Posts Tagged ‘radiation after prostatectomy’

don't punish a child for bed wetting....even the lowliest of animals will not sleep in their own urine....

don’t punish a child for bed wetting….even the lowliest of animals will not sleep in their own urine….

I ‘m the one in the blue diapers- When it comes to prostate cancer treatment decisions the likelihood of cure is only one of the factors to take in consideration. ps…I made the diapers out of the corner of the envelope the card came in….clever huh?


Prostate Cancer Treatments Often Cause Side Effects

05 Feb 2013

Prostate Cancer Study Tracks Long-term Urinary, Sexual and Bowel Function Side Effects Following Therapy

A new study comparing outcomes among prostate cancer patients treated with surgery versus radiotherapy found differences in urinary, bowel and sexual function after short-term follow-up, but those differences were no longer significant 15 years after initial treatment.

The study, led by first author Matthew Resnick, M.D., instructor in Urologic Surgery, Vanderbilt University Medical Center, was published in the Jan. 31 issue of the New England Journal of Medicine.

From Oct. 1, 1994, through Oct. 31, 1995, investigators enrolled men who had been diagnosed with localized prostate cancer in the Prostate Cancer Outcomes Study (PCOS).

For the current study, investigators followed 1,655 men between the ages of 55 and 74 from the PCOS group, of whom 1,164 (70.3 percent) had undergone prostatectomy, while 491 (29.7 percent) had undergone radiotherapy. At the time of enrollment, the patients were asked to complete a survey about clinical and demographic issues and health-related quality of life. The men were contacted again at set times following treatment and were asked about clinical outcomes and disease-specific quality of life issues.

Men whose prostates had been surgically removed were significantly more likely than those who received radiation therapy to report urinary leakage at two years and five years. However, at 15 years, the investigators found no significant difference in the adjusted odds of urinary incontinence. Nonetheless, patients in the surgery group were more likely to wear incontinence pads throughout the 15-year follow-up period.

Men in the prostatectomy group were also significantly more likely than those in the radiotherapy group to report having problems with erectile dysfunction two years and five years after surgery.

“At the two- and five-year time points, men who underwent prostatectomy were more likely to suffer from urinary incontinence and erectile dysfunction than men who received radiation therapy,” explained Resnick. “While treatment-related differences were significant in the early years following treatment, those differences became far less pronounced over time.”

Despite early and intermediate-term data revealing treatment-dependent differences in patterns of sexual dysfunction, after five years both groups had a gradual decline in sexual function. At 15 years, erectile dysfunction was nearly universal with 87 percent in the prostatectomy group and 93.9 percent in the radiotherapy group reporting sexual difficulties.

The authors noted that age may have played a role in the patients’ waning sexual function, as shown in unrelated studies.

Some patients also experienced problems with bowel function in the years following treatment.  Those who were treated with radiotherapy had more problems in the short term. Men in the radiotherapy group reported significantly higher rates of bowel urgency than those in the prostatectomy group at two years and five years. However, at 15 years, despite absolute differences in the prevalence of bowel urgency between the two groups, the researchers found no significant difference in the odds of bowel urgency. Men who had been treated with radiotherapy were significantly more likely to report being bothered by bowel symptoms at both the two-year and 15-year points.

“This study of 15-year outcomes represents a mature portrait of quality of life issues following prostate cancer treatment,” said David Penson, M.D., MPH, Ingram Professor of Cancer Research, professor of Urologic Surgery and Medicine, and director of the Vanderbilt Center for Surgical Quality and Outcomes Research, the senior study author.

“Regardless of the form of initial treatment, patients in this study had significant declines in sexual and urinary function over the duration of the study. The causes of these declines probably include advancing age and additional cancer therapies, in addition to the original therapy,” Penson said. “Patients need to be aware that all aggressive therapies for prostate cancer have significant side effects and perhaps these data make an argument for active surveillance (avoiding aggressive treatment and closely following the cancer) in certain cases.”

Since the median life expectancy after treatment for prostate cancer is 13.8 years, the authors suggested that these data may be used by physicians to counsel men who are considering treatment for localized disease.

Other authors for this study include Tatsuki Koyama, Ph.D., Kang-Hsien Fan, M.S., R. Lawrence Van Horn, Ph.D., Vanderbilt; Peter Albertsen, M.D., University of Connecticut, Farmington; Michael Goodman, M.D., MPH, Emory University, Atlanta; Ann Hamilton, Ph.D., University of Southern California, Los Angeles; Richard Hoffman, M.D., MPH, University of New Mexico and New Mexico VA Healthcare System, Albuquerque; Arnold Potosky, Ph.D., Georgetown University Medical Center, Washington, D.C.; Janet Stanford, Ph.D., Fred Hutchinson Cancer Research Center, Seattle; and Antoinette Stroup, Ph.D., University of Utah, Salt Lake City.

Funding for the research was supported by a grant from the National Cancer Institute – a division of the National Institutes of Health (R01-CA114524), and contracts from each of the participating institutions (N01-PC-67007, N01-PC-67009, N01-PC-67010, N01-PC-67006, N01-PC-67005, and N01-PC-67000). Resnick was supported by the Veterans Affairs National Quality Scholars Program (with use of facilities at Veterans Health Administration Tennessee Valley Healthcare System) and the T.J. Martell Foundation.

Source: Vanderbilt-Ingram Cancer Center



Read Full Post »

“A diplomat is a man who always remembers a woman’s birthday but never remembers her age.” – Robert Frost

Of the top ten questions I have gotten over the years about misconceptions/misunderstandings of the various treatment of prostate cancer-the concept of the delayed effect of radiation on one’s body is one of the more common.

The typical situation will be the guy who has either had seeds or external radiation. He may have had a little bit of a bumpy go of it early on in the radiation, maybe some urinary symptoms of frequency or urgency or mild self-limited diarrhea, but then did well. That is until about 2-5 years later when he notes blood in his urine or exacerbation of the urinary symptoms again.

In the case of blood that is now visible in the urine and often times associated with clots, I’ll mention to the patient and  the wife that his is probably an effect of the radiation and the expected come back is, “But he had radiation five years ago.”

I’ll come back to my thoughts on that but first a note about clots because this is another thing that patients have trouble grasping and something I hear very frequently. Patients will spend an inordinate amount of time explaining clots, the color, how it felt to come out, what it looked like and so forth. This is because they feel that a clot makes the bleeding more significant. The truth of the mater is that a clot is simply blood that settled in the posterior aspect of the bladder then formed a clot. When the clot is voiding out it is compressed into “worm form” as it goes through the prostate and urethra. If you can void at all i.e. no obstructive problem because of the clot then it has no real clinical significance.

“I noticed blood at the tip of my penis after I pee’d red blood. And then a maroon looking gelatin thing came out shaped like a worm, a bunch of them, then there was more blood at the tip of my penis. Ever since then the color of my urine has been blood-red.”

  • You rarely lose enough blood in the urine to affect the blood count (it won’t make you anemic.)
  • Clots are the result of blood doing what it does, clot, and are molded like my old Mattel worm maker when I was young.
  • Think of a clot as a bouillon cube swishing around in the bladder discoloring the urine until it is gone. This is why a patient will say they had blood in the urine, passed a clot and then the urine cleared. The bleeding from the prostate or bladder as a result of the radiation probably stopped hours or days ago. So no active bleeding just the bouillon effect of the clot coloring the urine by dissolving slowly.
  • People on blood thinners, including low dose aspirin, are more at risk of bleeding secondary to the effect of radiation.

Radiation cystitis and for that matter radiation urethritis of the prostatic urethra is a given consequence of radiation. It is not a given however if a particular patient will have any symptoms related to it. The symptoms and clinical issues:

  • With seeds the vessels along the course of the inner channel of the prostate (the prostatic urethra) become very engorged and the vascularity of blood vessels increase. Visually they look like dilated vessels on a person’s nose if they have that disorder that Jimmy Durante had. In turn they become friable and easy to bleed.
  • Radiation cystitis is a term for the same process of the bladder mucosa. The normal vascularity of the inner lining of the bladder becomes more reddened, the vessels more prominent. In some cases the vessels in one spot change and in other patients the whole bladder is involved.
  • It usually progresses with time and is more common a year or two out rather than immediately.
  • This is why in my book I say “Do you want to pay me now…the immediate issues related to a prostatectomy” or ” Do you want to pay me later-the delayed side effects of radiation.”

What are some of the treatments or management of blood in the face of a past history of prostate cancer and radiation?

  • If the patient is on coumadin or aspirin and okay with the cardiologist it is best to stop those.
  • The hope is that it is one vessel and that stopping the meds and increased hydration that it stops on its own. This is a common scenario.
  • If the patient continues to have blood in the urine with or without clots, for the short-term as long as voiding is possible and no problems with being unable to empty the bladder, it is best in this case as well to pee patient, I mean be patient-ha. You can wait up to 7- 10 days if necessary. Again it usually have very little effect on the hemoglobin.
  • Bleeding, with clots and difficulty voiding is a bad case scenario because now the urologist has to do something to get the clots out, place a catheter and get things flowing again. He may or may not have to be fulgurated or treat a bleeding vessel which is the culprit.
  • Here’s how it plays out. The patient had seeds three years ago. He notices some blood in the urine. He calls his urologist-note he calls the urologist not the radiation oncologist and is advised to stop any blood thinners, increase water intake and be seen that day or the next. The patient begins passing clots and then in time he can’t void at all “clot urinary retention.” This occurs right after the doctor’s office closes. He calls the operator at the hospital who contacts the urologist and is advised to go to the emergency room.
  • By the time the patient gets to the ER he is in near excruciating pain because of the inability to urinate. The clots have clotted off the opening from the bladder to the prostate and as a result urine cannot flow.
  • There is a wait to get into a room at the ER however once in the room an IV is started and an attempt probably by one of the ER nursing staff who is good at putting catheters in.
  • If the patient has had a prostatectomy and then the radiation, there may be a narrowing at the bladder neck area, the area of the anastomosis, and this will not let the catheter get by and hence after several attempts and meeting no success, the patient may be given pain meds and the urologist is called and told ” We can’t get a catheter in. You need to come.”
  • If the nurse is able to get a catheter in then the clots are attempted to be irrigated free so that urine can flow into the catheter and in turn relieve the patient.  What normally happens is the irrigation of clots and release of urine and hence relief for the patient is piecemeal. By that I mean that a little urine will come out and then the clot obstructs the foley catheter. The nurse then irrigates the catheter in hopes to retrieve more clot and re-establish urine flow. This may or may not happen as  you can’t irrigate as well through a pliable tube such as a catheter as it collapses on itself and thwarts the process. Over time with the suction of clots, irrigation of the clots and often times having to take out a catheter filled with clot that won’t irrigate and reinserting another one hopes to achieve a free-flowing catheter with clots.
  • At this point if not already having done so, a three-way catheter is placed so there can be continuous irrigation of fluid to prevent the catheter from getting obstructed and prevent the formation of more clots hence restarting the whole process.
  • If a catheter can’t be passed or if catheter keeps being obstructed by clots then the patient often times is taken to the operating room by the urologist and under anesthesia places a rigid cystoscope that is of larger diameter than the catheter and doesn’t collapse on itself, to irrigate out all the clots, stop the bleeding point and then placing the largest three-way catheter as possible.
  • All the while this is a very painful drawn out process that can be associated with bladder spasms which have been alluded to many times on this site.
  • In time if the clots are all out, the bleeding stopped, the catheter can be removed after a few days and things then go back to normal. The patient still has radiation cystitis, is still at risk for bleeding in the future and if lucky the degree of cystitis stabilizes. It will not go away, but it may quieted down a bit and not progress.
  • Now there are things the surgeon did not mention if you had a robotic prostatectomy for sure…but I can see now the brochure and the ads on the internet of the radiation guy playing golf “a few days after the procedure.”
  • As I say in the book, “There ain’t no free ride.”

More on this later ….think hyperbaric O2 treatments.

Read Full Post »


those wounds healed only by time are the hardest to bear and relinquish John McHugh

I got a big kick out of this article about the Proton therapy machine and its application to prostate cancer.

First of all it is informative and several doctors of various persuasion are interviewed:

  • We learn that it is a very expensive machine to purchase.
  • It takes a very large building to house it.
  • There only ten centers in the US.
  • It cost a lot more to have done than “traditional” radiation.
  • The “experts” differ on if it is better than traditional.
  • The experts differ on if it really is associated with fewer “significant” side effects.
  • The proton  radiation hits the nerves of the prostate responsible for erections just like standard.
  • It hits the prostatic urethra (think irritative voiding symptoms) just like standard XRT.
  • It has fewer rectal “significant” complications than standard (they think.)
  • Institutions that have the machine run it all the time to capture the financial outlay for the machine.
  • Institutions that use the machine make more money using it than if they used the standard machine.
  • Medicare has to pay a lot more for a patient to have this than standard, but it is covered under medicare.

But this is what is so funny about this article. You are an advocate of the machine if you have one and you are not an advocate of the machine if you don’t. If you don’t have one then it costs too much, no better, and no reason to spend all that extra money for so little clinical benefits in return. It’s funny and that old adage about “three types of lies- lies, damned lies and statistics.”  Read about rectal injuries – the numbers are better for the Proton but is it “significant” particularly at the cost. Cost benefit ratio hmmmmmmmmmmmmmm. Sounding a bit like the PSA. And of course one of the doctors is from some governmental study group….wow wonder what his take will be….think National Health Care.

Any way the whole purpose of this post is to say this:

What is the difference between an environmentalist and a developer?

The environmentalist already has his cabin in the woods.

Hence if you’ve got one it’s good, If you aint’ it ain’t.

Proton cancer therapy comes at a cost

 By Robert Langreth

Imagine a prostate cancer therapy that has almost no side effects. Hospitals say it exists and they’re vying to be among the first to offer it. Too bad the treatment may not work as well as advertised and could boost America’s already spiraling health care costs.

The technology uses narrowly focused proton beams to deliver precisely targeted blasts of radiation. The particle beams are delivered by 500-ton machines in facilities that cost from $100 million to $200 million, and can require a football- field sized building to house. A typical treatment costs about $50,000, twice as much as traditional radiation therapy though it is usually covered by Medicare or private insurance.

For U.S. taxpayers and employers facing spiraling health-care costs, that’s a worry.

“Proton-beam therapy is like the death star of American medical technology; nothing so big and complicated has ever been confronted by the system,” said Amitabh Chandra, a health economist at Harvard University’s John F. Kennedy School of Government. “It’s a metaphor for all the problems we have in American medicine.”

Yet even though the machines are breathtakingly expensive, hospitals and for-profit clinics are in a race to build proton-beam facilities for their prestige, perceived benefits, and potential revenue. One machine can generate as much as $50 million in annual revenue and new facilities are sprouting up around the country.

“It’s like a nuclear arms race now, everyone wants one,” said Anthony Zietman, a radiation oncologist at Boston’s Massachusetts General Hospital, which has had a proton-beam accelerator since 2001.

Proponents of the technology say it can zap cancerous tumors without damage to surrounding tissue. That’s a major benefit for the relatively small number of people who suffer from tumors of the spine, brain and eyes, where stray radiation may blind or paralyze, or in children who are more sensitive to radiation.

The therapy has even wider appeal for treating prostate cancer, a much more common disease, since existing treatment often causes rectal bleeding as well as impotence. More than 240,000 American men were diagnosed with prostate cancer in 2011, making it the nation’s most-diagnosed tumor, according to the American Cancer Society. Most of those men are potential candidates for proton-beam therapy.

“The easiest group to market to in the country is a group of men worrying about the functioning of their penis,” said Paul Levy, former head of Beth Israel Deaconess Medical Center in Boston.

The problem is that despite the push to build proton-beam facilities and the groundswell of enthusiasm for the treatments, it remains unclear whether the therapy does a better job of shrinking tumors or avoiding side effects than the far less costly traditional therapy. Clinical trials haven’t yet provided a clear picture proving the treatment’s worth for common tumors such as prostate cancer.

Lower rates of impotence, for one, are unlikely from the use of proton therapy because proton and traditional treatments deliver high doses of radiation to the nerves to the penis, Zietman said. So whether the pricey treatments will do a better job managing prostate cancer while also preserving sexual function is an open question.

Proton-beam therapy and traditional X-rays are equally effective at killing tumor cells. The debate is over side effects. Proton-beam therapy works by shooting intense, narrow beams into targeted areas of the body. Protons slow down as they travel deep in the body. Doctors can manipulate the speed of the atomic particles, allowing them to deposit most of their radiation as they come to a stop inside a tumor.

X-rays used in conventional radiation therapy are made up of photon beams that zip through a patient, exposing tissues along the way to excess radiation. While modern machines use multiple beams sculpted to intersect and concentrate high doses on a tumor, lower doses are spread over a much larger region.

The proton technology isn’t new, but only in recent years has it caught on. Loma Linda University Medical Center in Loma Linda, Calif., built the nation’s first hospital proton-beam accelerator in 1990, but the treatment became more viable after the American Medical Association granted proton therapy an insurance billing code in 2000, making reimbursement easier, said Allan Thornton, a radiation oncologist at Hampton University’s proton-beam center, which opened in August 2010. “That brought proton therapy out of the closet,” he said.

So far, 35,000 Americans have gotten proton-beam treatment and reimbursement payments from Medicare and insurance companies amount to only a small fraction of that paid out for traditional radiation therapy.

In 2010, the most recent year for which figures are available, Medicare spent $41.8 million on outpatient proton- therapy treatments, versus $1.06 billion for standard external- beam radiation.

The amount so far reimbursed for proton-beam therapy is small because most of the 10 existing facilities have been open only a short while. Another 10 facilities are slated to open within the next few years, according to Leonard Arzt, executive director of the National Association for Proton Therapy based in Silver Spring, Maryland. Dozens more hospitals and medical centers have expressed an interest in developing their own proton-beam facilities.

Some experts are concerned that the proliferation of these centers will put yet another heavy burden on the health-care system while providing unclear benefits to most patients. “It is an example of how our health-care system is set up to become more expensive without getting necessarily better,” said Steven Pearson, president of the Institute for Clinical and Economic Review, a research institute at the Massachusetts General Hospital in Boston.

Ion Beam Applications, based in Louvain-la-Neuve, Belgium, is the leading proton-beam facility manufacturer with eight installed U.S. accelerators. Hitachi Ltd. of Tokyo and Varian Medical Systems Inc. of Palo Alto, California, are among those companies also vying for part of the U.S. market.

The Mayo Clinic is spending $370 million for systems at its campuses in Minnesota and Arizona. In San Diego, Scripps Health is working with Advanced Particle Therapy LLC, a closely held proton-beam developer, on a $220 million facility in the San Diego area that is scheduled to open in 2013 and treat 2,400 patients a year. In New York, a group of five hospitals including Memorial Sloan-Kettering Cancer Center is working on a $250 million plan to build one of the machines.

The bottom line for proton centers, said Sean Tunis, chief executive officer of the Center for Medical Technology Policy, and a former Medicare official, is that hospitals can afford to build them because they are “extremely favorably reimbursed” by Medicare and many private payers.

“The finances are favorable to put in a lot of these centers and treat a lot of prostate cancer even though there is no evidence prostate cancer is treated better with it,” he said.

A report on proton therapy done by the U.S. Agency for Healthcare Research and Quality in 2009 suggests the benefits aren’t clear. After studying 243 published articles on the therapy, the group said it found only a handful that compared proton therapy to the standard treatment, and that “no trial reported significant differences in overall or cancer-specific survival or in total serious adverse events.”

Some evidence even suggests that proton therapy may be worse than traditional radiation treatments.

A University of North Carolina study of prostate cancer patients released in February found a somewhat higher rate of bowel side effects with the new machines, and similar rates of impotence and other side effects. While not definitive, the finding may indicate the protons lose precision as they penetrate the body, said lead researcher Ronald Chen, an oncologist at the university’s Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina.

“Statements about superiority are just unjustified, they are unsupportable,” said W. Robert Lee, a radiation oncologist and prostate cancer specialist at Duke University School of Medicine in Durham, North Carolina.

Proton-beam proponents aren’t fazed by those who doubt the value of the therapy.

“Yes, there are critics, but the best minds in the cancer business think otherwise,” said Hampton University president William R. Harvey. He calls the argument that proton therapy may burden the medical system “bogus” because it doesn’t consider the potential cost savings from avoiding side effects.

Thornton, of Hampton’s proton-beam center, said that an as- yet-unpublished study he did found protons will lower rates of rectal bleeding that can occur years after radiation for prostate cancer. “The data is pretty clear,” he said.

In the analysis of 20 previous studies, Thornton and his colleagues found that 7 percent to 9 percent of prostate patients who received standard radiation experienced severe rectal effects, compared with 0.75 percent to 1.5 percent of proton patients who suffered such side effects.

Findings from some published studies show the treatment may reduce the rate of severe rectal side effects to 1 percent or less from the 2 percent to 4 percent rate seen with standard equipment, said Robert Foote, chairman of radiation oncology at the Mayo Clinic in Rochester, Minn.

“The question people are really struggling with is ‘is that worth the extra cost?’” he said. The Mayo Clinic, which is building proton systems at its Minnesota and Arizona campuses, won’t use proton therapy for routine prostate cases where less expensive treatments work well, Foote said.

Once built, hospitals and treatment centers tend to keep proton-beam facilities running night and day. The University of Florida’s proton therapy institute in Jacksonville, for instance, treats patients from 6:30 a.m. to 11 p.m., five days a week, said Stuart Klein, its executive director. It generated $45.5 million in patient care revenue in its 2009 fiscal year, according to a tax filing.

“Radiation oncologists have gotten themselves into a trap,” said Zietman of Massachusetts General. “They’ve built very expensive centers, and the only way they can recoup the costs is to treat lots of prostate cancers. A lot of men are going to be channeled into proton therapy, not necessarily to their advantage, at a very great cost.”

Read Full Post »

history may not repeat itself…but it rhymes- M. Twain

Podcast on the Partin Table and the Gleason 8-9 patient. Who are you?

Read Full Post »

god gave you two hands so that you could hold on to only two of the past, present or future...which will you choose?

From the ASC Website

Finding and treating all prostate cancers early may seem like a no-brainer. But some prostate cancers grow so slowly that they would likely never cause problems. Because of an elevated PSA level, some men may be diagnosed with a prostate cancer that they would have never even known about at all — it would never have lead to their death or even caused any symptoms. But they may still be treated for these cancers, either because the doctor can’t be sure how aggressive (fast growing and fast spreading) the cancer might be, or because the men are uncomfortable not having any treatment.

I have read many times on various respected organizations websites that “doctors don’t know which prostate cancers are slow-growing and which are fast growing. Granted there are some Gleason 6’s by virtue of their location at the seminal vesicles that act aggressively…but in general we do know that Gleason’s 8 and above are very aggressive and behave very badly. So I believe a disservice is done to “unsuspecting” men who then make decisions about treatment or testing based on information that tends to down play the seriousness of the disease and then the nihilistic point that “since we don’t know if it will kill or not, and the side effects are so bad,  why be tested in the first place or if diagnosed why be treated.
I see it everyday in my practice and if you read between the lines on many of these “prostate sites” you’ll see that prostate cancer is way to over generalized to the public and that this dumbing down of the disease is being filtered down to the male and “lowering his guard.”  Check out the link to TheRedSock U.K.
For men in the prostate cancer community, a Gleason Score is sort of like an identity badge.  This simple number, used to grade the severity of prostate cancer, is forever etched into the minds of men diagnosed with prostate cancer.  Knowing this number is crucial in determining how to approach the prostate cancer and whether the cancer even needs to be addressed.  The simple number obtained from a prostate biopsy can also speak volumes as to what kind of prognosis a man with prostate cancer can expect.  In this post, I will explain how a Gleason Score is determined, explain its significance, and provide a very important warning about the dangers of relying on this number too greatly.
What is a Gleason Score?
About 40 years ago a pathologist in Minnesota named Donald Gleason evaluated the pathology specimens of hundreds of veterans diagnosed with prostate cancer.  He attempted to correlate how prostate cancer looked under the microscope with how men faired clinically.  In essence, he tried to look for patterns of the prostate cancer cells that could be then linked to prognosis and outcomes.  In so doing, Doctor Gleason created the grading system currently used worldwide to microscopically evaluate prostate cancer.
The Gleason score is determined by first surveying prostate samples under the microscope.  When prostate cancer is identified, it is evaluated in terms of how aggressive it looks.  Specifically, the pathologist looks at the shape and size of the cells, how they stick together, and whether they take the form of glands or simply look like amorphous sheets.  This last characteristic is called differentiation.  Well differentiated tumors look more like normal glands while poorly differentiated tumors do not really look like anything more than random cells stuck together.  Depending on this microscopic appearance, pathologists score the cancer on a scale of 1-5, with 1 being very mild or well differentiated and 5 being extremely aggressive or poorly differentiated.  After grading all of the cancerous areas in this fashion, the pathologist next determines the two types of tumors he sees most frequently in the specimen.  He then adds these two numbers up to get the Gleason Score.  For example, if the pathologist finds that 60% of the cancer is Grade 3 and 40% is Grade 4, the Gleason Score would be 3+4=7.  In short, the cancer in this example would be labeled Gleason 7. The Gleason Score can range from a score of 2(1+1) through 10 (5+5).  In reality, however, individual Gleason Scores of 1 or 2 are no longer seen as most pathologists no longer consider these patterns as true cancer.  Instead, practically speaking, the lowest individual score is 3, making the lowest realistic Gleason Score 6.  Rarely, a total Gleason Score of 5 may still be encountered.
Why is the Gleason Score Significant?
Gleason scores, themselves, are also grouped into categories.  Gleason 6 disease is considered mild to moderate risk prostate cancer.  It is the run-of –the-mill prostate cancer that most men get.  Gleason 6 cancer is the type to think about when you hear that prostate cancer is slow growing and MAY not affect you.  In contrast Gleason 8-10 cancer is considered aggressive cancer that most likely will affect you, particularly if you do nothing about it.  Prostate cancer with a Gleason Score of 8-10 is much more likely to grow outside of the prostate, leave positive margins after prostatectomy, and metastasize to the bones or lymph nodes as compared with cancer of a lower Gleason grade.  In addition, a Gleason Score of 8-10 significantly impacts the survival of men with prostate cancer.  A classic study followed men with prostate cancer that were treated conservatively.  After 15 years, the study reported that men in their 50s diagnosed with a Gleason 8-10 prostate cancer had an 80% chance of dying from the cancer as opposed to 20% for men with Gleason 6 disease.  I should, again, stress that these statistics were for men NOT aggressively treating their cancer, which truly demonstrates that differing natural history of Gleason 6 versus Gleason 8-10 disease.
In between Gleason 6 and Gleason 8-10 disease, of course, lies Gleason 7.  This type of prostate cancer is moderately aggressive with a prognosis that logically falls between the two groups.  In the above mentioned study, for instance, about 60% of men in their 50s died of Gleason 7 prostate cancer after 15 years.  Gleason 7 disease, however, can be more of a wild card.  It is very hard to predict how aggressive such disease really is.  Some Gleason 7 cancers behave more like Gleason 6 disease while others act much more aggressively, like Gleason 8-10 tumors.  Some of this discrepancy may have to do with whether a Gleason 7 cancer is 4+3 or 3+4.  As you may recall, the Gleason score is a sum of the two most commonly found cancer patterns in a prostate specimen.  In a Gleason 4+3=7 tumor, the more aggressive type 4 pattern is found in greater abundance than the milder type 3 pattern.  The opposite is true for Gleason 3+4=7 disease.  Studies have demonstrated that Gleason 4+3=7 disease is much more aggressive than Gleason 3+4=7 tumors.  One study, for example, demonstrated that after 5 years of follow up, men treated for Gleason 4+3=7 prostate cancer demonstrated a 40% risk of cancer progression as opposed to a 15% risk for their counterparts treated for Gleason 3+4=7 disease.  Hence, this small distinction may make a significant difference in treatment planning and prognosis and may explain why not all Gleason 7 tumors are the same.
The Pitfalls of the Gleason Score
Because the Gleason Score has demonstrated such correlations with outcomes for men treated for prostate cancer, it is heavily relied upon in making treatment decisions.  For those men choosing active surveillance rather than treatment, for example, a Gleason Score less than 7 is really mandatory.  As such, the Gleason Score can have a monumental impact on future quality of life.  The problem with relying on the Gleason Score from a prostate biopsy, however, is that this score is not always accurate.  Because the score is subjectively determined by a pathologist, there can be a great deal of variability in scoring.  One study, for example, reported that when prostate biopsy specimens were sent for a second opinion, 7% of tumors initially graded Gleason 6 were upgraded to a Gleason 7 while 16% of tumors initially graded Gleason 7 were downgraded to Gleason 6.  As I described above, this one point disparity can have a significant impact on treatment decisions and outcomes.  This is particularly true for men who choose active surveillance for what they think is Gleason 6 disease but , really, have Gleason 7 prostate cancer.
Another limitation of a Gleason Score determined from a prostate biopsy is that a biopsy may not provide a representative sample of the entire prostate.  Each biopsy sample is only a few centimeters long and a few millimeters wide as compared to the entire prostate, which can range in size from a walnut to a peach.  As a result, the Gleason Score on prostate biopsy is usually accurate only about 50% of the time as compared to the Gleason Score determined when the whole prostate is subsequently removed and examined after a prostatectomy.  One study, for example, evaluated 134 men with Gleason 6 prostate cancer on biopsy who subsequently underwent prostatectomy.  The study reported, that 50% of these men (who were thought to have Gleason 6 cancer) were actually determined to have Gleason 7 prostate cancer when the entire prostate was evaluated after prostatectomy.
Fortunately, studies have provided some guidance as to how to better determine if  a biopsy Gleason score may be underestimating the true aggressiveness of a given prostate cancer.  These studies have demonstrated that other aspects of the prostate cancer, gleaned from the biopsy and clinical information, may help predict more aggressive disease.  For example, men with a PSA greater than 5 and a prostate less than 60 grams in size may actually have more aggressive disease than the Gleason 6 prostate cancer found on biopsy.  In addition, prostate cancer that occupies more than 5% of the total biopsy tissue, is found on more than 1 biopsy core (sample), or takes up more than 10% of any core is likely to be more aggressive than the biopsy Gleason Score is reporting.  As a result, many active surveillance protocols exclude men with the criteria above despite the fact that they have only Gleason 6 disease.
Take Home Message
The Gleason Score is a very important characteristic of prostate cancer.  It is like a cancer ID card that allows urologists to determine prognosis and guide treatment decisions based on the appearance of prostate cancer cells under the microscope.  While a useful tool in evaluating prostate cancer, however, the Gleason Score can prove to be a double edged sword.  Gleason Scores reported on prostate biopsies are often inaccurate due to pathologist error or as a result of poor sampling.  As a result, the Gleason Score reported on a prostate biopsy can underestimate the true aggressiveness of prostate cancer.  While this inaccuracy may not be important for a man choosing to proceed with a prostatectomy or with radiation therapy, it can be critical for those men choosing to forego treatment and, instead, proceed with active surveillance.  For those men, it may be beneficial to get a second pathological opinion to make sure that their Gleason 6 prostate cancer is actually Gleason 6.  In such situations, looking at the Gleason score in the context of other risk factors such as PSA and tumor volume may also help determine the accuracy of the biopsy Gleason Score and provide some added reassurance that a more aggressive cancer is not lurking undetected in the prostate.  As always, talk to your urologist and make sure that you are getting all of the information necessary to make a knowledgeable decision about your prostate cancer

Read Full Post »

Penelope on Jibjab

Don’t monkey around with prostate cancer!

as we grow older...the beauty steals inward... emerson

Read Full Post »

take the pain, burn it as the fuel to overcome adversity

Mushroom Compound Suppresses Prostate Tumours, Australia

23 May 2011

A mushroom used in Asia for its medicinal benefits has been found to be 100 per
cent effective in suppressing prostate tumour development in mice during early
trials, new Queensland University of Technology (QUT) research shows.

The compound, polysaccharopeptide (PSP), which is extracted from the
‘turkey tail’ mushroom, was found to target prostate cancer stem cells and
suppress tumour formation in mice, an article written by senior research fellow
Dr Patrick Ling in the international scientific journal PLoS ONE said.

Dr Ling, from the Australian Prostate Cancer Research Centre-Queensland
and Institute for Biomedical Health & Innovation (IHBI) at QUT, said the
results could be an important step towards fighting a disease that kills 3000
Australian men a year.

“The findings are quite significant,” Dr Ling

“What we wanted to demonstrate was whether that compound could
stop the development of prostate tumours in the first place.

“In the past, other inhibitors tested in research trials have been shown to be up to 70
per cent effective, but we’re seeing 100 per cent of this tumour prevented from
developing with PSP.

“Importantly, we did not see any side effects from
the treatment.”

Dr Ling said conventional therapies were only effective
in targeting certain cancer cells, not cancer stem cells, which initiated cancer
and caused the disease to progress.

During the research trial, which was
done in collaboration with The University of Hong Kong and Provital Pty Ltd,
transgenic mice that developed prostate tumours were fed PSP for 20 weeks.

Dr Ling said no tumours were found in any of the mice fed PSP, whereas
mice not given the treatment developed prostate tumours. He said the research
suggested that PSP treatment could completely inhibit prostate tumour formation.

“Our findings support that PSP may be a potent preventative agent
against prostate cancer, possibly through targeting of the prostate cancer stem
cell population,” he said.

He said PSP had previously shown to possess
anti-cancer properties, and ‘turkey tail’ mushrooms (known as Coriolus
versicolor or Yun-zhi) had been widely used in Asia for medicinal benefits.

However, Dr Ling said it was the first time it had been demonstrated
that PSP had anti-cancer stem cell effects.

Although ‘turkey tail’ mushrooms had valuable health properties, Dr Ling said it would not be possible
to get the same benefit his research showed from simply eating them.

A fundraiser has been organised in September to support further tests for the
therapeutic potential of PSP against prostate tumours either alone or in
combination with other anti-cancer compounds.

University of Technology

Article URL: http://www.medicalnewstoday.com/releases/226143.php

I am in a seventies mood. Just watched a Captain Beefheart documentary on Youtube that was facinating.

I was in high school in the early seventies and was aware of all the “Grateful Dead” stuff going on but was not partaking. I was somewhat “unaware” and afraid to try stuff…then. My oldest brother was the first hippie in Troop County in Georgia. Bellbottoms, long hair, and making pot available to my classmates for a price legitimized him as a hippie. The music I was exposed to at that time was his influence and my next older brother. I remember distinctly a Captain Beefheart album cover (deep red and black coloring, I don’t know which one…very Frank Zappa looking) on the floor in the room of our house closest to the street…the television room. (See author page for picture of my grandmother’s house.) My older brothers were cutting edge music wise. I remember Rushton bringing home one of the first  Allman Brother’s album from the Bryon Music Festival (look at the bands that where there…amazing.) Poco, The Dead, Bowie, Traffic, of course The Beatles, The Kinks, Stones, CSN. were albums they were listening to at the time. I liked Elton John’s Tumbleweed Connection and James Taylor’s Mudslide Slim…my brothers did not quite get my liking that stuff at the time. One of my finest moments was when many years later Rushton said, ” John, I’ve been listening to some Taylor. It’s good…you were on to something back then in high school.”

Now the mushrooms. My brothers and their friends apparently figured out how to make a hallucinogenic mixture out of mushrooms that they called “Mushroom tea, or mushroom koolaid.” As I recall the mushroom they used had a thin blue line making a circle on the under surface of the top of the mushroom. I guess they crushed up the mushroom and then put in koolaid and then drank it. All of this was done under the radar of my mother, grandmother and of course me…I was clueless and of course was not invited or included in any of my older brothers activities. “Where’s John,” they would be asked. Rushton loved to say in reply, ” He’s at an Algebra party.”

You may not remember this “social syndrome” by which a person in high school in an attempt to be included will associate with others in whom he really doesn’t fit. I did it. I asked a girl to a dance who was thought to be one of the wildest students in the school. We were quite the mismatch. I don’t know what I was thinking…well I do… and nothing came of it and I did not benefit from her wildness. But alas…there was this guy who loved my older brothers and wanted to be in their circle. He was rather straight-laced, an athlete ( all my brothers were athletes) and wanted to do stuff with them. Usually it was the benign stuff, i.e. going to get a hamburger, a movie, etc. He was that type of friend for those type of events…not the hard stuff. I know of what I speak…I was that type of friend to others. They’d call me to play tennis or go fishing…but did not call me for parties.

So somehow the ground rules got broken when it came to this particular friend “gettin in with” my brothers in the “mushroom tea” affair. I don’t know where or how but this straight laced guy from a straight-laced family “fell in” with my brothers when they had made and decided to partake of the koolaid. I think they all drank it and they dropped him off at his house either that evening or the next day. That was just the start of it.

“Jennie, what in the world have your boys done to my son?”

My mother was a special person. I never feared, nor did any of us, a spanking or punishment. That was not how she rolled. My relationship and that of my brothers toward her was a sort of unfearful respect. I got in trouble one time in 6th grade and the principal asked me would I like a paddling or for him to call my parents. Well, my parents were my mother. It was a no brainer…”Call my mother.” My mother comes to get me playing the part of the disappointed and strict parent and making all sort of feigned and threatening faces at me and a concerned look to all the principal was saying and why I had to go home for the day.

As we are leaving the school my mother’s demeanor expectantly changed to a soft glowing smile with a smirk. “Where do you want to go eat for lunch Johnny boy?” I knew what I was doing.

My mother is told that the lady’s son has been “crazy” for three days and the last people who saw him normal were “her boys.” After some investigation it came out that he’d been “running” with the McHugh boys and had partaken of the psychogenic elixir they had concocted.

To the best of my knowledge this particular guy never got prostate cancer and neither have any of my brothers.

I never “drank the koolaid” and lo and behold….I got prostate cancer. Go figure, the above study from Australia is right!

As with many psychedelic substances, the effects of psychedelic mushrooms are subjective and can vary considerably among individual users. The mind-altering effects of psilocybin-containing mushrooms typically last anywhere from 3 to 8 hours depending on dosage, preparation method, and personal metabolism. However, the effects can seem to last much longer because of psilocybin’s ability to alter time perception.[13][14]

Read Full Post »

Older Posts »