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Old 08-03-2009, 05:29 AM   #1
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Prostate Cancer Radiation - HELP!

I need some opinions as soon as possible. A very dear cousin of mine was diagnosed with Prostate Cancer about 4 months ago (April 2009). He is 59 years old. Stage 1. His PSA score was 5.4 and he was told that he had 2 out of 12, a Gleason 7 and a Gleason 8, on the right back side of his prostate. He considered robotic prostatectomy and radiation seeds, as well as other forms of radiation. He spoke to many doctors and of course the radiologist told him that radiation would be the best treatment and the surgeon told him that prostatectomy would be the best treatment. He decided on the robotic di vinci prostatectomy with a Dr. who has performed over 4500 of them and is probably the best doctor in the world to perform the procedure.

He had the surgery in May 2009. Thank God he chose the surgery because the gleason 8 turned out to be a gleason 9. His surrounding lymph nodes were tested but came out negative. His surgical margins were also negative as were his seminal vescicles. We thought that this was remarkable with a gleason 9, however, the cancer had spread just outside the prostate capsule. The surgery went well. He has since had one PSA test that resulted in under 0.1. Again, also good news.

The doctor that performed the surgery told him that he should do radiation because there is a 90% chance of the cancer recurring with a gleason 9. Other doctors and research is only showing approximately 30% chance of recurrence for his diagnosis. I have done extensive research but there are not enough studies out there proving that adjuvant (before recurrence) radiation is advantageous to salvage (after recurrence) radiation. My initial thoughts were better safe than sorry and just do the radiation now, but after reading about the side effects of radiation (incontinence, impotence, bowel problems, and two major side effects are urethral stricture and rectal prostitis). I'm not so sure he should be subjected to all of that trauma when he's already been through so much.

The side effects of radiation are worse after a prostatectomy.
In fact, a reknowned doctor also told him to wait it out. He is receiving a lot of conflicting information. He is torn over this. We want him to live a full life and will do anything to prevent a recurrence or metastasis to his organs or bones. If anyone out there has had this same type of diagnosis or can offer some insight on what he should do, please let me know. We need your help!

 
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Old 08-04-2009, 05:46 AM   #2
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Re: Prostate Cancer Radiation - HELP!

I have one of four criteria used for radiation after a RP, and just barely one. One doc called it a 'close margin', the radiation oncologist called it a 'positive margin', think "inside the orange peel but not outside it". No other invlovement. Gleason was 3+4=7, 5%-10% in the biopsy before the RP. The stat the Rad Doc quoted based on a study said 40% recurrence vs 5% with radiation. The people I've spoken with all say the Doc's will give you the worst case side effects, none had anything other than mild tiredness. I'm seting up the rad schedule this week.

 
Old 08-04-2009, 11:30 AM   #3
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Re: Prostate Cancer Radiation - HELP!

Linda-
Here is our experience. PSA 9.6 Gleason 4+3 (7) Margins negative also nodes and vesicules negative but did have extra capsular extension. PSA started rising after 6 months so met with Rad Onc too. His doubling time was 3 months so we did do radiation. If I recall there was some info out there about follow-up radiation done within the 1st two years after surgery and before PSA rises to 1. there would be a good chance for a cure. So we were in a hurry to get the radiation done before hitting 1. because we were looking for a cure. He was still suffering from incontinence but felt we had to overlook that at the time in hopes of a cure. Radiation will set you back permanently on incontinence. Unfortunately we did not get a cure and his PSA continues to rise. So now onto hormone treatment. We don't know if we made the correct choice. Hindsight maybe not but the chance of a cure was overwhelming at the time. But now living with his incontinence is a horrible daily struggle. Should we have? Don't know but just can't second quess now. It does no good. We are taking the summer off from cancer and enjoying it until the next dreaded PSA. These are hard decisions to make. Good luck to your cousin.
Martha

 
Old 08-05-2009, 10:48 AM   #4
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Re: Prostate Cancer Radiation - HELP!

Hi Linda,

The situation you describe sounds very similar to my own. I had a RP done over 3years ago and everything was fine until my third year checkup when I discovered that my cancer had returned. ( Gleason 8, 4.1 psa at time of original diagnosis ).

I talked with a radiation oncologist at one of the leading cancer centers in this area, and decided to go for the radiation regardless of the possible side effects, since the radiation was my only real chance for a cure after the recurrence. ( I won't know if the radiation did any good until I go for a checkup in October, which is roughly six months after finishing the radiation ).

As far as side effects go, I was really concerned before the radiation since I experienced a urethural stricture after my RP. That was not a pleasant experience but was corrected after treatment, and the radiation didn't seem to make it return. I did have some bladder and bowel irritation during the rad treatments and for some time afterwards, but that seem to be okay now.

Of course, during this period of waiting for results, every time I don't feel quite right or have an upset stomach, I immediately think that it is the prostate cancer, if it still exists, that is causing the problem. I would suppose that I,m not alone thinking like this.

So to make a long story short, after thinking about all the possible side effects from radiation, I was just about determined not to go for it and elect to go on hormone therapy instead. The only problem with the hormone therapy is that with a Gleason 8 cancer, there is not a good chance that I will live for a long time since a Gleason 8 cancer is very aggressive and from the research that I've done, my chances of surviving a recurring Gleason 8 are slim and none. However since the radiation was my last chance for a cure I went for it and since the side effects have been minimal, I'm glad that I did. Let's just hope it works!

I hope this helps you Linda. I know that no decision involving prostate cancer is an easy one, but if it's there, doing nothing with an aggressive cancer is not really an option if a person wants to survive and making tough decisions are part of it.

Take care and all the best....Lionel

 
Old 08-05-2009, 03:33 PM   #5
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Re: Prostate Cancer Radiation - HELP!

Hi Linda,

Welcome to the board! You are getting some great responses. I went straight to hormonal blockade, which evolved in the first year to triple hormonal blockade, for my challenging case back in 1999/2000, but I was slated for radiation at one point and have paid some attention to developments since then, despite lacking first hand experience. I have a few thoughts that may help, and I'll insert them in an excerpt of your post in green. Good for you for helping out your cousin. Jim


Quote:
Originally Posted by Linda070770 View Post
.... A very dear cousin of mine was diagnosed with Prostate Cancer about 4 months ago (April 2009). He is 59 years old. Stage 1. His PSA score was 5.4 and he was told that he had 2 out of 12, a Gleason 7 and a Gleason 8, on the right back side of his prostate. ... He decided on the robotic di vinci prostatectomy with a Dr. who has performed over 4500 of them and is probably the best doctor in the world to perform the procedure.

From your location, guessing that your cousin lives in Michigan, and description, I'm guessing the doctor was Manny Menon. Right?

He had the surgery in May 2009. Thank God he chose the surgery because the gleason 8 turned out to be a gleason 9. His surrounding lymph nodes were tested but came out negative. His surgical margins were also negative as were his seminal vescicles. We thought that this was remarkable with a gleason 9, however, the cancer had spread just outside the prostate capsule. The surgery went well.

Does this mean that the doctor saw what turned out to be cancer just outside the prostate and was able to remove it in the surgery? Often spread beyond the capsule is minimal, just a mm or a few, but enough to cause trouble if not removed.

He has since had one PSA test that resulted in under 0.1. Again, also good news.

The doctor that performed the surgery told him that he should do radiation because there is a 90% chance of the cancer recurring with a gleason 9.

If Dr. Menon is the surgeon, you may be able to read abstracts about situations like your cousin's at www.pubmed.gov, a US taxpayers supported website we can use on this board because it is Government sponsored. I just went to the site with this search (without quotation marks) " prostate cancer AND menon m [au] " and got 77 hits. You could refine the search by adding things like " Gleason 8 to 10 ", " higher Gleason ", etc. I would lean toward his estimate as he was the doctor who is most familiar with your husband's case and RP details.

Other doctors and research is only showing approximately 30% chance of recurrence for his diagnosis.

Here's where I'm scratching my head and scowling in frustration with excellent docs who should know better: a conventional PSA test was apparently used, one with a lower limit of less than ("<") 0.1, instead of an ultrasensitive PSA test that is reliable to a lower limit of <0.01 - 100 times as sensitive! For your cousin such a test would probably be of enormous value, as it would illuminate the darkness surrounding possible recurrence, indicating not only whether recurrence was recurring but also giving clues to its aggressiveness.

Several studies have been published on the meaning of various tiny ultrasensitive PSA values after an RP. Here's a brief summary: the best is <0.01, with a very small chance of recurrence; values of 0.01, 0.02, and 0.03 are not bad, but the likelihood of recurrence increases with each step up. An ultrasensitive of 0.04 is not that good, though the balance really tips in favor of a recurrence at 0.05 and higher. On the other hand, some patients still have some healthy prostate tissue left after the surgery, and that may generate higher but stable PSAs. While one ultrasensitive PSA can suggest a lot, a series of them can smoke out that tell-tale upward trend, if there is one.

This could be a huge aid in decision making in the coming months. It could also provide great reassurance; say the PSA was <0.01; that would be reassuring. Repeated tests at that level would provide great assurance and peace of mind. Even the slightly higher scores would provide some reassurance. The higher scores, though not reassuring, would clarify and simplify decision making about a follow-up therapy.

I'm frustrated in part because so many doctors neglect these wonderfully informative tests, and I've known about them since I attended one of the National Conferences on Prostate Cancer, my first, back at Long Beach, CA in 2000. (By the way, the next in the series is in LA by LAX Airport in mid-September.) Ultrasensitive tests are key to managing my intermittent triple hormonal blockade therapy, and I have twice been able to drive my PSA down from its initial 113.6 and flare to 125 down to <0.01, before taking a vacation from the heavy duty drugs. The first approved ultrasensitive test - approved years ago - is the Immulite Third Generation PSA test manufactured by the Diagnostics Products Corporation. There are others, with some capable of scores with a lower limit of <0.01, but if I were choosing for your cousin, I would not want one that was sensitive only to <0.04, as some are, for instance.

It's likely that more docs haven't jumped on the ultrasensitive band wagon because the medical associations, including the American Urological Association, are still on the fence about their value. It appears to me that they are ignoring persuasive existing evidence and waiting for highly detailed, large scale trial evidence.


I have done extensive research but there are not enough studies out there proving that adjuvant (before recurrence) radiation is advantageous to salvage (after recurrence) radiation. My initial thoughts were better safe than sorry and just do the radiation now,

As Mart16 points out, a PSA value of 1.0 seems to be considered a key trigger point at the current state of knowledge. Radiation after that point is not as likely to be fully effective, per research, though it still may do some good. Based on your cousin's score of <0.1, he probably has some time to decide what to do, which includes standing pat as an option. That would change if subsequent PSA tests demonstrate a rapidly rising PSA, which is fairly unlikely.

but after reading about the side effects of radiation (incontinence, impotence, bowel problems, and two major side effects are urethral stricture and rectal prostitis). I'm not so sure he should be subjected to all of that trauma when he's already been through so much.

The side effects of radiation are worse after a prostatectomy.

You've already had responses that addressed both better and worse outcomes. One thing is certain: possible side effects are not certain side effects. For instance, incontinence is more likely, but it is not a certainty. Also, there are some countermeasures that do decrease radiation side effects that do occur for some men.

In fact, a reknowned doctor also told him to wait it out. He is receiving a lot of conflicting information. He is torn over this. We want him to live a full life and will do anything to prevent a recurrence or metastasis to his organs or bones.

A lifestyle program involving nutrition/diet/supplements, exercise and stress reduction appears to be a good investment, based on substantial and highly encouraging but not yet conclusive evidence.

A scan for bone density would be a good idea (Bone Mineral Density), especially the qCT (quantitative CT) version that is not likely to be thrown off by arthritis or calcification of blood vessels near the area being scanned. If density is below normal, a bisphosphonate drug with calcium and vitamin D3 supplementation would be helpful. The more powerful bisphosphonates help prevent, stabilize and even roll back bone metastases.

Mild drugs could also potentially help. One of the statin drugs, especially if taken for more than three years, would help substantially decrease the likelihood of death. Finasteride or Avodart might also be helpful.

I would be happy to go into detail or answer questions about any of this.


If anyone out there has had this same type of diagnosis or can offer some insight on what he should do, please let me know. We need your help!
Good luck to you and your cousin.

Take care,

Jim

Last edited by IADT3since2000; 08-05-2009 at 04:36 PM. Reason: Relocated end of green colored comment.

 
Old 08-06-2009, 05:28 AM   #6
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Re: Prostate Cancer Radiation - HELP!

Jim,

Thank you so much for the lengthy message. I really appreciate it. My cousin did have a Super PSA test conducted one month after the surgery. The score was 0.016. * Request for off-board contact removed by hb-mod, moderator *

Last edited by hb-mod; 08-18-2009 at 01:47 PM. Reason: Please do not request off-board contact, per Posting Policy

 
Old 08-06-2009, 09:17 AM   #7
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Re: Prostate Cancer Radiation - HELP!

Quote:
Originally Posted by Linda070770 View Post
Jim,

... My cousin did have a Super PSA test conducted one month after the surgery. The score was 0.016. Do you mind calling or emailing me directly so I can ask you a few more questions?
You're welcome. I did try to contact you with the private messenger system, but it is not working for your address. Please feel free to use the board if that is convenient. (Per board rules, we cannot post our email addresses.)

Here are some thoughts.

Is your cousin seeing an upward trend in the <0.1 PSA and the 0.16 PSA? What were the dates of both? Different PSA test versions, even done on the same patient with the same blood draw, typically come back somewhat differently. However, 0.16 is probably a valid indicator of a recurrence, although the medical convention is that a recurrence after surgery is not "officially" counted until the PSA hits 0.2.

Jim

 
Old 08-07-2009, 05:49 AM   #8
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Re: Prostate Cancer Radiation - HELP!

Jim,

Let me give you some additional information about my cousin.

Yes, it was Dr. Mani Menon that performed the robotic surgery here in Michigan, and he did see the cancer just outside the prostate capsule and was able to remove it during surgery. His last PSA tests (regular and super) were conducted a little over a month ago and the score for the regular test was under 0.1 The ultrasensitive PSA score was 0.016. You mentioned that 0.16 is probably a valid indicator of a recurrence, but it was 0.016 so it was still under 0.1.
Do you recommend that he has both of these tests every three months? That's what he's planning on doing. Would more frequent testing be beneficial if he opts to wait on the radiation?
Should he inform his doctor that he wants the test that is sensitive to <0.04?

He has done a bone density, which was negative, thank God. Remember that although it was a very agressive cancer, gleason 9, it had not spread to his lymph nodes or seminal vesicles.

He has incorporated a healthy lifestyle change that includes a proper diet, excercise and supplements. He is taking IP6 Inositol vitamins daily. He has reduced his red meat intake significantly, and this is a man who loves red meat. He is also starting an exercise routine.

Here's something new that we recently discovered. A couple of physician friends have informed him that the side effects of radiation are worse than he thinks because the radiation could increase his chances of cancer in other areas such as the bladder and the rectum. I have done research on radiation side effects but that one never came up. I know that the bladder and rectum would be affected by the radiation because targeting the healthy cells there produces side effects such as incontinence, urination burning, bowel problems and rectum bleeding but we did not know that there was a risk of developing cancer there through radiation. Did you know that?

So far, the doctors that he's talked to have suggested that he waits on the radiation until if or when the cancer comes back, and to deal with it at that time. That's what he is leaning on right now but we are still scared and want to make the right decision because we don't want it to have spread to his testicles and bones by the time we catch it.

Jim, God bless you for helping other people that are confused and looking for an answer. A person never knows how crucial it is to seek help from others until they are in this type of situation and desperately seeking a cure. This experience has taught us to share our knowledge and experience with any one out there that needs help.

Thanks again!

 
Old 08-07-2009, 08:50 PM   #9
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Re: Prostate Cancer Radiation - HELP!

Hi again Linda,

I'll insert some comments in green in an excerpt of your response, and this time I'll put my glasses on, and thinking cap too! Sorry I missed that 0.016. Should have realized that was inconsistent with the <0.1, and it makes a heck of a difference. Congratulations to your cousin for this preliminary but major success, and to Dr. Menon too!
Quote:
Originally Posted by Linda070770 View Post
...

It's reassuring to hear that a doctor of Dr. Menon's caliber is using the ultrasensitive tests to look for recurrence.

The ultrasensitive PSA score was 0.016. You mentioned that 0.16 is probably a valid indicator of a recurrence, but it was 0.016 so it was still under 0.1.

In fact, it's under 0.02, which is a level with rather good odds against a recurrence. At least at the moment, it appears that your cousin is not having a recurrence!

Do you recommend that he has both of these tests every three months?

No, the conventional PSA test is superfluous, though having the ultrasensitive test every three months makes good sense. There are two reasons I can think of why Dr. Menon may with to keep getting that additional result. First, it could be that he wants to make statements in his research papers about all patients of a certain type being tracked with a certain kind of PSA test. In other words, it could give him some crystal clear comparability with research he's involved with that extends to the time before there were ultrasensitive tests. The second reason is to help demonstrate to his less enlightened colleagues that ultrasensitive tests give much earlier indications whether there is a recurrence, giving far earlier peace of mind or far earlier warning.

That's what he's planning on doing.

Unless Dr. Menon needs the results, there is no reason to get a conventional test as well, until and if your cousin's PSA score rises to the point where it is giving useful information. With a test version sensitive to <0.1, that point would be a PSA of .1 or higher, since the ultrasensitive PSA is needed for clarity below .1.

Would more frequent testing be beneficial if he opts to wait on the radiation?

My savvy layman's view is that more frequent tests would not add much at this point, expect perhaps anxiety while waiting for the results. Three months seems about right for now to observe any rise in the score. (There have been some key times in my own treatment when my doctor and I were tracking results every one or two months. For quite a while now, I've been getting labs every two months; that's mainly because my triple blockade therapy has failures that tend to have one cluster around the ten to eleven year point, where I am now. If I can get my score down to <0.01 for a third time, we will be relaxing the PSA schedule to every three or four months.)

Should he inform his doctor that he wants the test that is sensitive to <0.04?

No, his test is already more sensitive than that, which is excellent. I'm sorry my misreading your earlier post prompted me to make that misleading comment.

He has done a bone density, which was negative, thank God.

That would mean that he does not have osteopenia, which is a milder form of osteoporosis. However, the DEXA scan that was probably used for his BMD scan can be fooled by arthritis or calcification of blood vessels in the areas being scanned; it will then report a healthy density when the density is actually decreased. If you cousin got a qCT (quantitative CT) scan, then his result is reliable. Still, it's good that he got the DEXA scan and the good result.

Remember that although it was a very agressive cancer, gleason 9, it had not spread to his lymph nodes or seminal vesicles.

Your cousin is in that group that clearly should have a curative attempt made, as he did. You don't want to mess around with aggressive cancer, giving it a chance to do its thing.

He has incorporated a healthy lifestyle change that includes a proper diet, excercise and supplements. He is taking IP6 Inositol vitamins daily.

Someday I'll have to look into Inositol. I know that some health conscious folks are enthusiastic about it, and if you go to www.pubmed.gov and search for " prostate cancer AND inositol ", you will get 91 hits. Most of the research is animal or lab research using prostate cancer cell lines, and there have not been clinical trials.

He has reduced his red meat intake significantly, and this is a man who loves red meat.

Personally, I think that is important. In fact, I've eliminated red meat and pork. Unfortunately, the research is not compelling yet, but it is strong enough to persuade me to take this harmless step. But it is sometimes hard to take a pass on some great beef and pork menus. It's not just the saturated fat in the meat. Unwise ways of cooking it can enhance cancer influencing effects. But perhaps most important, red meat and pork are big sources of arachidonic acid, and that supports the growth of prostate cancer.

He is also starting an exercise routine.

That's great. He should be sure to include strength exercises, though aerobic, balance and flexibility exercises are also worthwhile for us as prostate cancer patients.

Here's something new that we recently discovered. A couple of physician friends have informed him that the side effects of radiation are worse than he thinks because the radiation could increase his chances of cancer in other areas such as the bladder and the rectum. I have done research on radiation side effects but that one never came up. I know that the bladder and rectum would be affected by the radiation because targeting the healthy cells there produces side effects such as incontinence, urination burning, bowel problems and rectum bleeding

Mostly acute effects that resolve pretty quickly, with some preventive measures or countermeasures to help with longer-lasting or potentially permanent late effects. Also, these side effects are not certain; it's an odds thing, and an odds thing with the degree of severity also. These days, such effects are usually pretty mild when the radiation team is competent.

but we did not know that there was a risk of developing cancer there through radiation. Did you know that?

That's called secondary radiation. It does exist, but the odds appear to be very, very low. I'll bet that neither of the physician friends was a radiation specialist.

So far, the doctors that he's talked to have suggested that he waits on the radiation until if or when the cancer comes back, and to deal with it at that time. That's what he is leaning on right now but we are still scared and want to make the right decision because we don't want it to have spread to his testicles and bones by the time we catch it.

The testicles are are rare target for prostate cancer spread. Prostate cancer is very different from testicular cancer. With the aid of the ultrasensitive tests, he should have an excellent view of whether the cancer is still there, and if so, if it is aggressive. If needed, he will have plenty of advance warning and will be able to hit the cancer while it is still very small.

There is one possible hitch. Normally, though not so hot before diagnosis, after diagnosis the PSA is an outstanding way of tracking what the cancer is doing. The exception is with some Gleason score 8 to 10 cancers. Some of them do not produce much PSA, though many do, and it would be a rare cancer that would not produce enough to be picked up with an ultrasensitive test. There are at least four other markers that can do a better job for monitoring the cancer for these patients. The markers are known as PAP, CEA, NEA, and CGA. The Primer describes them, and I'll be glad to provide detail if you wish. If I were in your cousin's shoes, I would want to get my baseline levels of these markers with a simple blood draw; he probably will not need that data, but it will be useful if he does need it.


Jim, God bless you for helping other people that are confused and looking for an answer. A person never knows how crucial it is to seek help from others until they are in this type of situation and desperately seeking a cure. This experience has taught us to share our knowledge and experience with any one out there that needs help.

Thanks again!

You're welccome! One of the reasons I'm glad to help others is that I myself got some vital help from the Internet patient groups (particularly from the wife of one patient. That makes you want to "pay it forward."

Take care,

Jim

Last edited by IADT3since2000; 08-07-2009 at 08:54 PM. Reason: Spelling, right after posting.

 
Old 08-11-2009, 08:31 PM   #10
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Re: Prostate Cancer Radiation - HELP!

Jim, thank you again. My cousin has decided to wait on the radiation. By the way, Mani Menon is not the doctor that chose to do the ultra sensitive test on my cousin. It was James Montie of the University of Michigan. We will take your advice and ask for the ultra sensitive test every three months.

Good luck to you Jim, you have been a huge help!

 
Old 08-12-2009, 05:00 AM   #11
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Re: Prostate Cancer Radiation - HELP!

What is a "super PSA test" ? As far as I've heard anything under .1 is pretty much undetectable with accuracy so they call it 'zero'. There just are not enough cells to produce measurable amounts of PSA, if there are any cells left.
As far as causation, it's more than likely hereditary than diet. From Johns Hopkins:
"Studies of identical and fraternal twins have found that prostate cancer has a stronger hereditary component than many other cancers, including breast and colon cancer. A number of genetic mutations are linked to prostate cancer. Some analyses suggest that mutations in HPC1 increase the risk of prostate cancer, but other studies have failed to find an association."

Last edited by TomKsco; 08-13-2009 at 05:37 AM.

 
Old 08-17-2009, 04:18 PM   #12
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Re: Prostate Cancer Radiation - HELP!

Hi Tom and welcome to this board!

I can answer your questions, and I'll insert responses in green in an excerpt from your post.


Quote:
Originally Posted by TomKsco View Post
What is a "super PSA test" ?

Actually the proper terminology is "ultrasensitive PSA test," but super test gets the point across. It's a well researched technology.

As far as I've heard anything under .1 is pretty much undetectable with accuracy so they call it 'zero'. There just are not enough cells to produce measurable amounts of PSA, if there are any cells left.

Under .1 was the state-of-the-art for detection perhaps a decade and a half ago; it was an improvement on <.2, that was the previous best, as I recall it. However, technology was marching on, and researchers were having what to me was amazing success at reliably determining extremely small amounts of PSA. Unfortunately, the unenlightened information you received represents the state of medical practice for far too many doctors, even in 2009! I believe some of them know better, but they just do not want to deal with early knowledge of prostate cancer recurrence among their own surgery patients. Others who should know better lean on superficial conflicts in study results, ever a ready refuge for those who are uncomfortable with truth!

I first learned about this technology at the National Conference on Prostate Cancer 2000 at Long Beach, CA, when Dr. Stephen B. Strum, the moderator of the conference and a highly respected medical oncologist who specializes in prostate cancer, described it to us and backed up his presentation with a set of ten abstracts of formally published medical research studies that demonstrated the capability and value of ultrasensitive PSA testing.

Those studies, some dating to 1995 (hey - that's 14 years ago now!!! ) demonstrated that PSA could be reliably detected and monitored at <0.01 (yup, one hundredth of a unit of PSA! ) using PSA ultrasensitive test kits manufactured for use with blood collected in the usual way in ordinary medical offices. (My blood is collected as for any normal lab test, but specially packed and sent out of state to a lab that has the special capability to process an ultrasensitive test capable of <0.01 detection. Not all versions of ultrasensitive tests are that capable, but some give you faster results that can be done locally with results to <0.04, for instance. Sometimes that's good enough, depending on what you are using the test for, and the speed is nice.)

You might wonder why Dr. Strum took the trouble to include ten copies of abstracts in our workbooks that all made basically the same point: well, it was clear he was irritated with the prostate cancer medical community's sluggish and unenthusiastic response with this technology. Fortunately, nearly a decade later, that has begun changing , but far too many docs are not yet on board.

Why is it important? The main value I see is that it gives far earlier warning of a recurrence after prostate cancer surgery. One study showed that two different brands of ultrasensitive tests gave about a year's earlier warning of recurrence than standard tests. On the other hand, for patients who are extremely unlikely to have a recurrence, the ultrasensitive tests gave very early assurance of that. Also, for many of us, a couple of unfavorable ultrasensitive test results are enough of a kick in the pants to make us serious about using some promising lifestyle tactics against the cancer, and do them early enough where they might be all we need. (High quality pomegranate juice or extract is a good example, though confirming research would be most welcome.)

There are other values for these tests, as in assessing the effectiveness of a hormonal blockade drug program in a particular patient, and in indicating the time when going off-therapy from the heavy duty drugs is relatively safe.

I'm personally convinced it's a shame that many doctors monitoring post-surgery prostate cancer patients still do not use this technology , or even let their patients know about it. The American Urological Association has still not given ultrasensitive testing an endorsement, citing some conflicting research, which is unfortunate. My impression is that the research is rather clear, provided you are not looking for a perfect result and that you consider the characteristics of the patients in the studies where there is doubt.

You can do your own research and form your own opinion using a website we are allowed to use on this board because it is Government sponsored: www.pubmed.gov . If you go there and search with this search string, " ultrasensitive prostate specific antigen test " (without the quotation marks), you will get 45 hits. Some of those hits, especially before 1995, referred to tests with a sensitivity just to .1 as ultrasensitive, but starting in 1995 there were studies with results at least at the .01 level. Someday it may be that only tests capable of .001 sensitiveity will be dubbed ultrasensitive, but as of now, clinical value has not been demonstrated with a lower reading than <0.01, as far as I know. (Some tests are capable of at least 0.003 results if special, non-routine procedures are followed.)




As far as causation, it's more than likely hereditary than diet.

Perhaps that's putting it more strongly than the Hopkins researchers would put it, though it's easy to go down that track as your next sentence is true:

From Johns Hopkins:
"Studies of identical and fraternal twins have found that prostate cancer has a stronger hereditary component than many other cancers, including breast and colon cancer.

The research community now feels the link is probably stronger than for most other cancers, if not all, but that does not say the link is dominant or more important than environment, including diet. Researchers are working hard on these genetic links. I've been part of one such study, managed out of Johns Hopkins under the oversight of Dr. Patrick Walsh, myself.

Many researchers, including renowned researchers at Johns Hopkins such as Dr. Bill Nelson, are convinced that diet (including nutrition) is very important for prostate cancer. More on how you can see that for yourself later.

One reason it appears that diet is so important for prostate cancer actually is founded on genetics, such as the studies of men with a Japanese heredity in Japan versus men with the same Japanese heredity who come to the US to live. In basic terms, while the incidence of incidental, "insignificant" prostate cancer is the same wherever the men live, the incidence of significant prostate cancer for men of Japanese heredity is much higher if they establish themselves in the US. These studies have really caught the interest of researchers.

You can check on diet, nutrition, supplement, exercise, and stress reduction research for prostate cancer yourself at that www.pubmed.gov site. Just use search strings like " prostate cancer AND lycopene ", for example, substituting whatever catches your interest for lycopene. Be prepared for lots of information - that lycopene search picked up 293 hits! You can use the Limits feature to reduce hits as you wish, for instance by limiting to humans (cuts down on lab and animal results but not all of them), or clinical trials, and so on. You will find controversy, but there is an accumulating mound of evidence in support of many of these tactics - not yet absolutely convincing, but strong enough to send many of us to the produce, fish and supplement sections of grocery stores.


...
I hope this helps, but please feel free to ask followup questions or to toss around thoughts, including doubts. Once again, welcome to the board.

Take care,

Jim

 
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