Will the new American Cancer Society prostate cancer screening guidelines save your life?

29000 Men Comment
Following is the link to the American Cancer Society’s recent recommendations about PSA testing.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_prostate_cancer_be_found_early_36.asp

As a 7-year prostate cancer survivor - I am not a physician and I do not provide medical advice - I continue to believe that men should begin PSA testing at age 35 and track their results year-to-year, since a rapid rate of increase is associated with a high possibility of prostate cancer.

We often hear comments such as “don’t worry about prostate cancer, it generally is slow growing and you most likely will die from some other cause.” If this is the case, why are almost 29,000 men perishing each year from prostate cancer? And why have over a million men died from prostate cancer since the War on Cancer was declared in 1971?

If you like to do research, just try and find detailed information about the cohort of men that die each year: at what age were they diagnosed?, at what cancer stage?, how were they diagnosed?, how were they treated?

If you want a sobering look at why we all should be testing, visit the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) website and dive into the statistics yourself. It’s pretty straight forward and you will be able to make your own decision about the value of PSA Testing. Here’s a quote from a recent NCI monograph on prostate cancer survival: “Survival for those diagnosed with distant disease and with poorly and undifferentiated tumors is poor, pointing to the benefit of earlier diagnosis.” “Poor” to the point that if a man is diagnosed with Stage IV prostate cancer he has a roughly 5% chance of living 10 additional years.!

If you are one of the unlucky men, like me, to have prostate cancer, would you rather be diagnosed early when there is the possibility of effective treatment or later, when there is none?

PSA testing isn’t perfect, but it is the best test currently available and can be done for as little at $26.00 dollars without a doctor visit (note: I am not advocating PSA testing without medical supervision, only noting that testing services are available).

Prostate cancer is the mirror image of breast cancer, yet men refuse to talk about the topic for fear of possible treatment side effects. At the same time, the business community, with a few exceptions, is afraid to engage on the issue, even while they rush to create breast cancer awareness programs.* This is even true for the most macho of all consumer brands, the Harley-Davidson Motor Company.

I will be riding across the US and back this summer (the Tour de USA 2010) to raise awareness of these issues. Full event details can be found at Tour de USA website, along with a listing to the cities where we will stop. I would love to have help in creating local media events at each stop.




* I applaud the companies that are supporting breast cancer initiatives and encourage them to continue these programs.

Ron Koster's Part 1 for Prostate Cancer Newcomers

29000 Men Comment
As a six-year prostate cancer survivor, I have found that the two summaries written by Ron Koster, and reposted periodically by Nancy Peress, are particularly valuable reading for newly diagnosed survivors and their families. Following is a repost of Ron’s Part l. I posed Part ll the last time on February 5, 2010.

Date: Fri, 5 Mar 2010 09:36:08 -0500
From: Nancy Peress <nperess@CHARTER.NET>
Subject: Ron Koster’s Updated “WELCOME NEWCOMER!” -- Part 1 of 2

Sent 3/5/2010

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
Rons 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.

Stay Active to Reduce Your Risk of Prostate Cancer

29000 Men Comment The article below is more evidence that lifestyle has a direct impact on our risk of prostate cancer and, by extension, possibly the risk of recurrence. Read this article and then get active, and consider participating in one of our cycling events: http://www.29000men.org, Events Tab. Begin Article Can an active lifestyle protect a man from prostate cancer? Research reported in the journal Cancer Causes and Control (Volume 19, page 107) suggests that it might ... Much effort has been devoted to searching for lifestyle or environmental factors that might serve as promoters for prostate cancer. The incidence of microscopic prostate cancer (cancers too small to be seen except under a microscope) is similar among men in the United States and in all other countries that have been examined. However, the mortality rates from prostate cancer differ from one country to another and even within different regions of the United States. These differences suggest that factors such as diet, exercise, body weight, or exposure to certain substances or forces influence prostate cancer's progression from microscopic tumors to clinically significant ones. Some factors are believed to encourage the growth of prostate cancer, whereas others may have a protective effect. A long-term study of men working in the aerospace industry suggests that having a physically active job may reduce the risk of prostate cancer by nearly half. Researchers studied the effects of occupational physical activity on prostate cancer risk among 2,167 men who had worked at a nuclear and rocket engine testing facility in Southern California between the 1950s and 1990s. Over a 10-year period between January 1988 and December 1999, 362 of the men developed prostate cancer. Compared with men who did not develop the prostate cancer, these men were more likely to have had sedentary jobs that mainly involved sitting. Sedentary jobs included positions such as managers, data analysts, inspectors, administrators, and senior engineers. Jobs requiring high levels of continuous activity included positions like junior mechanics, patrolmen, firemen, electricians, janitors, truck-lift operators, and welders. Bottom line: The researchers speculated that men who are continually active during the day may have lower levels of androgens (male hormones), which can be altered with physical activity. If you have a sedentary job, try to compensate by engaging in regular exercise and physically challenging sports or hobbies. It's good for your heart and could help your prostate as well. Source: Johns Hopkins Health Alerts.

Can We Prevent Cancer Recurrence?

The threat of recurrence is something every cancer survivor lives with daily. Dan Butttner’s recent TED presentation, How to live to be 100+, offers some interesting insights. Thoughts?

Nitroglycerine a Possible Treatment Protocol for Prostate Cancer

Advanced Prostate Cancer 2/6/10 10:31 AM Joel Clinical Trials Drugs and Treatments On The Horizon Uncategorized Joel T Nowak Malecare nitroglycerin PSA recurrence Comments

In a clinical trial conducted at Queen’s University, Canada, researchers, Robert Siemens, Jeremy Heaton, Michael Adams, Jun Kawakami and Charles Graham, have found that nitroglycerin, the widely used explosive which is also commonly used to treat angina, can treat prostate cancer. The researchers found that very low doses of nitroglycerin slow the growth or even stop the progression of prostate cancer without the severe side effects we experience from current treatments.
The researchers based the trial on pre-clinical research carried out at Queen’s where they found that nitric oxide plays an important role in prostate tumor progression and low-dose nitroglycerin is capable of controlling this process.
The researchers used low doses of nitroglycerin in a 24-month, phase II study, involving 29 men who had increasing levels of prostate-specific antigen (PSA) following prostate surgery or radiation (PSA only recurrences). The men in the trial were treated with a low-dose, slow-release nitroglycerin skin patches known as NOVade. The pharmaceutical company, Nometics Inc. of Canada, developed the skin patches.
Of the 17 men who completed the study, all but one showed a stabilization or decrease in the rate of cancer progression, as measured by their PSA Doubling Time. There wasn’t any information presented about why 7 of the subject men failed to complete the study.
The trial results appeared in a recent issue of the journal Urology. In the journal they stated that, “We were very excited to see a significant slowing in the progression of the disease as evidenced by the men’s PSA levels, and to see this result in many of the men who completed the study.”
The potential for these findings could be significant and far reaching as nitroglycerin is inexpensive, has already demonstrated that it is safe and has already approved by the FDA. After additional confirmation studies, nitroglycerin patches could easily be prescribed as an “off label” and relatively benign treatment for recurrent prostate cancer. Nitroglycerin, perhaps a treatment on the horizon.
Joel T Nowak, MA, MSW

A New Strategy in the War On Cancer

I just viewed a very interesting podcast by Dr. David Agus. TED is a very interesting organization. You can access the podcasts through iTunes or directly at their website, TED.com. This particular presentation was given at TED MED. It gives some insights into possible new directions in cancer treatment and mentions zoledronic acid, which prevented cancer recurrence for three years in the cited case. One distressing note, however, the overall rate of cancer in the US is not decreasing.

Ken Koster's Part 2 for Prostate Cancer Survivor Newcomers

Date: Fri, 5 Feb 2010 06:11:25 -0500
From: Nancy Peress <nperess@CHARTER.NET>
Subject: Ron Koster’s Updated “WELCOME NEWCOMER!” -- Part 2 of 2

PCa is generally treated by three kinds of doctors: You probably saw a
UROLOGIST first. If the diagnosis indicates that the cancer has not
escaped the gland, it would be wise for you to see a RADIATION
ONCOLOGIST for a second opinion. If the cancer has escaped the gland,
a MEDICAL ONCOLOGIST might be the source of a second opinion. Some
patients seek a medical oncologist for another opinion even though the
cancer has not escaped the gland -- sort of a “neutral,” professional opinion.

You’re lucky to have found this source of information before you, your
friend or your relative has submitted to therapy. Even though you may
be “anxious” to “get on with it”, you can postpone treatment for a
brief period until you have done your home work, because you need to
know everything you can about each of the possible PCa treatment modalities.

The first group of treatments is used most commonly for men with
so-called localized prostate cancer that is confined to the prostate
itself or possibly to the prostate and the immediately nearby tissues:

- Active surveillance or watchful waiting (sometimes called expectant
management)

- Dietary, nutritional, and other forms of non-interventional
alternative therapy (potentially including acupuncture, nutritional
and/or herbal supplements, Essiac and green teas, positive mental
attitude, meditation, visualization, spiritual healing, humor, and prayer)

- Proton Beam Radiation therapy or PBRT

- Brachytherapy using either permanent radioactive implants (often
referred to as “seed implants”, or “SI”), or temporary radioactive
implants (often referred to as “high dose radiation”, or HDR”)

- Various other types of photon-based external beam radiation,
including Intensity Modulated Radiation Therapy (IMRT), Image-Guided
Radiation Therapy (IGRT), CyberKnife therapy, and others

- The different types of surgical treatment (radical prostatectomy),
which come in four basic categories: radical retropubic prostatectomy
(RRP), radical perineal prostatectomy (RPP), laparoscopic radical
prostatectomy (LRP), and robot-assisted laparoscopic prostatectomy (RALP)

- Cryosurgery (also known as cryoablation)

- High-intensity focused ultrasound (which has not yet been approved
for use in the USA but is available in other countries from
American-based physicians)

- Limited forms of hormone therapy using drugs like LHRH agonists,
antiandrogens, and 5 -reductase inhibitors either alone or in
combination with other types of therapy, often for limited periods of time


The second group of treatments is more customary for men with more
advanced forms of prostate cancer:

- Long-term or intermittent hormone therapies of various types,
including single-drug androgen deprivation therapy (ADT) and more
complex forms of ADT based on combinations of two or three hormonal drugs

- Chemotherapy, initially and usually using a docetaxel-based
(Taxotere-based) drug regimen

- Dietary, nutritional, and other forms of non-interventional
alternative therapy (see above)

- True watchful waiting in which therapy is avoided until symptoms
need to be treated

- Investigational drugs and drug combinations that are being tested in
clinical trials


We can help you learn more about this disease we call our hobby. The
diagnosis of PCa (like the diagnosis of many other cancers) is almost
always accompanied by the FUD factor -- FEAR, UNCERTAINTY, and DOUBT!
You can get rid of the FUD factor by taking charge; learn all you can
learn, so that YOU can decide which therapy YOU want.

A whole slew of good PCa books have been published. I have yet to
find the “perfect” book. I suggest you read at least these two for a
“more balanced” view:

- Guide to Surviving Prostate Cancer by Patrick C. Walsh, MD, and
Janet Farrar Worthington

- Prostate Cancer: A Non-Surgical Perspective by Dr. Kent Wallner.

The Patient’s Guide to Prostate Cancer by Dr. Mark B. Garnick is a
fast read, but there are now many, many other books available -- some
of which you’ll want to avoid -- some include misinformation; others
are scary enough to make you want to “take the pipe” rather than treatment.

After you’ve decided on the therapy of YOUR choice, you should seek
the most skilled, experienced practitioner available. Most survivors
agree that no matter what therapy YOU choose, you should do your
homework and be assured that the contemplated practitioner has done
several hundred successful procedures. There are individual
physicians who are highly specialized in all of the techniques listed
above, and other survivors will be happy to give you specific
recommendations, but ALWAYS remember that what worked for other
individuals may not work for or even be appropriate for you.

A listing of PCa SUPPORT GROUPS is available at several PCa Internet
sites. Most of the groups can be very helpful. Like doctors, you’ll
be more comfortable with some groups than others. In addition, there
are now several on line chat rooms and related support systems that
use interactive Web-based technology where you can meet with
survivors, physicians, and others willing to share their expertise.

When you are aware of all the PCa treatment options, the chances for
cure, recurrence, survival; their side/after effects; and you’ve
confirmed that information with other doctors, and men in support
groups; you may be ready to proceed. If not, don’t be bashful, come
back, share more of your concerns and ask us more questions.
Don’t waste a good opportunity to listen and ask questions when you’re
talking with a medical professional. Use a good tape recorder to take
notes every time you meet with a doctor, so that both you and your
partner are not pre-occupied with note-taking. Participate in the
discussion, and be sure you understand everything being said. You’ll
be glad for the opportunity to review the consultation -- probably
several times -- before you determine your treatment strategy.

Ron Koster, from the foothills of the Catskills