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Posted 8/27/2010 3:09 AM (GMT 0)
Just finished the book and it gives both a patient's perspective and a prostate doctor's perspective on the disease. Goes into a lot about scanning, especially using Color Doppler and MRIS as a tool to see exactly how fast the cancer is progressing. Also goes into a lot of detail on the side affects of all the various treatment options and what you can reasonably expect from the treatments. Also a lot on how to use diet to slow progression.

Basically the thread of the book is that you can live a long time with prostate cancer and only agressive or progressing cancer needs treatment, as low risk cancer very rarely results in death and if monitored properly can be treated only when necessary. The most important element of treating prostate cancer is quality of life, which will surely get a lot of flack from many doctors and patients.

Blum, who gives the patient's perspective, is a litttle out there at times, but got more entertaining as the book progressed.

The section on how to deal with the side affects of HT is valuable for anyone on HT.

Also is a good section on when to get a biopsy as Dr Scholz feels that men are way over biopsied.

I would definately put it on the reading list as it is not at all technical like Walsh's book and Strum's book and gives good practical advice that you won't find else where.

Definatly would be interested in other's perspectives.

JohnT

Posted 8/27/2010 3:12 AM (GMT 0)
Going to have to get a copy and read this one for myself. Sounds like a good initial review from you.
Posted 8/27/2010 4:47 AM (GMT 0)
Hi John,

Thanks for the heads up on this source of information. Sounds interesting, especially for the newly diagnosed. I may have to look at this book a little closer as time goes by.

All the best to you.

Mag.

Posted 8/27/2010 11:44 AM (GMT 0)
I should be receiving the book today via mail, shipped on the 23rd. Will be on it as soon as I can get it, then may comment on something in particular. John is there anything in the book that took you by surprize or something you have not heard elsewhere????
Posted 8/27/2010 2:48 PM (GMT 0)
"Basically the thread of the book is that you can live a long time with prostate cancer and only agressive or progressing cancer needs treatment, as low risk cancer very rarely results in death and if monitored properly can be treated only when necessary. "

There is going to be plenty of "discussion" on this point..AGE has much to do with it..Sure, if you are 70-80 years old when diagnosed with low-risk PC, the best treatment is probably nothing..

But today, with the new awareness of PSA testing, many men are being diagnosed in their 40's and 50's as threads on this board will verify...But cancer is cancer, low-risk or not, and given enough time "low-risk" can turn into "Terminal Illness"..

I suspect the book is trying to get U-docs, R-docs and surgeons to put the patients best interests first and not their OWN financial best interest with benefits little from "Watchful Waiting"..
Posted 8/27/2010 4:00 PM (GMT 0)
I haven't got my book ordered yet, but I was just wondering if Scholz expresses any opinions on using dutasteride in low grade cancer? I get the impression that Myers favors using it with low-risk disease. I've also seen an editorial comment attributed to Walsh (regarding the recent "prevention" trial) stating that it likely inhibits growth of minimal disease rather that actually preventing it from occurring in the first place. Sorry for getting a little off-topic.
Posted 8/27/2010 4:06 PM (GMT 0)
Fairwind,

You are dead wrong, all cancer is not the same and definately all cancer is not terminal.

This is what we have been led to believe for a lot of different reasons, which Scholz goes into.

The numbers are pretty clear, if you are over 50 and put a % in back of your age this is the probability that you have PC. This has been confirmed numerous time by autopsy. Yet only 3-4% of these men will die from prostate cancer. If only 16% are ever diagonosed what happens to the rest. Answer, they live to old age without any symptoms.

Zufus:

Some things that stuck out:

He never relies on free psa, because it is too impricise.

Epstein's research found that when psa density is 50% above expected, agressive cancer was likely. (prostate size in cc divided by 10 = expected psa. If actual psa is 50% greater than this, it is likely to be agressive and not indolant.

JT

Posted 8/27/2010 6:18 PM (GMT 0)
El Pero,
He mentions that he has a 55 year old patient that he has been treating with only proscar and diet change for the last 13 years with stable psa and no signs of any progression.
JT
Posted 8/27/2010 6:50 PM (GMT 0)
Thanks John I got my book and on page 65 right now. It is starting out as Blums history with his diagnosis and mindset to look at this from many angles and not rush into decisions that he had a right to challenge (he is not easily swayed let's say). So far very interesting and shows the progression of Dr. Scholz beginnings in medicine and how he got to be Dr. Scholz in effect. I will have to get back to you after reading it all. No doubt this will cause discussions.

This is nothing like Dr. Strum's book at all, thus far. It is more of a biographical nature of Blums travels and Dr. Scholz being his onco-doc later along the way...thus far..page 65 only.
Posted 8/27/2010 7:30 PM (GMT 0)
"Fairwind,
You are dead wrong, all cancer is not the same and definately all cancer is not terminal."

I didn't say it was...But there is only ONE WAY to be SURE what you are dealing with. Watchful waiting will not bring you that knowledge...

I know, from personal experience with blood relatives, that what is recorded on the death certificate is NOT necessarily what you died from..

My mother was diagnosed (at age 97) with terminal brain cancer. They sent her home and put her on "palliative care"..14 months later she died in her home, the family including me gathered around..Her death certificate, in the cause for death box, reads "congestive heart failure"...

So that's one less brain cancer death for the record books...

But you are correct about one thing..By the time we are 70, half the people who were born that year are ALREADY dead and the rest are joining them at a rapid pace..So many prostate glands, cancerous or not, can be left right where they are without changing the life expectancy at all....

Post Edited (Fairwind) : 8/27/2010 3:52:49 PM (GMT-6)

Posted 8/27/2010 9:23 PM (GMT 0)
To JohnT:

Please help on this one, I think I understand your formula above, I have seen you post it to before.

My prostate size was 42cc, divided by 10, equals an "expected" PSA value of 4.2. 50% above that to be considered dangerous would be a PSA of 6.3 (if I am doing this correctly). My final PSA prior to surgery was 16.3, and its important to notice, that there no evidence of any inflamation or infection at any point in time. If my math is correct, then my final PSA was just shy of 400% of the expected PSA, and based on what you said, again hoping I understood correctly, that would strongly indicate a very agressive PC strand. Am I reading this right, or reading too much into it?

Also, is this formula just a rule of thumb, or something that established stats would back up. Not doubting you, just asking you.

Thanks for the help in advance.

Real intersted in everyone's opinion of this new work, with our cancer type, any new work is important to me.

David in SC
Posted 8/27/2010 10:35 PM (GMT 0)
David,
What you did is correct. This is not a rule of thumb, but a formula worked out by Dr Epstien, the formost patholigist in prostate cancer. There are a lot of other ways to use psa also. What Dr Scholz tought me was that every variation from expected psa has to be explained before a diagonosis can be made. In my case I had a psa of 40 but a biopsy showing a Gleason 6, 5%. My expected psa was about 6 and the gleason 6 volume added 1 point for a max of 7. Therefore I had 33 points of psa that were not explained. There were only two possibilities for this, a large undetected transition zone tumor or matastisis. In order to get a correct diagnosis we had to look at both possibilities. Every gleason grade has a formula that can calculate the expected psa for the size of the tumor. If you know the gleason grade and the amount of psa generated by the tumor (benign psa -total psa) you can calculate the tumor size. It amazes me that most doctors don't use this. Tumor size is the best predictor whether the cancer will spread.
The formula that Epstien developed is used to eliminate patients from Active Surviellance; I don't know that it can be used alone to accurrately estimate agresssiveness; it is just one piece. Psa velocity, psa doubling time, PCA3 and psa density taken in combination with Gleason grade and number of positive cores can indicate agressiveness with a high degree of probability. In your case, all of these factors combined indicated you were dealing with an aggressive cancer.

JohnT
Posted 8/27/2010 10:44 PM (GMT 0)
Thanks for your prompt answer. From the beginning, I knew I had some high risk factors. But had never applied it to a formula like that. I have no reason to doubt the doctor's opinion on this. My tumor size was I believe 20%, I can only relate that % in the simplest of terms, that 1/5th of my prostate was cancerous. At the time, even my dr. was shocked that from my dx in 8/2008 my PSA was at 12.3, from 5.8 the year before, and rose to the 16.3 in just 3 months time with no evidence of infection or other cause. I have mentioned before, that in hindsight, from what I have learned here, I wish I had gotten a higher level 2nd reading of my dx slides, I am suspicous that it may have ,been a Gleason 8 instead of a 7, and a Stage III vs. Stage II, I say this only because of how it has reacted all along. It does help prove the theory that Gleason 7's can be hard to predict at times.
Posted 8/28/2010 1:35 AM (GMT 0)
John,

I am curious about how Dr. Scholz would advise me.

Hmmmm.

Retire

Posted 8/28/2010 1:43 AM (GMT 0)
Are you taking any supplements?? Proscar? Avodart?
Posted 8/28/2010 2:08 AM (GMT 0)
Fairwind,

I am not on any medication. The psa reading of 15 was conciously planned so it was clean (no sex, no dre's, no medication). It had been 8 months or more since there had been any sign of infection.

Odd at best. I wonder if my testosterone level is dropping...I am at about that age.

Retire
Posted 8/28/2010 2:10 AM (GMT 0)
Sorry,

I have taken muli vitamins, but the over the counter variety. No more than 150% of the recommended daily allowance, although the vitamins included doses of selinium.

Retire
Posted 8/28/2010 4:17 AM (GMT 0)
Retire,
Sholtz would tell you to wait and get a color doppler and an MRIS and a PCA3 test before you even thought about doing anything. With agressive pc it would be extremely rare for psa to drop that much. My guess is that you did have an infection and a psa of 5 or lower is your normal psa. A one core G6 would never generate a psa of 15 so something else was going on. A rapid rise and decrease in psa is a sign of infection not of pc.
JohnT
Posted 8/28/2010 7:00 AM (GMT 0)
John, that's very interesting info on Dr. Epstein's use of PSA density and grade to estimate tumor size! Do you have a cite to the original article on that?

Here's an article I found along similar lines:

PSA Density Predicts Worse Prostate Cancer Pathology
Jody A. Charnow April 29, 2009 Renal and Urology News

PSA density (PSAD) predicts pathologic upstaging following radical prostatectomy (RP) for prostate cancer, a study found. The finding suggests that PSAD may be an additional parameter that clinicians can use to counsel patients about heir post-operative outcomes, researchers concluded.

Michael R. Abern, MD, a urology resident at Rush University Medical Center in Chicago, and colleagues studied 203 patients, of whom 42 (21%) underwent perineal RP, 124 (61%) had retropubic RP, and 37 (18%) had robotic RP. PSAD was below 0.15 in 43% of subjects, 0.15-0.35 in 43%, and more than 35 in 14%. Compared with men whose PSAD was below 0.15, those with a PSAD above 0.35 were 3.1 times more likely to have extracapsular extension, 2.8 times more likely to have positive lymph nodes, and 40% more likely to have positive margins, Dr. Abern reported.

As a result of study findings, urologists at Rush now use a PSAD above 0.35 as an additional criterion to decide which patients should undergo pelvic lymph node dissections, Dr. Abern told Renal & Urology News.
Posted 8/28/2010 11:50 AM (GMT 0)
This is for Dave (Purg) by aggressive PCa John is mentioning, it is vs. indolent or ***** cat status's of PCa. Context on defining aggressive even in PCa is important, maybe we should call the types of PCa that are extremely resistant to drugs as 'defiant' PCa. Dave as you can witness I am alive and actually still  very well thus far it appears at 8+ yrs., with heavy duty (aggressive) PCa that caused total urinary blockage, high psa levels, and ultra high volume of PCa in every biopsy taken 75-95% and none lower and 12/12 biopsies all loaded, Gleasons 7,8,9's times two (2 sets like that). This means you got more hope than you know for long or longer survival or beating this entirely.

Blum wants you to improve in healing, mind, spirit, body and thus it is written in this same book(this is in effect Mr. Blums book and his words)- the value of "Romancing the Immune System", the guy used humor throughout the book of which humor is found useful to your immune system, also. Negativity is found to diminish ones immune system and/or can become a self fullfilling prophesy in some cases.(he gave an example or two on that). Further he quotes Colin Powell says 'cancer warrior' opposed to being merely a 'survivor'.  Well aware of what this disease can do, maybe not enough of us are aware of intangibles that contribute to living longer or better or defying some odds...includes me and after reading this book helped put into perspective value of diet, nutrition, exercise, positive enforcement of immune system(helps get those killer T cells to play pac-man), trying to define what you are dealing with before jumping into major decisions or major tests or treatments, getting opinions and consultation from others whom had input knowledge or wisdom. He cites a website for reading such:  www.cancerrecovery.org (Foundation for Cancer Research and Wellness) might be worth a cyber trip.  Of course everything in life...has some choices.

Post Edited (zufus) : 8/28/2010 7:09:12 AM (GMT-6)

Posted 8/28/2010 1:00 PM (GMT 0)
Guys,

This is a great debate. I think John T makes some terrific points. I think the one factor we have not taken into account is that pca is a dynamic disease. Even a thorough objective analysis of the current stage and growth rate of a tumor does not predict what it will look like in 5 years. After all, cancer is a genetic abnormality that has the real potential for becoming more abnormal.

Since we are in the dark about what genetic, biological, or environmental factors cause or exacerbate prostate cancer progression,men who choose to do nothing are taking a risk. What a guy does really comes down to his measure of the risk to his life, his willingness to accept that risk and what he has to lose in his life (his responsibility to others)

Tough call all around.

Retire
Posted 8/28/2010 1:05 PM (GMT 0)
Guys,

One final thought, it is also possible that my psa escalation was evidence of cancer growth and whatever was feeding that growth has dropped somewhat or infection. I do have to admit, I would like to know which it is before I get active treatment. (ideally)

Retire
Posted 8/28/2010 1:16 PM (GMT 0)
These are my S.W.A.G. thoughts, which could be junk:
Prostatitus can go undected or uncured by drugs, sometimes your own body can heal this condition (this is truth in urology) www.marinurology.com     www.wmfurology.com


PSA fluctuations can be much bigger than we would grasp, Terry Herbert has proven this at www.yananow.net/PSA101.htm   with PSA 101 course and his own 30 days of constant psa testings...you need to see his results...would blow your mind (psa history is paramount)

Other reasons and factors could come into play, unknowns even lab errors (confirm psa tests)

The next answer would be the heck if I know, what are we Kreskin types in medical world?

S.W.A.G.= scientific wild ass guess (we all can be qualified for this opinion) 

I better bail out now, this was John's post, said more than enough...

Posted 8/28/2010 3:41 PM (GMT 0)
Dave (Purg): Your comment here:


"To JohnT:

Please help on this one, I think I understand your formula above, I have seen you post it to before.

My prostate size was 42cc, divided by 10, equals an "expected" PSA value of 4.2. 50% above that to be considered dangerous would be a PSA of 6.3 (if I am doing this correctly). My final PSA prior to surgery was 16.3, and its important to notice, that there no evidence of any inflamation or infection at any point in time. If my math is correct, then my final PSA was just shy of 400% of the expected PSA, and based on what you said, again hoping I understood correctly, that would strongly indicate a very agressive PC strand. Am I reading this right, or reading too much into it?

Also, is this formula just a rule of thumb, or something that established stats would back up. Not doubting you, just asking you."

This prompts me to post these values that I dug up during various searches:

PCA from indolent prostate endothelial cells: 0.1 / cc

PCA from BPH cells 0.3/ cc

PCA from PCa cells/tumor 3.5/ cc

Be careful tho: a 60 gm prostate could have 50 cc indolent, 9 cc BPH and 1 cc cancer.
(Or if no BPH might have 59 indolent and 1 cancer).

So you can't just take your prostate size and do the math that way.

But i do like the .1 / cc x prostate size as a good starting point for 'normal' --

My 110 gm-er was around PSA 10 when I got my biopsy (and obviously the 5% of 1 core
was not a big PSA contributor -- could even theorize I was just fine up to PSA 11 !!).

That does explain why my GP was never too concerned even when I was pushing PSA 4.7.
Posted 8/28/2010 4:21 PM (GMT 0)
John,
I'm more than half way reading the book. My impression so far, is that too many choose aggressive treatments when in fact they can do well with AS. The authors are definitely against most surgeries, radiations and excessive biopsies. I agree with you on Blum being a little out of it at times but funny in other times. The use of color Doppler is encouraged.
So far I'm enjoying reading it and hope that I never have to use HT.
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