Interesting article in Washinton Post today

Here is the full link to the article.
When his PSA score spiked, prostate surgery loomed, but NIH offered another way.

-Gedman

a second opinion won't kill you.

What do you think of NCI & their advance MRI trials? Is it just for AS patients?

How exactly did you just learn that you were not a candidate for AS. You also mentioned that you are just trying to figure it out. Have you read any pca book, walshes, scardino etc.

The WaPo article is decent but, while it mentions that there are controversies surrounding the diagnosis and treatment of prostate cancer, it seems to have taken one side and to be oddly incurious about the other. Hopkins is one of the premier institutions in the world for prostate cancer. I would have been interested in hearing the thinking of the Hopkins surgeon when he made his recommendation.

The central point of the article is sound: men with prostate cancer almost always have the time it takes to get second opinions and gather additional information about their disease before they decide on a treatment, and they should not let fear or over-eager doctors rush them. My problem, in your context, is that they present one anecdotal story of one doctor at Hopkins who gave questionable advice on one occasion, without giving any details of the data that he was shown or why he said what he said, and it would be a pity if the article talked you out of getting a second opinion there.

I am all about second opinions. In my case a second reading of the samples from the third of my four biopsies re-scored my single positive biopsy core from Gleason 6 to 7 and provided the impetus to seek treatment (against the advice of a second-opinion surgeon who counseled waiting.) Given my post-op pathology it is clear, in retrospect, that my decision to treat was appropriate.

So, my advice would be to go ahead with you second opinion at Hopkins and look into the MRI as well (if you insurance will pay or you can otherwise afford it.)

Hi goodhealth2u, and welcome.   I’ll provide comment/reply on a couple of the specific questions/comments your raised.   In my reply, I will be referencing the NCCN “risk categories” which are defined in the thread titled, “ Newly diagnosed with PC? – read this thread first ” so please review those by clicking on that link.   Please note that thread is still new and growing, so it is somewhat incomplete as of today in terms of needing more good information added to it…but what is there is good.   The PC patients with NCCN designation as “ VERY LOW RISK ” include the very best candidates for active surveillance (AS).   AS is the only NCCN recommended treatment for men in this category with less than 20 years life expectancy (life expectancy is a better indicator than age because of varying health conditions).   For men with greater than 20 years life expectancy, NCCN recommends either i) AS, ii) surgery, or iii) radiation therapy, where the choice among these is more of an individual decision weighing many personal factors. You will notice that one of the criteria for “ VERY LOW RISK ” is that no biopsy core is >50% cancer (you had one core at 70%).   You have no doubt learned by now that biopsy sampling has an element of randomness and variability…the typical 12-core biopsy samples only about 1% of the typically sized prostate.   This is touches directly upon the benefit of one getting the additional MRI scan discussed in the article… especially if one pursues AS treatment path.   The NCCN criteria for no core >50% was a factor-of-safety criteria created for the vast majority of men today who pursue only the traditional 12-core TRUS-biopsy.   An MRI would provide someone with case characteristics like yours extremely valuable additional information—beyond the traditional biopsy information—if they chose to pursue AS.   For completeness of the discussion, the PC patients with NCCN designation as “ LOW RISK ” include many men who are also good candidates for active surveillance.   AS is the only NCCN recommended treatment for men in this category with less than 10 years life expectancy.   For men with greater than 10 years life expectancy, NCCN recommends either i) AS, ii) surgery, or iii) radiation therapy, where the choice among these is more of an individual.   In my opinion, for anyone who might be considering AS, getting into a NCI (or other) study which includes prostate MRI scans would be a huge boon.   Hope this helps…  

When researching, who are we talking about ?

I found this http://cassellfenichel.com/

Last paragraph in article.

((For more information about the MRI protocol for prostate cancer, contact Peter A. Pinto of the National Cancer Institute at 301-496-6353 or NCI’s Clinical Trials Referral Office at 888-NCI-1937)). 

Thanks to all of you. Great information. I called the National Cancer Institute today. They have been over whelmed with calls from the Washington Post article. They took my # and said one of the researchers will call me back. Tomorrow Im calling John Hopkins. Can you get this type of MRI mentioned in the article anywhere? I think it will be very hard to get into NCI...

Post Edited (goodhealth2u) : 2/27/2013 8:14:15 PM (GMT-7)