A Great Summary of Prostate Issues

29000 Men Comment
I’m now going into my 6th year as a prostate cancer survivor, and I have done a great deal of research over those years. Following is Part I of a three part series that I believe is some of the best information I have found. I will follow with Parts II and III in later posts. I can’t recommend the source enough: LISTSERV@LISTSERV.ACOR.ORG.

Date: Fri, 29 Jan 2010 07:01:15 -0500
From: Nancy Peress <nperess@CHARTER.NET>
Subject: Ron Koster’s Updated “WELCOME NEWCOMER!” -- Part 1 of 2

Sent 1/29/2010

Several weeks before his death on August 11, 2005, Ron asked me to go
on sending out his weekly Welcome Newcomer message for him. It’s my
honor to continue posting his message each week as one small example
of his dedication to helping men with prostate cancer. As Ron often
signed his emails, “Sometimes, it takes just one person to work a
miracle.” Ron was one of the miracle workers.

Revised and updated December 1, 2009 by Mike Scott (with we hope
Ron’s complete approval).
=====

In spite of the fact that almost everything about prostate cancer
(PCa) is controversial, you’ve found an excellent source of
information. Be patient, and don’t give up just because this resource
may frequently be dominated by irrelevant, repetitious, or esoteric
notes which may not be particularly helpful to the newcomer!

Risk for PCa is assessed primarily through a combination of two widely
used tests: the prostate specific antigen (PSA) test and the digital
rectal exam (DRE).

A normal PSA for a 50-year-old man is usually less than 2.5 ng/ml,
but there is no specific PSA value that is predictive of risk for
prostate cancer. A higher PSA level by itself does not necessarily
mean that you have PCa, and a lower PSA level does not necessarily
mean that you don’t have PCa.

The DRE enables your doctor to feel the size, shape, and texture of
your prostate to determine if you have a clinically normal or abnormal
prostate. However, you can have PCa without having a palpable
(feelable) tumor, and palpable nodules or abnormalities are not always PCa.

Even though much of the testing is extremely controversial, most PCa
survivors prefer and recommend that all men of about 40 be tested
early and regularly in the hope that early diagnosis will give greater
choice of treatment and cure with fewer side or after effects. Men
with a family history of prostate cancer or other risk factors may
want to get a first (baseline) PSA test at an even younger age.

High PSA levels may be cause by PCa, by benign prostatic hyperplasia
(BPH), or by a urinary tract infection such as prostatitis. However,
NO PSA ASSAY IS PERFECT and no specific PSA level is diagnostic for
prostate cancer! At 58 years of age, when I was diagnosed, my own PSA
was 3.6 ng/ml, my Gleason score was 7, and I was subsequently shown to
be pathological stage T2a (after surgery).

Other tests which your doctor may want to perform on a blood or urine
sample (or which you can ask him to carry out) include the PSA II or
Free PSA test, which can be used to rule out prostatitis and/or benign
prostatic hyperplasia (BPH) and the so-called PCA3 test, which can
help to predict risk for more aggressive forms of prostate cancer.
Older tests that are less commonly used today include the serum acid
phosphate test, the alkaline phosphatase test, and the prostatic acid
phosphatase (PAP) test.

The results of a PSA test and a DRE (and the PCA3 test) can be used,
in combination with information about your family history of prostate
cancer and other medical information, to assess your risk for PCa
using the Risk of Biopsy-Detectable Risk Calculator, which you can find at
http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp

The results of these tests, including a suspicious DRE, may give you
and your doctor good cause to decide you need a prostate biopsy. An
initial biopsy, today, usually consists of the removal of 8 to 12
biopsy cores using a specialized procedure under ultrasound biopsy.

If PCa is found in the tissue removed at biopsy, the pathologist who
examines the biopsy cores will assign what is known as a Gleason
score. It will be someplace between 6 and 10, the higher number
indicating a more aggressive form of PCa. The Gleason score has two
components, the GRADE and the SUM or SCORE. The GRADE is based on how
the individual cells look under the microscope. The Gleason grades
used to range from 1 to 5, with 1 being the closest to normal and 5
being bad. However, today, it is normal for all Gleason grades to
range only from 3 to 5 if cancer is thought to be present because
Gleason grades of 1 or 2 are considered not to be cancer. There are
both general and specific guidelines for each grade, but examining
prostate biopsy cores to establish the presence of cancer and the
Gleason grades of that cancer is difficult. The experience of the
pathologist is key -- which is why a second opinion on the biopsied
tissue is often a good approach.

When the pathologist reads a specimen, s/he looks at it to determine
the most common grade of tumor seen: that is the first number of the
SUM. Then the pathologist determines the next most common tumor area
and assigns a Gleason grade to it. This is the second number of the
Gleason SUM or SCORE. The two numbers, when added together, give the
SUM. Close reading of the pathology report, will often indicate both
the Gleason grades and the percentage of each grade, which may make
you feel better or worse than knowing the Gleason SUM or SCORE) -- but
the Gleason SCORE is what is reported in most of the medical
literature and used for comparisons. So a Gleason score of 3 + 4 = 7
means more grade 3 than grade 4 and a Gleason score of 4 + 3 = 7 is
just the opposite, meaning more grade 4 than grade 3.

It is VERY IMPORTANT, however, to understand that a “clean” or
negative pathology report of the prostatic tissue taken at a normal
8- or 12-core biopsy is no guarantee at all that PCa doesn’t exist in
your prostate.

If you are diagnosed with prostate cancer, BEFORE treatment, your
doctor will also assign a CLINICAL STAGE for your cancer. This
clinical stage will be based on the so-called TNM staging system,
where T refers to the primary tumor (in your prostate), N refers to
the evidence that there may be cancer that has extended to your lymph
nodes, and M refers to the evidence that the cancer has metastasized
(spread) to other areas in your body (usually, at first, bones like
your hips and your spine).

The following is the standard (AJCC) CLINICAL staging nomenclature for
prostate cancer, last updated in 2002:

Primary Tumor (T)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

T1 Clinically inapparent tumor not palpable nor visible by imaging

T1a Tumor incidental histologic finding in 5% or less of tissue
resected by TURP.

T1b Tumor incidental histologic finding in more than 5% of tissue
resected by TURP.

T1c Tumor identified by needle biopsy (e.g. because of elevated PSA)

T2 Palpable tumor but confined within the prostate

T2a Tumor involves one half of one lobe or less.

T2b Tumor involves more than half one lobe, but not both lobes.

T2c The tumor involves both lobes.

T3 Tumor extends through the prostatic capsule

T3a Extracapsular extension on one or both sides of the prostate

T3b Tumor invades one or both the seminal vesicles

T4 Tumor is fixed to or invades adjacent structures other than
seminal vesicles


Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single lymph node, 2 cm or smaller

N2 Metastasis to one or more lymph nodes 2 cm or larger, but none
larger than 5 cm in greatest diameter

N3 Metastasis to a lymph node greater than 5 cm in greatest diameter.


Distant Metastasis (M)

MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis to any site

M1a Distant metastasis to non-regional lymph nodes

M1b Distant metastasis to the bone(s)


You should know that if you decide to have a surgical treatment for
your prostate cancer, then it will be possible for your surgeon to
obtain a post-surgical PATHOLOGICAL stage for your prostate cancer
which will usually be slightly different that the CLINICAL stage.
Pathological staging is only possibly after surgical treatment.

If you initially shown to have prostate cancer on a biopsy, your
doctor may want you to have one or more imaging tests to try to
identify whether your cancer has escaped from the prostate
(metastasized) to other parts of your pelvic region or even to other
organs. These imaging tests can include color Doppler ultrasound
scans, computerized tomography (CT) scans, magnetic resonance imaging
(MRI) scans, bone scans, and the ProstaScint test. Some of these tests
involve injecting a radioisotope into the blood-stream. Absolutely
none of these tests or procedures is 100% accurate.

(please see part 2)

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Prostate Cancer Survivor Documentary Movie

I’m going to be making a documentary about prostate cancer survivors and their families during this summer’s Tour de USA. The city schedule (46 cities) is posted on the event site. If you would like to be interviewed and tell your story, just visit the website, join the mailing list and send us email. This is a story that really needs to be told.

January 20, 2010 Weight In - Biggest Loser Potential?

In my post last week, I was at 154 determined to drop back to 149 as my ideal weight - I’m 5“10”, and 149 still places me above my ideal BMI. I’m struggling a bit, though. The kids are still in the house and that ‘kid food’ is so tempting. Hello carrots and veggies! Check back and see how I’ve done next week. I’m also getting back on the back and hitting the weights in the gym. I’m also going to explore some weight programs for 65+, since I just hit that mark. What programs are you other survivors using to control your weight?

Where to Get Really Good Information from Prostate Cancer Survivors

Finding really good information about prostate cancer is a challenge. The ACOR LISTSERV provides an ongoing dialogue between prostate cancer survivors about their conditions, the treatments they are following and the treatment outcomes. if you are recently diagnosed or in your survivor period, I highly recommend subscribing to the LISTSERV. If you find it useful and have the resources, consider making a donation to support their operations.

Gene Mutation Tied to Increased Risk of Aggressive Prostate Cancer

January 12, 2010

A new gene mutation has been discovered that may explain why some men are especially prone to developing prostate cancer
Boston (DbTechNo) - A new gene mutation has been discovered that may explain why some men are especially prone to developing prostate cancer.

Prostate cancer is one of the more tricky forms of the disease, as it can either present as an aggressive tumor or a slow growing tumor which determines the appropriate form of treatment.

It is one of the more common types of cancer diagnosed in men, and the aggressive form of the disease is the second leading cancer killer for men in America.

Researchers have discovered a gene mutation dubbed “rs4054823″ which puts a man at a 25% increased risk of being diagnosed with the aggressive form of the disease.

“This finding addresses one of the most important clinical questions of prostate cancer — the ability at an early stage to distinguish between aggressive and slow-growing disease,” said the study’s lead author Jianfeng Xu, cancer expert at Wake Forest University Baptist Medical Center in North Carolina.

“Although the genetic marker currently has limited clinical utility, we believe it has the potential to one day be used in combination with other clinical variables and genetic markers to predict which men have aggressive prostate cancer at a stage when the disease is still curable.”

The study can be found in the upcoming addition of the Proceedings of the National Academy of Sciences.

Source: dbtechno.com

Obesity Responsible for 100,000 Cancer Cases Annually

Research is beginning to quantify that old saying that “we are our own worst enemy.”

A recent report from the American Institute of Cancer Research (AICR) states that excess body fat is a major cause of cancer. The AICR research looked at seven cancers know to have correlations with cancer and calculated the actual case counts that were likely to have been caused by obesity. The numbers in the study are shocking: 49% of endometrial cancers, 24% of kidney cancers, 28% of pancreatic cancers, 17% of breast cancers, and 9% of colorectal cancers.

Dr. Laurence Kolonel, Deputy Director of the Cancer Research Center of Hawaii and AICR/WCRF expert panel member, presented the new preventability estimates and noted that “We now know that carrying excess body fat plays a central role in many of the most common cancers,” and “it’s clearer than ever that obesity’s impact is felt before, during, and after cancer - it increases risk, makes treatment more difficult and shortens survival.”

29000 Men Comment
I am now going into my 7th year as a prostate cancer survivor and I’m watching my PSA bounce around at the .02, .06, .04 range. My doctors keep telling me not to worry, but I don’t believe I’m cured, and I still have that monkey on my back. Following my surgery in 2003, I went on a strict vegetarian diet and my weight dropped to 144 pounds, just 2 pounds more that when I graduated from college and went in the Army. Over the past two years, I gradually relaxed my diet and my weight increased to 154. My goal for 2010 is to return to my survival eating regime and lose that weight. After all, if the cancer returns, wouldn’t I be greatly to blame? In my business life I talk frequently about accountability. Well, this is pretty much the ultimate in personal accountability. My weight today was 154. Check my as I track my progress. If you want to begin exercising, consider bicycling. It’s a great sport.

Prostate Cancer TRAP

Prostate cancer cells are often resistant to cell death. Researchers led by Dr. Dario C. Altieri of the University of Massachusetts Medical School, therefore, explored the role of TRAP-1, a protein thought to regulate cell death, in prostate cancer survival. TRAP-1 was highly expressed in both high-grade human prostate cancer lesions and mouse models of prostate cancer, but not in benign or normal prostate tissue. In addition, TRAP-1 over expression in non-cancer prostate cells inhibited cell death, whereas TRAP-1-deficient prostate cancer cells had enhanced levels of cell death. Moreover, treatment with Gamitrinib, which inhibits TRAP-1, resulted in prostate cancer cell death, but not death of non-cancerous prostate cells. Therefore, targeting TRAP-1 via Gamitrinib treatment may be a viable therapeutic strategy for patients with advanced prostate cancer.

Leav et al suggest that "TRAP-1 [is] a novel marker of localized and metastatic prostate cancer, but not normal glands, required for prostate cancer cell viability, in vivo. Taken together with the preliminary safety of Gamitrinibs in preclinical studies, these data suggest that targeting mitochondrial TRAP-1 may provide a novel therapeutic approach for patients with advanced and metastatic prostate cancer" A similar approach may be also suitable for other types of cancer, as TRAP-1 is broadly expressed in disparate human malignancies. In future studies, Dr. Altieri and colleagues plan to "further dissect the biology of TRAP-1 cytoprotection in cancer cells, and test whether disabling its function may overcome drug resistance, the most common reason of treatment failure and dismal outcome in patients with advanced prostate cancer.”

Source: American Journal of Pathology