Prostate Cancer

[Ginetta]

Was diagnosed with this last April on a foreign medical renewal; overseas contract terminated and returned to the UK for treatment. Unrestricted UKCAA medical re-issued October and start with a new airline later this month.
A delicate and personal subject, but if anyone wishes to discuss, please feel free to PM me.

[Loose rivets]

What was your Gleason - and what treatment did you have?

[Ginetta]

Biopsy carried out abroad gave a score of 2+3=5. samples forwarded to the UK where re-evaluated as 3+3=6.
After surgery (robotic radical prostatectomy) final histology gave a Gleason score of 3+4=7.

[bcgallacher]

Had same problem - also radical prostatectomy - now all good - no chemo or radiotherapy.
Can I advise all men over 45 to get at least an annual PSA bloodtest - it is not a very reliable test but it is all there is. If prostate cancer is detected soon enough it is cureable - if too late it is only treatable.All of us will get it if we live long enough so it is really a good idea to be regularly tested.

[obgraham]

Unfortunately, the issue is a complex one, both in terms of screening (PSA), and treatment. It's not quite so simple as "everyone go get a PSA". Predicting the outcome in a given case is extremely difficult, and it's not helped by many of us docs, who think we know what's best in all cases.

Best advise is simply the old one: consider carefully the pros and cons of any proposed treatment, including "no treatment at all", and seek multiple medical opinions. Not internet forums.

Graham, MD

[Ginetta]

Bcgallacher makes a very worthwhile point. "If prostate cancer is detected soon enough it is cureable - if too late it is only treatable".

Whilst PSA screening would seem to be far from perfect, it is certainly much better than no screening at all. My PSA test was a suggestion by my then current AME, as one had not been done for several years; no other symtoms of a looming problem. I was therefore surprised when my PSA reading was 5.9.

Obgraham's advice is to seek multiple opinions; I did, my GP, UK AME and Urologist. Luckily there was consensus over the options available to me.

[bcgallacher]

I understand that better tests are being developed - blood and urine which will be more precise. The problem seems to be that prostate cancer can be slow developing in which case treatment may not be the best option or it can be of the aggressive type which can be fatal in a relatively short time.At the moment there is no way to tell one from the other so would you take the chance? In my case no.

[Capot]

....it's not helped by many of us docs, who think we know what's best in all cases.

My GP's reaction to a suggestion that he should offer a PSA test was; "What medical reason have you got for that?" This was my second visit to the surgery since moving in 1984, so I don't know him well, and vice versa.

He then gave a counter-suggestion that I should spend less time getting half the story on the internet. My daughter, an anaesthetist, who put me up to asking in the first place, said "Go back and tell him you're entitled to it."

I'd need to change GP first, I think, and it all seems not worth it.

[obgraham]

In these matters of health policy, it is important to separate the individual's circumstances from the overall situation. That's why, I repeat, it's important to get multiple opinions, and, as some point out, to switch docs if necessary to find those with attitudes one agrees with. It seems that most here are doing just that, and I'm not at all critical of what folks here are reporting.

However, when the "big picture" is the topic, things sometimes change. Recent studies (JAMA in October '09) point out that PSA tends to pick up more of the less aggressive tumors, and misses many of the most aggressive. So although the odds of a man being diagnosed with prostate cancer have risen from 1 in 11 to now 1 in 6 in areas where widespread PSA testing is done, a similar reduction in mortality/morbidity has not been seen.

It's a complicated matter. Hopefully research will lead to better methods of screening, detection, and treatment.

Graham MD

[Loose rivets]

From memory, cos it's a long lecture and I've not time to go through it again.

There is a US doctor who gave a lecture at a symposium that I'll try to find the link for. He talks of his results, and I think they're world beating if they can be believed. Given that he was talking to an audience of his peers, I doubt that there was too much BS.


The gist was that he gave Brachytherapy and external beam in the same period of treatment. This was followed by Colour-flow ultrasonic scans, which he seemed to think topped any form of back-up diagnostic tool there was.

His claim of a 91-97 % 5 year survival rate is better than anything I've heard of before or after.

I had Brachytherapy and it was almost a non-event. But, personal circumstances mean that I'm almost rolling the dice with my life when it comes to messing with follow-up procedures. I take myself off to the blood clinic, assess my own numbers, and ignore the strange feelings. But then, that's me.

I was told at home that with a PSA of 8> 'Watchful waiting might be the way forward." Mmmm...second biggest killer of men here in the US, thinks I. So I took myself off to a doctor in the US for a biopsy. This I paid for. I had a 4+3, which for some strange reason is more aggressive than a 3+4.

Right now, I think this procedure is the way forward. One of our Ppruning members talked of loss of libido following a radical procedure. This is a serious issue for anyone up to - and indeed including - my age. As it happens, I have a reduction, but not a loss of same. However, even with Brachytherapy, nothing is guaranteed on that score.
It takes 40mins or so. Go on the 'screen' and pick the lowest of four pop-sideways boxes when it comes out.

Pick it quickly, and get your cursor away and wait, or the box gets jammed over the screen.


Dattoli Cancer Center - Media Library (http://www.dattoli.com/difference/media.cfm)

[Ginetta]

I came across a link via an advert on Pprune, which has some good stuff on PSA screening as well as pointing out that screening is suggestive with potential pitfalls.

Medical News | Marbella High Care International Hospital | Private Hospital in Marbella | Marbella Surgery Hospital | Marbella Oncology Unit | Marbella Preventive Medicine (http://www.marbellahighcare.com/medicalnews/news.php?id=4)

Had I known about PSA velocity, I might well have had a PSA test(s) earlier. My biopsy would then have been sooner and I might possibly have avoided surgery as being the best option of a cure.

[Ginetta]

Had planned to edit my last post and add this link which was copied to me earlier today.


ANDREW LLOYD WEBBER: Love Never Dies... but here's how I nearly did | Mail Online (http://www.dailymail.co.uk/tvshowbiz/article-1241863/ANDREW-LLOYD-WEBBER-Love-Never-Dies--heres-I-nearly-did.html)

[Loose rivets]

It would be a lie of Blairite proportions


Great article, and the quote of the month perhaps.

[Molemot]

There's a similar thread in "Jet Blast" where I, and others, have told about our prostate predicaments ...

[airborne_artist]

I had a 4+3, which for some strange reason is more aggressive than a 3+4.

That's because a Gleason score is arrived at by adding the grading of the two highest types of cells found. The first score has to be > 55% of cells seen, while the second has to be only 5% - do the math.

I too have a 7 (4+3) :\

[Stacklay]

Hi; Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (spread) from the prostate to other parts of the body, This study revealed a protein named Siah2 as the first domino to fall – triggering the chain reaction of events that turns a non-malignant tumor into a metastatic neuroendo crine tumor.

[Loose rivets]

There's another more recent thread, with sound professional input and some thought-provoking links.

http://www.pprune.org/medical-health/423044-justification-routine-psa-testing-males-50yrs.html