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Old 06-21-2010, 07:25 AM   #1
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Are urologists too optimistic?

Hello,

I was reading on the internet and on one of the sites relating to PC, a member mentioned that oncologists think that urologists are too optimistic, especially for advanced cases of the prostate cancer. Is that true?

Now my Dad has recently been diagnosed with advanced PC with metastasis with PSA > 500. His urologist is very positive about him. However, when we discussed his case with an oncologist, he only gave him 6 months to 2 years.
I am just wondering whom to trust!
Now one point to note here is that the oncologist never mentioned Second line HT in the discussion. According to him, HT lasts for 6-12 months for advanced cases, then chemo for another few months and thats it.
Would appreciate your thoughts.

Regards
A worried daughter

 
Old 06-21-2010, 09:30 AM   #2
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Re: Are urologists too optimistic?

Hi Chadhas,

Your post below, especially the prognosis from the oncologist, leads me to believe that your dad's oncologist does not see many prostate cancer patients, or at least is not familiar with the ins and outs of modern hormonal blockade therapy. However, keep in mind that I am not a medical professional and have had no enrolled medical education unless you count the "School of Hard Knocks."

I have a hunch about the source of the oncologist's figures. Would you mind giving us a bit more information that would help clarify this? Specifically, could you tell us whether your dad has:

- widespread bone metastases with pain;

- widespread bone metastases but with no or minimal pain;

- bone metastases, but not widespread;

- no bone metastases; and

- the location and extent of any detected metastases.

Has your dad been on any kind of hormonal blockade therapy, and if so, what kind, starting when, and how long?

Would you mind giving us his last PSA figure and the date, and a few prior PSA numbers?

Has he been tested for DHT (dihydrotestosterone), and, if so, what was (were) the result and date?

I have a hunch that the urologist is right and that your dad may have many good years left with appropriate therapy. The expert medical oncologists I follow are generally far more optimistic about advanced cases than the urologists, but that may not be so for the average, general oncologist who is not especially expert in prostate cancer. I've run into some such medical oncologists, including some at major universities and who focused on prostate cancer research, who were fairly pessimistic about prognoses; I'm personally convinced they are wrong.

Take care,

Jim

Quote:
Originally Posted by Chadhas View Post
Hello,

I was reading on the internet and on one of the sites relating to PC, a member mentioned that oncologists think that urologists are too optimistic, especially for advanced cases of the prostate cancer. Is that true?

Now my Dad has recently been diagnosed with advanced PC with metastasis with PSA > 500. His urologist is very positive about him. However, when we discussed his case with an oncologist, he only gave him 6 months to 2 years.
I am just wondering whom to trust!
Now one point to note here is that the oncologist never mentioned Second line HT in the discussion. According to him, HT lasts for 6-12 months for advanced cases, then chemo for another few months and thats it.
Would appreciate your thoughts.

Regards
A worried daughter

 
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Old 06-22-2010, 01:24 AM   #3
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Re: Are urologists too optimistic?

Thanks a lot for your replies Jim and got!

Jim,

Your post was very relieving. Well here goes my dad's story and answers to your questions...

My dad is 65. He had knee/joint pain for few years because of arthritis I suppose. Other than that, he always was an active person.

1)
Feb-March this year he started feeling lower back pain and used to have constant fever with chills and this is why we took him to the doctor who initially said he could have Urinary Track Infection. Then he proposed some more tests, MRI, bone scan and eventually we got to know that he has advancved PC with bone mets to his spine, pelvis, sternum and right skull bones and PSA > 500. However, the word 'hotspot' is not mentioned in any of his reports. His prostate was enlarged (69 grams) and was compressing his left ureter which was causing the urinary infection and hence fever.

2)
He had his orchiectomy done on 29th march and is put on 3 weekly Zometa infusions + 50gm Bicalutamide daily.

3)
We will have his first 3 monthly PSA test done in July this year. So I don't have his PSA figures after the start of treatment yet.

4)
DHT (dihydrotestosterone) test is not very common in India as goelfamily mentioned in one of here posts. And my dad also has not been tested for that.

Also, he did not have his biopsy done as doctors did not feel the need of it (as his PC was spread already) so we don't know what his Gleason score is. Would you be able to guess what his GS must be?

Do you think we should suggest or rather force the urologist for dutasteride/Avodart in my Dad's case?

Your thoughts and inputs are greatly appreciated by all on this board and I am no exception. Thanks again for your reply.

Take Care!

Last edited by Chadhas; 06-22-2010 at 01:46 AM. Reason: didnt mention age

 
Old 06-23-2010, 03:05 PM   #4
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Re: Are urologists too optimistic?

Hi Chadhas,

I'm sorry your dad had such a rough introduction to prostate cancer. As "got" suggested, there is a realistic basis for optimism, though obviously your dad is facing challenging circumstances. I'll add some comments in green, starting off with that prognosis of six months to two years that you mentioned a few posts ago, which I think is probably quite pessimistic. I hope this post does not get overly technical, but my hunch is that you need to be aware of some of the key details in order to be able to believe it, and perhaps to convince doctors. (I can provide more detail if you would like.)

That estimate of six months to two years is close to estimates based on research done in the late '80s/early '90s plus an arguably inappropriate rule-of-thumb for post-refractory survival. For instance, in a key paper in the New England Journal of Medicine, Dr. David Crawford, a highly respected prostate cancer doctor from Colorado, and his team documented these times to hormone resistance for several classes of patients. (Hormone resistance (also known as hormone refractory disease, etc.) is essentially when hormonal therapy, particularly first line hormonal therapy, no longer controls the cancer well; second line hormonal therapy probably did not exist at that time.)

8 months for patients with wide-spread bone mets + pain [which would best match your dad's case]

18 months if wide spread bone mets without pain

4-5 years if just a few bone mets in the hip or spine
(with 30-40% still responding at 9 years per follow-up research, and a smaller percentge still responding much longer, at least twelve years.)

Now before we go further, remember that men in this study were treated with prostate cancer technology and understanding that were far inferior to what is available today. In fact, the PSA test itself was not approved by the FDA until 1987. As you no doubt surmise, results should be much better with today's technology.

Following the occurence of resistance to hormonal blockade therapy, as described above, there is a period of continued survival. Prostate cancer researchers have come up with a set of formulas they use to estimate the length of survival; it varies according to each patient's circumstances, and an average for a whole group in a research study is the end result figure, but it works out to about twenty months on average (the "Hallabi Nomogram"). I suspect this information is part of the doctor's survival estimate of eight months to two years.

HOWEVER, the research from a about a dozen studies going into that rule-of-thumb research counted survival from the time patients joined clinical trials, using that date as a proxy for the time they developed resistance, a convention that was practical for research purposes but clearly not fully accurate. It's likely there were substantial periods for many patients between the time of becoming resistant and the time of entering into a trial, the date used as the proxy for being hormone refractory. That means the real survival period is likely much longer than the twenty month average.

Three researcher/physicians were bothered by these widely used survival predictions that seemed unrealistically pessimistic in view of their own clinical experience. Their study, based on reviewing their records of 254 patients who had been treated with hormonal therapy, revealed much superior post-refractory survival averages: 40 months for patients who had bone metastases at the time of becoming refractory, and 68 months for those with no bone metastases at that time (Oefelein, Agarwal and Resnick (past president of the American Urological Association), 2004).

Moreover, it is very important to remember that the men in this 2004 study were treated with technology available in the 1990s or earlier - technology that was far less effective than what we have today. Therefore, if the three researchers studied survival of the same men but treated with today's technology, survival would no doubt be much better. Of course, that point is also true for the studies upon whose results the Hallabi Nomogram was based, as noted above.

As just one of many examples of improved technology not available when the men in these studies were treated, the powerful drug Zometa was not approved by the US FDA until 2001. As you probably know, some prostate cancer patients on Zometa have even been able to eliminate some bone mets, while reducing others, and protecting against additional bone mets. As another example of improved technology, the drug Avodart (dutasteride) was not approved by the FDA until this decade; it is now the preferred drug as the third leg of triple hormonal blockade therapy.

Despite the existence of the Oefelein study and the rationale explaining why ~20 months is a likely underestimate for post-refractory survival, there are many prostate cancer physicians who take the ~20 month figure as an iron clad, unchallengeable estimate. I know that for a fact because I've heard some of them talk about it, and I've discussed it with a few of them as a patient survivor representative in medical research meetings.

This survival estimating business is a soapbox issue for me as two respected doctors gave me only five years to live (three good years, two declining), back in 1999. I've come to understand how many doctors do not properly appreciate prostate cancer survival for advanced cancer patients, especially if modern therapy and information about life-style supporting tactics is not considered.



Quote:
Originally Posted by Chadhas View Post
Thanks a lot for your replies Jim and got!

Jim,

Your post was very relieving. Well here goes my dad's story and answers to your questions...

My dad is 65. He had knee/joint pain for few years because of arthritis I suppose. Other than that, he always was an active person.

Activity is important. If he has trouble with his legs, perhaps he can do exercises in a pool, or can listen to music while vigorously "conducting an orchestra" with his arms.

1)
Feb-March this year he started feeling lower back pain and used to have constant fever with chills and this is why we took him to the doctor who initially said he could have Urinary Track Infection. Then he proposed some more tests, MRI, bone scan and eventually we got to know that he has advancved PC with bone mets to his spine, pelvis, sternum and right skull bones and PSA > 500. ...

2)
He had his orchiectomy done on 29th march and is put on 3 weekly Zometa infusions + 50gm Bicalutamide daily.

The experts in hormonal blockade whom I follow would want him on 150 mg of bicalutamide because of his documented metastases. They would check the PSA, and if it did not drop enough, they might increase the dose even beyond that.

3)
We will have his first 3 monthly PSA test done in July this year. So I don't have his PSA figures after the start of treatment yet.

4)
DHT (dihydrotestosterone) test is not very common in India as goelfamily mentioned in one of here posts. And my dad also has not been tested for that.

It is a simple blood test - just another vial taken when blood is drawn. I think it's likely the sample could be shipped elsewhere for processing, though I'll bet that some of the highly sophisticated medical facilities in India could do the work. In view of your dad's advanced case, in my savvy layman's view, testing for both testosterone and DHT are very important.

Also, he did not have his biopsy done as doctors did not feel the need of it (as his PC was spread already) so we don't know what his Gleason score is. Would you be able to guess what his GS must be?

I'm pretty sure that no doctor would be very confident in making an estimate. However, based on the apparent aggressiveness, my impression is that doctors would guess he had a Gleason of 8 to 10. On the other hand, such cancers tend to underproduce PSA, and your dad has plenty of that! My own baseline PSA was 113.6, but my Gleason was a 4+3=7. It's somewhat unlikely that your dad's Gleason was a 6 or lower.

Do you think we should suggest or rather force the urologist for dutasteride/Avodart in my Dad's case?

I'm not aware whether it's possible to demand that a doctor in India provide a medication. In the US, as you are probably aware, you could go as far as telling a resisting doctor that you would go to someone else if he would not provide the prescription.

However, aside from the social issue, my strong layman's impression is that a 5-alpha reductase inhibitor drug, either Avodart or finasteride, would help. Having the results of a DHT test would pretty much conclude the issue. If the result were well below 10, which I think quite unlikely, then the doctor would have an argument that the 5-ARI drugs would probably not add much. If the DHT were fairly high, which is likely, then to me the case for a 5-ARI drug would be compelling. Dr. Myers and other experts like to see DHT below a certain figure; I'm confident their desired threshold is 10 or below.

The drug of choice these days is usually Avodart instead of finasteride; that's because finasteride inhibits a somewhat greater percentage of the conversion of testosterone into DHT, and the lower the amount of the potent DHT, the better! However, there's a small percentage of men whose genes make it hard for them to make use of Avodart, and finasteride is needed for such men. My impression is that either drug could be tried first; if suppression is inadequate, then switching would be advisable. Because of its lower cost, some US insurance companies want finasteride tried first. That seems reasonable to me. I'm personally convinced I've done better on two finasteride pills daily (10 mg total) compared to one finasteride daily (5 mg).


Your thoughts and inputs are greatly appreciated by all on this board and I am no exception. Thanks again for your reply.

Take Care!

You're welcome. I know it is hard to support a loved one from a long distance. I hope this helps.

Jim

 
Old 06-24-2010, 02:05 PM   #5
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Re: Are urologists too optimistic?

Thanks a lot for your reply Jim. That was quite inspiring.
I just hope my Dad's case proves to be an exception and he does well and proves that oncologist (a chemo expert) wrong; Miracles do happen!
Yes, its not easy when you are physically not there. Being here in UK, miles away from my family, this board has been a great help to me.

Thanks again...I might have some more queries in future
take care!

 
Old 07-06-2010, 02:48 AM   #6
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Re: Are urologists too optimistic?

Hello,

As we wait for my Dad's first PSA after surgery end of this week, I have few questions to ask here.

1) He had severe back ache which has fortunately gone. He feels pain in his lower legs. Earlier it was in the calf muscles. But now it has moved to the front part of the legs. What could be causing that? I am too scared thinking could this be metastasis?
His urologist feels it could be because of kidney function and has adviced a Kidney Function Test (KFT) that we will have tomorrow.

2) He has become hyper active after the treatment has started. He climbs stairs and exerts a lot on a daily basis. Is that because of the medication? I am not feeling too comfortable about this somehow.

Thanks
Chadhas

 
Old 07-07-2010, 09:24 AM   #7
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Re: Are urologists too optimistic?

Hi again Chadhas,

I think I've got a hot lead for you and will insert some comments in green. However, keep in mind that I am a layman with no medical credentials or enrolled medical education.


Quote:
Originally Posted by Chadhas View Post
Hello,

As we wait for my Dad's first PSA after surgery end of this week, I have few questions to ask here.

1) He had severe back ache which has fortunately gone. He feels pain in his lower legs. Earlier it was in the calf muscles. But now it has moved to the front part of the legs. What could be causing that? I am too scared thinking could this be metastasis?

Metastasis is a possibility, but, as I understand it, if these pains are recent, they probably are not due to metastases as the orchiectomy and bicalutamide have powerful tumor shrinking effects for many patients, and that would usually reduce or eliminate pain rather than causing it. I think there is another front running candidate as the cause.

His urologist feels it could be because of kidney function and has adviced a Kidney Function Test (KFT) that we will have tomorrow.

Perhaps that will answer the question, but that's not what I'm thinking.

2) He has become hyper active after the treatment has started. He climbs stairs and exerts a lot on a daily basis. Is that because of the medication? I am not feeling too comfortable about this somehow.

Ah yes, hyper activity - a very good thing to help combat PC, at at least appropriate and gradually increased activity is a good thing - followed by pains in the calf muscle and then in the front of his lower legs! Probably that front pain is in the old tibialis anterior muscle, one of the few muscles I can name, and for good reason. I have so been-there, done-that. Muscles build by being stressed to the point of mild damage and then recovering so that they are even stronger than before. It is best to do this gradually to avoid injury. I try not to go beyond soreness; pain is a sign of too-much too-fast.

I do racewalking for fitness, which is demanding on the lower leg (as well as on many other muscles). Beginning racewalkers need to condition the shin muscle - at the front of the lower leg (tibialis anterior) until it gets strong. Until that happens, it can be really sore, even feel like it is burning. Once it is conditioned, it is not a problem again - no soreness or pain. That's where I have been for years. While your dad is not racewalking, the stairs work and other activity could easily be causing the pain in the lower leg, especially the calf and shin muscles, I think.

There are several important stretches needed for racewalking to counteract the tightening of several muscles that otherwise occurs. This is especially important for the calf muscle. Such know-how, including how to warm-up and cool-down, is important.

I suspect the back pain was also due to muscles getting used to new demands due to exercise.

It is really important to get some knowledge about how to exercise effectively and safely. Building muscles is possible even for those of us with virtually no testosterone , but it takes much extra effort . My view is that it is worth it, a view echoed by the experts in hormonal therapy who consider exercise, especially including strength/weight bearing exercise, as very important. It is possible that your dad has decreased bone density, which is common for advanced prostate cancer patients. That could be combining with the stress of exercise to produce pain. It can be checked with a "bone mineral density scan", and there are ways to counter it. The Primer is excellent about this issue as well as the two types of scanning options (DEXA, qCT).

It's not likely at all that the medication and surgery are causing your dad to become active. The surgery usually have the oppositie effect due to a sharp reduction in testosterone produced from the testes, the dominant source, which we patients need to counter.


Thanks
Chadhas

You're welcome. Please remember that as a layman I could be very wrong about the cause of your dad's pain, but exercise as the cause should be considered. I'm pretty confident that that is the cause.

Good for your dad!

Take care,

Jim


 
Old 07-12-2010, 04:18 AM   #8
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Re: Are urologists too optimistic?

Thanks again for your reply Jim and apologies for the delayed response; was preoccupied with my travel to India and meeting my Dad's urologist.

We have our dad's first 3 monthly PSA results(First one after Orchiectomy on 29-03-2010) and it is 0.04. His PSA at the time of diagnosis and the surgery was > 500.
We are very happy about it.
I hope these are good results. But is this steep fall from >500 to 0.04 in first 3 months good?

I did discuss with the uro:
1) increasing Bicalutamide dose to 150mg and
Uro's reply: Since he had Orchiectomy, he does not need a higher dose.
2) starting Dutasteride
Uro's reply: dutasteride is a "chemo-prevention" drug and is not required in my dads case. What does that mean???

Morover, looking at the PSA fall to such a number, it seems I did not have a very strong case and he kind of refused

My queries:

1) We can still have a DHT test as it is not very uncommon here in Delhi, India.
Do you suggest we should go about it?
2) Is increase in Bicalutamide dose still required?
3) The Uro says no more Zometa is required. Are 6 infusions of Zometa enough for my Dad?

My dad's Kidney function test results are not very good and his createnine is still high. So the uro has sugeested another ultrasound which we will have tomorrow.

Hoping for the best!

Thanks & Regards
Chadhas

Last edited by Chadhas; 07-12-2010 at 07:56 AM. Reason: -

 
Old 07-16-2010, 08:58 AM   #9
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Re: Are urologists too optimistic?

Hi Chadas,

I'll join got in expressing joy in your dad's inspiring response with that very low PSA of 0.04! Really wonderful! I'll add some comments in green. I know I saw your post a couple of days ago, but somehow I thought I had responded, but had not.


Quote:
Originally Posted by Chadhas View Post
Thanks again for your reply Jim and apologies for the delayed response; was preoccupied with my travel to India and meeting my Dad's urologist.

We have our dad's first 3 monthly PSA results(First one after Orchiectomy on 29-03-2010) and it is 0.04. His PSA at the time of diagnosis and the surgery was > 500.
We are very happy about it.
I hope these are good results. But is this steep fall from >500 to 0.04 in first 3 months good?

No, that is not too steep! In fact, its a good sign, as some patients, like your dad evidently, have cancers that depend very heavily on testosterone. When it is cut off, the cancer can take a huge hit, as it has in your dad's case. It's better when the PSA falls so rapidly, much more rapidly than in my own case, in fact. I'm still in awe when patients achieve such declines, but we actually see that in a good number of patients when hormonal blockade is effectively done. GOELFAMILY's dad's response is another wonderful and inspiring example.

However, it's likely that not many cancer cells have actually been killed yet. It's more likely that they have been stunned so that they can no longer produce PSA and are much less aggressive. As the months of hormonal blockade tick by, an increasing proportion of cancer cells will die. Some expert researcher/clinicians believe that optimimum cancer cell death requires at least nine months of treatment. Even then, some resistant cells, particularly "cancer stem cells," are likely to remain, though hopefully they will be in a dormant state.


I did discuss with the uro:
1) increasing Bicalutamide dose to 150mg and
Uro's reply: Since he had Orchiectomy, he does not need a higher dose.

It's wonderful that the uro is using bicalutamide in addition to the orchiectomy, but urologists in the US often do not appreciate some of the key subtleties. One is that cutting off testosterone does not necessarily mean that DHT, the much more potent fuel for prostate cancer, is eliminated. However, based on your dad's profound and rapid PSA response, my layman's guess is that 50 mg is enough. I'm curious what the experts would say in your dad's case, but I can only wonder about that.

2) starting Dutasteride
Uro's reply: dutasteride is a "chemo-prevention" drug and is not required in my dads case. What does that mean???

In one sense it means that the uro knows a little about dutasteride, which is a start, but does not know much, which is typical. Yes, it is "chemo-preventive," meaning that it has been proven in a clinical trial to be able to prevent a percentage of prostate cancer in men who did not have the disease at the start of the trial. What he does not realize is that experts in hormonal blockade have been achieving some impressive results by combining finasteride or its sister drug dutasteride with surgical or medical halting of testicular testosterone (the orchiectomy in your dad's case) plus a drug to block the cancer cell fuel ports (bicalutamide).

Morover, looking at the PSA fall to such a number, it seems I did not have a very strong case and he kind of refused

The trick is not just to get the PSA down but to keep it down, and it's likely that dutasteride would help. Fortunately, the need does not appear urgent in your dad's case. You could start helping educate the urologist by sending him published medical research papers on use of 5-alpha reductase inhibitors (finasteride or dutasteride) to help combat prostate cancer. I recommend you start with the paper by Scholz, Lam, Strum and team in the Journal of Urology, or Urology, a few years ago. The language is confusing for laymen, but the uro may understand.

My queries:

1) We can still have a DHT test as it is not very uncommon here in Delhi, India.
Do you suggest we should go about it?

Yes, that's another way to make the case for dutasteride. Alternately, if the DHT is already below 5 (in usual US units), then the argument for dutasteride is much weaker.

2) Is increase in Bicalutamide dose still required?

An expert might say so, but my layman's impression i

3) The Uro says no more Zometa is required. Are 6 infusions of Zometa enough for my Dad?

I do not know enough to even suggest an answer, but, because your dad has permantly shut down production of testosterone from the testes, the bone making process will be more challenging. He needs to be monitored at least annually in my layman's opinion with an appropriate bone mineral density scan. Perhaps one of the milder bisphosphonate drugs, like Fosamax, Actonel, or Boniva in the US, could be used, along with the usual calcium and quality vitamin D3 supplements, with 25-hydroxy vitamin D tests for monitoring.

My dad's Kidney function test results are not very good and his createnine is still high. So the uro has sugeested another ultrasound which we will have tomorrow.

Hoping for the best!

Thanks & Regards
Chadhas
Take care and continued good luck,

Jim

 
Old 07-20-2010, 10:12 AM   #10
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Re: Are urologists too optimistic?

Hello,

Thanks a lot got and Jim for your encouraging words!

@got,

The ultrasound went well. The Prostate is back to 22 grams. It was 69 grams at the time of diagnosis. The size in terms of cms/metres is also in normal range. He had hydronephrosis and the left kidney was not functioning as normal as the ureter was affected because of enlarged prostate. That blockage to the kidney is also gone now, thankfully.

He still has pain in the calf muscles, which according to the doc, could be because of tiredness or low hemoglobin which is 8.5 at the moment which is still low but atleast it went up from 6.9(at the time of diagnosis)

@Jim,

We met with my dad's uro again and
1) He has agreed on "serum testosterone level test" which we will get done soon.
2) He has put dad on 0.5mg dutasteride. (I don't know what made him do so, probably we did convince him a bit)
3) He will be doing a bone scan and Bone Mineral Density scan after completion of 1 year (March 2011) of Orchiectomy and start of treatment, something that you also suggested.
4) Next PSA, Hemoglobin, KFT and LFT are all scheduled for next month, i.e. after 4.5 months.
5) Alongwith that, my dad is on daily dose of Lycopene tablets, VitaminD + Calcium, Iron tablets.

Now, we met a uro-oncologist today for second opinion and he was convined with the Orchiectomy + 50mg Calutide dose.

However, he did insist on continuing Zometa. According to him, it should be a 4 weekly dose for lifetime to which I do not agree because of the side effects but I am convinced that few more infusions can be given. What do you suggest???

He suggested a bone scan every six months instead of 1 year. Do you agree???

He thinks this (0.04) is the minimum level to which my dad's PSA could go. But I am expecting it to fall further. What are your thoughts on this???

Waiting for a response and best wishes to all!

Take Care
Chadhas

 
Old 07-26-2010, 03:07 AM   #11
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Re: Are urologists too optimistic?

Hello,

The uro-onco also suggested that the folic acid capsules that my dad is on should be stopped as Folic acid mutates the cancer cells (alongwith the normal cells). Is that true???

Thanks & Regards
Bhavna

 
Old 07-30-2010, 02:09 AM   #12
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Re: Are urologists too optimistic?

Hello got,

Thanks for the information. The uro also mentioned that folic acid should be stopped but we kind of missed it. But after the onco metioned the same, we are very sure it should.

Lets see what Jim has to say!

Thanks & Regards
Chadhas

 
Old 07-31-2010, 03:31 PM   #13
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Re: Are urologists too optimistic?

[COLOR="black"][COLOR="black"][COLOR="black"][COLOR="black"]Hi Got and Chadhas,

I'm replying to your (Got's) post a couple of posts back.

For a long time many of us were taking 400 IU of vitamin E daily based on some encouraging results for men taking just 50 IU, as I recall it. Then it became clear that 400 IU could cause excessive blood thinning in some men, creating a risk of threatening bleeding following an accident or surgery. One of the leaders in nutrition and prostate cancer said a few years ago there was no evidence that a dose of just 200 IU a day was risky. However, he now feels that other antioxidants are better for us, so I believe he has turned away from vitamin E. I have not yet been able to review his information; I'll have to go to a library to do so.

I'm continuing to take the equivalent of 200 IU per day, partly because my overall program is working so well and I do not want to upset the apple cart. Do you know anything more about the doctor's basis for saying that vitamin E was harmful? I suspect he or she did not have all or enough of the facts, as is unfortunately commonly the case. I suspect the doctor was relaying an uninformed view of unfavorable results from the SELECT trial that involved both vitamin E (alpha tocopherol form) and selenium. Unfortunately, the wrong form (and dose) of vitamin E was used in that trial, but that was not that easy to see at the beginning. (I was concerned enough about it to contact a couple of leading doctors, and others were also concerned. However, as "just a patient," my views and questions did not carry much weight. There were some plausible reasons for sticking with the alpha tocopherol despite concerns expressed by some leading researchers.)

I just did a quick review of www.pubmed.gov as well as another kind of review to see if I was missing something; nothing turned up, but maybe I have overlooked something. My review indicates that many researchers are still pretty excited about the potential of the gamma form of vitamin E against prostate cancer.


Quote:
Originally Posted by got View Post
I just found out from the head of a huge hospital that vitamin E (50mg) and beta carotene (30mg) both cause cancer (they were running a study to see if these supplements prevented cancer),

I have never seen an indication that there is a significant risk of vitamin E causing prostate cancer. There was a famous study focusing on beta carotene and vitamin E as related to cancer, and that study pretty much nailed beta carotene as a risk factor, especially for lung cancer among smokers. However, vitamin E was an innocent bystander as I recall it.


so I would stop the folic acid

Folic acid has never been on the radar as a significant plus or minus factor for prostate cancer, as far as I recall. Therefore, I took a look at PubMed (www.pubmed.gov - a site we can use here because it is Government sponsored) for research linking prostate cancer and folic acid for the past two years.

I use the search string " prostate cancer AND folic acid ", with the following limits activated under the Limits button: abstracts, humans, males, last 2 years. I got only 14 hits, which indicates fairly limited research interest, and only four of those appeared to be focused on the link between prostate cancer and folic acid, with the others apparently involving an incidental or quite peripheral link. (However, you can do the same search to see if you have a different take.)

I read the four pertinent abstracts. It appears that in most of the comments that folic acid had no influence on prostate cancer or a possibly beneficial impact. In one study, there was one piece of evidence that raised concern, though the abstract says at the start that information is sparse and conflicting:

J Natl Cancer Inst. 2009 Mar 18;101(6):432-5. Epub 2009 Mar 10.

Folic acid and risk of prostate cancer: results from a randomized clinical trial.
Figueiredo JC, Grau MV, Haile RW, Sandler RS, Summers RW, Bresalier RS, Burke CA, McKeown-Eyssen GE, Baron JA.

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA. ...

Comment in:

J Natl Cancer Inst. 2009 Mar 18;101(6):363-5.

Abstract
Data regarding the association between folate status and risk of prostate cancer are sparse and conflicting. We studied prostate cancer occurrence in the Aspirin/Folate Polyp Prevention Study, a placebo-controlled randomized trial of aspirin and folic acid supplementation for the chemoprevention of colorectal adenomas conducted between July 6, 1994, and December 31, 2006. Participants were followed for up to 10.8 (median = 7.0, interquartile range = 6.0-7.8) years and asked periodically to report all illnesses and hospitalizations. Aspirin alone had no statistically significant effect on prostate cancer incidence, but there were marked differences according to folic acid treatment. Among the 643 men who were randomly assigned to placebo or supplementation with folic acid, the estimated probability of being diagnosed with prostate cancer over a 10-year period was 9.7% (95% confidence interval [CI] = 6.5% to 14.5% [meaning the true value, if a very large group had been studied, would have been in that range]) in the folic acid group and 3.3% (95% CI = 1.7% to 6.4% [ditto regarding the range]) in the placebo group (age-adjusted hazard ratio = 2.63, 95% CI = 1.23 to 5.65, Wald test P = .01). In contrast, baseline dietary folate intake and plasma folate in nonmultivitamin users were inversely associated with risk of prostate cancer in other words, the more folic acid, the less prostate cancer, which is what we would like to see, so the results conflict in this study], although these associations did not attain statistical significance in adjusted analyses. These findings highlight the potential complex role of folate in prostate cancer and the possibly different effects of folic acid-containing supplements vs natural sources of folate.


You can see that the researchers really do not know what is going on yet. It also is important to remember that the parent study focused on colorectal cancer, with the study data redigested for prostate cancer. Often results get murky when that is done. Such studies are useful as probes to see if anything unusual or interesting turns up, but they are not persuasive. The UCLA's Keck School of Medicine is quite savvy on nutrition and prostate cancer, by the way. They've done some great work on pomegranates and prostate cancer, for instance.


....we just don't know about supplements yet, your doctor may have the latest info...our bodies tend to take care of themselves. Like the tumor, is the body encircling the cancer to keep it from spreading?

I too believe in a mind-body connection, but I also believe that often that connection is not enough to ward off hostile influences from our dietary and other lifestyle aspects of the environment. There is actually an abundance of research on these matters for prostate cancer. However, unfortunately, almost none of it is conclusive. If you want to have some informative fun, try your hand at checking into it. Try PubMed searches like " prostate cancer AND vitamin D3 ", " prostate cancer AND pomegranate ", "prostate cancer AND fish oil ", " prostate cancer AND lycopene ", " prostate cancer AND exercise ", and " prostate cancer AND curcumin ". You can click on the blue hypertext titles to view brief descriptions ("abstracts") of the studies if they have abstracts (most do). Some have free links to complete copies of the studies. If you do this, I would like to know your impression.

I am learning lots from you...sounds like it is going good!
Keep up that learning and sharing!

Take care,

Jim

 
Old 08-17-2010, 07:48 AM   #14
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Chadhas HB User
Re: Are urologists too optimistic?

Hello,

Its been 4.5 months since my dad's orchiectomy and we got his PSA done today.
Result is <0.04.
(3 months post-op PSA was 0.04 down from >500)
I think this is good result, hope you all will agree.

Thanks & Regards
Chadhas

 
Old 08-18-2010, 05:28 AM   #15
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Re: Are urologists too optimistic?

Hello Chadhas,

I'm replying to your post that is immediately preceding this one as I type:


Quote:
Originally Posted by Chadhas View Post
Hello,

Its been 4.5 months since my dad's orchiectomy and we got his PSA done today.
Result is <0.04.
(3 months post-op PSA was 0.04 down from >500)
I think this is good result, hope you all will agree.

Thanks & Regards
Chadhas
Yes,

That continues to be a wonderful result, especially considering where your dad started. Congratulations!

Your dad may be at the limits of "best medical practice" in India, as the ultrasensitive test being used is at its lower limit. Tests sensitive to <0.04 are fairly common in the US; in fact, they are often used in my oncologist's large group practice. I am one of the few patients being managed with a test sensitive to <0.01; it takes longer to get results by several days as the sample is shipped out of state to a special lab. My test is the Roche ECLIA version. There are other versions capable of such low results.

All that said, my savvy layman's impression is that your dad's case is being well managed.

On the other hand, some of the leading medical oncologists specializing in prostate cancer use the extra capability for their case management decisions, so it might be worthwhile to try to get a test with a limit of <0.01 for your dad's next test.

Take care,

Jim

 
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