Prostate Cancer

<p>A dear friend of mine of over 30 years has been diagnoced with prostate cancer. He is 52 years old, has always been a strapping athlete, 6'2, 200 lbs, with being diabetic for about 20 years. From basic info on medical websites, it seems the average age for prostate cancer is around 70 years old, and they seem to give good odds on survival for 5 years. Studies say a 5 year survival rate is pretty good for 70, with or without an illness, they really don't know how much the cancer contributes to a death rate at that age. I can't seem to find much about prognosis in younger men. I'd appreciate any information if you have known somebody that has gone through this.</p>

<p>GA2012MOM, I'm sorry about your friend. My father was a relatively young man when he developed prostate cancer. I wish I could point you to some good websites, but I suspect much of your friend's prognosis will depend on the stage and grade of his cancer rather than his age. Interestingly, my father was also a diabetic and a vigorous exerciser. Many men live a very long time with prostate cancer and I do hope your friend is one of them.</p>

<p>Prostate cancer is very treatable with early detection. There are a number of options. My husband had the robotic surgery in 2006 and is completely clear at this point. Most of the men I know opt for the robotic surgery, but there is a radiation option, too. It is VERY important for men to get the PSA screenings. In older men, if the cancer is in early stages, sometimes the doctor will recommend no treatment. Please send me a PM if you or your friend would like to talk to my husband.</p>

<p>GA2012MOM, I sent you a PM.</p>

<p>There is no evidence that the robotic surgery has better results than "traditional" open surgery. (The incision for open surgery is much smaller now than in was 20 years ago.) Robotic surgery costs about two or three times as much, and requires significantly more time under anesthesia. And in fact there are some ways in which it can be inferior: for example, if the tumor is near the nerve bundles, a skilled surgeon can literally feel with the fingers whether there is likely involvement, while the robotic surgeon simply cannot tell. (Prostate tumors are not visible or detectable on scans.) It can be easier for the surgeon in the open method to biopsy lymph nodes, etc. I'm not saying that robotic surgery is bad, I'm just pointing out that use of highly expensive technology does not make it superior. In both cases, it is likely to take several hundred procedures before the surgeon is operating at peak expertise. </p>

<p>From what I've learned, radiation instead of surgery is most likely to be chosen for a patient who is not well enough to withstand surgery. Radiation, like all other therapies, has progressed, but it is definitely not superior in terms of avoiding side effects and complications such as incontinence and impotence, and can very likely have added complications as a result of unavoidable damage to the rectum and bladder and other surrounding structures. It is also impossible to address possible lymph node involvement with radiation.</p>

<p>The age of your friend probably has little to do with his prognosis. The stage of the tumor has everything to do with it. There are well-established statistical scales based on tumor stage and PSA. There is an enormous amount of information available online through Johns Hopkins.</p>

<p>My H, an extremely fit 56 yr old, had prostate surgery in March. He just received the results of his first post-op PSA: negative.</p>

<p>Dad just turned 80. He had prostate cancer at 70. Had regular
psas every 6 mos. The one month it jumped/ doubled it was lost in chart. The dialysis dr caught it several mos later when rcords were shared. I cannot remember he grades etc but I do remember mom asking dr on scale 1 to 10 how bad. 10 being worse, it was a nine. Mom shopped around looking for a "better" diagnosis. I finally was able to get them to go with me. We ended up at loma Linda. They are close to city of hope and I set up appt but mom cancelled when they asked the name of his meds a second time. They went to USC but mom didn't like diagnosis (he still had cancer). He had to have proton and then regular radiation. Usually proton is sufficient. Seems like every patient feels there's was best treatment. Dad is fine despite the severity and his renal disease. He is not diabetic I wish your friend the best and I think there are many options available. My guess is he will have options to choose from and he will be fine.</p>



<p>Stage is not everything. Tumor grade is also very important. Tumor Grade, in prostate cancer called the "Gleason Score," is a measure of how differentiated the cells are and offers some prediction of how aggressive the tumor is likely to be.</p>

<p>Also, age is a very important consideration in prostate cancer. A younger man (say in his 50s) needs to be treated much more aggressively than a guy in his 80s who is very likely to die of something else long before the cancer can take him down.</p>

<p>The PSA levels are not the only marker for prognosis. If he is having surgery they will present numbers after the surgery. Is he having the nerve sparing surgery? When someone is this young that is the best way to go.</p>

<p>I'm a practice manager for a group of urologists. Like others have posted above, the Gleason score on the prostate biopsy will be very important in determining the treatment recommendation as well as the staging work-up (bone scan and abdominal/pelvic CT scan to look for bone lesions and enlarged lymph nodes). There are several options of treatment including an open radical prostatectomy which includes lymph node dissection, the daVinci robotic prostatectomy, brachytherapy (which is radiation seed implantation) and external beam radiation therapy (our center utilizes the Calypso marker which is like a GPS for pinpointing the radiation to the exact location). There are a couple of newer therapies like cryotherapy and proton beam therapy but I'm afraid I'm not familiar with these. The other option is active surveillance where the patient opts to have no treatment but watch the PSA and digital rectal exams every three months and has a repeat biopsy at one year's time. This is just coming to light as a viable alternative for some patients, although with your friend in his early 50's, this might not be his best option. Please don't rule out radiation therapy based on information on this board. Surgery also leads to incontinence and impotence (even the "nerve-sparing" surgery). Each treatment has good success rates and pros and cons. Your friend's urologist will go over all of this with them. A second opinion at a tertiary center in your area might be a good idea also. Good luck.</p>

<p>GA2012MOM, my main motorcycle traveling buddy (probably 100,000 miles together) has been battling this bastidge for over 6 years. Missed one PSA. As luck would have it, that was the one. </p>

<p>Reminds me to schedule mine.</p>

<p>Many, many good thoughts headed your friend's way.</p>

<p>A member of my family was diagnosed with advanced prostate cancer at age 45 after symptoms sent him to his doc. His first PSA was off the charts, don't remember the number but it was very high. Seemed so wrong to us as PSAs aren't advised until age 50 and he was so young. </p>

<p>He participated in an experimental study at a top research hospital, went through various surgical procedures, chemo, etc. and fought like hell. Sadly, he survived less than a year. As we know, early diagnosis is the key to this horrid disease. I pray your friend caught his early.</p>

<p>Sending you and your friend my best wishes for a good outcome.</p>



<p>It's important to distinguish bewtween the two different uses for the PSA test. One is cancer detection. This is the use that typically begins at age 50. You take yearly tests and if the PSA starts to rise you get a check-uo and do further tests to see if there might be cancer. The other use is cancer monitoring. This is where someone already has cancer and is being treated and the doc can track the success (or not) of the treatments by the rise and fall of the PSA levels. This is usually done in prostate cancer cases no matter what the age of the patient. </p>

<p>At 45 your family member was too young to have begun routine detection testing, and that probably delayed his diagnosis. But since his cancer had eventually been diagnosed based on symptoms it was entirely appropriate to then use the test to monitor the treatments. </p>

<p>Prostate cancer in the age 40s is rare but not unheard of. I'm sorry to hear that your relative fell vicitim to this disease.</p>

Stage is not everything. Tumor grade is also very important. Tumor Grade, in prostate cancer called the "Gleason Score," is a measure of how differentiated the cells are and offers some prediction of how aggressive the tumor is likely to be.


<p>Yes, I was too vague. There are three elements (the stage, the Gleason Score, and the PSA) that taken together are fed into the Partin Tables, that give statistical predictions based on thousands of patients of whether the disease is likely to involve lymph nodes, spread beyond the gland, and so forth. That, plus the patient's age and health, suggests whether to consider watchful waiting, surgery of some type, or some other course of treatment. </p>

There are a couple of newer therapies like cryotherapy and proton beam therapy but I'm afraid I'm not familiar with these.


<p>We were told that whether or not proton beam therapy is considered apparently has a lot to do with access to the hugely expensive and rare machines. In the Boston area, for example, almost of the available time on the--I think--one machine is scheduled for childhood cancers, and it is booked up very far in advance. In Florida, it is reportedly more feasible to schedule a prostate patient. Cryotherapy, if I recall correctly, may make the delicate nerve-sparing procedures more difficult to execute successfully.</p>

<p>Regarding radiation, I think that lot of people automatically assume that it has fewer or less severe side effects than invasive surgery, but that's not necessarily true. It's natural for people to shy away from surgery. A combination of surgery and radiation is also possible, depending on the situation, and can have great results </p>

<p>There have been major strides in treating prostate cancer since my father was diagnosed and first treated almost 20 years ago. And there is tons of great information available on the internet. The JHU site is an obvious option, but there are many good ones.</p>

<p>BTW, on the second opinion front, people shouldn't overlook the value of getting a second pathology opinion on the biopsy to determine the Gleason Score. You can have your samples sent to the labs of one of the famous hospitals without paying for an additional consultation with a urologist or surgeon at that hospital. What to do if the scroes are significantly different is another matter, of course. My H and a friend of ours both had the experience of a 7 (3 + 4, not 4+3) turning into a 6, but both were young so it didn't alter the course of treatment.</p>

My father was diagnosed with stage 4 prostate cancer at age 52 in 1986. He had what was described as very aggressive treatment at the time. They knocked it into remission until 2008. He now has what is considered a chronic cancer diagnosis, not dissimilar to Elizabeth Edwards. He enjoys a phenomenal quality of life. While this is of course is anecdotal, I hope it gives you comfort.</p>