Do You Think We Are Winning the War on Cancer?

Just over 2,000,000 people die annually in the United States. Cancer account for just over 500,000 deaths each year. Almost 40 years after President Richard M. Nixon declared the War on Cancer in 1971, 25% of all deaths each year are from cancer.

A March 19, 2010 Gallup poll result shows that the number of Americans living with cancer increased by 0.3 percentage points in 2009, an increase in 690,000 adults diagnosed with cancer.

The American Cancer Society estimates that a full third of all cancers are related to poor eating habits and lack of exercise. It’s time for each of us to take responsibility for our health. What can we do? Just get outside and do something; walk, ride a bicycle, play with your children and grandchildren, coach a youth sports program. Just do something. If you play with the Internet at all, go to http://www.presidentschallenge.com and create a free activity tracking account and start earning points towards President’s Challenge awards. You can monitor your own activities and compare yourself to others of age and gender by location. You can also join the Prostate Cancer Prevention Group, Group ID number 59216, join a local group in your area, or create your own group.

Go to http://www.29000men.org, click on the “Events” tab, and join us on one of our cycling adventures.

Keep the rubber side down, have fun, and stay healthy!

A Hot New Italian to Help My Exercise Program

As many of you know, The Prostate Cancer Awareness Project creates and supports bicycling events as a means of getting the word out about the importance of testing and early detection of prostate cancer. We also believe that exercise and lifestyle change help prevent prostate cancer from occurring and in preventing or delaying recurrence.

Following my surgery in May of 2003, I returned to bicycling and since then have ridden 16,362.6 miles and climbed 226,177 vertical feet of climb, including a climb up the fabled Alpe d’Huez in the summer of 2009.

After almost 21 years riding my 1988 Serotta Davis Phinney road bike, I’m headed for an upgrade!

I’m in discussions with the US distribution company for Formigli bicycles to become a sponsor of our bicycling events and provide discounts on their exquisite products in support of our programs. I will personally purchase the initial frame and it will be a Formigli Classic lugged steel frame in black, set up for road riding and climbing.

But how to select the frame size?
Formigli produces only made to order frames, so you need to provide them a complete set of specifications, such as seat tube length, head tube length, chain stay length, bottom bracket drop, etc. As you can see, at this point I’m well beyond simply fitting my body to an existing frame; I actually have the opportunity to create a frame with the riding geometry for my specific intended use, which will be hill climbing and long distance cruising - think century rides.

i’ve contacted a number of local bike shops and it looks like my first stop is going to be Veloworx in Santa Monica, California. The team there was trained in fitting by Paul Swift, who I’ve met several times at Interbike. I meet with them tomorrow afternoon. Check back for the report!

Are We Men Simply Too Cowardly to Talk About Prostate Cancer?

29000 Men Comment

Read this provocative article by Stan Goldberg. Stan’s thesis is that men are afraid to talk about prostate cancer because it carries a stigma of impotence and incontinence. I think Stan is right. Do you?

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.