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After Diagnosing Prostate C Then The Decision-Making
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Robert Cohen
medicine forum Guru Wannabe


Joined: 28 Apr 2005
Posts: 116

PostPosted: Tue Jul 04, 2006 12:53 pm    Post subject: After Diagnosing Prostate C Then The Decision-Making Reply with quote

LOS ANGELES TIMES 3-page article on-line (free registration may be
required).

http://www.latimes.com/features/health/la-he-prostate3jul03,0,3036757.story?coll=la-home-health
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betsyb
medicine forum beginner


Joined: 16 Apr 2006
Posts: 9

PostPosted: Tue Jul 04, 2006 2:23 pm    Post subject: Re: After Diagnosing Prostate C Then The Decision-Making Reply with quote

"Robert Cohen" <robtcohen@msn.com> wrote in message
news:1152017593.525082.201090@h44g2000cwa.googlegroups.com...
Quote:
LOS ANGELES TIMES 3-page article on-line (free registration may be
required).

http://www.latimes.com/features/health/la-he-prostate3jul03,0,3036757.story?coll=la-home-health


How sad and adult like yourself cannot paste an article YOU want read. I
will not register to read anything nor will I click a link to make someone
else. money?
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Robert Cohen
medicine forum Guru Wannabe


Joined: 28 Apr 2005
Posts: 116

PostPosted: Wed Jul 05, 2006 12:32 am    Post subject: Re: After Diagnosing Prostate C Then The Decision-Making Reply with quote

Well: The copyright laws are to me ambiguous, but I certainly can
understand about "no free lunch."

Anyway: I could and have re-posted stuff here that is
copyrighted--sometimes I do/sometimes I don't.

But now just to argue back for argument sake:

Since, except for the subscription fee showbiz entertainment section,
Calendar, the pretty good L.A. TIMES on-line requires registration for
their marketing cookie, I cannot see what the big deal of refusing to
register is: You do not need to tell them true facts for their data
collection. You're allowed near total anonymity by using fake this and
fake that here on the internet--I'd say it's expected and that many
honest people nevertheless lie to surveyors.

Imho, one is hurting oneself by not taking advantage of the "free"
wealth of publications: Unless you enjoy going to a library everyday in
person, then... .

For instance: The NY TIMES is one of the best newspapers in the World.
Most--not all--of it is freely available with small cookie registration
hassle.

One denies oneself access to so many great newspapers & magazines by
avoiding the annoying cookie crape.

Yes, it's brave new worldish, but what isn't?

Do you pay for everything that you buy only in cash?

Credit card activity leaves records for us paranoiac types to worry
ourselves about.

The Christian Science Monitor does not require cookie registration:
They are nevertheless a fine, unusual, great independent publication
with a totally free website too.

But...uh... don't expect an evaluation there of ..."un-natural drugs,"
at least I can't recall any health -medical articles at
<www.csmonitor.com>, but thatttttt's okaaaaaaayyyyyy.

betsyb wrote:
Quote:
"Robert Cohen" <robtcohen@msn.com> wrote in message
news:1152017593.525082.201090@h44g2000cwa.googlegroups.com...
LOS ANGELES TIMES 3-page article on-line (free registration may be
required).

http://www.latimes.com/features/health/la-he-prostate3jul03,0,3036757.story?coll=la-home-health


How sad and adult like yourself cannot paste an article YOU want read. I
will not register to read anything nor will I click a link to make someone
else. money?
Back to top
Robert Cohen
medicine forum Guru Wannabe


Joined: 28 Apr 2005
Posts: 116

PostPosted: Wed Jul 05, 2006 1:26 pm    Post subject: Re: After Diagnosing Prostate C Then The Decision-Making Reply with quote

Fighting Prostate Cancer by Doing Nothing
Treatment itself can be dangerous. And, scientists now say, it might
not be necessary -- even for younger men.
By Susan Brink, Times Staff Writer
July 3, 2006


IT was, many physicians would say, the right thing for a man of 53 to
do. So Larry Cano had a prostate-specific antigen, or PSA, test. "It
was 5.3," says Cano, a film producer from Newport Beach. "They say
anything over 4 is noteworthy."

The noteworthy result, followed by a positive biopsy, sent Cano
pinballing from surgeon to radiologist and back with what he believes,
three years later, was an exaggerated sense of urgency.

ADVERTISEMENT
He may have been right. Researchers - and a few doctors - are
beginning to agree: Even many younger men with prostate cancer can
afford to wait.

"Most of the time, I tell men that they may need treatment, but they're
not going to die," says Mark Scholz, a Marina del Rey oncologist,
specializing in prostate cancer. "A lot of men with low-grade cancer
may not need treatment for five to 10 years."

Some may never need it.

No one initially told Cano that his prostate cancer was not an
emergency, that he had time to talk to men who had been through the
same diagnosis, to do his own research, to take a deep breath and think
about how he wanted to live the rest of his life. No one told him that
he could leave his prostate intact, right where it was, while carefully
monitoring his condition - and that he might be able to do that for
quite a long time. Maybe forever.

Cano didn't fit the profile of the traditional candidate for what's
called watchful waiting, an option that has become synonymous with
doing nothing. That approach has been recommended for older men or
those threatened by other diseases.

Men like him - younger, healthier men diagnosed with earlier stages
of cancer - are typically urged to act quickly. They represent the
changing demographic of the disease and, like Cano, often feel lucky to
catch it early. Cano even made an appointment for surgery. "I thought,
just buck up and get it done," he says.

But then he took some time to think again. He did a lot of reading,
weighed risks and benefits, and ultimately decided on a form of waiting
that is anything but passive.

What Cano chose represents the newest thinking in the disease, and the
approach is so different from watchful waiting that no one calls it
that any more. They call it active surveillance.

Three years later, his prostate is still where nature put it, he feels
fine, and he has become a diligent student of his medically relevant
numbers. So far, his cancer is not progressing.

Theoretically, half of men diagnosed with the disease have caught it
early enough to at least try active surveillance. The prostate stays,
and the patient and his doctors regularly hover over new test numbers
and images, on the alert for any sign of change. But only about 12% of
such men go that route.

Cano knows full well that he is trading the treatment risks -
impotence and incontinence - for the risk of waiting too long and
missing the best opportunity to cure his cancer. For his choice to pay
off, he has to monitor his condition on a tight schedule, and be ready
to act if it changes - all the while hoping for the good luck of
slow-growing cancer cells.

Such monitoring of early disease, increasingly debated in the inner
sanctum of medical meetings and on the pages of scientific journals,
rarely makes its way to the list of choices offered to patients. In
fact, the number of men choosing to wait is going down, according to a
federal database, even as the number of younger men with low-risk
disease is going up.

No one argues that men with more advanced disease ought to make a
treatment decision soon. But the growing number of men who are finding
out in their 50s and 60s that they have early-stage prostate cancer are
also routinely being urged toward surgery or radiation soon after
diagnosis, even though medicine currently offers no way of knowing for
sure who needs treatment and who doesn't.

It's little wonder, then, that about 150,000 of the 234,460 men
diagnosed with the disease each year move quickly to have surgery,
radiation seed implants, or one of a variety of other radiation
techniques.

"Of the rest, probably about half get hormone treatments and half get
watched," says Scholz, Cano's physician. Those watched are typically
elderly or have other life-threatening conditions. And they are watched
in the old way. "Too much waiting and not enough watching," says Peter
Carroll, urologist at UC San Francisco.

Adding confusion to men's hurried decisions, medical science offers no
definitive answers to who is a good candidate for surgery, or who might
do better with radiation, because there has never been a head-to-head
clinical trial of surgery versus the different forms of radiation.

"Neither side wants to find out the other one is better," says Dr.
Stephen Doggett, a Tustin radiologist whose practice consists of
providing brachytherapy, the implantation of radiation seeds into the
prostate. "No one has ever proven that one is better than the other."

But for some men, neither a rush to treatment nor the old, passive
wait-and-see approach is appropriate. "I spend half my time talking
guys down out of the tree," Scholz says. If surgical or radiation
treatment were akin to, say, treatment for basal cell carcinoma in
which the common skin tumors are removed and the patient suffers no
serious consequences, then early diagnosis followed by universal
treatment would be a no-brainer. But with prostate cancer, the usual
treatments can have emasculating side effects. "If we had a nontoxic
treatment, you wouldn't care," Scholz says. "But we're making them
impotent, making them leak urine."




--------------------------------------------------------------------------------

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- Letting it all hang out
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Fighting Prostate Cancer by Doing Nothing
July 3 2006


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"It's a chink in the armor of manhood," Cano says. "It's a dastardly
disease that affects you in the seat of what some people conceive of as
maleness. It can affect your sexual function, and then evolve into
something that can kill you. You're damned if you do, and damned if you
don't."

*

ADVERTISEMENT
Risks of treatment

Because the prostate sits so near the nerves that govern erection as
well as the ability to control urine flow, it takes great finesse to
remove or destroy the 1 1/2 inch-long gland while leaving those nerves
intact.

Some physicians - prostate cancer support groups call them medical
artists - have decades of experience with thousands of either
surgical or radiological patients, and, using techniques that spare the
nerves near the prostate, end up with a far lower incidence of
impotence and incontinence.

But the national averages for side effects remain grim. More than half
of treated men will have permanent sexual dysfunction, and up to 30%
will have some degree of chronic urinary incontinence. Most of them
will be cured of their cancer, though an unknown number won't know that
they didn't need the cure. And a small number of men getting surgery or
radiation will have cancer that has already spread beyond the prostate.
For them, the ultimate indignity is that they could well suffer side
effects of treatment, and still have a growing cancer in their bodies.

In a study begun in 1996, Dr. Laurence Klotz, urology professor at the
University of Toronto, has been attempting to shed light on the gray
area of who needs treatment and who will live a long, healthy life
without treatment. Men who are good candidates for waiting are those
with a PSA of less than 10; a Gleason score, the number used to grade
prostate cancer for potential aggressiveness, of less than 6; and fewer
than a third of cores taken in biopsy with cancer cells.

Follow-up monitoring includes a PSA test every three months, and
periodic repeat biopsies.

Deemed good candidates, the 500 men in Klotz's study waited, as Cano is
doing, and chose a therapy only if their cancer took a turn for the
worse.

So far, about a third of the active surveillance group have gone on to
have surgery or radiation. About 20% got treatment after experiencing a
rapid doubling time of their PSA count - that is, the number doubled
in less than three years. And 5% received treatment after follow-up
biopsies showed an increase in their tumor grade. PSA doubling time and
increase in tumor grade are both indications that it's time to act more
aggressively.

Another group of men in the active surveillance group, with no danger
signs, opted for treatment anyway. "About 12% just got nervous," Klotz
says. "It's the word 'cancer' that's a problem. The word puts into gear
the whole freight train of adverse expectations about the future."

That leaves about two-thirds of the volunteers still waiting, and still
healthy. In the entire group, those remaining on active surveillance,
and those treated after waiting, there has been a 99% survival rate,
with three prostate cancer deaths. "And those three died very rapidly,"
Klotz says. Their disease, he speculates, had likely already escaped
the prostate and traveled to other parts of the body.

The study is being expanded, supported in part by the Canadian and U.S.
National Cancer institutes, to look at 2,100 men. Results of that
larger comparison study are years away - not soon enough to help Cano
with his decision.

*

Faced with a decision

Three years ago, Cano's urologist did what many surgeons do. He
recommended immediate surgery. A radiologist recommended radiation.
Another radiologist recommended brachytherapy. A month after diagnosis,
the urologist scheduled surgery because Cano thought he was ready.

He cried with his wife, went over provisions in his will, and thought
about his daughter. "I was 53, happily married, and my child was 14,"
he says. "I began to think that I'd rather walk her down the aisle than
worry about whether I had sexual function. Having a great sex life
doesn't help you if you're dead."

But while waiting for his date with the scalpel, he began to hear of an
alternative that appealed to him: triple blockade hormone therapy. The
treatment was once thought to be the last arrow in the quiver for men
whose cancer had spread, sometimes in spite of prostate removal or
radiation treatment. Using it early on in treatment, as Cano did, is
controversial and as yet unproven, but a handful of doctors recommend
the therapy, which blocks testosterone production, in an attempt to
control the cancer. Koltz thinks it's far too toxic, with side effects
that include impotence and sometimes personality changes, to use
routinely on men whose cancer is low-risk.

But Scholz supported Cano's decision, and began working with him in
monitoring his disease. Cano canceled his scheduled surgery and began a
regimen using the hormone blockade therapy for a year. It rendered him
impotent during the year of treatment, and afterward reduced his sex
drive - a consequence he thinks could just as well be a result of
getting older - and continues to play a few games with his short-term
memory, he says. But his PSA has dropped to 1.3 and a follow-up biopsy
found no evidence of cancer. He's hoping that with continued
monitoring, he'll be able to avoid drastic treatment for more years,
giving medical science more time to refine and improve techniques.

Murray Corwin, 78, also took his time deciding. But in 1991, when he
began his slow and careful disease monitoring, there wasn't much
support for stalling - not even at home. "Families apply enormous
pressure to do something," he says. "That's what my daughter said to
me: 'What are you going to do?' "




--------------------------------------------------------------------------------

Single page CONTINUED
<< back 1 2 3 next >>



MOST E-MAILED
- Letting it all hang out
- WWFFD? Who cares?
- Fighting Prostate Cancer by Doing Nothing
More Health News
- Fighting Prostate Cancer by Doing Nothing
- Ripped, buff, tough -- it's a goal
- I love you! I hate

Fighting Prostate Cancer by Doing Nothing
July 3 2006




Page 3 of 3 << back 1 2 3


For a while, he did nothing to his body, though he worked his
engineer's mind hard seeking information. He waited, returning to his
doctor every three months for a new PSA test. Frustrated by a lack of
information, he helped found the Fullerton Prostate Forum
(www.prostateforum.org) to seek and share new information. (Cofounders
Bill Dehn and Dan O'Conner have both since died of the disease.)

Even now, he unfolds a taped-together chart of his early PSA numbers.

ADVERTISEMENT
"I use it to show how I was able to feel comfortable waiting," he
says. He had carefully charted his numbers over a period of more than
two years, and points to the red dot on the chart that told him he
could wait no longer. His PSA, which had been flat all that time,
suddenly spiked. It was time to get treatment, and he opted for
radiation.

The big risk of waiting is that without, and perhaps despite, diligent
monitoring, the cancer could spread beyond the reach of the knife or
radiation beam. Lou Pfeffer, 78, of Hacienda Heights knew the risk of
waiting, took it anyway, and now has lost the opportunity to be cured.

Following his 1993 diagnosis, he wandered around in a daze. "I thought
I had the worst case of cancer in the world, and I was going to die
next week," he says. "It's a very hard decision to figure out what to
do."

Physicians urged him to have medical treatment. "They'd put their arm
around me and say, 'You know, if you were my dad, I'd say, get it out
and get on with your life,' " he says. Instead, he waited. He read
about alternatives and studied prevention research. Soon, he went on a
macrobiotic diet and lost 65 pounds in half a year.

Being overweight is associated with an increased risk of prostate
cancer, and crucifers such as broccoli - as well as lycopene, found
in tomatoes - may help prevent it. Supplements including selenium and
vitamin E are also associated with a reduced risk of prostate cancer.
And a study in the July 1 journal Clinical Cancer Research found that
an 8-ounce glass of pomegranate juice daily for treated men increased
the length of time PSA levels remained stable.

Pfeffer tried dietary improvements and supplements - too late to
prevent his prostate cancer, but hoping to keep it in check.

He monitored his PSA counts, had follow-up biopsies, and held steady
for more than nine years. Then a color Doppler ultrasound image, a new
imaging technique that can help pinpoint the location and growth of
cancer, showed that his tumor was getting larger. Unfortunately, it had
also started to grow outside the prostate. Now he's taking hormone
blockade therapy and hopes to control his cancer indefinitely. Some 13
good quality-of-life years after his diagnosis, he has no regrets.

As Cano monitors his own numbers, he also closely watches worldwide
research on prostate cancer, hoping that what looks promising in petri
dishes, lab rats or clinical trials might ultimately prove to be a
better treatment with a lower risk of destruction.

For now, he's his own health sentry, on full alert for signs of change.

*

(INFOBOX BELOW)

The choices

For men who are considering treatment, experts recommend that they
examine all their choices. Talk to surgeons, radiologists and
oncologists for their perspectives. Choose a doctor who has a lot of
experience - hundreds of patients a year. Ask each physician what his
or her track record is for side effects such as impotence and
incontinence. Here's an overview of the options:

Radical prostatectomy. This surgery to remove the prostate gland
is the most common treatment, and one with a long track record. If
cancer has not spread, the surgery will cure it. In some cases, the
nerves surrounding the prostate can be spared, reducing the risk of
impotence, but the technique requires a highly experienced surgeon.

Radiation therapy. Various forms of radiation are directed at the
prostate gland to kill the cancer cells. The oldest form, conventional
external beam radiation, has the highest risk of causing rectal
incontinence and has largely been replaced with more technically
advanced forms of delivering radiation. They include intensity
modulated radiation, which uses computers to more precisely deliver
radiation to the tumor while minimizing doses to the adjoining tissue.
Another technique, 3D conformal radiation, uses computerized tomography
to more accurately locate the tumor. Proton beam radiation uses a
unique radiation delivery system that may better target the tumor.

All are far less destructive than the old external beam radiation, and
each can deliver higher amounts of radiation to the prostate gland
while reducing the risk of damage to rectum and bladder tissue.

Brachytherapy. In this form of treatment, radioactive seeds are
implanted into the prostate, usually during outpatient surgery. When
guided by new computer imaging technology, experienced radiologists can
more precisely place the seeds within the prostate, and spare
surrounding nerves.

Cryosurgery. Using ultrasound guidance, probes are inserted and
liquid nitrogen is circulated to freeze the prostate.

Androgen deprivation therapy. Sometimes called chemical
castration, the therapy aims to deprive the prostate of testosterone,
which causes prostate cancer cells to grow. For men with advanced
cancer, this is the last option. But it is sometimes used before
radiation treatments to reduce prostate size. And it is beginning to be
used, rarely, by men hoping to forestall other treatments. Intermittent
ADT allows men to stop the treatment at times, allowing them to reclaim
their ability to have erections.

For more on prostate cancer:

Prostate Forum - Organized by men frustrated by a lack of
information, this California group offers speakers at monthly meetings
in Fullerton, educational materials including a video library and
discussion groups. http://www.prostateforum.org or (714) 607-9241.

Us Too - Modeled after successful breast cancer support groups,
this organization has become an international education and support
group with local meetings nationwide. http://www.ustoo.org .

The National Cancer Institute provides information on clinical
trials and basic information on all treatments for prostate cancer.
http://www.cancer.gov .

- Susan Brink




--------------------------------------------------------------------------------

Single page << back 1 2 3



MOST E-MAILED
- Letting it all hang out
- WWFFD? Who cares?
- Fighting Prostate Cancer by Doing Nothing
More Health News
- Fighting Prostate Cancer by Doing Nothing
- Ripped, buff, tough -- it's a goal
- I love you! I hate you!






Robert Cohen wrote:
Quote:
Well: The copyright laws are to me ambiguous, but I certainly can
understand about "no free lunch."

Anyway: I could and have re-posted stuff here that is
copyrighted--sometimes I do/sometimes I don't.

But now just to argue back for argument sake:

Since, except for the subscription fee showbiz entertainment section,
Calendar, the pretty good L.A. TIMES on-line requires registration for
their marketing cookie, I cannot see what the big deal of refusing to
register is: You do not need to tell them true facts for their data
collection. You're allowed near total anonymity by using fake this and
fake that here on the internet--I'd say it's expected and that many
honest people nevertheless lie to surveyors.

Imho, one is hurting oneself by not taking advantage of the "free"
wealth of publications: Unless you enjoy going to a library everyday in
person, then... .

For instance: The NY TIMES is one of the best newspapers in the World.
Most--not all--of it is freely available with small cookie registration
hassle.

One denies oneself access to so many great newspapers & magazines by
avoiding the annoying cookie crape.

Yes, it's brave new worldish, but what isn't?

Do you pay for everything that you buy only in cash?

Credit card activity leaves records for us paranoiac types to worry
ourselves about.

The Christian Science Monitor does not require cookie registration:
They are nevertheless a fine, unusual, great independent publication
with a totally free website too.

But...uh... don't expect an evaluation there of ..."un-natural drugs,"
at least I can't recall any health -medical articles at
www.csmonitor.com>, but thatttttt's okaaaaaaayyyyyy.

betsyb wrote:
"Robert Cohen" <robtcohen@msn.com> wrote in message
news:1152017593.525082.201090@h44g2000cwa.googlegroups.com...
LOS ANGELES TIMES 3-page article on-line (free registration may be
required).

http://www.latimes.com/features/health/la-he-prostate3jul03,0,3036757..story?coll=la-home-health


How sad and adult like yourself cannot paste an article YOU want read. I
will not register to read anything nor will I click a link to make someone
else. money?
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Ed Friedman
medicine forum beginner


Joined: 02 May 2005
Posts: 27

PostPosted: Wed Jul 05, 2006 9:31 pm    Post subject: Re: After Diagnosing Prostate C Then The Decision-Making Reply with quote

Interesting article, but either sci.med.prostate.cancer or
alt.support.cancer.prostate are really the target newsgroups you should
be posting this to.

Ed Friedman
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