportion is .222...Generally doctors look for a proportion of  0.15 or less

    My layman opinion only is that the most critical information for diagnosis comes from the biopsy, and in your case, probably the PET Scan...........I suggest that you discuss this with your doc.

    Above I mentioned reasons for PSA increase that you may also wish to discuss with your doc.

     

    More Follow-up

    So following up on some suggestions and my own research, and in discussions with my doctor, I was able to reslove the folowing ...

     

    I already have the beginning stages of cancer  ... grade T1c.  As such medications such as Proscar and Avidar are NOT in my best interest.  Proscar was studied over a ten year period to see if it had any effect upon reducing the size of the prostate ... and in fact it did!  Additionally it was determined that Proscar actually assists in the delaying of the growth of a patient's cancer, which would be good news.  But the study also identified a small sample of those in the test actually saw their cancer accelerate in growth with the casue/effect yet to be identified.  Therefore Proscar is not for me.  Additionally, if the prostate shrinks, either naturally (which it sometimes, but rarely, will do) or via the use of drugs, it does not address what is actaully happening with the known and identified cancer.  Having cancer changes the game plan a bit.

     

    As far as exercise goes I have been encouraged to maintain an active exercise routine, as lower BMI's have a diret correlation to PSA scores.  However, in terms of testing PSA exercise should be stopped for 48-72 before a blood test; same with absentinence from sexual activing .. both vigorus exercise and sexualy activity will increase the PSA resdings.

     

    One question I was not able to answer was if my next PSA comes back elevated how can I determine if I should respond with some form of actual treatment (other than the present AS).  I have been refered to the Partin tables as well as the Capra tables; the Partin Tables (developed at Johns Hopkins) addres the probability that the cancer will grow and spread to other organs while the Capra tables suggest the potential for reoccurance of the return of cancer should the Prostate be surgically removed.  I have not had the time to look in depth into these two tools but my inital reveiw of the Partin tables is proving satistically very informative.  However, while I am far from reaching any conclusion regarding a course of treatment, I tend to believe that radiation (due to the inability to perform surgery at a later date is removed as an option) and drug therapies ( I presently do not have tumors and have a low-grade cancer) would be a secondary choice to that of surgery.  Again, not nearly close to making any decision, and clearly not before obtaining a second opinion.

     

    Bottom line, as we all know, is that each case is unique and I will have to make my future decisions based uponupdated information and my research over the next few months.  But as always I am interested in other's comments.

     

    Ross

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #18
    beau1020 said:

    More Follow-up

    So following up on some suggestions and my own research, and in discussions with my doctor, I was able to reslove the folowing ...

     

    I already have the beginning stages of cancer  ... grade T1c.  As such medications such as Proscar and Avidar are NOT in my best interest.  Proscar was studied over a ten year period to see if it had any effect upon reducing the size of the prostate ... and in fact it did!  Additionally it was determined that Proscar actually assists in the delaying of the growth of a patient's cancer, which would be good news.  But the study also identified a small sample of those in the test actually saw their cancer accelerate in growth with the casue/effect yet to be identified.  Therefore Proscar is not for me.  Additionally, if the prostate shrinks, either naturally (which it sometimes, but rarely, will do) or via the use of drugs, it does not address what is actaully happening with the known and identified cancer.  Having cancer changes the game plan a bit.

     

    As far as exercise goes I have been encouraged to maintain an active exercise routine, as lower BMI's have a diret correlation to PSA scores.  However, in terms of testing PSA exercise should be stopped for 48-72 before a blood test; same with absentinence from sexual activing .. both vigorus exercise and sexualy activity will increase the PSA resdings.

     

    One question I was not able to answer was if my next PSA comes back elevated how can I determine if I should respond with some form of actual treatment (other than the present AS).  I have been refered to the Partin tables as well as the Capra tables; the Partin Tables (developed at Johns Hopkins) addres the probability that the cancer will grow and spread to other organs while the Capra tables suggest the potential for reoccurance of the return of cancer should the Prostate be surgically removed.  I have not had the time to look in depth into these two tools but my inital reveiw of the Partin tables is proving satistically very informative.  However, while I am far from reaching any conclusion regarding a course of treatment, I tend to believe that radiation (due to the inability to perform surgery at a later date is removed as an option) and drug therapies ( I presently do not have tumors and have a low-grade cancer) would be a secondary choice to that of surgery.  Again, not nearly close to making any decision, and clearly not before obtaining a second opinion.

     

    Bottom line, as we all know, is that each case is unique and I will have to make my future decisions based uponupdated information and my research over the next few months.  But as always I am interested in other's comments.

     

    Ross

    There Are Options After Radiation Treatment

    Men often say they want to go w/surgery to remove their prostate, instead of radiation, because if the surgury fails and the cancer reoccurs they can still treat the prostate w/radiation but, if they go w/radiation, they can't remove the prostate later (and impliedly have fewer follow-up treatment options). 

    This simply is NOT true!!!  

    If radiation treatment fails, you have essentially the same options as you do with failed surgery.  Surgical removall of the prostate is still an option after radiation, but is seldom done for a variety of reasons, including the trauma involved in the process and the tissue damage caused by radiation treatment which can complicate surgical removal.

    However, you can still treat the prostate with radiation again (using the same or an alternative method) and you can receive hormonal therapy, which is EXACTLY the same form of salvage therapy incorporated when surgery fails.

    So, if one chooses surgery over radiation as the initial and primary method of treatment, do so because you believe it is the BEST course of action for you BUT don't do it because you think that if surgery fails you have better/greater follow-up options than you do w/radiation. 

    This simply is NOT the case. 

    You have the essentially the same follow-up options whether you undergo surgery or radiation 1st.  In fact, you have greater options if you choose radiation, because you can still choose to attempt to remove the prostate following radiation, which would not be an option you'd have if you chose surgery 1st.

    End of rant.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #19
    beau1020 said:

    More Follow-up

    So following up on some suggestions and my own research, and in discussions with my doctor, I was able to reslove the folowing ...

     

    I already have the beginning stages of cancer  ... grade T1c.  As such medications such as Proscar and Avidar are NOT in my best interest.  Proscar was studied over a ten year period to see if it had any effect upon reducing the size of the prostate ... and in fact it did!  Additionally it was determined that Proscar actually assists in the delaying of the growth of a patient's cancer, which would be good news.  But the study also identified a small sample of those in the test actually saw their cancer accelerate in growth with the casue/effect yet to be identified.  Therefore Proscar is not for me.  Additionally, if the prostate shrinks, either naturally (which it sometimes, but rarely, will do) or via the use of drugs, it does not address what is actaully happening with the known and identified cancer.  Having cancer changes the game plan a bit.

     

    As far as exercise goes I have been encouraged to maintain an active exercise routine, as lower BMI's have a diret correlation to PSA scores.  However, in terms of testing PSA exercise should be stopped for 48-72 before a blood test; same with absentinence from sexual activing .. both vigorus exercise and sexualy activity will increase the PSA resdings.

     

    One question I was not able to answer was if my next PSA comes back elevated how can I determine if I should respond with some form of actual treatment (other than the present AS).  I have been refered to the Partin tables as well as the Capra tables; the Partin Tables (developed at Johns Hopkins) addres the probability that the cancer will grow and spread to other organs while the Capra tables suggest the potential for reoccurance of the return of cancer should the Prostate be surgically removed.  I have not had the time to look in depth into these two tools but my inital reveiw of the Partin tables is proving satistically very informative.  However, while I am far from reaching any conclusion regarding a course of treatment, I tend to believe that radiation (due to the inability to perform surgery at a later date is removed as an option) and drug therapies ( I presently do not have tumors and have a low-grade cancer) would be a secondary choice to that of surgery.  Again, not nearly close to making any decision, and clearly not before obtaining a second opinion.

     

    Bottom line, as we all know, is that each case is unique and I will have to make my future decisions based uponupdated information and my research over the next few months.  But as always I am interested in other's comments.

     

    Ross

    The drug Avodart goes to two

    The drug Avodart goes to two recepters, not one recepter as Proscar does, so AVodart is more effective. At first studies were done among men who were not diagnosed to measure the effectiveness of this drug; after success was shown among this group of men, a couple of years later, studies were done among men diagnosed who were in an Active Surveillance protocol. I listed these studies in my previous post. Also, Avodart will shink the prostate. 

    Since your prostate is large you are currently not a canidate for Bracky...seed inplants.

    As far as SBRT, ...one of my friends, who I mentored,  had that procedure. His prostate was large as yours is.....he had a lot of trouble afterward peeing...he had to go around with a catheter for quite a while......his prostate eventually shrunk resulting from atrophy,  due to the radiaition...........................you would have to speak with your doc if you are at some time interested in SBRT, or another radiation procedure.

    ...........

    You are asking when to pull the plug and seek active treatment............well, you need to obtain diagnostics tests that are relavant to your case, such as a PET SCAN, etc...the PSA trend is part of the puzzle...you and your doc have to look at everything.

  • CJ613
    CJ613 Member Posts: 6
    #20
    I had cyberknife. I would

    I had cyberknife. I would choose that robotic surgery if I had the option to do it over. I have bad side effects. Little control of my bowels and urine. I did get rid of the cancer, but now I have diapers in my future. The surgery can result in impodence, Viagra. Also incontinance. But you can't have your colon fried with surgery. Choose a good doctor and facility. Just my opinion. Just be aware that no treatment is 100% trouble free. I have a friend that had CK and has no side effects. Also have a friend that had surgery with no side effects. The choice is yours and good luck.

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #21
    CJ613 said:

    I had cyberknife. I would

    I had cyberknife. I would choose that robotic surgery if I had the option to do it over. I have bad side effects. Little control of my bowels and urine. I did get rid of the cancer, but now I have diapers in my future. The surgery can result in impodence, Viagra. Also incontinance. But you can't have your colon fried with surgery. Choose a good doctor and facility. Just my opinion. Just be aware that no treatment is 100% trouble free. I have a friend that had CK and has no side effects. Also have a friend that had surgery with no side effects. The choice is yours and good luck.

    It is not necessary to post the same thing repetitively.  This is the same identical post by you that I have seen in 3 different places.  Once is usually enough, especially if you start your own thread.  I get that you had a bad CK experience but the fact that 3 of 5 of those posts are identical makes your credibility suspect to those of us who have been on this forum for many years.

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