PROSTATE CANCER, Treat? Cut? or Ignore?

PROSTATE CANCER, Treat? Cut? or Ignore?
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To Treat or Not to Treat Prostate Cancer: That Is the Question

January 18, 2012

By Durado Brooks, MD, MPH

Imagine being told by your doctor, "You have cancer."  Then imagine that their next words are "... but we probably don't need to do anything about it."  Many people would immediately start looking for another doctor. But hold on just a moment.

Last month the National Institutes of Health (NIH) brought together experts from around the world for a summit to examine the state of our scientific knowledge on "active surveillance" as a management strategy for prostate cancer. For those of you who are unfamiliar with the term, active surveillance essentially means monitoring the cancer closely and delaying active treatment (surgery or radiation, for instance) until there are signs it is needed; the delay may be months, years, or forever. This summit pointed out that while there is still much we need to learn about this once-controversial approach, there is a wealth of data supporting the potential value of active surveillance for a large number of the 240,000 men in the United States who are diagnosed with prostate cancer each year. 

Not treating cancer?

To most individuals, the idea of having cancer and choosing not to treat it smacks of fatalism, or just giving up. In order to understand why this is not the case, it is important to appreciate that all prostate cancers are not created equal. 

There are many prostate cancers that can be singled out as likely to be slow growing and posing a low risk to the affected man;  these can be identified by looking at a man's PSA level (prostate specific antigen; a protein made by the prostate gland and measured in the blood), Gleason score (a numerical representation of how a man's tumor looks under the microscope), and other factors (size of the tumor, how much of the prostate gland is invaded by cancer, etc.). The vast majority of men with these low-risk tumors will end up dying of something other than prostate cancer, and few of these men would ever experience any harm from their cancer if it went untreated (or if it was never found in the first place).  

It's estimated that as many as half of the prostate cancers diagnosed each year in the US fit into this low-risk category. However, to most people the term "low-risk cancer" sounds like an oxymoron.  This quandary prompted a number of summit speakers to question whether this type of tumor should even be called "cancer," or if the scientific community should come up with a new, less frightening term to describe these slow growing prostate lesions.  

For most men who are told that they have prostate cancer the first question is, "How soon can we get rid of it?" In the US, 90% of these men move very rapidly to what is viewed as definitive therapy, usually prostatectomy (surgical removal of the prostate gland) or killing the cancer cells with radiation treatment. These treatments come with the risk of side effects and complications, most commonly damage to bladder or bowel function, and sexual difficulties.  A recent report from the US Preventive Services Task Force estimates that 1 or more of these complications occur in up to 30 of every 100 men treated for prostate cancer; the same report indicates that 1 of every 200 men who undergo surgical removal of their prostate dies within 30 days of their surgery.  These numbers point to why it's so important to explore alternative approaches to managing this disease.

Watchful waiting and active surveillance

Prostate cancer is primarily a disease of older men, and many men diagnosed with the disease already have multiple health problems (and in some cases a limited life expectancy).  Given these circumstances it has long been the practice of doctors who treat prostate cancer to weigh these factors and to recommend to some men that, as opposed to beginning treatment shortly after diagnosis, they be observed by their doctors and begin treatment only if they develop symptoms that suggest that their cancer is getting worse.  This approach is known as "watchful waiting."

Over time, evidence emerged that most men who were observed in this fashion did well for a number of years.  This information, combined with the growing number of low-risk tumors being diagnosed as a result of having widespread PSA screening for prostate cancer, raised the question as to whether younger, healthy men might also benefit from a delayed treatment approach. 

Managing the cancer in these men evolved from simple observation to more intensive follow up, including repeated PSA tests and regular biopsies of the prostate gland, treating the cancer only if it begins to grow or spread. This approach has become known as "active surveillance" (differentiating it from the more passive watchful waiting).  Research studies were undertaken to find out about the impact of both of these approaches on the long-term outcomes of men with prostate cancer, and speakers at the NIH summit described findings from a number of such studies.

'A viable option' for low-risk patients

In one of these studies, the Prostate Cancer Intervention vs. Observation Trial (PIVOT), men diagnosed with low-risk prostate cancer were given the option of prostatectomy or observation; these men were then tracked over time. PIVOT used a traditional watchful waiting approach: men were simply observed and treatment was begun only if symptoms developed or if the man requested it.  After approximately 10 years of follow up the risk of dying from prostate cancer was small (less than 10%), and was essentially the same whether a man chose surgery or observation.  The risk of death from any cause, including both prostate cancer and other diseases (referred to as "all cause mortality") was also about the same between these groups. 

A number of other studies have been carried out to look at outcomes of active surveillance, using observation combined with repeat PSA tests and prostate biopsies to look for whether the cancer was spreading or getting worse. These studies, some of which have been underway for 15 years or more, have found that only a small proportion of men diagnosed with low-risk disease will show signs of significant cancer progression. 

Like PIVOT, most active surveillance studies have found low rates of death from prostate cancer among men with low-risk disease. They have also found similar rates of all cause mortality in men who choose active surveillance when compared to men who got immediate treatment. In addition, men who choose an observational approach (active surveillance or watchful waiting) avoid or delay the side effects associated with surgery or radiation. Based on the strength of the accumulated evidence the NIH expert panel concluded that "active surveillance has emerged as a viable option that should be offered to all low-risk patients."

Bottom line

So why do 9 out of 10 men with prostate cancer in the US end up being treated shortly after they're diagnosed? It turns out that many prostate cancer patients have never heard of active surveillance or watchful waiting, and are never told that observation is an option they could consider for their cancer. In other cases active surveillance is discussed as a potential management option but is presented in an unfavorable manner (i.e., "we can treat your cancer or we can just do nothing"). 

Even in circumstances where active surveillance is discussed in a fair, objective manner there are a number of other factors that may influence the likelihood of men choosing and sticking with this option.  These include whether or not their physician supports their choice, support from family and friends, and the patients' personal perceptions of and experience with cancer (whether they themselves have had other types of cancer in the past, or observed friends or family go through cancer treatment).

So if you or someone close to you has been diagnosed with prostate cancer - slow down! After getting past the shock, start asking some questions. Find out all that you can about the tumor, and determine whether the cancer fits into the low-risk category. Be sure to explore all treatment options, including active surveillance. In some cases of prostate cancer "no treatment" may turn out to be the best treatment.

Ti view the original article CLICK HERE

The NIH expert panel draft report can be accessed at http://consensus.nih.gov/2011/prostate.htm.

Brooks is director of prostate and colorectal cancers for the American Cancer Society.

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PROSTATE CANCER - Can Cancer Ever Be Ignored?

PROSTATE CANCER - Can Cancer Ever Be Ignored? 

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Can Cancer Ever Be Ignored?

By SHANNON BROWNLEE and JEANNE LENZER

Published: October 5, 2011

• As chief medical and scientific officer of the American Cancer Society, Otis Webb Brawley — who is also a professor of oncology and epidemiology at Emory University — is the public face of the cancer establishment. He operates in a world of similarly high-achieving, multiple-credentialed, respectable professionals, where insults tend to be delivered, stiletto-style, in scientific language that lay people aren’t meant to understand. So it can be more than a little jarring to hear, for example, James Mohler, chairman of the urology department and associate director of the Roswell Park Cancer Institute in Buffalo, say of his friend: “I have known Otis for over 20 years. He doesn’t come off as being ignorant or stupid, but when it comes to prostate-cancer screening, he must not be as intelligent as he seems.” Or Skip Lockwood, the head of Zero, a prostate-cancer patient advocacy group, charge that Brawley is more concerned about saving men’s sex lives than about saving the men themselves.

David Walter Banks/Luceo

Dr. Otis Brawley has been an outspoken skeptic of routine P.S.A. testing.

Brawley has become the target of these attacks because of his blunt and very public skepticism about the routine use of the prostate-specific antigen, or P.S.A., test to screen men for early prostate cancer. “I’m not against prostate-cancer screening,” Brawley says. “I’m against lying to men. I’m against exaggerating the evidence to get men to get screened. We should tell people what we know, what we don’t know and what we simply believe.”

The P.S.A. test, which was approved by the U.S. Food and Drug Administration in 1986, has become an annual ritual for millions of middle-aged men who assume that finding prostate cancer early will prevent death. By 2008, nearly half of men over 50 reported that they were screened in the previous 12 months. Despite the seeming logic of the P.S.A. test, the evidence that it saves lives is far from conclusive, and Brawley is not the only one questioning it. A growing cadre of doctors, epidemiologists, patients and cancer biologists are rethinking its value. And the most recent studies, while not ending the debate, indicate that routine P.S.A. testing appears not to reduce the number of deaths, and if it does, the benefit is exceedingly modest.

Patients and their doctors are now faced with radically polarized views about the logic of routine testing. On one side are physicians like Mohler, who argue that the test can reduce a man’s chances of dying of prostate cancer, plain and simple. This side of the debate is passionate, backed by the persuasive conviction of men who have survived prostate cancer and well financed by the multibillion-dollar industry that has grown up around the testing and treatment of the disease.

The other camp makes a less emotionally satisfying argument: on balance, scientific studies do not support the claim that screening healthy men saves lives. Screening, Brawley and others argue, can lead healthy men into a cascade of further testing and treatments that end up injuring or even killing them. As Richard Ablin, who discovered a prostate-specific antigen, put it in an Op-Ed in The New York Times, using the P.S.A. test to screen for cancer has been “a public health disaster.”

So what should a man do when his doctor suggests a routine P.S.A. test? The U.S. Preventive Services Task Force, a panel of independent experts that evaluates the latest scientific evidence on preventive tests and treatments, is charged with making recommendations in just such situations. It already recommends against routine screening for men over 75. According to an internal document, in 2009 the task force conducted an in-depth analysis of data and seemed poised to give routine P.S.A. testing a “D” rating — “D” as in don’t do it — for any man of any age. But this was around the time that the task force stated that routine mammography for women ages 40 to 50 was not necessary for every woman.

That recommendation caused a public uproar, and Ned Calonge, the task-force chairman at the time, sent the P.S.A. recommendation back for review. One year later, in November 2010, just before midterm elections, the task force was again set to review its recommendation when Calonge canceled the meeting. He says that word leaked out that if the November meeting was held, it could jeopardize the task force’s financing. Kenneth Lin, the researcher who led the review, quit his job in protest, and now, nearly two years after its initial finding, it remains uncertain when the task force will release its rating for P.S.A. screening.

Cancer screening is a growing field; existing tests are becoming more sensitive, and new tests are constantly developed. We now have CT scanning for lung cancer, and there is also a blood test marketed by Johnson & Johnson known as a “liquid biopsy,” which searches for stray cancer cells in the bloodstream. More testing inevitably brings more treatment, because the urge to correct every cellular anomaly, no matter how small or potentially harmless, is practically irresistible. But if there is one lesson from the P.S.A. test, it is that more information and intervention do not always lead to less suffering.
 
The popularity of the P.S.A. test as the main weapon against prostate cancer is due in large measure to the earnest and passionate advocacy of William Catalona, a urologist from Northwestern University Feinberg School of Medicine. During his residency training at Johns Hopkins Hospital in the mid-1970s, Catalona set up a clinic for late-stage prostate-cancer patients. Back then, the only tool for finding prostate cancer was a digital rectal exam — actually feeling the prostate through the rectal wall. By the time many tumors could be detected, the cancer was already advanced, and removing the prostate surgically did not offer a reliable cure.

Catalona grew close to many of the men he treated, as well as to their families. “Prostate cancer is a terrible death,” he said. “They developed bone fractures, they had a lot of pain, they lost weight. They required heavy doses of narcotics.”

Catalona wanted to catch these cancers early, when they might be curable. He noticed that men with more advanced cancers at the time of surgery tended to have the highest P.S.A. levels. Could there be a bright line, a “safe” level of P.S.A. that could distinguish healthy men from those with prostate cancer? After reviewing his own patient records, he decided the cutoff level should be 4 nanograms of P.S.A. per milliliter of blood. He followed up with a study of 1,653 patients. The results, published in 1991 in The New England Journal of Medicine, showed that P.S.A. testing could detect prostate cancer several years earlier than a digital rectal exam.

The test quickly gained powerful support: Gerald Murphy, who held the position at the American Cancer Society now held by Brawley, pushed the society to endorse the test. In 1996, Gen. H. Norman Schwarzkopf, a prostate-cancer survivor, appeared on the cover of Time magazine over the statement “There’s a simple blood test everyone should know about.”

By then, doctors were using the test for routine screening. “P.S.A. testing was so easy,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute (full disclosure: one author of this article is an instructor at Dartmouth). Doctors were predisposed to use the test for several reasons. First and foremost, there was the perception that early detection could save lives. It was also easy to administer. “It was a blood test,” Welch says. “You didn’t need equipment. . . . You didn’t need to put any scopes up any part of the body. Heck, you didn’t even need to ask the patient if he wanted it; you could just check off the box on a list of tests, like cholesterol, when you did a blood draw.” Today it’s common for doctors to order the P.S.A. test and patients to take it without talking about what it might really mean.

At one time, Otis Brawley, too, assumed that routine screening was the best medical practice. Sitting in his living room in an Atlanta suburb, Brawley recounted his transformation from believer to skeptic.

In 1988, after medical school at the University of Chicago, Brawley landed a prestigious fellowship at the National Cancer Institute in Bethesda, Md. There he came under the tutelage of Barnett Kramer, an oncologist and epidemiologist who went on to become the associate director of the institute’s early detection and community oncology program. Kramer walked Brawley through a short history of screening, beginning with the Pap smear, which has been an unqualified success, significantly cutting cervical-cancer deaths.

But other cancer screening tests had not worked out so well. For example, researchers at the Mayo Lung Project conducted a study between 1971 and 1983 to determine whether frequent chest X-rays could help reduce deaths from lung cancer. Chest X-rays detected lots of suspicious spots and shadows on the lungs and probably led to some cures of early lung cancers, but the study ultimately found no difference in death rates between the patients who were screened and those who were not.

Kramer suggested one probable explanation: diagnosing the spots picked up by X-ray often requires surgery, which carries a small but definite risk. Brawley knew that many spots seen on X-rays are simply old scars or minor abnormalities commonly seen in healthy people. With so many innocent blips detected, complications from lung biopsies and other invasive tests, along with treatment complications, could kill enough patients to negate any benefit from early detection.

Prostate cancer is the second-leading cause of cancer death among men, after lung cancer. In 2009, it was diagnosed in approximately 192,000 men. A small number of tumors are very aggressive, but the majority of prostate tumors are not likely to cause death. They grow very slowly, and only a fraction break out of the prostate, seed new tumors in other parts of the body and kill the patient. The current thinking is that about 30 percent of men in their 40s have prostate cancer, 40 percent of men in their 50s and so on, right up to 70 percent of men in their 80s. Yet only 3 percent of all men die from the disease. In other words, far more men die with prostate cancer than from it, and only a tiny fraction of prostate cancers ever cause symptoms, much less death.

But here is the tricky part: Unless there are symptoms or a finding on a physical exam, doctors generally cannot accurately predict which cancers are destined to be indolent, to sit around for years growing slowly, if at all, and those that will ultimately prove lethal.

In his discussions with Kramer, Brawley saw that these two pieces of information — the fact that a certain number of prostate cancers will never cause harm, and that doctors can’t reliably predict which cancers will be dangerous — had powerful and potentially devastating consequences for men. The first implication was that using the P.S.A. test to screen men who had no symptoms would uncover a huge reservoir of indolent cancers. Most of those cancers that men previously died with — and not from — would now theoretically be detectable. And once detected, the majority of those cancers would be treated.

The most frequent treatment then, as it is now, was the surgical removal of the entire prostate gland. The prostate sits at the base of the penis, wrapped around the urethra, which is the tube that carries urine and semen out of the penis. Trying to separate gland from urethra is a difficult job, and even the best of surgeons can damage the urethra or the bundle of nerves that initiate erections. About half of men who undergo radiation or surgery will have permanent side effects like impotence and incontinence. Up to 1 in 200 men die within 30 days from complications related to the surgery.

“You didn’t have to be brilliant to see that history was repeating itself,” Brawley says. “Doctors were just substituting a blood test for chest X-rays.”

Tim Glynn, a self-described country lawyer from Setauket, N.Y., was 47 in 1997 when he went to his primary-care doctor, troubled by a vague feeling of being down. After his physical exam, Glynn was sent to have his blood drawn. Along with thyroid and cholesterol levels, the doctor ordered a P.S.A. test. A week later, Glynn returned to hear the results. His P.S.A. was elevated. He was told to get a biopsy as soon as possible.
After the biopsy, he walked into a bar in the middle of the afternoon and ordered a martini. A few weeks later, Glynn’s urologist told him the biopsy showed prostate cancer and recommended that he have his prostate removed immediately. Glynn chose to do some homework first.

One of Glynn’s clients happened to be Richard Ablin, the scientist. Ablin told him that not all prostate cancers are alike, and that he could wait; if he developed symptoms, or if his P.S.A. shot up, he could always opt to be treated at that time. (Some doctors recommend “active surveillance,” in which the patient is periodically given P.S.A. testing and biopsies, rather than immediate treatment.) Glynn chose to hold off on surgery.

Kerri Glynn, Tim’s wife of now 39 years, was terrified by her husband’s decision. “I felt as if an ax had fallen,” she says. In her mind it was better to be safe than sorry, and safe meant being treated immediately. “She was a wreck,” Glynn says. “She was scared witless.”

His colleagues were also worried about his decision to forgo treatment. “My business partner was clearly very anxious, and my assistant asked if she should look for a new job,” Glynn recalls. “And there was the fear that if this became public knowledge, there would be clients who wouldn’t want to deal with us because they wouldn’t want to engage a lawyer who was going to be dead the next day. When you see the people around you falling apart, you sort of have to get treated for them, so you can go back to a normal life.”

For many people, not being treated after a diagnosis of cancer is psychologically unbearable. Our view of cancer, says Barnett Kramer, is still shaped by the fact that until relatively recently, cancers were only discovered when they were causing symptoms. Before current treatments were available, such cancers were often fatal. We can now screen for cancers long before they become symptomatic, but it’s still very difficult to imagine that they can safely be left untreated. Brawley says, “I have had patients say, ‘Damn it, I’m an American — you can’t tell me I have cancer and we’re going to watch — you have to treat it.’ ”

Glynn had the surgery. Fourteen years later, he still takes drugs for impotence. It would be more than a year following surgery before he had the energy to play a set of tennis again. “The toll that this took on energy and physicality was like being aged five years,” he says.

One way to look at Glynn’s story is as a success. His cancer was removed. His impotence is being managed. But Glynn sees it differently, and so do many other men who have been treated for prostate cancer. Darryl Mitteldorf is the executive director of Malecare, a cancer-patient support group. He says it is not uncommon for men to regret their decision to be tested and treated for prostate cancer. “We have men come in very upset, week after week, telling us what they’re not telling their doctors,” he says. One-third of men who are given a P.S.A. test were never asked if they wanted it. Of men who are asked, more than half say their doctor failed to mention possible side effects that result from treatment.

Brawley tells the story of a patient who had surgery and then underwent radiation, which left him with severe damage to both his rectum and ureter. “He had every side effect known to man,” Brawley says. “He had a bag for urine, a bag for stool, he was a terrible mess, in and out of the hospital with infections.” The man died six years after his surgery, from an overwhelming infection. Yet cancer statistics would list such a man as a success story, Brawley says, “because he survived past the five-year mark.” Would an untreated prostate cancer have killed him within six years, too? There is simply no way to know. 

Many doctors suggest that African-American men and those with a family history should be tested as early as age 40, because they are at increased risk of dying of prostate cancer. But Brawley, who is African-American and has declined P.S.A. screening himself, says this recommendation is based on conjecture, and even for men at higher risk, the test may cause more harm than good. Until the proper studies are done, he asserts, “We just don’t know.” 

The dueling narratives of P.S.A. testing boil down to the way each side frames the potential for harm from the disease compared with the collateral damage from the test and subsequent treatment. Mohler says, “P.S.A., when used intelligently to detect prostate cancer early in men after proper education . . . performs pretty well; it actually performs better than a mammogram.” P.S.A. advocates are concerned that statistics play down the value of each life saved. Some also argue that the statistics will validate their view as men are followed beyond 14 years. More important, they worry that if men reject screening, malignant cancers will go undiagnosed. 

David Newman, a director of clinical research at Mount Sinai School of Medicine in Manhattan, looks at it differently and offers a metaphor to illustrate the conundrum posed by P.S.A. screening. 

“Imagine you are one of 100 men in a room,” he says. “Seventeen of you will be diagnosed with prostate cancer, and three are destined to die from it. But nobody knows which ones.” Now imagine there is a man wearing a white coat on the other side of the door. In his hand are 17 pills, one of which will save the life of one of the men with prostate cancer. “You’d probably want to invite him into the room to deliver the pill, wouldn’t you?” Newman says. 

Statistics for the effects of P.S.A. testing are often represented this way — only in terms of possible benefit. But Newman says that to completely convey the P.S.A. screening story, you have to extend the metaphor. After handing out the pills, the man in the white coat randomly shoots one of the 17 men dead. Then he shoots 10 more in the groin, leaving them impotent or incontinent. 

Newman pauses. “Now would you open that door?” He argues that the only way to measure any screening test or treatment accurately is to examine overall mortality. That means researchers must look not just at the number of deaths from the disease but also at the number of deaths caused by treatment.

Many experts agree with Newman, and two large studies of P.S.A. screening, published in The New England Journal of Medicine in 2009, came to the same conclusion: There was no difference between the screened and unscreened groups in overall deaths. One trial, conducted in the United States, showed no reduction in prostate-cancer deaths over a period of up to 10 years when men 55 and older were screened. The other, which was carried out in several European countries, showed that screening reduced mortality from prostate cancer by 20 percent, yet the overall number of deaths in each group was the same. Newman gives one possible reason for this: the benefit of early diagnosis could be offset by complications from diagnostic tests and subsequent treatment.

Each study has been criticized for design and execution issues that might have skewed the results, but the failure to reduce overall mortality reported in the European study is probably no fluke, Newman says. An analysis of six studies of screening involving nearly 400,000 men, published last year in the British medical journal BMJ, found no significant difference in overall mortality when screened men were compared with controls. Philipp Dahm, a professor of urology at the University of Florida College of Medicine and lead investigator for the analysis, says the study shows that P.S.A. screening “does not have a clinically important impact” on overall mortality. Or as Kramer, an author of the U.S. study, crisply puts it, “Men may be trading one cause of death for another.” 

For Brawley, the greatest tragedy of P.S.A. screening is that it has been a distraction from making greater progress in reducing deaths with the one clear helpful thing: distinguishing between the prostate tumors that really need to come out and those that are better left alone. Instead, new types of P.S.A. screening are being promoted. “We live in a time when our failure to define questions properly has delayed our progress and harmed health,” he says. “We keep pursuing son of, son of P.S.A.”

As it stands, each man must decide for himself how he wants to play the odds. “Let’s put this in perspective,” says Welch, whose most recent book is “Overdiagnosed: Making People Sick in the Pursuit of Health.” “The European trial says 50 men have to be treated for a cancer that was never going to bother them to reduce one death. Fifty men. That’s huge. To me, prostate screening feels like an incredibly bad deal.” 

Other men, Welch acknowledges, may arrive at a different conclusion, and he is careful to avoid pushing his own patients in one direction or the other. The answer is ultimately personal, he says, and while studies of groups of people can feel unhelpful if you could be the one in the group with cancer, that is all we have to go on. 

The solution, in Welch’s view, and in that of a growing number of physicians, including Brawley, is to make sure men fully grasp the downstream decisions they may face as a result of screening — the risk of knowing too much. Studies have found that when men are given balanced information about both the cons and pros of P.S.A. testing, they are less likely to opt for screening than men who were merely offered the test. Given this, Brawley asks, how can it be ethical for a doctor not to inform men of the risks — or to fail to even tell a man that the test has been ordered? “If a man understands the risks and benefits and does not want to be screened, that decision should be supported,” he says. “But just saying that gets you in trouble.”

Shannon Brownlee (brownlee@newamerica.net) is acting director of the New America Foundation Health Policy Program and an instructor at Dartmouth Institute for Health Policy and Clinical Practice.
Jeanne Lenzer (jeanne.lenzer@gmail.com) is a freelance journalist and a frequent contributor to the British medical journal BMJ.
Editor: Vera Titunik (v.titunik-MagGroup@nytimes.com)

To view the original article CLICK HERE

 .

 Please Be Sure To

Tweet My Blogs

To Spread The Facts World Wide To Give Others HOPE

I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

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on: http://GregLanceWatkins.Blogspot.com
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Health/Cancer Blog: http://GregLW.blogspot.com  

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PROSTATE CANCER - A Random Chat

PROSTATE CANCER - A Random Chat

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Hi,

on one of the many Forums I contribute to (most of which are political thought and debate - and discussion of world events with a smattering of other subjects!):

In answer to the comment most men seem to get prostate cancer

Image via Wikipedia

 johnofgwent Said: 

Yes, they do. I have no idea why, but surveys carried out in this country by the NHS proved a majority of men over the age of 50 "on the slab" had this cancer to some degree, but died of something else before the cancer had expressed itself to any great degree.

Midas rightly felt it apposite to query this:

Eh?? According to Cancer Research, there were 37,051 new cases of prostate cancer diagnosed in the UK in the last year for which they publish full figures (2008), that's approximately 0.12% of the male population....

My interjection was:

Hi,

I believe both of you are right.

John has stated a projected autopsy rate whilst Midas has presented a live diagnosis rate based on all age groups (which is a bit misleading).

It is a well founded belief amongst oncologists, I am given to believe, that most men over 60 or 65 have prostate cancerous cells, most over 70 have traceable prostate cancer but few will find time to die of it before something else spares them!

CAVEAT: many believe that a high PSA (Prostate Specific Antigen) reading in the blood indicates cancer of the prostate.

I do NOT have prostate cancer but due largely to age and genetics I have an enlarged prostate and one of the lobes is notably enlarged - my PSA is thus very high as with a bigger but otherwise healthy prostate PSA output is high.

A high PSA in a random test is little more than an indication there MIGHT be enlargement and that the enlargement MIGHT be cancerous.

PLEASE NOTE - I am NOT qualified in this or any other medical field - merely experienced ;(

I hope this helps - so panic not John even if you are found to have a problem it may well be benign - and may I suggest Midas that you check if in doubt but be minded that few with prostate cancer are diagnosed in life and only a small percentage of those find it to be life threatening or terminal.

DO NOTE: The sooner ANY cancer is identified the better - do NOT permit your doctors to fob you off without providing sound and plausible reasons for urethral, vaginal or anal bleeding - ALL are un-natural (save for the obvious!0.

Do NOT accept any fob off for any type of prolonged dull ache pain from the pelvic or abdomen area nor any 'flash' pain that repeats from the pelvis or down the upper leg(s) from the pelvis.

7,500,000 people a year die from cancer each year - many could have been given extra years of quality life had they been diagnosed early.

YOUR HEALTH is YOUR responsibility and ignoring symptoms is foolish in the extreme.

Anyone who wants to chat about cancer or possible cancer is welcome to call me if you believe my 13 years of experience of this pernicious disease can help them and anyone just wanting a chatty look at cancer do read my blog.

JUST TO TIDY UP:
It is a prostate gland and not as many seem to name it prostrate!

The prostate is a male specific gland producing a sugary type nutrient fluid as a carrier for semen and thus a seminal fluid.

The gland is about the size of a walnut, though it tends to enlarge with age, and it is located at the base of the male bladder where the urethra (Drain pipe for the bladder!) passes through its center.

There is a belief that HPV (Human Papilloma Virus) may well be carried in these seminal fluids giving rise to HPV which if contracted young (before natural resistances have built up adequately) may well develop into cancer of the esophagus, rectum or vagina - dependent on ones practices!

For more information do read my blog. IF you feel it will help you opr a friend.

Regards,
Greg

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I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.
You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help. . YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com  
TWITTER: Greg_LW  
Health/Cancer Blog: http://GregLW.blogspot.com  

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06-Jun-2011 - BLOODS, CLINIC, DELAYS & THE REAL WORLD!

06-Jun-2011 - BLOODS, CLINIC, DELAYS & THE REAL WORLD!

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  Hi,

Just to put some of this in perspective:

Mortality from cancer worldwide

Each year more than 7.5 million people worldwide die from cancer. Because of the size of its population around half of these people (50%) are in Asia). Around 12% of deaths worldwide are from cancer. The proportion of all deaths caused by cancer varies, from only 4% in Africa to 23% in Northern America ( Figure 3.11-2). In the UK around 24% of all deaths are caused by cancer.

Even considering WHO predictions that Cancer deaths will rise to 15M a year by 2020 CLICK HERE worldwide that is scarey but a tiny weenie number when you consider there will be approaching 8 Billion people alive then.

So currently out of around 56 Million deaths a year only about 7.5 million are related to cancer.

OK that's you dead from boredom with statistics but it does put some facts around the fear ;-)

Now to really bore you!

So on Monday Lee and I went to Velindre for a Clinic as although I had not been notified last Thursday I remembered I had Chemo on Wednesday (low on my priorities that week!) but when did they intend to check my bloods and when was Dr. lester going to come up with the results on my scan.

As anyone who has played these games will know - you desperately want the results of scans but you try to put them off as it MIGHT be a death sentence - Scanziety!

Anyway I bit the bullet and I suggested I came in for clinic on Monday and then if there was a problem someone else, with luckier results, could have my Chemo slot on Wednesday!

So we walker into Velindre on time! Another 40 miles down the M4! More of that later, but I've had a bit of a cunning wheeze I think!

It is astonishing in that busy hospital with all those agitated and concerned faces around just howmany seem to greet me by name!! I suppose it is 'cos of the crazy 'T'Shirt slogans and the determination to laugh about life and laugh with people however rough it gets!!

It is astonishing how many people end up chatting as they sit their looking glum and you say 'Hi great to see you are still alive it gives me hope'! They ALWAYS smile after that!

Anyway - in for another armful of blood to be taken! No problem we were laughing about the risks of washing up when you are on Chemo - DANGEROUS might cut your finger!!

Right so off the blood samples go and the tests, which are done mechanically (well electro Mechanically sort of electronic and printed out on screen) are then human checked by someone with one of the world's most boring jobs! 

That should take just over 20 minutes but in any busy blood unit it takes nearer an hour - werll it is all down to resources and of course Managers come far before Medical Care! Clearly there are far too many managers and parasites in the Kleptocratic QUANGOcracy.

What we need is more clinical & medical staff - not more parasites - clearly there is a log jam at Bloods and another in Radiography.

I would NOT have possibly terminal Cancer if instead of squandering £1Billion The Local Welsh Health Service had not squandered the money but bought the required Scanners and funded them. The scan I should have had in the first 2 weeks of January so that this could all have been sorted with simple surgery but waiting until the end of March to prove what we already knew led to metastases that may well kill me!

ANNOUNCEMENT:

whilst we were chatting with a couple where the wife had been a Sister at The Royal Gwent, in one of the few units she believed functioned OK, her husband had Prostate Cancer and was waiting for news of scans with a mixture of bold equanimity and trepidation - don't we all!

The announcement was that Dr. Jason Lester's clinic was running 90 minutes late!


Actually nuisance as it may be I never really mind - he sets up his clinic on a planned time scale, as is essential, but when he sets it up he has no way of knowing just how long his patients may take to assimilate what may be very grave news and he will - as I have seen repeatedly, give the time that is needed to every patient according to that need.


I may need that time one day and I may well think of the delay but ...

So Lee and I checked in with the sister managing the clinic and asked if we could Mike Off to the canteen for an hour - no problem, the coffee is better, it is comfier and there is an outside view!

 Please Be Sure To
 ..

To Spread The Facts World Wide 
To Give Others HOPE

I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help. . YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com  
TWITTER: Greg_LW  
Health/Cancer Blog: http://GregLW.blogspot.com  

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03-May-2011-20:30hrs. - I Must TRY To UPDATE GOOD NEWS TOO!

03-May-2011-20:30hrs. - I Must TRY To UPDATE GOOD NEWS TOO!

Hi,

I really must make more effort to update when my location changes as Roger had been reading the blog and Anne phoned thinking she would be speaking to Lee as I was still seemingly in hospital.

Mea Culpa – I was out again and had not caught up so she was quite surprised when I answered the phone!

Anyway it was really great that knowing I was in hospital or at least having read the blog and thought I was still there Anne and a couple of others called up to offer Lee support – Thanks, it really is a great help for both of us.

Roger is back on Sutent but this time the dose is down to 37.5 as 50 had just made him too ill – this time to their relief his system seems to be controlling the side effects a bit better. The normal fatigue but not the more extreme manifestations he had during the last cycle on 50mg. Dosage which he had been forced to abandon.

Roger has picked up an error in my brief comments on his Cancer Trail as it started NOT with RCC but with Prostate Cancer and what seemed to be a very successful radical prostetectomy. There was every reason to believe that he was in the clear.

Then a completely new round started with RCC this time but he has promised to write up his details rather better for me and I'll include them on a link on this blog.

Check out the Hot Links in the Right sidebar for more details or use The SEARCH BOX at the top of the sidebar.

Anyway – yes I'm back home and my thanks to Anne and others for their calls of support.

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

. If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order. . Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help. . YOU are welcome to call me if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com

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28-Apr-2011 - St. DAVID's NURSING aka MacMILLAN

28-Apr-2011 - St. DAVID's NURSING aka MacMILLAN

Hi,

well having stumbled off to bed this morning at 10 to 7 around 10:50hrs. I woke up with a sore mouth and really horrid tummy ache - I can't work out whether the stomach ache is some sort of side effect or maybe just a product of swallowing too much air with my ffod as I gulpped it being unable to chew or swallow properly - either way it wasn't until the following evening that it finally stopped being a pain!

I malingered and felt sorry for myself in bed until about 12:30hrs. when I heard Lee doing something in the kitchen - I am so restless she has given up trying to sleep in our bed and usually when I wake up she has slid off to sleep in peace and comfort without being kicked and elbowed and is in the spare bedroom - who can blame her.

Yeah, Yeah, Yeah those thoughts ill become you!

I got up chucked my 2nd. dose of mouth wash for the morning in and swished it about for the required 3 minutes! The instructions on that bottle say take 15ml. and swish around the mouth for 3 minutes - one wonders if the chap who wrote the instructions had ever tried it with mouth ulcers - 10ml. is no problem but with mouth ulcers the second you put 0.2% solution of CHLORHEXIDINE GLUCONATE in your mouth the saliva glands go into overdrive!

OK so after about 1 minute it seems like you have at least a cup full in your mouth and after 2 minutes you have no choice but to spit some out!

Then off to the office - about an hour later the phone goes and it is Nairn from St. David's Nursing they largely fill the role in Monmouthshire and Wales of MacMillan Nursing in England - she is just down the road and can she pop in.

PANIC - I'm still in a dressing gown so Lee meets her and I throw some clothes on!

I remember Nairn clearly when I see her, as I had meetings with her when Lee's Mother had Brain Cancer and during those 3 cruel months.

We sat outside on the bench for a while chatting, although I'm not meant to go in the sun, yet another side effect of chemo!

Nairn went through the various ways she could assist Lee and I during this battle and it is surprising what doors she can instantly open.

The main thing from my point of view is the knowledge that Lee now has a competent support situation if I do suddenly get ill in the battle, and they will help her through it until I recover.

I've managed to beat this bastard disease4 for 13 years and just 'cos the Book Makers only offer 5-15% survival if people only backed certainties the entire racing business would collapse!

We don't expect it to be easy but over the last 13 years with Lee's Mother, both my parents and my Aunt all having far from simple deaths we really don't expect easy! Also we know so many people who have been in contact with me as a result of the help line I have offered both sufferers, fighters and carers not least of whom was our good friends Rosemarie and Peter and the cruel and savage death of Peter from Prostate cancer at 60 just as they were both about to retire.

My parents house keeper and help Pat is battling at the moment and she has served the family for about 30 years - her husband was doing some part time building for Lee and I and put a new flat roof on my parent's house for us and suddenly in the middle of another job, just before Christmas he developed a cancer on his neck which he was firstly treated with chemo for but it wasn't too wonderful and so he finished a course of radio therapy just a fortnight ago and we are all keeping our fingers crossed.

Then of course there is Robin who had a radical prostectomy and has regular treatment now to try to control his metateses! We chat on the phone regularly and take the mickey out of our respective situations.

Then there is Roger who we have known for 30 years and he has so far lost a kidney, an adrenal gland, some intestine and half his liver to RCC (Renal Cell Carcinoma) he is struggling his way through his 2nd. or 3rd. course of Sutent under the same specialist as I am at Velindre.

Then there is Stuart Archer and having beaten bowel cancer once it has come raging back and his chemo is beating him about harshly and although he knows his prognosis is not good he is fighting it all the way with hopes for further treatments if this round of chemo lets him down.

Just to add to it there is Alan - my Father's younger brother who was fast losing his voice and they have now found a lump on his lung which was crushing the nerve to the vocal chord - at 83 he is fairly pragmatic about it but all too well aware that Brenda could not cope if he was incapacitated and their only son is now an American citizen as he and his wife Paula (whose Father has cancer) live in West Virginia.


I guess Cancer burst into my life with my cousin John who died after an 11 year battle when he was only in his early 50s 15-Jul-1994 and I guess the next was Mike Slinn and so on and on and on!

Would it be fair to say there does seem to be a lot of it about!

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com

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