Archive for the ‘prostate cancer book’ Category


if you point your finger at someone, there are three pointing back at you….



Previous post addressing the issue. Be sure to read the link to Walsh’s explanation.

Read Full Post »

From “The Decision”

On one particular occasion (however it has happened countless times) I had just told a patient that his biopsy showed cancer. I began to lay out an overview of the options and happened to start with surgery. Before I could continue, the patient told me, “My brother has a friend who has prostate cancer, and he did radiation because a doctor told him that if he had surgery he’d be impotent and that surgery lets air get to the prostate and will make it spread. My brother and his friend told me to steer clear of surgery.” Now, normally I will take a deep breath and slowly explain the pros and cons of both radiation and surgery and the concept of apples to apples, but sometimes I have a little fun showcasing the folly of how some patients will place so much credence on something someone has told them. On this occasion I said, “Mr. Jones, thank you for sharing that with me. What type of work does your brother do?” “He sells insurance.” “Thank you. And what type of work does your brother’s friend do?” “I think he builds houses.” I then said,” Okay. Based on what you have told me, this is what I’d recommend for your cancer. My advice to you would be for you to do what your brother said his friend was told by his doctor about your brother’s friend’s cancer. Do you have any other questions for me?”

There was a story that was in the news several years ago regarding claims made by several people that the Arkansas  State Patrol would secretly bring women to Bill Clinton when he was governor there. One lady in particular said that Clinton undressed in front of her in a hotel room and that she saw something about him that could prove that he did what she claimed he did. The thing she noticed was never publicized or reported but it was something that she said was “proof positive” that she had seen Clinton without clothes one.

I know what it was. It is a urologic condition that is only noticable if the male is erect. (Follow me here….everything always goes back to urology, prostate cancer, dogs or fish.) I also am a student of politics but try to leave that out on this site…most of the time….the doctors in white coats at the White House supporting Obama’s Health Plan was too much to not to comment on or make fun of….but  I digress.

So here’s the quiz question for today: What urologic condition can only be noted by an observer of a male in the erect state ? This condition cannot be detected by an observer in the flaccid state. 

I know this is very interesting to all of you and that the anticipation of the answer  is killing you. Don’t get bent out of shape….here’s the answer.

Peyronie’s disease.   In this disease there is a fibrous “plague” on the expandable tissues of the penis that in the erect state prevents that portion of the tissue to expand. This in turn curves the penis in the direction of the plague and only detectable when the penis is erect. I would bet that this is the “characteristic finding peculiar to Clinton” to which the lady claimed she saw.

What’s neat about this claim and why it could be used in a novel or detective story is that not only would the person have to be naked, which you can’t prove happened, but there would have been a condition that the accuser, would only know or could testify to, if the defendant was both naked and erect. Brilliant. As you know nothing came of the law suit however we do not know if there was a settlement…. I bet there was because I could have been an expert witness to confirm the lady’s claims from purely a urologic perspective.

So what does this have to do with the link above to the year journey of  the gentleman’s prostate cancer.

Just like the Lockerbie bomber and the lady’s claims about Clinton, as you learn more about prostate cancer and the nuances you can piece together the unsaid or unwritten part of a person’s journey with prostate cancer. Apples to apples, prostates to prostates is how I describe this in my book.

Here are some salient points to get you started. You then read this man’s story…(I haven’t but I don’t need to) and see if you can pick out favorable stuff or unfavorable stuff. Knowledge is power, past is prologue. This actually brings up an interesting point. Do you want to know your prognosis if you have recently been diagnosed with prostate cancer? Do you want to know if your parameters or favorable or not? Well…you do need to know the difference between favorable and unfavorable factors because that might help you decide to value cure over ease of treatment. Knowledge of good signs or bad signs may or may not determine how aggressively you view your cancer and subsequent treatment decisions. Just because uncle Bob did good with his cancer doesn’t mean you will do with yours. It is prostate cancer, but ” ain’t all prostate cancers the same” my frin. 

See if you know which of the following are good or bad, favorable or unfavorable and how each would affect a patients course or ones decision:

  •  a treatment that results in a low PSA that stays there and there is no other treatment given….ever.
  •  additional treatment is necessary…whatever it is
  • the PSA changes upward after the initial treatment
  • there’s evidence prostate cancer in the bone or lymph nodes
  • the path report of a removed prostate reveals perineural invasion
  • the path report reveals seminal vesicle involvement
  • a Gleason’s 6 versus a Gleason’s 8
  • the path report of the biopsy has only one of 12 positive for prostate cancer
  • the biopsy path report has 10 of 12 positive cores
  • you are young when diagnosed
  • you are old when you are diagnosed
  • the radiation therapist wants you to be on hormone therapy before he begins radiation treatment
  • hormone therapy corrects the elevated PSA and then the PSA comes back up on hormonal therapy
  • you are on casodex, your PSA rises, you stop the casodex, and your PSA goes back down
  • you have had radiation with pellets (brachytherapy) and at about 18 months the PSA begins to rise…reason to worry?
  • PSA bounce after radiotherapy
  • the path report of the prostate removed has extra-prostatic extension
  • the path report of the prostate removed shows capsular penetration
  • the prostatic acid phosphatase is elevated (bet you don’t know this one)
  • Gleason’s 6, small biopsy volume, path without seminal invasion,no capsular invasion, in the center of the gland away from the apex, urethra margin and away from seminal vesicles, small volume on final prostate path report

This is just the start of it…. and the reason the “Decision” is so hard…the above doesn’t even consider all the potential affronts to the male ego as it relates to continence and potency. That is a whole “nother” chestnut.

So when it comes to prostate cancer and you read about it or hear about it from others….read between the lines and consider everything.


Read Full Post »

no stick is too unimportant or too big for the pepster

Charles B. Huggins

Prostablog post on L.B.

A few nuances about prostate cancer and hormone therapy.

  • Hormone suppression does not cure prostate cancer. It will allow a person to live longer. Whether you start hormone suppression early on in the disease or later has very little affect on the ultimate life expectancy.
  • Different prostate cancers ( volume of disease and Gleason’s score) respond differently to hormone therapy.
  • There are varying populations within a particular person’s prostate cancer of hormone sensitive and hormone insensitive prostate cancer cells. ( The more hormone sensitive cells the better response to hormone deprivation.)
  • If there is a beneficial response i.e. the PSA goes down, how long that effect lasts varies from person to person as well.
  • If there is a beneficial response… in time the cancer figures that out and begins to populate more hormone insensitive cells.
  • As a result hormone therapy delays, to varying lengths of time and degrees, but does not cure prostate cancer.

That is all for now… I will lay out later the most probable scenario for the L.B. For any urologist to even try to predict the life expectancy of a patient, the patient would have had to been well beyond the phase of androgen insensitivity i.e. the PSA went down and then over time it went back up and there was evidence of metastatic bone disease. (Androgen refractory) At the very least a doctor should have said that the time to death was unpredictable given the known nuances of prostate cancer and hormone therapy.


Read Full Post »


a good doctor prescribes the bark of the quinquina when the patient would be obliged to eat the whole tree

He adds that, in general, 15 to 25 percent of men whose initial biopsy shows a low-risk prostate tumor will actually have a high-grade cancer upon further review of the entire prostate once it is removed.

So…how big a boy are you?  It seems to me that some patients wear the decision to pursue active surveillance on their sleeve, as if by doing nothing places them on the cutting edge of prostate cancer treatment. (See Clark Howard post) Here’s a question for you….what is wrong with the philosophy that one will do something when things get really bad? I think you know.

Now back to surveillance. If you know from the get go that you have about a 20% chance that your prostate cancer is actually more aggressive than your biopsy reports suggests, then how does that flavor your confidence to pursue surveillance. I am not saying it is wrong to make that choice, but see it for what it is: possibly making a decision on a flawed premise. Read the report below for yourself. By the way I have a patient that included in this study…he is 80 and enrolled in the program about 3 years ago. ( That’s another thing…if you making decisions on patients that are in their late 70’s and your are mid 50’s, then you are not comparing apples to apples or prostates to prostates.

So, surveillance…are you Okay with risk that while you are waiting for proof that your disease is more aggressive than you thought and that by the time you act….it may not be as favorable  as it would have been if you had acted from the start.

How big a boy are ya?

Johns Hopkins experts have found that men enrolled in an active surveillance program for prostate cancer that eventually needed surgery to remove their prostates fared just as well as men who opted to remove the gland immediately, except if a follow-up biopsy during surveillance showed high-grade cancer.

Active surveillance, or “watchful waiting,” is an option open to men whose tumors are considered small, low-grade and at low risk of being lethal. Given the potential complications of prostate surgery and likelihood that certain low-risk tumors do not require treatment, some men opt to enroll in active surveillance programs to monitor PSA levels and receive annual biopsies to detect cellular changes that signal a higher grade, more aggressive cancer for which treatment is recommended. Yet, according to the Johns Hopkins experts, there is concern that delaying surgery in this group until biopsy results worsen may result in cancers that are more lethal and difficult to cure.

Bruce Trock, Ph.D., associate professor at the Johns Hopkins Brady Urological Institute, and his colleagues compared the pathology results of men in an active surveillance group at Johns Hopkins who later had surgery with those who also had low-risk tumors and opted for immediate surgery.

Results initially showed that 116 active surveillance participants who had surgery were more likely to have high-grade, larger tumors than 348 men who had immediate surgery. But Trock says that these results were found only in 43 (37 percent) men in the surveillance group who were recommended for surgery because a follow-up biopsy during surveillance worsened to indicate a high-grade tumor.

Gee whiz….ONLY 37% of follow-up biopsies during surveillance worsened….That’s good isn’t it….or is that bad?

“We think that these men had high-grade tumors to begin with that their initial biopsy missed, and this group may be over-represented in men who are recommended for treatment after an initial period of active surveillance,” says Trock. He adds that, in general, 15 to 25 percent of men whose initial biopsy shows a low-risk prostate tumor will actually have a high-grade cancer upon further review of the entire prostate once it is removed.

Apart from the 43 men whose pathology results worsened during surveillance, the remaining men in the surveillance group had similar pathology results at surgery to those in the immediate surgery group. “This means that most tumors are not likely to worsen during the period of active surveillance,” says Trock.

The researchers calculate that the risk of finding high-grade tumors in the entire group of 801 active surveillance patients is low — about 4.5 percent per year.

Trock is leading a National Cancer Institute-funded study with four other cancer centers to identify biomarkers that may identify men who have worse tumors than their initial biopsy indicates.

The Johns Hopkins Active Surveillance program, led by H. Ballentine Carter, M.D., of Johns Hopkins, has enrolled 801 men since 1995 and is believed to be the largest such program in the U.S. Fourteen men in the program who later had radiation and four who had radical prostatectomy developed recurrences, but no participants have developed distant metastases and none have died from prostate cancer. Fourteen men in the program died from other causes unrelated to prostate cancer.

The current study was funded by the Johns Hopkins Prostate Cancer Specialized Program of Research Excellence (SPORE) grant awarded by the National Cancer Institute and by Dr. and Mrs. Peter S. Bing. The research also was presented at the American Urological Association Annual Meeting (Abstract #1062).

Based on abstracts and presentations by Johns Hopkins Kimmel Cancer Center scientists at the annual meeting of the American Society of Clinical Oncology (ASCO), June 4-8, in Chicago.


Vanessa Wasta

Johns Hopkins Medical Institutions

Read Full Post »

Medical News Today

Walk your dog and diagnose your neighbor’s prostate cancer.

Dogs Trained To Effectively Sniff Out Prostate Cancer

02 Jun 2010   

Dogs can be trained to correctly identify certain prostate cancer cell-derived volatile organic compounds (VOCs) in urine, according to new data from researchers in Paris. These promising new data were presented on June 1, 2010 during the 105th Annual Scientific Meeting of the American Urological Association (AUA). The session was moderated by AUA Public Media Committee Chair Anthony Y. Smith, MD.

In recent years, new findings have emerged to indicate that dogs, due to their strong scenting ability, are capable of detecting cancer. Past studies have focused on breast, lung and bladder cancers. This new study addresses the ability of canines to accurately detect the presence of prostate cancer.

Using urine samples from 33 patients with biopsy-confirmed prostate cancer, researchers trained dogs (using the clicker-training method) to recognize the characteristic olfactory signatures of prostate cancer-derived VOCs. The dogs were then trained to discern cancer urine from control urine and, finally, were asked to signal cancer urine from among five individual samples (only one was from a patient with confirmed cancer). Sensitivity and specificity were 100 percent and 91 percent respectively; of the 66 total urine samples (33 in each group), the dogs correctly classified 63 samples. The negative predictive value was 100 percent.

“These data suggest that prostate cancer tumors may excrete certain VOCs that turn up in a patient’s urine and that this ‘scent’ may be specific to prostate cancer,” said Dr. Smith. “What we need to do now is figure out what those VOCs are and whether or not we can develop a specific test to identify them. But, don’t be surprised in a few years if we have to ‘call in the dogs’ to make a diagnosis-if it holds up, the dogs are better than PSA!”

Source: American Urological Association

Read Full Post »

a wise man doesn't need advice...a fool won't take it

It’s funny… Richard Ablin  kept on referring to all the money that urologists make doing biopsies and PSAs. When people start striking right at the money that ” those rich doctors” make, I’m sorry, I just tune out. To me this mindset has a preconceived notion that then flavors and influences that person’s view of the whole subject. I believe it taints it.  I received a delightful comment earlier today and in it there was mention ” tumor seeding.” It is a very common question and concern of patients of mine. The correct answer to the question is that tumor seeding from the prostate at the time of prostate biopsy has not been proven or shown to occur. Does that mean it hasn’t happened? No. Maybe it has.  It took about two seconds to find a discussion on seeding and how bad the urologist is for not telling everybody that he could spread their cancer. Here’s the deal. How will we get the specimen to see if there is cancer? We got to get it somehow. So… is  the risk of having undiagnosed cancer less than the risk of seeding the biopsy track or vice versa. I don’t know. In my 24 years I have never seen or heard of any patient having an issue with seeding. Look at it this way and remember this as you read the remarks from below, by the way this debate must have been going on in 2002 also, but then consider this. You have voluntarily gone to a urologist and now you have taken the time out of your schedule, you’ve had a PSA which is high, and exam by your family doctor, and now you are there with the “specialist.” What do you do?  Well, go prepared, ask a bunch of questions, determine if the doctor is reasonable, likable and competent, discuss the deal with the doctor and your family and friends and make a decision.  Note the angst in the piece below and in Ablin’s op- piece. You’ll see what I mean. Also see how I got a little testy in my response  to his letter that was written to but not accepted by the NYTs.

Re: Re: Prostate Biopsy — Spread Cancer Cells??

Post a new topicby Guest on Sun May 12, 2002 11:36 am

You and other urologists appear to be oblivious to this risk. There is much anacdotal evidence posted on the Internet about this risk under “needle tract seeding” and “needle tract metastasis”. One study puts the risk of needle tract seeding (spreading the cancer) at 0.5% (1 in 200) and another at 5.0% (1 in 20). FYI, theses studies are not prostate biopsy studies but have examined the needle biopsy seeding risk from adrenal, liver and carcenoma biopsies. Also, check out the newsgroup sci.med.diseases.cancer.

If the odds of needle tract seeding are .5% to 5.0%, this suggests that prostate biopsies should be used VERY SPARINGLY. Since PSA test results lead to many unnecessary biopsies being performed, many men are exposed to this risk.

In my case, it appears that my prostate cancer would still be confined to the prostate capsule, except that I had the prostate biopsy three years ago. Of course, the only way to prove that needle tract seeding occured is via an autopsy. That’s the interesting thing about proving that needle tract seeding occurs: the evidence is destroyed during surgical removal. And I doubt that many autopsies look for needle tract seeding. Be assured, mine will.

Why do you think urologists turn a blind eye to this risk? Could it be that without PSA tests and needle biopsies showing that men have prostate cancer, they would lose a lot of cash flow business in the form of radical prostatectomies? BTW, only 3% of men die of prostate cancer because it is usually confined to the prostate capsule and very slow-growing.

The medical community needs to rethink the needle tract seeding risk in the context of prostate cancer and the characteristics of prostate cancer. I only wish that my urologist had told me about this risk. FYI, I asked and got the same answer that you gave me on the Internet, i.e. the wrong answer.

Read Full Post »

Meaning of song
The lyrics tell of the last days of the American Civil War and its aftermath. Confederate soldier Virgil Caine “served on the Danville train,” the main supply line into the Confederate capital of Richmond, Virginia. General Robert E. Lee’s Army of Northern Virginia is holding the line at the Siege of Petersburg. As part of the offensive campaign, Union Army General George Stoneman’s forces “tore up the track again”. The siege lasted from June 1864 to April 1865, when both Petersburg and Richmond fell, and Lee’s troops were starving at the end (“We were hungry / Just barely alive”). Virgil relates and mourns the loss of his brother: “He was just eighteen, proud and brave / But a Yankee laid him in his grave.”

Ralph J. Gleason (in the review in Rolling Stone (US edition only) of October 1969) explains why this song has such an impact on listeners: “Nothing I have read … has brought home the overwhelming human sense of history that this song does. The only thing I can relate it to at all is ‘The Red Badge of Courage’. It’s a remarkable song, the rhythmic structure, the voice of Levon and the bass line with the drum accents and then the heavy close harmony of Levon, Richard and Rick in the theme, make it seem impossible that this isn’t some traditional material handed down from father to son straight from that winter of 1865 to today. It has that ring of truth and the whole aura of authenticity.”

Robertson claimed that he had the music to the song in his head but had no idea what it was to be about. “At some point [the concept] blurted out to me. Then I went and I did some research and I wrote the lyrics to the song.” Robertson continued, “When I first went down South, I remember that a quite common expression would be, ‘Well don’t worry, the South’s gonna rise again.’ At one point when I heard it I thought it was kind of a funny statement and then I heard it another time and I was really touched by it. I thought, ‘God, because I keep hearing this, there’s pain here, there is a sadness here.’ In Americana land, it’s a kind of a beautiful sadness.” [1]

[edit] Context within the album and The Band’s history
According to the liner notes to the 2000 reissue of The Band by Rob Bowman, the album, The Band, has been viewed as a concept album, with the songs focusing on peoples, places and traditions associated with an older version of Americana.

Though never a major hit, “Dixie” was the centerpiece of The Band’s self-titled second album, and, along with “The Weight” from Music From Big Pink, remains one of the songs most identified with the group.

The Band frequently performed the song in concert, and it can be found on the group’s live albums Rock of Ages (1972) and Before the Flood (1974). It was also a highlight of their “farewell” concert on Thanksgiving Day 1976, and is featured in the documentary film about the concert, The Last Waltz, as well as the soundtrack album from the film. It was #245 on Rolling Stone Magazine’s list of the 500 greatest songs of all time.[2]

The last time the song was performed by Helm was in The Last Waltz (1978). Since Robertson went to the record label and claimed that he wrote the music and lyrics, he has writing credits to the song (and most other songs by The Band, including “The Weight”). Helm, a native of Alabama, claims to have contributed significantly to the lyrics. In his 1993 book ‘This Wheel’s on Fire’, Helm writes ‘Robbie and I worked on “The Night They Drove Old Dixie Down” up in Woodstock. I remember taking him to the library so he could research the history and geography of the era and make General Robert E. Lee come out with all due respect.'”

Levon Helm refuses to play the song and it has not been heard live since 1978 even though Helm holds concerts, which he calls “Midnight Rambles”, several times a month at his private residence in Woodstock, NY.

The Night They Drove Old Dixie Down lyrics
Songwriters: Robertson, Robbie;
Virgil Caine is the name and I served on the Danville train
‘Til Stoneman’s cavalry came and tore up the tracks again
In the winter of ’65, we were hungry, just barely alive
By May the tenth, Richmond had fell
It’s a time I remember, oh so well

The night they drove old Dixie down
And the bells were ringing
The night they drove old Dixie down
And the people were singing
They went, “La, la, la”

Back with my wife in Tennessee, when one day she called to me
“Virgil, quick, come see, there go the Robert E.Lee”
Now I don’t mind choppin’ wood, and I don’t care if the money’s no good
Ya take what ya need and ya leave the rest
But they should never have taken the very best

The night they drove old Dixie down
And the bells were ringing
The night they drove old Dixie down
And all the people were singing
They went, “La, la, la”

Like my father before me, I will work the land
And like my brother above me, who took a rebel stand
He was just eighteen, proud and brave, but a Yankee laid him in his grave
I swear by the mud below my feet
You can’t raise a Caine back up when he’s in defeat

The night they drove old Dixie down
And the bells were ringing
The night they drove old Dixie down
And all the people were singing
They went, “Na, na, na”

The night they drove old Dixie down
And all the bells were ringing
The night they drove old Dixie down
And the people were singing
They went, “Na, na, na”

Read Full Post »

Older Posts »