Prostate Cancer (Merged)
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Please may I know what members who have posted earlier think of where Watchful Waiting might fit into a sensible and realistic cancer treatment regime? Thank you.
Unlike many cancers, prostate cancer is usually extremely slow growing, so while it may be present in the prostate, in it's very early stages, it does not represent a threat to other areas or organs, so keeping a close watch on the progression of development is deemed acceptable.
Unlike other cancers, which grow at very rapid rates, the majority of prostate cancer develops over a timescale that can well be 10 years or more. A high profile politician here in Ireland was diagnosed with prostate cancer in 1995 at age 69, and it is only this year that he succumbed to it. It was not deemed treatable 10 years ago, which suggests that he has been suffering from the early stages for considerably longer.
The other thought is that there is a lot of research at last being done on prostate, so if a patient is not in urgent need of treatment, there is a possibility that newer techniques for treatment may well be available before treatment is essential. In some cases, the development is slower than anticipated, so a rush to what may be major surgery can be avoided.
Equally, if the patient is not fit, or a smoker, or has other health issues, postponing surgery may be worthwhile if it is going to allow changes of lifestyle that will assist the recovery from surgery.
The emphasis is on watchful, it's not a case of the patient being long fingered, or to be specific, it should not be, the emphasis is most definitely on watching, and then making informed decisions at the point where it is necessary to intervene.
At the age of 67, and please don't misunderstand me here, if a routine scan detects cancer, it is very possible that you will be watched, and depending on other health issues, you may die with prostate cancer rather than as a result of prostate cancer.
My father in law is 83, and has had prostate cancer for a number of years, and as a result of other health issues, it's almost certain now that he will die before the prostate cancer becomes a serious threat.
Radical prostatectomy is by no means minor surgery, at the age of 51, and being relatively fit, I was able to cope with the surgery and recovery. There is no way that my father in law would be capable of surviving such surgery because of other health issues. He might be offered radio therapy if the need arose, but to be honest, from what I've seen reported, even that is not an easy option.
This isn't a medical opinion, just the thoughts of someone that's been there, and had to stare this one down and then take definitive decisions at relatively short notice. So far, it's been the right decision, 3 years down the line the PSA is still undetectable, which is as good as it gets.
Hope that helps a little
Regards
Prostate Cancer - Again
Hi all,
Didn’t particularly want to start a new thread on this but the previous one has been closed and it’s about time it was flagged up again. Talking to colleagues there is very little awareness of Prostate Cancer and, coupled with men’s general reluctance to discuss such subjects means that many are missed until it’s too late. Well, it’s out there and it got me.
My father, 67, was diagnosed with Prostate Cancer in April 03. Put the frighteners on me as he’d not had much in the way of symptoms but had been for a PSA test recommended by his GP which came back with a score of 128!! I happened to see a magazine article at the Barbers a month later which made me decide to go and have a similar test. GP happy to oblige and the blood was duly taken. Quite a shock when the result came back “out of range” – The limit for someone my age, 43 at the time was 2.5 – my result was 2.6. I was assured that there was nothing to worry about yet but I should keep an eye on it. My AME agreed and for the next 4 years we watched as the scores slowly went up. This year it got to 3.2 and I was referred to a consultant. My options were to do nothing yet, (just keep having the tests) or have a Biopsy and find out one way or the other. No contest as far as I was concerned. As my PSA was still relatively low, a 10 point biopsy was required and 4 weeks later I had a result – 2 out of the 10 cores were positive. PSA 3.2, Gleason 3+3. An MRI and Bone scan confirmed that it was Prostate Cancer but that it had not spread anywhere else.
Having been diagnosed at an early age, 47, and an early stage of the disease meant I had the full range of treatments available together with the option of doing nothing – yet.
After talking it over with wife and consultant the do nothing approach was ditched and, of the various treatments on offer, High Intensity Focussed Ultrasound or HIFU was selected. Basically, this uses the same technology as used in the biopsy to map the prostate but the power is turned up to very high levels and the affected area is "zapped" to destroy the tumour. There are fewer side effects with this technique and those which do occur are more easily treated.
On the appointed day I was wheeled into theatre and came to some 4 ½ hours later. An overnight stay was required due to the length of time I’d been under the anaesthetic. That was last Saturday.
I’m now off work for the next 6 weeks at least whilst I recover. I feel very bruised and sore but I can walk and move around. I have a catheter sticking out of my lower abdomen to ensure I can still empty my bladder which is a very sore process but improving.
The good news – My employers, my AME and the CAA have been very supportive and kept me flying until the day before my op. My father, still with us, is now 71, has a PSA score in the teens and is enjoying life to the fullest extent possible.
Hopefully, the recent TV campaign in the UK by the late Bob Monkhouse will have moved the subject a bit higher in everyone’s conscience and more cases will be diagnosed at an earlier stage before it gets chance to spread. I’m due back in hospital for tests on Monday and if all is well then catheter will come out.
Will keep you informed.
In the meantime, if you think it can’t get you, if you think it can get you or you simply don’t know, here’s a good place to start. http://www.prostate-cancer.org.uk
Happy to take pm's on this.
Didn’t particularly want to start a new thread on this but the previous one has been closed and it’s about time it was flagged up again. Talking to colleagues there is very little awareness of Prostate Cancer and, coupled with men’s general reluctance to discuss such subjects means that many are missed until it’s too late. Well, it’s out there and it got me.
My father, 67, was diagnosed with Prostate Cancer in April 03. Put the frighteners on me as he’d not had much in the way of symptoms but had been for a PSA test recommended by his GP which came back with a score of 128!! I happened to see a magazine article at the Barbers a month later which made me decide to go and have a similar test. GP happy to oblige and the blood was duly taken. Quite a shock when the result came back “out of range” – The limit for someone my age, 43 at the time was 2.5 – my result was 2.6. I was assured that there was nothing to worry about yet but I should keep an eye on it. My AME agreed and for the next 4 years we watched as the scores slowly went up. This year it got to 3.2 and I was referred to a consultant. My options were to do nothing yet, (just keep having the tests) or have a Biopsy and find out one way or the other. No contest as far as I was concerned. As my PSA was still relatively low, a 10 point biopsy was required and 4 weeks later I had a result – 2 out of the 10 cores were positive. PSA 3.2, Gleason 3+3. An MRI and Bone scan confirmed that it was Prostate Cancer but that it had not spread anywhere else.
Having been diagnosed at an early age, 47, and an early stage of the disease meant I had the full range of treatments available together with the option of doing nothing – yet.
After talking it over with wife and consultant the do nothing approach was ditched and, of the various treatments on offer, High Intensity Focussed Ultrasound or HIFU was selected. Basically, this uses the same technology as used in the biopsy to map the prostate but the power is turned up to very high levels and the affected area is "zapped" to destroy the tumour. There are fewer side effects with this technique and those which do occur are more easily treated.
On the appointed day I was wheeled into theatre and came to some 4 ½ hours later. An overnight stay was required due to the length of time I’d been under the anaesthetic. That was last Saturday.
I’m now off work for the next 6 weeks at least whilst I recover. I feel very bruised and sore but I can walk and move around. I have a catheter sticking out of my lower abdomen to ensure I can still empty my bladder which is a very sore process but improving.
The good news – My employers, my AME and the CAA have been very supportive and kept me flying until the day before my op. My father, still with us, is now 71, has a PSA score in the teens and is enjoying life to the fullest extent possible.
Hopefully, the recent TV campaign in the UK by the late Bob Monkhouse will have moved the subject a bit higher in everyone’s conscience and more cases will be diagnosed at an earlier stage before it gets chance to spread. I’m due back in hospital for tests on Monday and if all is well then catheter will come out.
Will keep you informed.
In the meantime, if you think it can’t get you, if you think it can get you or you simply don’t know, here’s a good place to start. http://www.prostate-cancer.org.uk
Happy to take pm's on this.
Last edited by Fortyodd2; 4th Sep 2007 at 17:01.
Thanks for the post Fortyodd, I think that it is fantastic that you bring into the open, a subject clouded in ignorance and general embarrasment, and its great to hear that you are progressing well.
The current message is to get to the doc as soon as you notice any urinary symptoms, and get checked out.
I've got to throw in a word of warning re: the PSA test- it's just not that reliable at picking out what we hope it would- the science isn't that brilliant, so , as far as I'm aware, the use of the test alone as a "screening" tool is limited.
The current message is to get to the doc as soon as you notice any urinary symptoms, and get checked out.
I've got to throw in a word of warning re: the PSA test- it's just not that reliable at picking out what we hope it would- the science isn't that brilliant, so , as far as I'm aware, the use of the test alone as a "screening" tool is limited.
Thanks Gingernut,
I would agree that, from all the comments I've heard that the PSA test alone is not clever enough to be used as a screening tool but there are some new developments which could improve things. Having a test done, even if it proves negative, still puts a dot on a chart that can later be used to plot a trend and that's what helped my case. I didn't have any obvious symptoms and only went to the doc in the first place due to "Family History". Chances are that my dad developed it at about the same age as me but didn't get picked up till much later in life.
I still count myself as very lucky.
I would agree that, from all the comments I've heard that the PSA test alone is not clever enough to be used as a screening tool but there are some new developments which could improve things. Having a test done, even if it proves negative, still puts a dot on a chart that can later be used to plot a trend and that's what helped my case. I didn't have any obvious symptoms and only went to the doc in the first place due to "Family History". Chances are that my dad developed it at about the same age as me but didn't get picked up till much later in life.
I still count myself as very lucky.
Update:
Went back to the hospital yesterday for “tests”. Basically to see that my bladder & waterworks system were capable of managing without the extra installed plumbing. Passed said tests which meant that I could have the catheter removed – as a result, I now have 2 belly buttons and my bladder is grateful for being returned to its original capacity. Still feeling a little bruised but improving – I won’t be riding my pushbike for some time.
The consultant is happy with progress so far. I have another progress check in 2 weeks time and then it’s a case of allowing natures repair process to get on with it. In the meantime I need to be getting plenty of gentle exercise and avoiding sitting for too long. Next appointment with the consultant will be at the end of November by which time I will have had a further blood test. If all is well at that point then he will write me up to the AME/CAA to get my medical back. If I had a “Normal” job, I could go back to work next week.
http://www.prostate-cancer.org.uk
The consultant is happy with progress so far. I have another progress check in 2 weeks time and then it’s a case of allowing natures repair process to get on with it. In the meantime I need to be getting plenty of gentle exercise and avoiding sitting for too long. Next appointment with the consultant will be at the end of November by which time I will have had a further blood test. If all is well at that point then he will write me up to the AME/CAA to get my medical back. If I had a “Normal” job, I could go back to work next week.
http://www.prostate-cancer.org.uk
A thank you to those who have been in touch for your words of support.
A couple of themes have emerged which I think are worth mentioning. From some others who have been diagnosed, they initially were reluctant to report the symptoms they were experiencing as they feared it would be diabetes which would see them grounded immediately/permanently - (like me, mostly single pilot, helicopter types). The other is a general ignorance of/lack of available information on the disease and its symptoms. The website link on my earlier posts is a good place to go for more information and there is always the option of talking to your GP/AME.
As I said in my first post, had my father not been diagnosed I would probably not have been picked up as I was not suffering from any of the common symptoms. In fact, the only thing I had become aware of in the last couple of years was that my bladder had become very intolerant of ground coffee. One cup would see me visiting the loo about 3 times in the following hour!
A couple of themes have emerged which I think are worth mentioning. From some others who have been diagnosed, they initially were reluctant to report the symptoms they were experiencing as they feared it would be diabetes which would see them grounded immediately/permanently - (like me, mostly single pilot, helicopter types). The other is a general ignorance of/lack of available information on the disease and its symptoms. The website link on my earlier posts is a good place to go for more information and there is always the option of talking to your GP/AME.
As I said in my first post, had my father not been diagnosed I would probably not have been picked up as I was not suffering from any of the common symptoms. In fact, the only thing I had become aware of in the last couple of years was that my bladder had become very intolerant of ground coffee. One cup would see me visiting the loo about 3 times in the following hour!
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PC3A Test for Prostate Cancer
http://www.channel4.com/news/article...+cancer/826962
Will not be given on NHS unless there is a very strong family history of the disease. Costs between £200 and £400 depending on which report you read. Test involves giving a urine specemin after the gland has been 'massaged' via a DRA. Result in 7 to 10 days, the test reveals the presence of genetic 'markers' indicative of the cancer.
Will not be given on NHS unless there is a very strong family history of the disease. Costs between £200 and £400 depending on which report you read. Test involves giving a urine specemin after the gland has been 'massaged' via a DRA. Result in 7 to 10 days, the test reveals the presence of genetic 'markers' indicative of the cancer.
Update
All well at the progress check today and I have been cleared to drive again as the "wound" where the catheter was removed has healed nicely. Now have to wait until the end of November for the next checks which will decide if I can get back to flying. Again, thanks to all Pruners who have been in touch for your support. 
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Many thanks for being so open about what some perceive to be a taboo subject. I'm in the RAF and as aircrew, we take an annual medical. It was only by accident that a colleague (also over 50) informed me that once you'd reached 50, you could request the extra blood test screening for this. I've had it checked now for the last 2 years, nothing to worry about I've been told. However, is the blood test for this sufficiently accurate or should I be slightly more concerned?
Wishing you a full and speedy recovery!
Wishing you a full and speedy recovery!
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Yes well done Fortyodd for bringing this not-often-enough-talked-about-man's-subject out again...
Being a bit more anatomically aware than some, and not too shy to talk to sundry GPs, I have had concerns about my prostate on and off throughout my forties having felt that it was sometimes enlarged (and being proved right), and having sometimes less than ideal bladder function (sometimes needing to go two or three times during the night, and noticing sometimes small leaks of a drop or two after returning to bed, but nevertheless still able to drink beer in respectable UK quantities and company without being the first to the toilet...
)
I nevertheless have had a pervading image in my mind from a US made movie I saw two or three years ago (can't remember the name) in which the lead actor's father suffered from prostate cancer, could not afford the medical bills, and as it got worse, found himself sitting lady's style on the toilet, straining in pain to empty his bladder...I wouldn't wish that upon anyone...least of all me...
Despite two or three visits to specialists after renewed 'episodes' of things 'not seeming quite right' over the last ten years, including recently an endoscopy under local anaesthetic (not as uncomfortable as I imagined and quite interesting to watch on tv
), plus PSA and flow tests, I have been given no adverse feedback. I haven't been told that there was nothing to worry about, just not told anything informative at all basically. I do rate the head of practice at my GP's surgery too ... but the low key approach seems to be the UK way unless you make a nuiscance of yourself. Not necessarily good in my opinion. Seems to fit with an old-fashioned 'work until you drop' type culture, but doesn't seem to sit well with 'planning a long leisurely retirement' kind of thing...
My view is that disorders of the Prostate gland are amazingly still very much a cloudy subject in the United Kingdom if not worldwide, and only remain so because UK GPs and specialists are not ready to get into the oncosts of pro-active preventative regimes at the moment. Probably eats far too far into their precious budgets.
Having seen this thread, whilst also recognising that simple PSA tests are notoriously rough and ready indicators, I think I'll call my GP in the morning and just check to see what the numbers actually are for my tests.
Best wishes to Fortydd with the recouperation, and thanks A2QFI for the link to the report about the new test.
Being a bit more anatomically aware than some, and not too shy to talk to sundry GPs, I have had concerns about my prostate on and off throughout my forties having felt that it was sometimes enlarged (and being proved right), and having sometimes less than ideal bladder function (sometimes needing to go two or three times during the night, and noticing sometimes small leaks of a drop or two after returning to bed, but nevertheless still able to drink beer in respectable UK quantities and company without being the first to the toilet...
)I nevertheless have had a pervading image in my mind from a US made movie I saw two or three years ago (can't remember the name) in which the lead actor's father suffered from prostate cancer, could not afford the medical bills, and as it got worse, found himself sitting lady's style on the toilet, straining in pain to empty his bladder...I wouldn't wish that upon anyone...least of all me...
Despite two or three visits to specialists after renewed 'episodes' of things 'not seeming quite right' over the last ten years, including recently an endoscopy under local anaesthetic (not as uncomfortable as I imagined and quite interesting to watch on tv
), plus PSA and flow tests, I have been given no adverse feedback. I haven't been told that there was nothing to worry about, just not told anything informative at all basically. I do rate the head of practice at my GP's surgery too ... but the low key approach seems to be the UK way unless you make a nuiscance of yourself. Not necessarily good in my opinion. Seems to fit with an old-fashioned 'work until you drop' type culture, but doesn't seem to sit well with 'planning a long leisurely retirement' kind of thing...My view is that disorders of the Prostate gland are amazingly still very much a cloudy subject in the United Kingdom if not worldwide, and only remain so because UK GPs and specialists are not ready to get into the oncosts of pro-active preventative regimes at the moment. Probably eats far too far into their precious budgets.
Having seen this thread, whilst also recognising that simple PSA tests are notoriously rough and ready indicators, I think I'll call my GP in the morning and just check to see what the numbers actually are for my tests.
Best wishes to Fortydd with the recouperation, and thanks A2QFI for the link to the report about the new test.
Psychophysiological entity
The big question.
Suppose you have an old bloke, say 68 years old. He's told that he has a nodule on the right side of his prostate and he asks the doc if it's likely to be anything else but cancer. 'No' is the answer.
Well, given that it is indeed the case of almost certain probability, then one of the options at this age is to play the waiting game. Monitor and wait.
Firstly, what is the risk factor of playing that game like at this particular age?
If deciding to monitor only, is there any point in going through the tedious ritual of a biopsy? I mean, what will it profit you to be sure of something you're not going to do anything about?
Just wondered.
Suppose you have an old bloke, say 68 years old. He's told that he has a nodule on the right side of his prostate and he asks the doc if it's likely to be anything else but cancer. 'No' is the answer.
Well, given that it is indeed the case of almost certain probability, then one of the options at this age is to play the waiting game. Monitor and wait.
Firstly, what is the risk factor of playing that game like at this particular age?
If deciding to monitor only, is there any point in going through the tedious ritual of a biopsy? I mean, what will it profit you to be sure of something you're not going to do anything about?
Just wondered.
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The biopsy result (tumor aggressiveness, etc) might influence whether or not to continue the "watchful waiting" plan.
Best discussed by urologic oncologists. More than one.
_______
Graham
Best discussed by urologic oncologists. More than one.
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Graham
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If deciding to monitor only, is there any point in going through the tedious ritual of a biopsy? I mean, what will it profit you to be sure of something you're not going to do anything about?
Are you saying you will not seek treatment on a bad biopsy result?
Are you saying you will not seek treatment on a bad biopsy result?
My 2 cents worth on Loose rivets question. An elderly relation of my wife has been diagnosed - current PSA of 7.8. He's 86 and his doctor has said that if he hasn't died of anything else before he's 120 then to come back and see him. The drop in quality of life and the upheaval caused by surgery at his age would not be worth it. So he's having injections once every 3 months to keep it quiet and he's enjoying the rest of his life.
As for me - blood test on Thursday - watch this space.
As for me - blood test on Thursday - watch this space.
Fortyodd, the management of your relatives case appears reasonable, (most men over 80 have prostate cancer) but caution, LR's situation is slightly different.
LR, it sounds like your current situation with your prostate, is causing you some confusion. Watchful waiting is a reasonable strategy in some cases, but it sounds like that you havn't had a firm diagnosis (via needle biopsy), yet?
As already expressed by obs g, you will need to take specialist advice on this, it's unlikely your GP will have access to the tests, and interpretation of the results, that they will have.
Keep us posted, ginge.
LR, it sounds like your current situation with your prostate, is causing you some confusion. Watchful waiting is a reasonable strategy in some cases, but it sounds like that you havn't had a firm diagnosis (via needle biopsy), yet?
As already expressed by obs g, you will need to take specialist advice on this, it's unlikely your GP will have access to the tests, and interpretation of the results, that they will have.
Keep us posted, ginge.
Last edited by gingernut; 17th Nov 2007 at 13:20.
Psychophysiological entity
That's right.
The specialist seemed fairly certain that the lump would be cancer and said there was no point in putting the (squeezed )drops into the jar...we'd past that stage because of what he'd felt.
He wants to do a biopsy, but given the possibility of me 'doing nothing' for a while, this seems that an unpleasant procedure could be delayed.
I asked him what the risks were of a biopsy freeing cells globally. He said that it was not an issue. I wish I could be sure of that.
I can't see the point of a biopsy unless there is a wide scale of findings from such a procedure. In other words, giving a guideline as to the urgency factor. Right now it seems that he is just going to confirm what he already knows.
What I haven't had is a Free PSA analysis. What I read is that this gives a very good indicator of the likelihood of malignancy.
He seemed quite certain that the biopsy was the only way to go now, but he is also the owner of the clinic, and in a cynical moment I wondered if he was drumming up business. Having said this, he does seem a nice guy that knows his stuff...but having said that, I see some figures that indicate that a fair proportion of lumps can be benign. That counters what he said.
So, does stabbing it release deadly cells globally?
And does the biopsy tell more than just yes or no?
As for playing the waiting game, well, my back pain was so bad yesterday that when he told me about the lump I didn't give the proverbial toss. But then, if I followed my own beliefs, the pain was probably psychosomatic.
I guess I could flick a coin.
The specialist seemed fairly certain that the lump would be cancer and said there was no point in putting the (squeezed )drops into the jar...we'd past that stage because of what he'd felt.
He wants to do a biopsy, but given the possibility of me 'doing nothing' for a while, this seems that an unpleasant procedure could be delayed.
I asked him what the risks were of a biopsy freeing cells globally. He said that it was not an issue. I wish I could be sure of that.
I can't see the point of a biopsy unless there is a wide scale of findings from such a procedure. In other words, giving a guideline as to the urgency factor. Right now it seems that he is just going to confirm what he already knows.
What I haven't had is a Free PSA analysis. What I read is that this gives a very good indicator of the likelihood of malignancy.
He seemed quite certain that the biopsy was the only way to go now, but he is also the owner of the clinic, and in a cynical moment I wondered if he was drumming up business. Having said this, he does seem a nice guy that knows his stuff...but having said that, I see some figures that indicate that a fair proportion of lumps can be benign. That counters what he said.
So, does stabbing it release deadly cells globally?
And does the biopsy tell more than just yes or no?
As for playing the waiting game, well, my back pain was so bad yesterday that when he told me about the lump I didn't give the proverbial toss. But then, if I followed my own beliefs, the pain was probably psychosomatic.
I guess I could flick a coin.
Hi Loose rivets,
I'm not a doctor but for me personally I would have a biopsy if it was recommended to me. Don't worry about whether the Dr also owns the clinic. In the overall scheme of things, that shouldn't be a deciding factor in my point of view.
Gingernut and obgraham always seem to give sound advice from my observations and they seem to be suggesting that consulting a specialist is the way to go at this point.
Good luck with it all.
VH-MLE
I'm not a doctor but for me personally I would have a biopsy if it was recommended to me. Don't worry about whether the Dr also owns the clinic. In the overall scheme of things, that shouldn't be a deciding factor in my point of view.
Gingernut and obgraham always seem to give sound advice from my observations and they seem to be suggesting that consulting a specialist is the way to go at this point.
Good luck with it all.
VH-MLE