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href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/">Back to front page »</a></p> <div class="blog_post lead single cancer "> <div class="post-info"> <small class="post-date" id="day_5">February 5, 2008,  11:07 am</small> <h2 class="post-title">No Answers for Men With Prostate Cancer</h2> </div> <div class="post-content"> <p>Last year, 218,000 men were diagnosed with prostate cancer, but nobody can tell them what type of treatment is most likely to save their lives.</p> <p>Those are the findings of a troubling new <a href="https://web.archive.org/web/20080224222815/http://www.annals.org/cgi/content/full/0000605-200803180-00209v1#R5-2321" target="_blank">report</a> from the Agency for Healthcare Research and Quality, which analyzed hundreds of studies in an effort to advise men about the best treatments for prostate cancer. The report compared the effectiveness and risks of eight prostate cancer treatments, ranging from prostate removal to radioactive implants to no treatment at all. None of the studies provided definitive answers. Surprisingly, no single treatment emerged as superior to doing nothing at all.</p> <p>“When it comes to prostate cancer, we have much to learn about which treatments work best,'’ said agency director Carolyn M. Clancy. “Patients should be informed about the benefits and harms of treatment options.”<a id="more-243"></a></p> <p>But the study, published online in the Annals of Internal Medicine, gives men very little guidance. Prostate cancer is typically a slow-growing cancer, and many men can live with it for years, often dying of another cause. But some men have aggressive prostate cancers, and last year 27,050 men died from the disease. The lifetime risk of being diagnosed with prostate cancer has nearly doubled to 20 percent since the late 1980s, due mostly to expanded use of the prostate-specific antigen, or P.S.A., blood test. But the risk of dying of prostate cancer remains about 3 percent. “Considerable overdetection and overtreatment may exist,'’ an agency press release stated. </p> <p>The agency review is based on analysis of 592 published articles of various treatment strategies. The studies looked at treatments that use rapid freezing and thawing (cryotherapy); minimally invasive surgery (laparoscopic or robotic-assisted radical prostatectomy); testicle removal or hormone therapy (androgen deprivation therapy); and high-intensity ultrasound or radiation therapy. The study also evaluated research on “watchful waiting,'’ which means monitoring the cancer and initiating treatment only if it appears the disease is progressing.</p> <p>No one treatment emerged as the best option for prolonging life. And it was impossible to determine whether one treatment had fewer or less severe side effects.</p> <p>Many of the treatments now in widespread use have never been evaluated in randomized controlled trials. In the research that is available, the characteristics of the men studied varied widely. And investigators used different definitions and methods, making reliable comparisons across studies impossible. </p> <p>“Investigators’ definitions of adverse events and criteria to define event severity varied widely,'’ the report notes. “We could not derive precise estimates of specific adverse events for each treatment.'’</p> <p>The report findings highlighted by the agency include:</p> <ul> <li>All active treatments cause health problems, primarily urinary incontinence, bowel problems and erectile dysfunction. The chances of bowel problems or sexual dysfunction are similar for surgery and external radiation. Leaking of urine is at least six times more likely among surgery patients than those treated by external radiation.</li> <li>Urinary leakage that occurs daily or more often was more common in men undergoing radical prostatectomy (35 percent) than external-beam radiation therapy (12 percent) or androgen deprivation (11 percent). Those were the findings of the 2003 Prostate Cancer Outcomes Study, a large, nationally representative survey of men with early prostate cancer.</li> <li>External-beam radiation therapy and androgen deprivation were each associated with a higher frequency of bowel urgency (3 percent) compared with radical prostatectomy (1 percent), according to the 2003 report. </li> <li>Inability to attain an erection was higher in men undergoing active intervention, especially androgen deprivation (86 percent) or radical prostatectomy (58 percent) than in men receiving watchful waiting (33 percent), according to the 2003 report.</li> <li>One study showed that men who choose surgery over watchful waiting are less likely to die or have their cancer spread, but another study found no difference in survival between surgery and watchful waiting. The benefit, if any, appears to be limited to men under 65. However, few patients in the study had cancer detected through P.S.A. tests. As a result, it’s not clear if the results are applicable to the majority of men diagnosed with the disease.</li> <li>Adding hormone therapy prior to prostate removal does not improve survival or decrease recurrence rates, but it does increase the chance of adverse events.</li> <li>Combining radiation with hormone therapy may decrease mortality. But compared with radiation treatment alone, the combination increases the chances of impotence and abnormal breast development.</li> </ul> <p>The most obvious trend identified in the complicated report is how little quality research exists for prostate cancer, despite the fact that it is the most diagnosed cancer in the country.</p> <p>Studies comparing brachytherapy, radical prostatectomy, external-beam radiation therapy or cryotherapy were discontinued because of poor recruitment. Two ongoing trials, one in the United States and one in Britain, are evaluating surgery and radiation treatments compared with watchful waiting in men with early cancer. Other studies in progress or development include cryotherapy versus external-beam radiation and a trial evaluating radical prostatectomy versus watchful waiting. </p> <p>“Successful completion of these studies is needed to provide accurate assessment of the comparative effectiveness and harms of therapies for localized prostate cancers,” the study authors said.</p> </div> <div class="post-tools"> <ul id="post-tools-243"> <li class="comments-tool"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/no-answers-for-men-with-prostate-cancer/#comments" class="post-comment" title="Comment on No Answers for Men With Prostate Cancer">Comments (152)</a></li> <li class="email-tool"> <form method="post" name="emailThis_243" id="emailThis_243" style="display: inline;" enctype="application/x-www-form-urlencoded" action="https://web.archive.org/web/20080224222815/http://www.nytimes.com/mem/emailthis.html"> <input type="hidden" name="type" value="1"/> <input type="hidden" name="url" value="http%3A%2F%2Fwell.blogs.nytimes.com%2F2008%2F02%2F05%2Fno-answers-for-men-with-prostate-cancer%2F"/> <input type="hidden" name="title" value="Well%3A%20No%20Answers%20for%20Men%20With%20Prostate%20Cancer"/> <input type="hidden" name="full_text" value="%3Cp%3ELast%20year%2C%20218%2C000%20men%20were%20diagnosed%20with%20prostate%20cancer%2C%20but%20nobody%20can%20tell%20them%20what%20type%20of%20treatment%20is%20most%20likely%20to%20save%20their%20lives.%3C%2Fp%3E%0A%3Cp%3EThose%20are%20the%20findings%20of%20a%20troubling%20new%20%3Ca%20href%3D%22http%3A%2F%2Fwww.annals.org%2Fcgi%2Fcontent%2Ffull%2F0000605-200803180-00209v1%23R5-2321%22%20target%3D%22_blank%22%3Ereport%3C%2Fa%3E%20from%20the%20Agency%20for%20Healthcare%20Research%20and%20Quality%2C%20which%20analyzed%20hundreds%20of%20studies%20in%20an%20effort%20to%20advise%20men%20about%20the%20best%20treatments%20for%20prostate%20cancer.%20The%20report%20compared%20the%20effectiveness%20and%20risks%20of%20eight%20prostate%20cancer%20treatments%2C%20ranging%20from%20prostate%20removal%20to%20radioactive%20implants%20to%20no%20treatment%20at%20all.%20None%20of%20the%20studies%20provided%20definitive%20answers.%20Surprisingly%2C%20no%20single%20treatment%20emerged%20as%20superior%20to%20doing%20nothing%20at%20all.%3C%2Fp%3E%0A%3Cp%3E%26%238220%3BWhen%20it%20comes%20to%20prostate%20cancer%2C%20we%20have%20much%20to%20learn%20about%20which%20treatments%20work%20best%2C%27%26%238217%3B%20said%20agency%20director%20Carolyn%20M.%20Clancy.%20%26%238220%3BPatients%20should%20be%20informed%20about%20the%20benefits%20and%20harms%20of%20treatment%20options.%26%238221%3B%3Ca%20id%3D%22more-243%22%3E%3C%2Fa%3E%3C%2Fp%3E%0A%3Cp%3EBut%20the%20study%2C%20published%20online%20in%20the%20Annals%20of%20Internal%20Medicine%2C%20gives%20men%20very%20little%20guidance.%20Prostate%20cancer%20is%20typically%20a%20slow-growing%20cancer%2C%20and%20many%20men%20can%20live%20with%20it%20for%20years%2C%20often%20dying%20of%20another%20cause.%20But%20some%20men%20have%20aggressive%20prostate%20cancers%2C%20and%20last%20year%2027%2C050%20men%20died%20from%20the%20disease.%20The%20lifetime%20risk%20of%20being%20diagnosed%20with%20prostate%20cancer%20has%20nearly%20doubled%20to%2020%20percent%20since%20the%20late%201980s%2C%20due%20mostly%20to%20expanded%20use%20of%20the%20prostate-specific%20antigen%2C%20or%20P.S.A.%2C%20blood%20test.%20But%20the%20risk%20of%20dying%20of%20prostate%20cancer%20remains%20about%203%20percent.%20%26%238220%3BConsiderable%20overdetection%20and%20overtreatment%20may%20exist%2C%27%26%238217%3B%20an%20agency%20press%20release%20stated.%20%3C%2Fp%3E%0A%3Cp%3EThe%20agency%20review%20is%20based%20on%20analysis%20of%20592%20published%20articles%20of%20various%20treatment%20strategies.%20The%20studies%20looked%20at%20treatments%20that%20use%20rapid%20freezing%20and%20thawing%20%28cryotherapy%29%3B%20minimally%20invasive%20surgery%20%28laparoscopic%20or%20robotic-assisted%20radical%20prostatectomy%29%3B%20testicle%20removal%20or%20hormone%20therapy%20%28androgen%20deprivation%20therapy%29%3B%20and%20high-intensity%20ultrasound%20or%20radiation%20therapy.%20The%20study%20also%20evaluated%20research%20on%20%26%238220%3Bwatchful%20waiting%2C%27%26%238217%3B%20which%20means%20monitoring%20the%20cancer%20and%20initiating%20treatment%20only%20if%20it%20appears%20the%20disease%20is%20progressing.%3C%2Fp%3E%0A%3Cp%3ENo%20one%20treatment%20emerged%20as%20the%20best%20option%20for%20prolonging%20life.%20And%20it%20was%20impossible%20to%20determine%20whether%20one%20treatment%20had%20fewer%20or%20less%20severe%20side%20effects.%3C%2Fp%3E%0A%3Cp%3EMany%20of%20the%20treatments%20now%20in%20widespread%20use%20have%20never%20been%20evaluated%20in%20randomized%20controlled%20trials.%20In%20the%20research%20that%20is%20available%2C%20the%20characteristics%20of%20the%20men%20studied%20varied%20widely.%20And%20investigators%20used%20different%20definitions%20and%20methods%2C%20making%20reliable%20comparisons%20across%20studies%20impossible.%20%3C%2Fp%3E%0A%3Cp%3E%26%238220%3BInvestigators%26%238217%3B%20definitions%20of%20adverse%20events%20and%20criteria%20to%20define%20event%20severity%20varied%20widely%2C%27%26%238217%3B%20the%20report%20notes.%20%26%238220%3BWe%20could%20not%20derive%20precise%20estimates%20of%20specific%20adverse%20events%20for%20each%20treatment.%27%26%238217%3B%3C%2Fp%3E%0A%3Cp%3EThe%20report%20findings%20highlighted%20by%20the%20agency%20include%3A%3C%2Fp%3E%0A%3Cul%3E%0A%3Cli%3EAll%20active%20treatments%20cause%20health%20problems%2C%20primarily%20urinary%20incontinence%2C%20bowel%20problems%20and%20erectile%20dysfunction.%20The%20chances%20of%20bowel%20problems%20or%20sexual%20dysfunction%20are%20similar%20for%20surgery%20and%20external%20radiation.%20Leaking%20of%20urine%20is%20at%20least%20six%20times%20more%20likely%20among%20surgery%20patients%20than%20those%20treated%20by%20external%20radiation.%3C%2Fli%3E%0A%3Cli%3EUrinary%20leakage%20that%20occurs%20daily%20or%20more%20often%20was%20more%20common%20in%20men%20undergoing%20radical%20prostatectomy%20%2835%20percent%29%20than%20external-beam%20radiation%20therapy%20%2812%20percent%29%20or%20androgen%20deprivation%20%2811%20percent%29.%20Those%20were%20the%20findings%20of%20the%202003%20Prostate%20Cancer%20Outcomes%20Study%2C%20a%20large%2C%20nationally%20representative%20survey%20of%20men%20with%20early%20prostate%20cancer.%3C%2Fli%3E%0A%3Cli%3EExternal-beam%20radiation%20therapy%20and%20androgen%20deprivation%20were%20each%20associated%20with%20a%20higher%20frequency%20of%20bowel%20urgency%20%283%20percent%29%20compared%20with%20radical%20prostatectomy%20%281%20percent%29%2C%20according%20to%20the%202003%20report.%20%3C%2Fli%3E%0A%3Cli%3EInability%20to%20attain%20an%20erection%20was%20higher%20in%20men%20undergoing%20active%20intervention%2C%20especially%20androgen%20deprivation%20%2886%20percent%29%20or%20radical%20prostatectomy%20%2858%20percent%29%20than%20in%20men%20receiving%20watchful%20waiting%20%2833%20percent%29%2C%20according%20to%20the%202003%20report.%3C%2Fli%3E%0A%3Cli%3EOne%20study%20showed%20that%20men%20who%20choose%20surgery%20over%20watchful%20waiting%20are%20less%20likely%20to%20die%20or%20have%20their%20cancer%20spread%2C%20but%20another%20study%20found%20no%20difference%20in%20survival%20between%20surgery%20and%20watchful%20waiting.%20The%20benefit%2C%20if%20any%2C%20appears%20to%20be%20limited%20to%20men%20under%2065.%20However%2C%20few%20patients%20in%20the%20study%20had%20cancer%20detected%20through%20P.S.A.%20tests.%20As%20a%20result%2C%20it%26%238217%3Bs%20not%20clear%20if%20the%20results%20are%20applicable%20to%20the%20majority%20of%20men%20diagnosed%20with%20the%20disease.%3C%2Fli%3E%0A%3Cli%3EAdding%20hormone%20therapy%20prior%20to%20prostate%20removal%20does%20not%20improve%20survival%20or%20decrease%20recurrence%20rates%2C%20but%20it%20does%20increase%20the%20chance%20of%20adverse%20events.%3C%2Fli%3E%0A%3Cli%3ECombining%20radiation%20with%20hormone%20therapy%20may%20decrease%20mortality.%20But%20compared%20with%20radiation%20treatment%20alone%2C%20the%20combination%20increases%20the%20chances%20of%20impotence%20and%20abnormal%20breast%20development.%3C%2Fli%3E%0A%3C%2Ful%3E%0A%3Cp%3EThe%20most%20obvious%20trend%20identified%20in%20the%20complicated%20report%20is%20how%20little%20quality%20research%20exists%20for%20prostate%20cancer%2C%20despite%20the%20fact%20that%20it%20is%20the%20most%20diagnosed%20cancer%20in%20the%20country.%3C%2Fp%3E%0A%3Cp%3EStudies%20comparing%20brachytherapy%2C%20radical%20prostatectomy%2C%20external-beam%20radiation%20therapy%20or%20cryotherapy%20were%20discontinued%20because%20of%20poor%20recruitment.%20Two%20ongoing%20trials%2C%20one%20in%20the%20United%20States%20and%20one%20in%20Britain%2C%20are%20evaluating%20surgery%20and%20radiation%20treatments%20compared%20with%20watchful%20waiting%20in%20men%20with%20early%20cancer.%20Other%20studies%20in%20progress%20or%20development%20include%20cryotherapy%20versus%20external-beam%20radiation%20and%20a%20trial%20evaluating%20radical%20prostatectomy%20versus%20watchful%20waiting.%20%3C%2Fp%3E%0A%3Cp%3E%26%238220%3BSuccessful%20completion%20of%20these%20studies%20is%20needed%20to%20provide%20accurate%20assessment%20of%20the%20comparative%20effectiveness%20and%20harms%20of%20therapies%20for%20localized%20prostate%20cancers%2C%26%238221%3B%20the%20study%20authors%20said.%3C%2Fp%3E%0A"/> <input type="hidden" name="description" value="In%20a%20major%20report%20comparing%20prostate%20cancer%20treatments%2C%20no%20one%20approach%20emerged%20as%20superior."/> <input type="hidden" name="pub_date" value="20080205"/> <input type="hidden" name="author" value="Tara%20Parker-Pope"/> <input type="hidden" name="section" value="Health"/> <input type="hidden" name="nytdsection" value="Health"/> <input type="hidden" name="nytdsubsection" value=""/> <input type="hidden" name="encrypted_key" value="cAX67TNywZxVmwgssEKkQQ"/> <input type="hidden" name="encryption_partner" value="about"/> </form> <a class="post-email" href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/auth/login?URI=http%3A%2F%2Fwell.blogs.nytimes.com%2F2008%2F02%2F05%2Fno-answers-for-men-with-prostate-cancer%2F"><strong>E-mail this</strong></a> </li> <li id="share243" class="share"> <a onclick="javascript:showHideShareTool('sharelist243', 'share243');" id="sharebox243"> Share</a> <ul class="hide" id="sharelist243"> <li class="delicious"><a href="javascript:blogPostShare('delicious', 'surgery,radiation,prostate-cancer,cryotherapy,AHRQ', 'February 5, 2008', '243');">Del.icio.us</a></li> <li class="digg"><a href="javascript:blogPostShare('digg', 'surgery,radiation,prostate-cancer,cryotherapy,AHRQ', 'February 5, 2008', '243');">Digg</a></li> <li class="facebook"><a href="javascript:blogPostShare('facebook', 'surgery,radiation,prostate-cancer,cryotherapy,AHRQ', 'February 5, 2008', '243');">Facebook</a></li> <li class="newsvine"><a href="javascript:blogPostShare('newsvine', 'surgery,radiation,prostate-cancer,cryotherapy,AHRQ', 'February 5, 2008', '243');">Newsvine</a></li> <li class="permalink"><a href="javascript:blogPostShare('permalink', 'surgery,radiation,prostate-cancer,cryotherapy,AHRQ', 'February 5, 2008', '243');">Permalink</a></li> </ul> </li> </ul> </div> <div id="related"> <h3>Related</h3> <ul> <li><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/29/the-sex-of-your-surgeon-may-matter/">The Sex of Your Surgeon May Matter</a></li><li><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/06/despite-risks-vitamins-popular-with-cancer-patients/">Despite Risks, Vitamins Popular With Cancer Patients</a></li><li><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/14/sex-after-prostate-surgery/">Sex After Prostate Surgery</a></li><li><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/14/the-mysteries-of-surgeons-revealed/">The Mysteries of Surgeons, Revealed</a></li> </ul> </div>   </div>  <div id="blog_comments"> <h3 id="comments">152 comments so far...</h3> <ul class="commentlist"> <li class="clearfix" id="comment-23896"> <div class="index">1.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23896" title="">1:33 pm</a> </div> <div class="comment"> <p>My 92-year-old father is dying of prostate cancer. He will most likely not live to see his 93rd birthday this August. When first diagnosed 10 years ago (following a routine PSA test), he was told by his doctor, “Don’t worry, these things are so slow-growing, you will die of something else long before the cancer kills you.” He was given Lupron shots for several years until they became ineffective. A couple of years ago, after the cancer had spread into his spine, he was given external radiation treatments. Now the cancer is in all his bones, and, in unrelenting pain, he is hoping for death to come soon. He wonders, if he had had surgery at the time the cancer was first discovered, he might indeed have been able to die of “something else.” Considering that he still has no other serious health issues, I suspect that is the case. He might have lived to be a centenarian. </p> <p><cite>— Posted by V. Ritschard </cite></p> </div> </li> <li class="clearfix" id="comment-23907"> <div class="index">2.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23907" title="">2:00 pm</a> </div> <div class="comment"> <p>Having undergone radical prostatectomy rather pragmatically than thoughtfully, I now wish that I had done things differently. My life has been a nightmare of incontinence and erectile disfunction. I should have let nature take it’s course.</p> <p><strong>From TPP — My recent column and blog post on sex after prostate cancer surgery elicited many similar responses. To read more, click <a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/14/sex-after-prostate-surgery/" rel="nofollow">HERE</a></strong> </p> <p><cite>— Posted by rich </cite></p> </div> </li> <li class="clearfix" id="comment-23911"> <div class="index">3.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23911" title="">2:05 pm</a> </div> <div class="comment"> <p>It will be very helpfull to readers if the simtoms of postarate cancer are highlited </p> <p> Kulkarni,INDIA<br/> <strong></p> <p>from TPP — Often prostate cancer is detected early when there are no symptoms. for a link on symptoms that can occur with later-stage prostate cancer, click <a href="https://web.archive.org/web/20080224222815/http://www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.271349/k.87DD/Prostate_Cancer_Symptoms.htm" rel="nofollow">HERE</a><br/> Frequent urination, erectile dysfunction and blood in the urine can be symptoms, but those can be symptoms of a number of less serious complaints as well.</strong> </p> <p><cite>— Posted by venkat kulkarni </cite></p> </div> </li> <li class="clearfix" id="comment-23912"> <div class="index">4.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23912" title="">2:05 pm</a> </div> <div class="comment"> <p>Of course, the 92 year old given surgery as an 82 year old might have died on the table at 82 or had six years of incontinence before dying of an unrelated heart attack at 88. </p> <p><cite>— Posted by john </cite></p> </div> </li> <li class="clearfix" id="comment-23924"> <div class="index">5.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23924" title="">2:31 pm</a> </div> <div class="comment"> <p>Actually, in most cases your surgeon makes the decision for you. In my case with a very low PSA score I was railroaded for radical prostatectomy: and the result, at the age of 60, is total impotence and partial incontinence! Of course, my surgeon collected $20,000 fee for the surgery and the famous hospital in which the surgery was performed enriched its bottom line by $72,000.</p> <p>I was poorly advised, realizing the situation I tried to read all what is written about prostate cancer and read four books. Albeit well meaning, testimonials and the scare stories pushed radical treatments and the surgery first. My urologists office staff at every visit spoke of “metastasizing” prostate cancer in a chorus even though I had a PSA level of 8.1. I believe scare tactics were used to make the radical surgery acceptable to me.</p> <p>Prostate cancer treatment should be determined by many existing circumstances: including the patience’s age, sex life, and marital status. After a radical prostatectomy often patience sex life is over unless he agrees to receive implants and the like.</p> <p>If an asexual life is OK with you, you rather be alive but asexual you better weigh your options well, and get emotional support of a partner or a close person to you. </p> <p><cite>— Posted by A. M. Kelo </cite></p> </div> </li> <li class="clearfix" id="comment-23932"> <div class="index">6.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23932" title="">2:44 pm</a> </div> <div class="comment"> <p>With all due respect to the subject at hand, I can’t help but think that the next “blog” I will see mentioned somwhere, will involve a discussion of whether or not people put the toilet paper over or under–and the pursuant discussion thereafter. It could also be a network reality series.</p> <p><strong>From TPP — Im confused by this comment given the serious nature of this particular post.</strong> </p> <p><cite>— Posted by Philip C </cite></p> </div> </li> <li class="clearfix" id="comment-23935"> <div class="index">7.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23935" title="">3:01 pm</a> </div> <div class="comment"> <p>I am 54 years old and was diagnosed with prostate cancer alomst 4 years ago as a result of a PSA test. Since then I have undergone two treatments: radical surgery and external beam radiation therary when the PSA began to rise again. It is my belief that, had I not had the original test, I would most likely be dealing with bone cancer today. </p> <p>I question the comment on “overdetection and overtreatment” in the agencies report. </p> <p>With respect to detection, I think it is fair to say that earlier testing can detect disease or establishes baseline PSA levels that can aid in decision making on the results of future tests. While prostate cancer is generally slower growing, the cancers that are detected earlier are often the more agressive variants that can be sucessfully dealt with sooner rather than later. </p> <p>At the end of the day the patient (and his family) must make a treatment choice based on the best evidence available. There are no certainties in dealing with cancer and the decision involvies weighing up probabilities - you are betting with your life. You pit your life expectancy against the potential rate of cancer growth. The treatment side effects enter as secodary variables. The status quo of normal functions vs life with potential issues vs when you think the disease will metastitize and become painful and fatal. Many choose the watchful waiting option to defer making this choice and maximize their period of normalcy. </p> <p>I challenge the concept of “over treating” the disease. This has a negative connotation. There are more, and less invasive, options now available and men are taking advantage of these to deal with thier cancers. How can this be a bad thing?</p> <p><strong>From TPP — Because many men are being rendered impotent and incontinent by treatments that may or may not be necessary.</strong> </p> <p><cite>— Posted by M Maydan </cite></p> </div> </li> <li class="clearfix" id="comment-23945"> <div class="index">8.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23945" title="">3:24 pm</a> </div> <div class="comment"> <p>My brother was diagnosed with prostate cancer at age 47. I had suspected it the year previously when his PSA test came back below 4 but still in positive numbers. He read books, we spoke to friends and doctors. Radical protatectomy seemed the best procedure. However, the high rate of impotence was NEVER made clear, definitely not by the surgeon. I’m glad he had the surgery, I feel we have the best chance for the cancer to be completely removed. I wish, though, that this depressing side effect of ED would not have been a surgical outcome. It affects his quality of life. </p> <p><cite>— Posted by Susan </cite></p> </div> </li> <li class="clearfix" id="comment-23946"> <div class="index">9.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23946" title="">3:29 pm</a> </div> <div class="comment"> <p>poster number one — help you father ask for pain medication. (demand it). my dad had awful pain from metastatic prostate Ca and it took a lot of work to get his doctor to get him adequate relief. Finally got him on a fentanyl patch and then we switched physicians to a family practice doc who helped him feel better (ie supported) about increasing the dose and working out a plan for breaktrough pain. Transdermal is great because it means the patients don’t have to keep their eye on the clock. At some point the oncologist and the urologist may not be that helpful any longer, but anestheiologist / pain specialists provide a great service. We met with the physician and asked him if he could recommend someone who could help my father with evolving pain issues, or if he felt comfortable helping him, and he said “I’d be honored” and that was that. </p> <p>So thanks again Dr Moon. And thank you all who work in hospice, can’t thank the hospice folks enough.</p> <p>I can’t comment on the surgery vs waiting issue. hindsight is not 20/20, where cancer is concerned. looking therough the retrospectoscope I dont know if my family made the right decision, but the urge is always to take the cancer out, so we would certainly do it again. Don’t beat yourselves up! </p> <p>Pain control is a no brainer — and inadequate pain control should not be tolerated. All the best to everyone </p> <p><cite>— Posted by Susan </cite></p> </div> </li> <li class="clearfix" id="comment-23947"> <div class="index">10.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23947" title="">3:29 pm</a> </div> <div class="comment"> <p>I’m 42 years old and African-American (i.e. at higher risk for prostate cancer than most Americans). My father died from prostate cancer in 2006 after living with the disease for 10 years. It saddens me to realize that 1) there is no recommended course of treatment that is better than any other and 2) my father was one of the unfortunate 3 percent. He initially had radiation treatments and his PSA was low for years. Then the cancer spread and his PSA shot up. He was being treated with chemotherapy and hormone therapy until his doctors determined that his options were closing. He died at home with hospice care. Even though he was technically a cancer survivor having lived with the disease in remission for more than 5 years, he was constantly worried about his PSA before and after every doctor visit over those 10 years. He had decent quality of life really but little peace of mind. </p> <p><cite>— Posted by Sean </cite></p> </div> </li> <li class="clearfix" id="comment-23983"> <div class="index">11.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23983" title="">6:11 pm</a> </div> <div class="comment"> <p>Are there are studies that compare the side effects of radical prostatectomy with robot assisted radical prostatectomy?</p> <p><strong>From TPP: Yes there are studies that compare the two. There’s no difference in terms of side effects (impotence, incontinence etc.) What matters the most is the experience of the surgeon whether it’s a robotic or open procedure. I know there is some data being presented on this in the spring at the national urology meeting. There was a study comparing consecutive surgeries at two major institutions, one surgeon did open and one did robotic. Erectile function results were the same. One important difference that emerged was shrinkage (in penis length) There appeared to be a loss with the open procedure and not with the robotic, but the difference may be explained by different techniques in measuring. The review article from today also looked at differences in recovery between the two types of surgery. Here’s what the review article says:</strong> <em>Two studies with median follow-up periods of 30 and 67 months reported that overall survival was similar between laparoscopic radical prostatectomy and robotic-assisted radical prostatectomy. No differences existed between treatments in terms of PSA relapse; however, estimates were wide and ranged from 28% lower to 90% higher with laparoscopic radical prostatectomy . Wound healing was better with laparoscopic radical prostatectomy compared with open radical prostatectomy. Robotic-assisted radical prostatectomy and open radical prostatectomy had similar reintervention rates. Length of hospital stay was shorter after robotic-assisted prostatectomy than open radical prostatectomy (median, 1.2 vs. 2.7 days) </em></p> <p><strong>Finally, are you considering this procedure? Experience of the surgeon counts the most. But in terms of your recovery of erectile function, it depends on your age, if the tumor is contained and if you have an active sex life now without need for erectile function drugs. I just wrote about this issue in “On Sex After Prostate Cancer, Confusing Data.” To read the column, click <a href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/2008/01/15/health/15well.html" rel="nofollow">HERE.</a> I’d also encourage you to read the many reader comments that followed this story. Click <a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/14/sex-after-prostate-surgery/" rel="nofollow">HERE</a>. </strong> </p> <p><cite>— Posted by Bob </cite></p> </div> </li> <li class="clearfix" id="comment-23989"> <div class="index">12.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23989" title="">6:19 pm</a> </div> <div class="comment"> <p>I don’t understand comment 6, either, as this is a very important topic. I wonder if some of the uncertainty about over treatment and early detection doesn’t also apply to breast cancer. </p> <p><cite>— Posted by kaleberg </cite></p> </div> </li> <li class="clearfix" id="comment-23990"> <div class="index">13.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23990" title="">6:20 pm</a> </div> <div class="comment"> <p>I’m surprised there is no direct mention of Proton Radiotherapy in the article. Several people I know have mentioned it’s effectiveness on treating prostate cancer. <a href="https://web.archive.org/web/20080224222815/http://www.protonbob.com/proton-treatment-homepage.asp" rel="nofollow">http://www.protonbob.com/proton-treatment-homepage.asp</a></p> <p>I would like to hear people’s thoughts on this treatment modality</p> <p><strong>From TPP — Isn’t that the same thing as external beam radiation therapy? The report does include proton beam therapy, and concluded there was no evidence to show its superior. the numbers in parenthesis represent the original citations, which can be found in the report.</p> <p><em>Proton-Beam Radiation Therapy</p> <p>Several nonrandomized reports from 1 center of excellence provided clinical outcomes after combined proton-beam and photon radiation therapy (53–57). Between 86% and 97% (54, 57) of men were free of disease at the end of follow-up, and 73% to 88% did not have biochemical failure (53–56). Two percent to 8% had distant metastases (54, 57).</em></p> <p></strong> </p> <p><cite>— Posted by Timothy </cite></p> </div> </li> <li class="clearfix" id="comment-23993"> <div class="index">14.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-23993" title="">6:25 pm</a> </div> <div class="comment"> <p>I wonder what causes the issue of incontinence after<br/> Prostrate cancer surgery.<br/> I am wondering if there is a bladder sling surgery that can be used as effectively on Men as it works on<br/> Females?. </p> <p><cite>— Posted by Mr.radiotube </cite></p> </div> </li> <li class="clearfix" id="comment-24004"> <div class="index">15.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-24004" title="">6:58 pm</a> </div> <div class="comment"> <p>Until there is a durable and replicable treatment protocol for prostate cancer, experience from peers is the best guide for the newly diagnosed man. Peer support and experience may be the most durable decision making laboratory for men diagnosed with prostate cancer. Meeting every week for the last ten years, the Malecare support group here in NYC provides both a dialogue and a neural network mirroring the treatment choice making process that takes place between patient and MD. Significantly this peer supported choice making creates a sense of empowerment. No matter what the outcome may be, men who take time to learn and take to heart the variety of treatment options, tend to avoid the emotional pain that often accompanies a post treatment reoccurrence. </p> <p><cite>— Posted by Darryl Mitteldorf, http://www.malecare.com </cite></p> </div> </li> <li class="clearfix" id="comment-24016"> <div class="index">16.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-24016" title="">8:08 pm</a> </div> <div class="comment"> <p>Re:AM Kelo (poster #5): My husband is a radiation oncologist and would completely agree with you that in some cases patients are being pressured to undergo surgery. Patients often get their diagnosis via the urologist (who does the biopsies). A urologist is a surgeon and surgeons want to operate. As a patient you should demand a consultation with a radiation oncologist to discuss other treatment options so you can make an informed decision that’s right for you. Unfortunately, because of their desire to operate, urologists may not make the referral unless you specifically request it. </p> <p><cite>— Posted by west coast MD </cite></p> </div> </li> <li class="clearfix" id="comment-24026"> <div class="index">17.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-24026" title="">8:32 pm</a> </div> <div class="comment"> <p>I am 45 years old and a pathologist. I refuse to have a PSA test for some of the following reasons 1) Pure and simple fear an abnormal result will come back. I realize most elevated results are in the context of benign prostate conditions, but even then the uncertainty of what an abnormal result implies can have overwhelming psychological impact. An abnormal result may mean months (years?) of fear, perhaps for nothing 2) Although I am playing what many might consider to be the crapshoot of hoping to “die with rather than of prostate cancer”, the fact is I will indeed die with it from a statistical point of view. 3% odds are pretty good in my mind. 3) I do many autopsies and regularly take samples for microscopic examination of the prostate of men dying of something else eg heart attack or lung cancer. It is amazing how often cancer is present in these “random” samples. I would say in the order of 30- 50% in men over 60. They do indeed die with their prostate cancer.<br/> My “bottom line” is that I respect men who undergo a PSA screening program for prostate cancer because it takes nerves of steel-which I don’t have- to deal with whatever result comes back. I am banking on those 3% odds to see me through- time will tell. </p> <p><cite>— Posted by Andrew Mitchell </cite></p> </div> </li> <li class="clearfix" id="comment-24032"> <div class="index">18.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-24032" title="">8:54 pm</a> </div> <div class="comment"> <p>To #14, most incontinence after prostatectomy is caused by sphincter deficiency (”stress incontinence”) and less commonly urge-related causes. </p> <p>Sling procedures have been shown to be effective in improving post-prostatectomy incontinence, though it is too soon to assess the durability of this response. It also appears to be more appropriate in men with milder degrees of leakage. </p> <p>Prevention is the best treatment for incontinence and this is best accomplished by seeking out experienced, preferably fellowship trained surgeons, especially for robotic surgery where there are many surgeons offering this operation for which they are not formally trained and have minimal experience. </p> <p><cite>— Posted by TNC </cite></p> </div> </li> <li class="clearfix" id="comment-24034"> <div class="index">19.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-24034" title="">9:11 pm</a> </div> <div class="comment"> <p>By the way, concerning #5 AM Kelo-</p> <p>The average reimbursement for to the surgeon by Medicare and most private payers is $1200 or so. This includes your preoperative counseling visit, operation, hospital days, and 90 days post-operatively. If your surgeon received $20,000 for a radical prostatectomy, it is almost certainly because you paid out-of-pocket or he is an out of network surgeon.</p> <p>At this reimbursement rate, there is very little financial incentive for most urologists. One can make significantly more money with small procedures in the office.</p> <p>Certainly there is a great deal of overtreatment for prostate cancer; however, given our current scientific capabilities, we are unable to predict who will benefit from treatment and who will die of something else first. The medicolegal environment in this country also contributes to the overtreatment problem. You might be the first in line to sue your doctor had he recommended a “watchful waiting” strategy and had you developed metastasis.</p> <p>No one in this country should feel railroaded into treatment. Your surgeon should present all of the options to you, discuss the relative risks and benefits and help you come to a decision. </p> <p><cite>— Posted by Phillyurologist </cite></p> </div> </li> <li class="clearfix" id="comment-24052"> <div class="index">20.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-24052" title="">10:08 pm</a> </div> <div class="comment"> <p>If you have to ask if Proton radiation is the “same” thing as photon radiation as delivered by IMRT, you need to go to the listed web site and educate yourself on the very significant differences between the two. While there may not be statistical evidence (yet) of the superiority of Protons, to a man the patients treated at Loma Linda in CA will tell you that in their mind they have received the best treatment possible for their prostate cancer. I know as I am one of the patients. 54 years old and in the 4 months since treatment my PSA has dropped from 5.7 prior to treatment to 1.1 at the end of January 2008.</p> <p>To answer post number 14, incontinence is the result of cutting the urethra to remove the prostate and then re-attaching it. In the process nerves to the bladder sphincter are damaged and in some men function is never restored. </p> <p><cite>— Posted by John Welch </cite></p> </div> </li> <li class="clearfix" id="comment-24075"> <div class="index">21.</div> <div class="commentmetadata"> February 5th,<br> 2008<br> <a href="#comment-24075" title="">11:31 pm</a> </div> <div class="comment"> <p>I am a 58 year old who recently discovered through PSA screening and a subsequent 8 needle prostate biopsy, that I have prostate cancer (Gleason Score 6 & a T1C). My father died from prostate cancer at the age of 67 before there was such a thing as PSA testing, and there is certainly evidence today of a genetic link. </p> <p>My initial inclination was to undergo a radical prostatectomy. Cut It Out! My urologist certainly pointed me in that direction. I proceeded to read extensively on the topic. I interviewd a top radiation oncologist and a top (robotic) surgeon. Both acknowledged the probability (but no guarantee) with my stage of diagnosis that I could take some time to decide on a course of action before they would think that a radical local procedure was essential. Further study revealed that the 10 year survival rate, and for that matter the 15 year survival rate according to some well documented and published studies is no better for prostate surgery, radiation or watchful waiting (no prostate localized procedure) +/- 1-3%. That’s a pretty amazing statement! </p> <p>I’ve since learned more, and have embarked on a serious effort to starve my prostate cancer of fuel through implementation of a rigid macrobiotic diet. In a day, I cut out animal protein (except modest intake of fish), all dairy products, caffiene, eggs and hydrogenated vegetable oils. I do not smoke, nor do I consume alcohol or drugs. Color me motivated! The side benefits of this are amazing. I’ve reduced my weight by almost 10%. I no longer need to take blood pressure medication. I am sure that my next blood work will reveal that my cholesterol has dropped considerably. My belly fat has melted away, and I get many comments on how trim I look. I am more energetic. I have started to excercise more. The initial BPH type symptoms that I had (urinary urgency and frequent urination at night) have improved dramatically. I embarked on this course with the logical arguments for it posed by Roger Mason in his book “The Natural Prostate Cure” (download via <a href="https://web.archive.org/web/20080224222815/http://www.youngagain.org/" rel="nofollow">www.youngagain.org</a> or available on Amazon and elsewhere). I have come to believe that it is within the realm of possibility to recover from prostate cancer; or to get into remission through diet. I’m intent to prove my approach with the desired results in a year’s time. Wish me well.</p> <p>Technically, my regime, from those listed in the article is the one termed “Watchful Waiting”. But mine is not a passive process, and with my dietary approach and close monitoring, “Active Surveilence” is the more appropriate terminology. </p> <p>If you or a loved one have a diagnosis of Prostate Cancer it’s imperative to learn as much about it as possible before having any radical local procedure (imo), all of which have substantial risks associated with them and dubious surety of improved outcome. Read the John Hopkins Prostate White Paper for a good overview. Read Dr. Peter Scardino’s Prostate Book. Read Dirk Benedict’s “The Confessions of a Kamakazie Cowboy”, Read Roger Mason’s Prostate book and his “Zen Macrobiotics for Americans”. Read the published studies. Learn just the right questions to ask and ask them. Be proactive! </p> <p><cite>— Posted by Sonarman </cite></p> </div> </li> <li class="clearfix" id="comment-24130"> <div class="index">22.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24130" title="">2:15 am</a> </div> <div class="comment"> <p>I am a widow and advocate who has been active in education and working to solve many of the problems that men and women dealing with the realities of prostate cancer experience. I hope that the men who choose to not get regular PSA’s do not eventually develop a deadly prostate cancer. It is not a very good way to die. I would not wish a prostate cancer death on anyone. I have lost many friends to this horrible disease. Some have died way too young. It is the second highest cause of cancer death in men. Medscape has an article today with the headline: American College of Preventive Medicine Does Not Recommend Prostate Cancer Screening With DRE, PSA </p> <p>The funny thing they say at the end of the article: “# Prostate cancer trails only lung cancer as a cause of cancer-related mortality among American men, but survival rates are very good if prostate cancer is diagnosed as local disease.<br/> # In the current recommendation, the ACPM concludes that there is insufficient evidence to recommend routine prostate cancer screening with either the digital rectal examination or PSA.”</p> <p>Seems like a slight disconnect here. They do not recommend testing that they say could give a man a “very good” survival rate. How will men be diagnosed as local disease if they are not tested?</p> <p>They want to wait until a large trial is completed. which will not be for many years. They seem to be willing to sacrifice men’s lives. </p> <p>At the same time we are cutting back funding for research that could lead to the answers that men and their physicians need. </p> <p>I just don’t get it. </p> <p>Poster number 17 in my mind it takes nerves of steel to not be tested if early treatment can give you a very good survival rate. The prostate cancer is the number 2 cancer killer and the most frequently diagnosed cancer. </p> <p><cite>— Posted by cancer widow </cite></p> </div> </li> <li class="clearfix" id="comment-24155"> <div class="index">23.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24155" title="">4:03 am</a> </div> <div class="comment"> <p>Tara-Parker Pope:<br/> This report deserves the Pulitzer prize for ‘Communty Service Medical Reporting.’ Your approach and analysis is perfect.</p> <p>Your procedure of treating the subject with actual<br/> real life experiences, professional opinions, and comments beats any other approach to such a complex dilemma.<br/> A. Gibson, III</p> <p><strong>From TPP — Thanks for your kind words. I think it’s a hugely important issue that deserves far more attention than it receives.</strong> </p> <p><cite>— Posted by Andrew Gibson </cite></p> </div> </li> <li class="clearfix" id="comment-24165"> <div class="index">24.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24165" title="">5:15 am</a> </div> <div class="comment"> <p>I am really glad to read someone is addressing ways of stopping this cancer, #21. I’d like to add to your starving the cancer to death - AVOID SUGAR and artificial sweeteners like the plague! Cancer feeds on sugars. </p> <p>What no one has addressed yet is “prevention” - a test doesn’t prevent anything, nor does finding something early. </p> <p>I think it should be fairly common knowledge by now that we live in a chemical world and it is taking it’s toll on our health. I am VERY strongly in favor of eliminating toxins, providing REAL educational facts (not the garbage we’re conditioned to believe so some company can make a lot of money by manipulating facts and studies), and making industries stop pumping this garbage into our lives and bodies.</p> <p>I am so fed-up with the toxic products AND food on the market that I could just scream! </p> <p>For what it’s worth, I am lead to believe that most cancers cannot start or survive in an alkaline system. I don’t know all the details about this type of cancer - what I do know is that we are surrounded by poisons 24 hours a day and we need to do what we have to do to make it stop - it’s ruining the health of us and our kids. </p> <p>Here are a couple links that I think are helpful and will contribute significantly to making things change: <a href="https://web.archive.org/web/20080224222815/http://aromatherapy4u.wordpress.com/2007/06/11/diet-and-eating-choose-your-foods-like-your-life-depends-on-them/" rel="nofollow">Choose Your Foods Like Your Life Depends on Them</a> and <a href="https://web.archive.org/web/20080224222815/http://www.storyofstuff.com/" rel="nofollow">Story of STUF</a></p> <p>I wish you all well and like #21 said - “be PROACTIVE” - let’s fight like hell to get as many poisons out of our life and environment as possible! </p> <p><cite>— Posted by Evelyn Vincent </cite></p> </div> </li> <li class="clearfix" id="comment-24214"> <div class="index">25.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24214" title="">9:44 am</a> </div> <div class="comment"> <p>Hello, such confusion is all the more reason for the medical system, which by the way is us; to establish what I call “possible pathways to prostate cancer”<br/> Each bump in the road puts another “emotional card” on the stack. Another side effect? another card. Another development? another card. Pretty soon you might end up like me, a tumbled down pile of emotional cards.</p> <p>Why not work off a check list when with patients? So when you go over the dizzying array of options; at least it’s in writing, you know, they know what you went over. EACH SURPRISE CREATES ANOTHER DENT in your WELL BEING</p> <p>Have it go from simply cancer, to spread into my Thoraric spine and you might have an emotional breakdown. Did anyone say it could go to your BRAIN next? NO, but after wanting more Surprises, I read that and wasn’t in shock when they did an MRI of my brain.</p> <p>GET TOO UPSET? and your hospital WILL TOSS YOU OUT THE DOOR such as mine did, Dartmouth Hitchcock Medical Center in Lebanon, NH, yes the famed Dartmouth College Medical School </p> <p>There’s lots to be careful about, don’t believe all you read. AND AT THIS POINT, BEING 55 WITH STAGE IV DO YOU REALLY THINK I CARE WHO KNOWS WHAT ANYMORE? </p> <p><cite>— Posted by Gregory Giro Burlington Vt </cite></p> </div> </li> <li class="clearfix" id="comment-24219"> <div class="index">26.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24219" title="">10:05 am</a> </div> <div class="comment"> <p>I had my prostate removed two years ago at the tender age of 51. Initially I was quite happy with the results-no continence problems and erections with medication and even occasionally without medications. But now the result of being prostateless seems to be affecting me more than I expected it would. My sex drive is diminished and sex is much less satisfying. Not only is the intense physical need for release not there, but the actual physical sensation is less. I just feel old. I didn’t realize how much sex drive was an integral part of my makeup and how much I would miss it when it wasn’t there. It is not even that I question the need for the surgery as it was Gleason Scale 9, and I am very thankful to the skillful surgeon who operated on me robotically, I am just surprised now how affected I am by this change. </p> <p><cite>— Posted by eric </cite></p> </div> </li> <li class="clearfix" id="comment-24221"> <div class="index">27.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24221" title="">10:11 am</a> </div> <div class="comment"> <p>I am 64 and had a radical prostactecomy in 8/01. I did a great deal of research before deciding on the treatment option. In the end the radical seemed like the best option despite the associated risks. I have had a very successful outcome with no erectile difficulty and infrequent urinary leakage. The most important factor in my postop result was the choice of surgeon. My surgeon performs this surgery very frequently with great success in nerve sparing outcomes and survival. My advice: Find a surgeon who is very skilled, does this surgery frequently and has the data to support the success of his work.</p> <p>Bill</p> <p>Bill </p> <p><cite>— Posted by Bill </cite></p> </div> </li> <li class="clearfix" id="comment-24228"> <div class="index">28.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24228" title="">10:29 am</a> </div> <div class="comment"> <p>As a Family Physician, this is a topic that I deal with daily and is one of the most challenging conundrum’s of medicine. You can read all you want about this topic and still not know what to do if you are diagnosed with prostate cancer. The reason boils down to the fact that it is so terribly common (Autopsy studies of men dying of any cause indicate as many as 80% of 80 year old men have some degree of prostate cancer and 40% of 40 year old men!!!) and therefore the numbers of men actually suffering and dying from it actually represent a very small percentage (something </p> <p><cite>— Posted by Tim W </cite></p> </div> </li> <li class="clearfix" id="comment-24234"> <div class="index">29.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24234" title="">10:52 am</a> </div> <div class="comment"> <p>Re: Post 20: Many individuals want to believe that they have chosen the best treatment for their disease, and after they have made their choice and gone through treatment, have a desire to continue to justify their choice to their world, even if they might have some doubts. This is an example of cognitive dissonance reduction. The statement that there is no statistical significance (yet) means that there is no statistical evidence yet. The review shows that there is no one best therapy proven as of yet.</p> <p>Four months is not enough time to really assess the long term efficacy (and the potential for development of side effects) of a treatment. Any one anecdote cannot stand up to the experience of hundreds and thousands of patients. One of the problems of many of the studies reviewed is the relatively short follow up periods. For prostate cancer, one need to look at ten, fifteen years and longer. In addition to well designed prospective randomized trials, observational studies of patients treated ten, fifteen and twenty years ago have their quality of life and disease status assessed. The data for proton therapy follow up is far shorter than for studies looking at other modalities.</p> <p>Re: Post 20: Proton therapy uses protons, (positively charged subatomic particles); external beam radiation uses x rays, also known as photons. Proton and external beam radiation are both delivered in a fairly similar fashion, requiring daily treatment visits over seven to nine weeks. Proton bean therapy is also far more expensive than external beam therapy, at least three to five times the expense or more. Do we as a society want to pay exorbitant rates for a treatment choice that has not been proven to be clinically better both in disease control and side effect profile than a lower cost and reasonable alternative? Maybe the biggest difference is the balloon in the rectum? </p> <p> If I could get paid time off of work, and an eight week “vacation” in Southern California while I get treatment, sounds good to me. If it is “free”, I would probably rather be driven in a Rolls Royce than a Yugo, even though both autos will get me to the same destination. If I have to pay personally, it would be a different story. The question is do we as a society want to pay for all of these Rolls Royces?</p> <p>Re: Post # 19 about the potential for litigation if an adverse outcome comes as a result of the choice of watchful waiting is of concern to me as well, as a practicing physician. At present, only through documentation of the patient discussion, using informed consent principals for this “treatment option” (watchful waiting) may serve as a defense. It is unfortunate that patients may undergo treatment because of their physician’s fear of litigation if they are not treated. </p> <p><cite>— Posted by Dr. Dave </cite></p> </div> </li> <li class="clearfix" id="comment-24238"> <div class="index">30.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24238" title="">10:56 am</a> </div> <div class="comment"> <p>There feels to me like a point is being missed in all these responses (I’m 64 and have no signs of any cancer and am 64 … I do a PSA test every year).<br/> Years ago Health Magazine ran a cover story on health in the USA. The idea was that Americans are the sickest people on the planet because they obsess so totally about their health. I believe this … I offer a simpler approach. 1) eat a balanced diet (a little of lots and lots of things … let your body decide what it needs rather than some author); 2) get plenty of rest (stress in this society is off the charts and most of it is unnecessary .. take a good nap each day, it does wonders); 3) get plenty of exercise (our bodies were designed to get physical — not to take the ‘easy’ way out).<br/> Of course, this doesn’t guarantee good health but it sure would decrease the incidence of health problems by a LOT and remove a bunch of the Up-Tight attitude we so embrace.<br/> My father had prostrate cancer for over 15 years. He had the castration procedure to try and help slow it down … it seems like it worked. He died of multiple organ failure at 87.<br/> Good luck to all of you, but how about trying not to focus on possible failures so much and get out and enjoy life. </p> <p><cite>— Posted by Dirk Faegre </cite></p> </div> </li> <li class="clearfix" id="comment-24244"> <div class="index">31.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24244" title="">11:13 am</a> </div> <div class="comment"> <p>Is there no effective way to discern which type of prostate cancer someone has, metastatic or not? I read that with some other cancers genetic typing can be done that steer the patient to the appropriate treatment. </p> <p><cite>— Posted by Bob </cite></p> </div> </li> <li class="clearfix" id="comment-24247"> <div class="index">32.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24247" title="">11:20 am</a> </div> <div class="comment"> <p>Because of family history I followed my PSA, which went up and down, for several years and had several biopsies before being diagnosed at age 62. I also had BPH symptoms for years. I read many things and sought a second opinion before making the decision to have a radical prostatectomy. I believe my decision was the right one for me based on all the information I was able to consider. The results, so far have been good. Urinary function- excellent. Sexual function - not so good. The disease is complex and my advice to anyone would be get your PSA test and if the news is bad do your own research and make a decision that you believe is best for you. Consider Prostate cancer research when considering how to allocate your charitable contributions. </p> <p><cite>— Posted by Douglas </cite></p> </div> </li> <li class="clearfix" id="comment-24251"> <div class="index">33.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24251" title="">11:31 am</a> </div> <div class="comment"> <p>I have always fought the stupid argument that the roughly 30% reduction in PCa deaths are not a result of early detection and early treatment. You often read statements that part of this lowering may be a result of better treatment options. This is possibly so, but NOBODY gets treated unless they have been diagnosed. Will there be side effects? Yes there may be. But most of the treatment improvements have been aimed primarily at reducing these. We’ve gone from 40,000 annual deaths down to 27,000 in the last decade or so, despite a rising population. How much empirical evidence is needed to convince people that diagnosis and treatment saves lives?</p> <p>There are side effects from virtually every type of cancer treatment. Given the typical breast (or lump) removal, followed by radiation and chemotherapy, every breast cancer survivor is “scarred” in one way or another - physically and emotionally. Yet we urge breast cancer screenings on an annual basis. Wake up and look at the evidence. The biggest side effect of all is dying because you were not diagnosed and treated.</p> <p>Stephen Corman,<br/> Secretary, National Alliance of State Prostate Coalitions </p> <p><cite>— Posted by Stephen Corman </cite></p> </div> </li> <li class="clearfix" id="comment-24262"> <div class="index">34.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24262" title="">11:59 am</a> </div> <div class="comment"> <p>To No. 17:<br/> I agree with you and it’s why I, a 52yo woman, don’t have “regular” mammograms, pap smears, cholesterol screenings, etc. It’s mostly fear of finding “something” that then starts you on the Interstate Highway of “No Choice but to Comply with Big Medicine.” Once you get on, the off-ramps are few and far between. I prefer to play my odds. Irrational? Maybe. But I still have a choice. I eat healthy, exercise daily, don’t smoke. I control what I can and leave the rest to chance. </p> <p><cite>— Posted by Kim </cite></p> </div> </li> <li class="clearfix" id="comment-24267"> <div class="index">35.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24267" title="">12:03 pm</a> </div> <div class="comment"> <p>Part one: Annals paper and RP (rad prostatectomy):</p> <p>Well, I think this Annals meta-analysis is a very poor paper. It really mixes up a lot of different stages of prostate cancer, and doesn’t give a fair shake to some of the better therapies for early disease, especially brachytherapy (implantation of radioactive seeds) or proton beam therapy. </p> <p>I think a much better resource is here:<br/> <a href="https://web.archive.org/web/20080224222815/http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9616&nbr=5136#s23" rel="nofollow">http://www.guideline.gov/summary/summary.aspx?ss=15&doc _id=9616&nbr=5136#s23</a></p> <p>because it summarizes decisions based on stage of disease. </p> <p>Radical prostatectomy has the highest rate of urinary incontinence. Impotence is one thing, but<br/> peeing your pants is quite a disability. </p> <p>This is a much better paper in the January issue of cancer relating to the prevalence of disabilities with the various treatment options: </p> <p><a href="https://web.archive.org/web/20080224222815/http://www.eurekalert.org/pub_releases/2007-11/mgh-pc111907.php" rel="nofollow">http://www.eurekalert.org/pub_releases/2007-11/mgh-pc11 1907.php</a></p> <p>Basically, the bladder is like sculpture that sits on a base, which is the prostate. In RP, one actually cut offs a length of the penis that goes through the prostate and the remainder is reattached. It’s easy to see why this treatment could result in lack of bladder control, since the whole “base” on which the bladder normally sits is cut out.</p> <p>I also do think that urologists push radical prostatectomy, with psychological spin such as, “well, this way no tumor is left behind”, etc. </p> <p>(more in next post on brachytherapy and proton beam.)</p> <p>-pht </p> <p><cite>— Posted by Physician heal thyself </cite></p> </div> </li> <li class="clearfix" id="comment-24271"> <div class="index">36.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24271" title="">12:14 pm</a> </div> <div class="comment"> <p>Part 2: brachytherapy (”seeds”)</p> <p>Basically, if you can’t cut out prostate cancer, you have to zap it. You can do this 3 ways: Regular X-rays, proton-beam, or brachytherapy (radioactive seed implants). </p> <p>For me, brachytherapy makes the most sense for early disease, since you’re basically putting the “gun” right into the tumor and blasting away. There are 3 types of seeds: iodine, palladium, and cesium (new). Palladium seeds seem to have fewer side effects, esp. with regard to the rectum. </p> <p>The radioactivity of the implanted seeds is not permanent. The seeds stay radioactive for about 18 months (iodine), 6 months (palladium), or ~2 months (cesium - not sure of the exact half life), since these isotopes have different half-lives. Once 5 half-lives have passed, radioactivity is close to zero. </p> <p>Brachytherapy depends a lot on who does it, and if you don’t put enough seeds in to cover the whole prostate, the results are not very good. But in good hands, the results are astoundingly good, with stable PSA levels in 80-90+ % of patients even up to 10 years depending on the stage of disease. </p> <p>The idea of radiation is, you may want to go outside the prostate to zap tumor that may have spread outside the gland. When the Gleason score is more advanced or the PSA is high, the chance of spread is high, so you may want to blast away around the prostate. Some people combine seeds with external radiation. But for early disease, the seeds alone seem to work OK. </p> <p>Brachytherapy (”seeds” alone) has an almost zero rate of incontinence, in contrast to prostatectomy. The rates of impotence may be the same. Some of the studies looking at side effects of “seeds” are looking at studies combining seeds with external radiation. </p> <p>There can be some rectal toxicity. The main problem with brachytherapy is urinary urgency, and sometimes obstruction. But this is a problem mostly for people with large prostates. (You can shrink down the gland by androgen deprivation treatment for a few months prior to seed implantation. </p> <p>If you have early stage prostate cancer, I would urge you to look into brachytherapy - but go to one of the best centers that are doing this. </p> <p>-pht </p> <p><cite>— Posted by Physician heal thyself </cite></p> </div> </li> <li class="clearfix" id="comment-24274"> <div class="index">37.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24274" title="">12:19 pm</a> </div> <div class="comment"> <p>To what does ACPM attribute the significant decrease in prostate cancer morbidity if not early detection?</p> <p>And, if a large decline in CaP deaths over the recent 12 to 15 years is attributable to early detection, then DRE and PSA must be credited with much of that reduction, since science and the concerted war on prostate cancer has depended almost exclusively upon DRE and PSA for early detection of our disease.</p> <p>Granted, DRE and PSA are far from perfect detection methods; however, until our scientists and national institutes provide men with improved diagnostic processes, DRE and PSA will continue to be the primary, albeit imperfect, methods for early detection and survival of our insidious disease; and, pending replacement by superior techniques, DRE and PSA should be encouraged, not discouraged, by responsible health authorities.</p> <p>To deny the use of the only detection processes available to men who may face dreadful deaths if early detection is discouraged is both unacceptable and immoral. </p> <p><cite>— Posted by Phil Olsen </cite></p> </div> </li> <li class="clearfix" id="comment-24276"> <div class="index">38.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24276" title="">12:25 pm</a> </div> <div class="comment"> <p>Part 3: Proton beam</p> <p>With regard to proton beam, the advantage is, that regular radiation is like a bullet or laser beam. Proton beam is like fireworks. You shoot it, and you can make it explode a certain distance from the source, so you can protect tissues before and beyond the prostate but which are in the “line of fire”. </p> <p>There’s a long waiting list for the Loma Linda site that does proton beam, and only about 5 sites available. And you have to get 5 day a week treatments for 6-8 weeks. But basically, it’s like external radiation with the touted advantage that you can give a higher dose to the prostate. </p> <p>There’s a book available on Amazon by Marckini, who had this at Loma Linda, and a website (order of the balloon), where people tout proton beam and Loma Linda. </p> <p>The problem is, that there is only one published study of results, and these are great, but not fantastic. </p> <p>Proton therapy for prostate cancer: the initial Loma Linda University experience1.<br/> International Journal of Radiation Oncology Biology Physics, Volume 59, Issue 2, Pages 348-352, 2004.</p> <p>My own belief is that the results for early prostate cancer are no better than for good brachytherapy where most of the gland has been adequately implanted with seeds. With brachytherapy, it’s one visit and you’re done. With proton - beam, it’s 8 weeks.</p> <p>Plus, the people doing regular radiation therapy are now zapping the prostate from various angles, and this also minimizes toxicity to tissues in the line of fire, since the firing lines converge on the prostate, but each “firing line” angle gives only a small dose of radiation to the tissues ahead of and beyond the prostate. So the regular radiation therapy people are saying that their new treatment can give the same higher dose of radiation with the same lower incidence of side effects as proton beam, but there are no comparative studies.</p> <p>A practical problem is that the Loma Linda center is not accepting new patients. There are only about 5 of these centers in the U.S. If you really want this quickly, try the one at Bloomington, Indiana. There also is one in Texas, and one in Florida, and I think one or two more. </p> <p>For early disease, my thinking is this: Why shoot at something from 3 feet away when you can put your gun into the tumor and blast away locally, exactly where you want to. But for more advanced disease, external beam seems to be the way to go. </p> <p>-pht </p> <p><cite>— Posted by Physician heal thyself </cite></p> </div> </li> <li class="clearfix" id="comment-24283"> <div class="index">39.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24283" title="">12:49 pm</a> </div> <div class="comment"> <p>As the wife and lover of a wonderful male, I read constantly about this cancer. The more information we have the more hope we have. </p> <p><cite>— Posted by a reader </cite></p> </div> </li> <li class="clearfix" id="comment-24284"> <div class="index">40.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24284" title="">12:49 pm</a> </div> <div class="comment"> <p>How come there is nothing here about prevention!!!??? </p> <p><cite>— Posted by Ode </cite></p> </div> </li> <li class="clearfix" id="comment-24285"> <div class="index">41.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24285" title="">12:50 pm</a> </div> <div class="comment"> <p>In late 2003,because of a sudden PSA rise from 3.9 to 5.4, I consulted a urologist – he examined me and decided to take samples from my prostate — of the 12 biopsy samples, three were cancerous and nine were benign — two of the cancerous samples had a Gleason Score of 8 and the third had a Gleason Score of 9 — fortunately, the cancer was confined to the right side of the prostate — my urologist was very helpful and explained all available treatments — his final recommendation was to have six weeks of radiation followed by seed implant and hormone therapy — having been in research in the computer and telecom industry for 40 years, I decided to thoroughly investigate available therapies, which I did for the next six weeks using the Internet — as a result of my findings, I chose to have the cancer destroyed through cryosurgery — after meeting with Dr Aaron Katz of Columbia Presbyterian in New York City, I walked into the Columbia Presbyterian Hospital at 7:00AM one morning in March 2004, had a one hour operation at 1:00PM and walked out that night at 7:00PM — my recovery took two days and for the past four years my health has been normal — my PSA declined to 0.50 where it has remained — fortunately, I have not experienced any of the limitations or problems described by other men responding to this article – in summary, I believe that cryosurgery has both saved my life and the quality of my life — I also believe that that it may help others save their lives and the quality of their lives — however, from my experience, I believe that the most important issue that must be decided when faced with choosing a treatment is whether or not the cancer has spread outside the prostate – if not, I believe that cryosurgery may be the best option — if it has spread outside the prostate, the situation is much more complex — however, even in this situation, there is good hope that a solution can be found through removal of the prostate followed by hormone treatment or anti-cancer drugs – one silver lining in this situation is that prostate cancer cells appear to have a very difficult time establishing themselves outside the prostate and without a source of testosterone </p> <p><cite>— Posted by John </cite></p> </div> </li> <li class="clearfix" id="comment-24300"> <div class="index">42.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24300" title="">1:26 pm</a> </div> <div class="comment"> <p>I am 64 years old and was diagnosed with prostate cancer last year. My urologist made me aware of different types of treatment, but wanted to perform a radical prostatectomy. I found that I had to do my own research and select the treatment that I felt was most appropriate for me. I chose radioactive seed implants with subsequent external beam radiation. I completed treatment during September, 2007 and, to date, I am pleased with the results. I have no significant side effects. By the way, most surgeons will not perform a radical prostatectomy if you are older than 70. </p> <p><cite>— Posted by Steve J </cite></p> </div> </li> <li class="clearfix" id="comment-24310"> <div class="index">43.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24310" title="">2:00 pm</a> </div> <div class="comment"> <p>My father was diagnosed with prostate cancer at age 59, and died of it ten years later at age 69. He was diagnosed after rising PSA scores, and initially treated with radiation. He was okay for a while, but when the cancer came back, surgery was ineffective.</p> <p>My father (before he died) and stepmother regretted not going for radical surgery at the first instance.</p> <p>It’s a dozen years later, and I’m in my 50s now. So far my PSA is low, but I presume I am at risk for the same kind of aggressive cancer. Maybe treatments are a little better in 2008, but given genetic factors and my father’s experience, if I am diagnosed, I’m inclined to go for surgery first. </p> <p><cite>— Posted by Ephraim </cite></p> </div> </li> <li class="clearfix" id="comment-24313"> <div class="index">44.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24313" title="">2:08 pm</a> </div> <div class="comment"> <p>I had prostate cancer diagnosed by a surgeon/urologist.After doing as much research as possible with the assistance of my son who was working at a med- school library I decided on external beam radiation over a 6 week treatment schedule.The treatment was surprisingly devoid of any side effects and 4 years post-treatment I seem to be doing fine.I belong to a patient support group and find that most patients are sold on a treatment course by the diagnosing physician.I wish everyone could get unbiased advice from a panel of informed clinicans before deciding on a treatment option or watchful waiting.I was personally panic-stricken when first diagnosed at age 58 and almost booked surgery that day but opted to have several drinks instead.After calming down I started researching.My only advice is to do your own due diligence . Everyone you talk to seems to have the answer but the science shows there is no answer.You have to pick from a number of treatment or non-treatment options which all have their own shortcomings and anxieties attached to them. </p> <p><cite>— Posted by Doug </cite></p> </div> </li> <li class="clearfix" id="comment-24315"> <div class="index">45.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24315" title="">2:15 pm</a> </div> <div class="comment"> <p>The problem with identifying an effective treatment for prostate cancer is the great biological variability of the disease (as witnessed by the number of personal stories posted). Thus the only valid method for judging efficacy is the randomized, controlled trial, of which there are few, and none definitive.</p> <p>Absent an intervention demostrably superior to watchful waiting, I will take my chances with the natural history of the disease. For the onus is on the interventionalist (be he surgeon or radiation therapist) to prove his procedure is better than nothing. BTW, read Philip Roth’s Exit Ghost for an insightful depiction of the miseries visited upon a prostate cancer sufferer by his urologists! </p> <p><cite>— Posted by Steve, MD </cite></p> </div> </li> <li class="clearfix" id="comment-24338"> <div class="index">46.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24338" title="">3:05 pm</a> </div> <div class="comment"> <p>In 2005, I experienced a slightly elevated PSA and was sent back for a repeat. It was a point higher. A long story short, a 3 mos. doubling time, aggressive prostate cancer, and with a radical protatectomy, nerve sparing, all went well (save dual pulminary embolisms that made the experience almost meaningless).</p> <p>But, the nerve sparing left a cell or two. My PSA testing in Bangkok went from 0.01, to 0.40, then 0.44 at the radiologists. Salvage radiation was performed, 37 treatments, and the PSA went down to 0.14, then to 0.08, then 0.05(January 2008). March will tell more.</p> <p>My mistake: accepting the wisdom that prostate cancer is a slow grower; my doubling rate meant get the sucker treated ASAP. I waited an unnecessary 6 weeks. The final biopsy showed it at the capsule margins, but not outside.</p> <p>Next week I am having them take another look inside the bladder, a radiation induced ulcer may have developed with associated urinary blockage and pain. Sexually, ED drugs do fine, and while I have no semen my climax is perhaps even more “climatic,” so to speak.</p> <p>Considering however my PSA velocity then would today have me with a PSA well close to 1000, and probably a wide range of other cancers, one more step, another day, eh? </p> <p><cite>— Posted by Bob </cite></p> </div> </li> <li class="clearfix" id="comment-24340"> <div class="index">47.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24340" title="">3:28 pm</a> </div> <div class="comment"> <p>Prostate cancer? Who cares! Breast cancer is sexier. </p> <p><cite>— Posted by Michael Tashman </cite></p> </div> </li> <li class="clearfix" id="comment-24348"> <div class="index">48.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24348" title="">4:02 pm</a> </div> <div class="comment"> <p>Increasing failure rates, i.e. failure to cure cancer, aside from other ugly side effects, stem from the increasing efforts to “find the cancer.” Unfortunately, physicians are using inadequate diagnostic tools. Instead of high-technology medical imaging devices, they actually “look” for cancer using needles. To make matters worse, numbers of exploratory needle biopsies are escalating. In their perceived diligence, some physicians utilize an extreme version of this practice, termed “saturation needle biopsy,” which actually punctures the prostate gland with 40-80 needle cores in one procedure. OUCH! Symptoms of needle biopsy vary from bleeding, to incontinence to sepsis. Other symptoms may be even more sinister. A little-known but real phenomenon is needle tracking of cancer cells outside the prostate. These cells can lie dormant in the body’s lymph system for years. There are documented instances of this phenomenon. One case described an actual prostate cancer tumor in the rectal wall at the exact point of a previous needle biopsy - years earlier! It may well be that the high failure rate of “curative” procedures may actually be due to needle tracking from prostate biopsies! MRI is used for every other part of the body to find and diagnose disease. Why not in the prostate? Imagine if a neurosurgeon told you he intended to find your brain tumor using needles?</p> <p>Mike<br/> Sarasota, FL </p> <p><cite>— Posted by Mike </cite></p> </div> </li> <li class="clearfix" id="comment-24353"> <div class="index">49.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24353" title="">4:30 pm</a> </div> <div class="comment"> <p>Part 4: Prostate cancer vaccine in 5 years?</p> <p>See this story in the Sydney Morning Herald. This vaccine or a similar one, was tried in a mouse model with seemingly very good results. Now it’s being tried in patients in so-called phase 1 trials (these are done to just see if the vaccine is safe and don’t study efficacy).</p> <p>Here is the link: </p> <p><a href="https://web.archive.org/web/20080224222815/http://news.smh.com.au/prostate-cancer-vaccine-5-years-away/20080206-1qi1.html" rel="nofollow">http://news.smh.com.au/prostate-cancer-vaccine-5-years- away/20080206-1qi1.html</a></p> <p>Meanwhile, I’m not sure about the hormones and diet stuff. Avoid DHEA, zinc supplements, B12/folate supplements (maybe, evidence not very clear), and any kind of herbal supplement that may contain testosterone-like substances. Green tea, supposedly helps. </p> <p>But it you’re doing watchful waiting, be careful, and follow the PSA carefully, esp. the PSA doubling time, and keep in mind the ratio of PSA to gland size. If your PSA is high with a smallish gland, then the cause of the elevation is more likely to be due to malignancy.</p> <p>pht </p> <p><cite>— Posted by Physician heal thyself </cite></p> </div> </li> <li class="clearfix" id="comment-24355"> <div class="index">50.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24355" title="">4:37 pm</a> </div> <div class="comment"> <p>Age 75. My PSA for the past 5 years has risen from 3.9 (first time tested) to 5.8 (last reading). The scores zig-zagged somewhat–the highest was 6.3. I have no symptoms of other problems. My free PSA was 10. Urol. wants (”strongly suggests”) a biopsy because of free PSA. I refused. I believe at my age and the PSA scores (from internet reading) that watchful waiting is the correct procedure unless the PSA increases dramaticaly. I wouldn’t have an operation so why have a biopsy. Urol., young guy, has wonderful, expensive offices–I sometimes wonder if I’m an income source. </p> <p><cite>— Posted by art </cite></p> </div> </li> <li class="clearfix" id="comment-24360"> <div class="index">51.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24360" title="">4:47 pm</a> </div> <div class="comment"> <p>I had a Gleeson 8, the cancer broke through the sac. I have had radical surgery, radiation, chemo, Lupron and Zomata. I leak, I have no erections nor do I have any sexual desires.</p> <p>I have, hugged and kissed three adult children and six grandchildren. I have seen the sunrise over the Atlantic, on a daily basis; I have seen the Canadian Rockies…. And there will be much more to fill my life.</p> <p>I smile everyday and sleep every night. I put “pee” pads in my underwear and in my night cloths. I hug my children and my grandchildren. I hug and thank my Rachieeee.</p> <p>No one very promised me a rose garden…. But I have my rose colored glasses….and everyday is a great experience. I go to Memorial Sloan Kettering four times a year, I get scanned and then I hug the kids again. I have always tried to eat the good foods and take the proper supplements and will continue to do so. I exercise to counter act the drugs.</p> <p>And when the day is done… I hug the kids and grandkids once again….and wait for the next sunrise over the Atlantic…. For I will be there to start my day.</p> <p>Ira </p> <p><cite>— Posted by Ira </cite></p> </div> </li> <li class="clearfix" id="comment-24365"> <div class="index">52.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24365" title="">5:00 pm</a> </div> <div class="comment"> <p>I am 62 and last november I was dignosed with a high gleason 8 after a 12 samples biopsy which show the carcinoma in just one sample.After lots of reading I decided for radical prostectomy since it seems to be the only course that could cureme and eliminate the cancer with 100% of certainty. The surgery was done in jan 4 2008 and I had a TC1 localized tumor. Urinary problems have been minimal and erections are normal and at the same level and quality as before. It is very important to choose an experient surgeon. I was very afraid of the risk of becoming impotent and I advise not to be as concern as I was before the surgery. </p> <p><cite>— Posted by Miguel </cite></p> </div> </li> <li class="clearfix" id="comment-24366"> <div class="index">53.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24366" title="">5:01 pm</a> </div> <div class="comment"> <p>I am more confused than ever, however I wish there were more references to seed therapy. </p> <p><cite>— Posted by Rick </cite></p> </div> </li> <li class="clearfix" id="comment-24374"> <div class="index">54.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24374" title="">5:30 pm</a> </div> <div class="comment"> <p>On March 30, it will be three years since my meeting with “da Vinci”… I am now cancer free… and am now guaranteed of NOT dying from pc… this (typical) government report says nothing… great, is this the Administration’s approach to lowering health care costs!!!</p> <p>We would be far better served by taking the dollars spent (wasted?!) on this report and providing a grant to Dendreon to complete the (idiotic) additional last minute testing that the FDA required on Provenge… which all too often, as in the case of da Vinci and so many other US developed medical procedures and drugs, is now being dispensed in Europe… </p> <p>Or, how about recommending the commencement of screening at 40 as opposed to 50… the last time I heard, the secret to successful cancer treatment is early diagnosis… and then if we follow the report, a man might have an additional 10-15 years to do nothing about the cancer growing in him…</p> <p>And while I’m at it…Michael Tashman… you’re an idiot… I’ll be looking for you on WebMD crying for information… </p> <p><cite>— Posted by Stan Brody </cite></p> </div> </li> <li class="clearfix" id="comment-24378"> <div class="index">55.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24378" title="">6:01 pm</a> </div> <div class="comment"> <p>(Part 1 of 5)<br/> It’s sad to contemplate the needless confusion and misunderstandings that result from oversimplified information uncarefully dispensed and uncritically received.</p> <p>At the very least, researchers, physicians and patients should be honest and clear about the meanings of the second and third most important considerations: incontinence and impotency. For example: Two months after Patient1’s surgery in December, he regularly leaks an eyedropper worth of urine daily, and has a gusher of many tablespoons several times a month, on sneezing or similar stress. Is Patient1 continent, or is he incontinent? Four months after Patient2 concluded the last of his EBRT treatments in 2007, he had no continency issues. A year later, when data were gathered for a study, he had a very minor stedy dribble that was easily contained by one pad per day. The study doesn’t know it, but his leakage will get gradually worse for another two years, and plateau at a need for three to four pads per day. At the time of the study, is Patient2 continent, or is he incontinent? In the year before Patient3 had his prostectomy, he had regular sexual relations once a week, but with diminished erectile function compared to his 30s — about 8 on a scale of 10. A year after the surgery, he achieves a 6 on a scale of 10 about once a month, more often only a 3 or 4, despite taking ED medications. Is Patient3 impotent, or has he recovered potency?</p> <p>The problem is that these questions are answered with binary “yes” or “no” when they deserve to be placed on a gradient, perhaps a two-dimensional gradient. It takes time to convey the information well, and time to assimilate it and use it in weighing options. </p> <p><cite>— Posted by PaulC1956(at) </cite></p> </div> </li> <li class="clearfix" id="comment-24379"> <div class="index">56.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24379" title="">6:02 pm</a> </div> <div class="comment"> <p>(Part 2 of 5): On treatment vs nontreatment. </p> <p>All interventions (surgery, radiation, hormones, etc.) do some damage. The risk of the amount and type of damage done by a possible treatment should be compared to the risk of the amount and type of damage done by nontreatment. This comparison is difficult to do, and it naturally varies from one man to another — Is a 10% greater chance of living to age 90 preferable to a 90% chance of permanent lifelong sexual dysfunction? </p> <p>The answer depends not just on your current life expectancy and function, but also on the relative value you place on length-of-years vs quality-of-days.</p> <p>In 2008, if a man has a Gleason sum of 6 or less, and a PSA doubling time of more than two years, it seems obvious to me he should choose active surveillance and hope for technological developments while remaining vigilant for unusual developments in his own particular case. Most men do not realize that prostatectomy has a 100% likelihood of impaired sexual function (no semen production) and 80% likelihood of permanently diminished sexual ability (erectile function), and they would be ill-counseled to choose the certain downsides of surgery if their disease is mild and unaggressive. </p> <p><cite>— Posted by PaulC1956 </cite></p> </div> </li> <li class="clearfix" id="comment-24380"> <div class="index">57.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24380" title="">6:02 pm</a> </div> <div class="comment"> <p>(Part 3 of 5): On comparing studies. </p> <p>The misinformation and oversimplification is appalling. I grant that the datasets are very difficult to work with, because of the nonstandardized (or changing standards) for various terms and diagnostic criteria, and that we will only ever be able to compare apples to quinces, but there’s no excuse for comparing apples to hippopotami without at least an explanatory disclamatory footnote.</p> <p>For example: The term “man newly diagnosed with prostate cancer” has very different meanings in 1985 than in 2005. In 1985, he was very likely to be either elderly or symptomatic or both; in either case, his life expectancy was less than 10 years. In 2005, he was probably diagnosed as a proximal result of a PSA test (which didn’t exist in 1985); I would venture to guess that at least half of such men would have been adjudged completely healthy by 1985 standards. If this is correct, the pool of potential “men newly diagnosed with prostate cancer” has doubled relative to the population, but only through a change in the term’s definition that added a lot of men with early-stage and low-grade disease. In such circumstances, it would be impossible for the rate of morbidiy and mortality not to drop — and such a drop would reflect nothing about the value of diagnosis or treatment.</p> <p>Similarly, results of radiation done in the 1990s are not comparable to results from the practice as it is now performed, aided by high-performance computers for imaging, simulations, and dose calculations.</p> <p>Any study or meta-analysis that lumps together utterly distinct populations does us all a disservice. Information can be learned, but only through extraordinary statistical manipulation that requires subtle teasing — of the underlying set of assumptions, some will later be shown invalid, and some have unknown interdependencies confounding the degrees-of-freedom. </p> <p><cite>— Posted by PaulC1956 </cite></p> </div> </li> <li class="clearfix" id="comment-24381"> <div class="index">58.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24381" title="">6:03 pm</a> </div> <div class="comment"> <p>(Part 4 of 5 - long): On overtreatment.</p> <p>I agree with the assertion that there is too much treatment going on, and agree with the many comments noting that men typically are steered by urologists to surgery as a first or preferred option. Not only was that my own experience, it was the experience of most the men in the support groups I belong to. If I were not as well-informed (arrogant?), persistent (stubborn?), and independent-minded (rebellious?) as I am, my experience would have been identical to that of commenter #5 (A. M. Kelso). I did eventually decide to undergo prostatectomy, but I reached the conclusion totally independently of my urologist. His failure to volunteer information on other treatment modalities destroyed any I trust I might have had in him, anyway.</p> <p>My decision to undergo surgery was based on two main comparisons and several smaller ones. I looked, as best I could, at the five-year, ten-year, and twenty-year curves of likely disease progression in my case versus likely technological advancements. Although very promising therapies are currently in the pipeline, my sad conclusion was that my Gleason 4+3 disease was sufficiently aggressive that I stood a 5% chance of dying and a 25% chance of very significant progression in the time these therapies would mature, and that the likely advantages of waiting didn’t quite outweigh the likely advantages of earlier treatment. One of the reasons I chose surgery was that it would provide much more diagnostic information, via the pathology report, than any other treatment modality. At age 50, my strategy was to take an early minor hit against quality-of-life in order to increase the probability of ten-year[fifteen-year] survival from 80%[70%] to 90%[80%], while maximizing the amount of information available to my future physicians. </p> <p>Since then, I’ve learned much more about the hit that surgery takes on quality-of-life, and I’ve learned how frequently men undergoing prostatectomy are counseled to undergo further treatment, such as radiation or hormone therapy, and I’ve learned more about the efficacy of dietary changes, which I had previously dismissed as being health-faddish. Had I known then what I know now, I would not have chosen surgery.</p> <p>And I would have been wrong, because the pathology report, obtainable by no means other than prostatectomy, showed that my disease was much more aggressive than anyone had suspected: Gleason 5+4. </p> <p>And yet: I would have been right, because in my extremely unusual case, surgery was almost completely ineffective: My PSA level diminished from 5.2 before surgery to 4.5 after, thus probably indicating that the cancer had been systemic for some time. Any other local treatment (brachytherapy, IMRT/EBRT/protons, HIFU, cryosurgery) would eventually have demonstrated the same result, with less damage to me. Had I simply waited another year or two, the new diagnostic tests would have shown the systemic nature of the disease without my having to undergo any damage from any local treatment. And perhaps a second biopsy would have disclosed the higher Gleason score. </p> <p><cite>— Posted by PaulC1956 </cite></p> </div> </li> <li class="clearfix" id="comment-24382"> <div class="index">59.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24382" title="">6:03 pm</a> </div> <div class="comment"> <p>(Part 5 of 5): On “overdetection”. </p> <p>This assertion makes no sense to me. I suspect that it’s a shorthand acknowledgment of undereducation, which is definitely a problem. What argument can be made in favor of ignorance? If a man has insignificant prostate or skin cancer, and everybody knows it’s a humdrum vicissitude of no consequence whatsoever, who would claim that he is better off not knowing? I see this as an issue of terminology and oversimplified information. No physician or patient should ever speak or think of a PSA result as “positive” or “negative” any more than they would say that a measurement of temperature or blood pressure, or obesity is “positive” or “negative”. The second most important information from a PSA test — and it’s a distant second — is the value compared to the expected or normal value. The most important information is the result’s context in a sequence of time: If it is increasing over time, is it an arithmetic sequence (1, 2, 3, 4, …) or a geometric sequence (0.5, 1, 2, 4, …)? This is the huge diagnostic difference between PSA testing for prostate cancer compared to mammography for breast cancer. </p> <p>BTW, FWIW, I am not a doctor or mathematician; I never even graduated from college. I’m just a bright and motivated layman. </p> <p><cite>— Posted by PaulC1956 </cite></p> </div> </li> <li class="clearfix" id="comment-24393"> <div class="index">60.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24393" title="">6:33 pm</a> </div> <div class="comment"> <p>Tara deserves a lot of credit for stepping up and trying to speak to a topic that speaks less to science and more to technologies used to treat a disease. Collectively, physicians don’t understand the biology of prostate cancer. This is likely the prime reason for failures. In the case of Gleason 8 cancer, we tend to rush patients into surgery,despite knowing that 85% of Gleason 8 cancers return within 5 years regardless of the treatment performed. Conversely, in many cases we are trying to do too much for a disease that predictably requires less. A case in point is a Gleason 6 cancer that we have shown responds to conservative measures highlighted by diet and nutrition, referencing: Journal of Clinical Interventions in Aging, Volume 2, Number 1, April 2007. As a physician, I try to do for the disease what is required and nothing more while allowing quality of life issues to remain intact. Speaking to Ode’s earlier comment, we are planning to conduct a Prevention Trial called the ProCap Trial utilizing a product that has been patented worldwide versus prostate inflammation, a putative cause of prostate cancer. Hopefully, we will be recruiting latter this year.<br/> Posted by Ron from Sarasota, Florida</p> <p><strong>From TPP — Thanks for adding this useful information to the discussion.</strong><strong></strong> </p> <p><cite>— Posted by Ron </cite></p> </div> </li> <li class="clearfix" id="comment-24401"> <div class="index">61.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24401" title="">6:59 pm</a> </div> <div class="comment"> <p>I don’t understand the “close your eyes and cross your fingers” approach. My husband ate a healthy diet, was a non-smoker, even ran marathons, but all that didn’t keep him from developing cancer symptoms nine years ago at age 47. Excellent nerve-sparing surgery has provided a good quality of life with regular erections and no incontinence. Why skip the test and leave your loved ones behind unnecessarily?<br/> I do agree with the comments about due diligence, self-education, and choice of the best approach for your situation. </p> <p><cite>— Posted by Martine </cite></p> </div> </li> <li class="clearfix" id="comment-24402"> <div class="index">62.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24402" title="">7:00 pm</a> </div> <div class="comment"> <p>To #31 Bob, unfortunately no, there are currently no ways to tell the slow growing, average types of prostate cancer from the invasive, dangerous forms. This is, frankly, why physicians are so aggressive about treatment. We have yet to discover any genetic markers that would be helpful in guiding diagnosis and treatment (similar to HER2+ breast cancers or familiar cancer syndromes like FAP). If you were to ask most research urologists, this is really going to be the new frontier of prostate cancer research. </p> <p><cite>— Posted by Melinda </cite></p> </div> </li> <li class="clearfix" id="comment-24407"> <div class="index">63.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24407" title="">7:11 pm</a> </div> <div class="comment"> <p>Thanks to Tara Parker-Pope for this excellent article and moderation of comments. Actually the comments are useful and cover a lot of relevant ground.An underlying thread is of course ‘what is the best treatment for me’? This is an important starting point and not as difficult as it sounds.Firstly, screening with the PSA test provides a useful ‘marker’ but it is important that FreePSA/%FreePSA are included. If the result indicates possible concern, the next step is to institute regular tests (say three monthly). This enables the PSAV (velocity) or doubling time to be measured. At the same time patients can check to ensure BPH,Prostatitis is not causing the elevation (most common). These are notoriously difficult to dislodge. A DRE (digital rectal examination) performed by a qualified specialist is critical.It defines the ‘normality’ or otherwise of the prostate.The risks of Biopsies are high and have been pointed out in the comments.Biopsies ought to be reserved for very high PSA levels (where no other factor is present) and fast-accelerating PSA levels. As an alternative a transrectal ultrasound can ‘map’ the vital statistics of the prostate (dimensions, weight) and a colour doppler ultrasound performed by an expert has been shown to detect significant cancers as effectively as a biopsy, but without the risk. If the cancer is defined as ‘insignificant’ (most cancers) then Active Surveillance or Diligent Monitoring is appropriate. This is practised by leading hospitals and independent specialists. Find one and follow their guidelines. Definitions of ‘insignificant’ or ‘indolent’ cancer can be found on the web. Diet has been shown to make a contribution as certain Asian communities of little or no prostate cancer but start to develop it after migration to western countries. The most published prostate specialists seem to agree that excessive alcohol, caffeine, sugar, dairy, fatty foods, carbonated drinks etc. make a contribution. On the other hand green tea, olive oil, fresh fruit and vegetables, fish, lean meat compensate as do regular light exercise, good sleep and low-stress environment.Everything in moderation is a good rule, and there are cases of low-medium cancer remissions via this approach. It is true that the Prostate medical fraternity world-wide is guilty of gross over-servicing and regardless of comments made here and elsewhere the financial benefits to such practitioners are enormous. Additionally, undertaking procedures on low-risk patients enhances their figures. The answer to this is to engage very seriously in your own study, find a specialists that you are comfortable with and monitor your situation. The vast majority of men can keep their cancers under control this way and will indeed die of something else. For some the appeal of a ‘cure’ is irresistible. The issue is the downsides, particularly to the serious procedures (radical prostatecomy, radiation,hormone treatment). Everyman should be aware that these are life-changing and can be extremely traumatic. On the other hand, new procedures are being developed and perfected and there are procedures which are ‘normal’ in some regions but not in others - e.g. High Intensity Focused Ultrasound (HIFU) which is the procedure of choice in Europe, is very successful, has lower side-effects, is repeatable and at least as effective as radical procedures. It will be introduced to the USA and is undergoing late-stage trials. Other procedures such as Cryosurgery (freezing) have been mentioned. All procedures must be performed by a very, very experienced professional (hundreds of procedures). In considering any treatment low/mid-range cancer patients (the majority) need to consider that most procedures are irreverible and lead to a ‘cascade’ of other treatments. This will prevent access to the many new developments that are underway in laboratories all around the world.<br/> For those men who are unfortunate enough to have a serious level of cancer (very agressive, fast-growing)fast action and expert help is critical. One of the keys is to prevent metasteses and for most men this is achievable with a highly-qualified medical team. it is worth noting that there is no ‘cure’ for Prostate cancer, although in most cases it can be forced into remission to enable a normal lifespan.However vigilance is always important. Men and their partners/families can obtain a great deal of information from the internet, from Prostate forums, websites dedicated purely to Prostate patients and case histories, and excellent books that cover all aspects of the disease. It is not such an intimidated process once research is undertaken, a plan is mapped, and the procedures and steps followed. As a prostate cancer patient, working with many other men, I hope this is helpful.<br/> Ross </p> <p><cite>— Posted by Ross Williams </cite></p> </div> </li> <li class="clearfix" id="comment-24431"> <div class="index">64.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24431" title="">8:47 pm</a> </div> <div class="comment"> <p>This part of the study says it all:<br/> “The most obvious trend identified in the complicated report is how little quality research exists for prostate cancer, despite the fact that it is the most diagnosed cancer in the country.”</p> <p>Most diagnosed, little quality research!</p> <p>Being diagnosed with advanced PC 3 years ago at 42 years old this topic is obviously very important to me. </p> <p>The Times should be commended for running a number of recent articles on the subject.</p> <p><strong>From TPP — It’s an absolute outrage. I hope to continue to highlight the paucity of data and lack of research funds for men with prostate cancer. i am so appreciative to readers like yourself for sharing their stories.</strong> </p> <p><cite>— Posted by DavidE </cite></p> </div> </li> <li class="clearfix" id="comment-24432"> <div class="index">65.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24432" title="">8:54 pm</a> </div> <div class="comment"> <p>When I was first diagnosed in 1986 I was 60 years of age. I was given no choice of treatment. My Urologist told me my Gleason Score was 9 and that what I had was a very agressive form of cancer. He had a bone scan and a Stress Test done and then it was External Beam Radiation. When that was over with, I got so plugged up with blood clots from my nuked Prostate that I could not urinate. Three days in the hospital with a tri-catheter in me and clean water running through it cleared that up. Then came the incontinence which was unrelenting. The extent of my erectile dysfunction was that I could get a soft erection but not enough to have intercourse with my wife.</p> <p>I stayed cancer free until 2003 and then in November a PSA test revealed a reading of 29.7. In January of 2004, I kept an appointment with a Urologist and he did not even suggest a biopsy. He said the cancer was back and sent me for a bone scan. When that revealed the cancer had not spread he gave me two choices 1) death in two years of less or castration (either chemically or surgically). He ran a camera up into my bladder and showed me the unhealed radiation damage from my previous treatment and said he could heal that and cure my incontinence. So we opted for surgical castration and the TURP at the same time. The operation was on February 13, 2004.</p> <p>Physically it was nothing. It cleared up my incontinence in a wink. The side effects were what a woman going through menopause gets. The hot flashes and night sweats were not bad; but the mood change has been devastating. I will blow up at anyone that rubs me the wrong way at the drop o a hat. It cost me agreat part-time job that I dearly loved when I chewed out afellow employee for her stupidity.</p> <p>My PSA is, now, 0.40. The Urologist removed 35 grams of flesh from my Prostate and my bladder area when he did the castration and that and my testicles were sent to the lab for testing. There was no sign of cancer in any of it. I asked the Urologist how that could be and he said it was probably in the outer areas where he did not take any flesh from. </p> <p>The operation has caused such an adverse change in my personality that if I had the opportunity to go back, I would not have had it done. I cry a lot because even the slightest thing that I feel good or bad about causes the tears to flow. It can be a good piece of music or something that has absolutely bearing on my family or I; it matters not. It is a lousy way to live a life. </p> <p><cite>— Posted by Ralph </cite></p> </div> </li> <li class="clearfix" id="comment-24447"> <div class="index">66.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24447" title="">9:51 pm</a> </div> <div class="comment"> <p>Not so “surprisingly”, the Budwig Protocol was NOT among the (more or less<br/> barbaric) “treatments” evaluated.</p> <p>Well, what else can we expect from conventional medicine …??</p> <p>In case you want more info: <a href="https://web.archive.org/web/20080224222815/http://budwigprotocol.tripod.com./" rel="nofollow">http://budwigprotocol.tripod.com.</a></p> <p>Health and spiritual growth to all, RNM. </p> <p><cite>— Posted by RN Mendez </cite></p> </div> </li> <li class="clearfix" id="comment-24455"> <div class="index">67.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24455" title="">10:12 pm</a> </div> <div class="comment"> <p>I am the author of comment #21</p> <p>Re: Comment #24 - I failed to list the items you pointed out as also having been totally taken out of my diet; sugar in all forms and any artificial sweetners. Also not mentioned were tropical fruits (lots of sugar there) and for the most part, nightshade vegetables. I could not agree more, that cutting out sugar is extremely important. The whole connection of sugar and liver and thyroid and Testosterone and Estrogen are entwined in the Prostate puzzle. My macrobotic plan would not be very complete with sugar and sweteners included. My adherance to macrobiotic principals is total, and I don’t cheat. The stakes are too high. </p> <p>Re: Comment #48 - I am concerned about needle tracking, and believe that needle biopsies need to be very carefully considered before having them done. While mine aided my diagnosis, and led to me taking action, poking holes in the prostate is not a good thing. It is not Prostate Cancer localized in the prostate that is in most cases potentially terminal, but rather the metastasis of Prostate Cancer to other areas of the body that delivers the end stage of the disease. It is for this reason, that I have come to believe that localized treatments are not the nearly the whole answer or for me the right answer. Even with my relatively early diagnosis(PSA 3.15 & Gleason 6 & T1C), I would not be surprised to learn that there are traces of Prostate Cancer at the microscopic level and dormant in other areas like my lymphatic and skeletal systems, where the metastasis of the disease is ultimately most likely. I will not lightly treat the suggestion of any further needle biopsies in my case. Why help the genie out of the bottle. Hopefully, there will be further advances in imaging and other detection systems that will improve upon PSA screening, and obviate the need in most cases for needle biopsies.</p> <p>I am what I eat.</p> <p>Sonarman </p> <p><cite>— Posted by Sonarman </cite></p> </div> </li> <li class="clearfix" id="comment-24456"> <div class="index">68.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24456" title="">10:16 pm</a> </div> <div class="comment"> <p>this is a great topic and discussion.<br/> what about doing an article on how we can reduce the risk of getting prostate cancer.</p> <p><strong>from TPP — I’m not sure they know a lot but i will definitely look into it. great topic. Right now there is an ongoing study of vitamin E and selenium but the data aren’t in. but yes, i’m sure there is much to say thanks.</strong> </p> <p><cite>— Posted by bruce </cite></p> </div> </li> <li class="clearfix" id="comment-24461"> <div class="index">69.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24461" title="">10:27 pm</a> </div> <div class="comment"> <p>I remember an article (possibly in TNYT) from 5-10 years ago that cited a physician at Columbia Presbyterian who electrically tested for erection capability after prostatectomy and had cosmetic (not the right name) surgeon in the OR to repair nerve damage until erectile capability was demonstrated. He apparently had good results, but I have not heard anything of this approach since.</p> <p>As far as the toilet paper reference above, I believe it refers to the series of writers to Ann Landers on which way the toilet roll was to be inserted in the dispenser so the loose end was on the outside coming over the top, or the inside keeping any pattern against the wall, not visible as it hung down. </p> <p><cite>— Posted by Donald </cite></p> </div> </li> <li class="clearfix" id="comment-24469"> <div class="index">70.</div> <div class="commentmetadata"> February 6th,<br> 2008<br> <a href="#comment-24469" title="">11:16 pm</a> </div> <div class="comment"> <p>Over the last decade since I was diagnosed and treated for prostate cancer there have been many VIP’s who contracted the disease, were treated and<br/> then appeared in the various media advocating for early detection and treatment in very positive presentations. Side effects, disease recurrence and other negative factors are not mentioned in these presentations.<br/> I think the net effect of this is that many more men have been tested, and treated over those years following their example and as a result added to the number treated unnecessarily. </p> <p><cite>— Posted by Justin </cite></p> </div> </li> <li class="clearfix" id="comment-24485"> <div class="index">71.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24485" title="">12:06 am</a> </div> <div class="comment"> <p>The prostate cancers that are bound to kill you quickly (within 5 yrs) are probably not curable. The ones that you most likely cure are the ones that are going to kill you in 10-20 yrs. So early detection and treatment are more like an insurance policy that you pay for with typically minor stress incontinence and erectile dysfunction against the possibility of dying from prostate cancer. Before you get a PSA test, ask yourself this: “Am I willing to pay a significant price now for a better chance at living longer?” And with respect to watchful waiting, it is reasonable, though slightly surreal, scenario to say “Gee, I hope I die of something else first.” Also, if you are considering a radical prostatectomy, ask your surgeon “What are the success rates for incontinence and impotence in YOUR hands (not what the general literature says the success rates are)?” </p> <p><cite>— Posted by Dr. J </cite></p> </div> </li> <li class="clearfix" id="comment-24487"> <div class="index">72.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24487" title="">12:10 am</a> </div> <div class="comment"> <p>I was recently told that I have Prostate cancer. I have met with a surgeon and will meet soon with a radiation specialist. I’ve been told by my urologist that these doctors are very good. They practice in a well respected local hospital and do many of these procedures. I’ve looked at the state medical malpractice web site and there were no negatives there. My question is: Is there any way to find out how hospitals and doctors compare to each other as far as results? eg. If I traveled to Johns Hopkins would my chances be greatly improved over the local respected hospital? Does anyone keep track of these things? </p> <p><cite>— Posted by Brian </cite></p> </div> </li> <li class="clearfix" id="comment-24488"> <div class="index">73.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24488" title="">12:17 am</a> </div> <div class="comment"> <p>I`m so thankful that I found this discussion. I am a 61 yr old man and was recently informed that my PSA is 6.8 and after re-test, I`m assuming the doc will recommend biopsy. He says there is 1 in 6 chances I have Ca. My inclination is to refuse and my reasoning is more philosophical that most. It can be summed up as “no one gets out alive”.</p> <p>By that I mean that, even though I am healthy and active, I`ve come to terms with my own mortality, especially after watching my father struggle though the last few years of his life before passing on at 93. I don`t want to experience 93 and I </p> <p><cite>— Posted by PhilB </cite></p> </div> </li> <li class="clearfix" id="comment-24496"> <div class="index">74.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24496" title="">12:42 am</a> </div> <div class="comment"> <p>Dendreon’s immunotherapy PROVENGE is a safe and effective treatment for advanced prostate cancer (and likely early stage as well) according to the FDA’s own advisory commitee. A vote of 17-0 and 13-4 on safety and efficacy respectively in march should have led to approval, however a bewildering delay for “more data” has occurred following objections from chemotherapy interests. None of the terrible side effects of chemotherapy occur with provenge and it is only a matter of time and exposure until it is available. Support the call for Congressional hearings: <a href="https://web.archive.org/web/20080224222815/http://caretolive.com/" rel="nofollow">http://caretolive.com/</a> </p> <p><cite>— Posted by chris sefton </cite></p> </div> </li> <li class="clearfix" id="comment-24504"> <div class="index">75.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24504" title="">1:36 am</a> </div> <div class="comment"> <p>I watched my favorite uncle die from prostate cancer. It wasn’t pretty. When I was diagnosed, I felt like I had a ticking time bomb in my gut, and I wanted it out. It is six years later and, in a statistical sense, I would not reject the hypothesis that my PSA is zero. Sex is not as good, but the last survey of dead men that I read claimed that 100% suffered from ED, not to mention lack of physical affection from wife, children, and grandchildren. The DaVinci machine, a relatively new development, seems to produce better results than a regular NSRP so the technology for treatment is improving all the time. I would advise anyone facing the choice of treatment options to weigh thoughtfully the complaints of those with varying degrees of ED or incontinence against the complaints of those dying from metastatic prostate cancer. </p> <p><cite>— Posted by Robert </cite></p> </div> </li> <li class="clearfix" id="comment-24530"> <div class="index">76.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24530" title="">3:32 am</a> </div> <div class="comment"> <p>I second the comments of Bill at posting number 27. My case appears to identical to his except that I was 59 when the cancer was discovered. The ED was gone in four weeks and small problems with incontinence were gone in two or three months. The only other drawback was that jogging was out for about four or five months. All that was eight years ago. </p> <p><cite>— Posted by John </cite></p> </div> </li> <li class="clearfix" id="comment-24546"> <div class="index">77.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24546" title="">4:52 am</a> </div> <div class="comment"> <p>Great comments, all! Thanks.<br/> At age 61, my doctor discovered I had Prostate Cancer. After going over all at the time available treatment options, I elected to have the Prostate removed. To me it is a two-pronged problem; a medical one and a “head” one… I wanted the Prostrate gone, and not have a “prune” of a Prostate gland left and continue to wonder about it. I’m now 73 - annual PSA still .02 or some other very low number. And I still feel fine. My father passed away at the same age I am now due to Prostate Cancer. A very painfull death, I might ad. </p> <p><cite>— Posted by Don </cite></p> </div> </li> <li class="clearfix" id="comment-24549"> <div class="index">78.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24549" title="">5:08 am</a> </div> <div class="comment"> <p>Men with newly diagnosed prostate cancer should indeed carefully consider and research their options. For those interested in further considering brachytherapy (radioactive seed implants) as an option, a good resource is <a href="https://web.archive.org/web/20080224222815/http://www.prostatepointers.org/" rel="nofollow">http://www.prostatepointers.org</a></p> <p>You can join the “SeedPods” mailing list and enter into a dialogue with others about their experiences. </p> <p><cite>— Posted by am </cite></p> </div> </li> <li class="clearfix" id="comment-24570"> <div class="index">79.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24570" title="">6:47 am</a> </div> <div class="comment"> <p>Prostate cancer, as well as many other cancers, can be eliminated through diet. I cooked a macrobiotic diet for a friend with “inoperable” prostate cancer (because it had spread to his lymph nodes) for 4 months 9 years ago. He was cancer free at the end of 4 months, and still is, much to the amazement of the well-respected medical institution that had given him a death sentence. Guys, head to your local Health Food Store! </p> <p><cite>— Posted by Penny </cite></p> </div> </li> <li class="clearfix" id="comment-24582"> <div class="index">80.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24582" title="">8:36 am</a> </div> <div class="comment"> <p>10 years ago my husband was diagnosed and treated for fast growing cancer. He had prostatectomy, radiation and Lupron shots ever since. When the PSA stayed up I read of a study that advised low fat diet as fat needed for cancer cells. He has been on a fat free diet since and almost immediately the PSA fell. My husband has erectile dysfunction but bladder exercise took care of the bladder problems. He never complains. </p> <p><cite>— Posted by Laurel </cite></p> </div> </li> <li class="clearfix" id="comment-24590"> <div class="index">81.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24590" title="">9:25 am</a> </div> <div class="comment"> <p>I found this article to be interesting, important, and most thought-provoking.</p> <p>I was somewhat disappointed that you did not mention the work of Ornish and his colleagues who are conducting a randomized clinical trial of early prostate cancer using a lifestyle approach. Their treatment has none of the troubling side effects of more invasive procedures and could offer some additional options and hope. Thusfar, results are showing that men in the treatment group have decreased PSA values while those in the control group have continued to increase. Here are some references to his study:</p> <p>Ornish D, Weidner G, Fair WR, Marlin R, Pettengill EB, Raisen CJ, Dunn-Emke S, Crutchfield L, Jacobs FN, Barnard RJ, Aronson WJ, McCormac P, McKnight DJ, Fein JD, Dnistrian AM, Weinstein J, Hgo TH, Mendell NR, Carroll PR. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005 Sep;174(3):1065-9.</p> <p>Daubenmeir JJ, Weidner G, Marlin R, Crutchfield L, Dunn-Emke S, Chi C, Gao B, Carroll P, Ornish D. Lifestyle and health-related quality of life of men with prostate cancer managed with active surveillance. Urology. 2006 Jan;67(1):125-30. </p> <p><cite>— Posted by Sue </cite></p> </div> </li> <li class="clearfix" id="comment-24591"> <div class="index">82.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24591" title="">9:29 am</a> </div> <div class="comment"> <p>I never understood why breast cancer and prostate cancer weren’t crusaded against TOGETHER. All we ever hear about is the tyranny of breast cancer, the horror of breast cancer, the tragedy of breast cancer, etc. and men are given the short shrift as if prostate cancer is just something they should deal with. </p> <p>Why not combine the two into one campaign? Probably, as one commenter put is, “not sexy enough” for activists or philanthropists.</p> <p>Doesn’t seem like equal treatment of these gender-specific disease. Wonder why that is. </p> <p><cite>— Posted by Observer </cite></p> </div> </li> <li class="clearfix" id="comment-24592"> <div class="index">83.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24592" title="">9:30 am</a> </div> <div class="comment"> <p>I am 64. Two years ago I was diagnosed with locally advanced prostate cancer. My Gleason’s were 8’s and 9’s, PSA never higher than 4.7. Initially,the only option offered me was hormone therapy and radiation. Later, I was guided to cryotherapy experts who said their approach would be effective.</p> <p>I chose the hormone and radiation. I have just completed 2 years of Zoladex and Casodex and 43 radiation sessions. I have almost no side effects and managed the hormone therapy well, thanks to a great wife and well established commitment to exercise. I have made some diet changes.</p> <p>My last Zoladex three month lasting injection was 12/26. Last PSA was lower than .01. Of course I have no idea at this point whether or not the treatment was effective. I am adjusting to the reality that what lies ahead is at best uncertainty and vigilance. It is a difficult adjustment made easier when I manage to stay in the moment and be interested in people and things outside myself.</p> <p>Good luck to everyone. </p> <p><cite>— Posted by Harry </cite></p> </div> </li> <li class="clearfix" id="comment-24597"> <div class="index">84.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24597" title="">9:50 am</a> </div> <div class="comment"> <p>Responding to #15, in the removal of the prostate, the sphincter between the prostate and bladder is impaired and the sphincter at the bottom of the prostate is excised with the gland. So there is one weakened sphincter left to control urine flow. </p> <p>For a little less than a year I bought thin feminine napkins, cut them in half and stuck the piece onto my briefs. The sense of embarrassment, shame, and wonderment by others in perusing the female sanitary products section in drug and food markets is sosmething I shall never forget. This included the real or imagined looks from checkout clerks! </p> <p>I had one of a series of multiple silicone injections around the remaining sphincter, used a decade ago, as treatment. My experience is that my body slowly healed and my brain gradually learned to adjust and much higher degree of continence ensued. But pressure incontinence, due to unusual body movements,e.g., lateral moves, leg lifting, squatting, still cause some leakage. My body’s immediate response is a PC tightening. Be aware hat Relaxant medications and alcohol loosen my sphincter control. I am certainly grateful for the level of control that developed. I want to believe that, in time, far better treatment for prostate CA will be developed. </p> <p><cite>— Posted by CN </cite></p> </div> </li> <li class="clearfix" id="comment-24615"> <div class="index">85.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24615" title="">10:27 am</a> </div> <div class="comment"> <p>It is taught in medical school that family history is very important in assessing a patient’s health. It would seem to me very useful to know the demographics of men with aggressive PC. Did they have family members who died from PC? What race, nationality has higher incidence? While FH alone is not totally predictive, it would go a long way in reducing the number of over diagnosed and over treated disease.</p> <p>For interest, would those posters on this thread respond with their FH (fam hist) and the type of PC they have? My guess is that if you have no FH of aggressive PC, your PC will be very benign. </p> <p><cite>— Posted by daniel </cite></p> </div> </li> <li class="clearfix" id="comment-24637"> <div class="index">86.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24637" title="">11:26 am</a> </div> <div class="comment"> <p>There is an excellent treatment for prostate cancer available at a number of medical facilities in the US. The treatment is called Proton Therapy. </p> <p>The side effects of this treatment are very minimal compared to the alternatives out there. </p> <p>To obtain more information about this treatment visit <a href="https://web.archive.org/web/20080224222815/http://www.protonbob.com/" rel="nofollow">www.protonbob.com</a> . </p> <p>The most renouned facility is the Loma Linda Medical facility. Their Website is <a href="https://web.archive.org/web/20080224222815/http://www.protons.com/index.html?type=search&keyword=proton%20treatment&adid=2099110098&placement=&gclid=CNqn0PG8spECFUV0OAodzEhsdQ" rel="nofollow">http://www.protons.com/index.html?type=search&keyword=p roton%20treatment&adid=2099110098&placement=&gclid=CNqn 0PG8spECFUV0OAodzEhsdQ</a></p> <p>There are also facilities in Boston, Indiana, and Jacksonville, FL to name a few.</p> <p>Anyone diagnosed with prostate cancer owes it to themselves to obtain information about Proton Therapy before even considering anything else.</p> <p><strong>From TPP — I appreciate that so many people are enthusiastic about this treatment, but please. There is no more data on this treatment than any of the others. </strong> </p> <p><cite>— Posted by LV </cite></p> </div> </li> <li class="clearfix" id="comment-24655"> <div class="index">87.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24655" title="">12:23 pm</a> </div> <div class="comment"> <p>I am a 54 year old man with recently diagnosed PC. My Gleason is 3.5/3.5 so the PC seems to be a ‘Garden Variety’. I am now working through the maze of alternatives in orer to make a treatment decision. Wow - it’s too bad this is so up in the air. Anyway, I tend to want to ‘cut it out’ but I am very, very wary of surgery. I have been doing research on HIFU and find this very, very attractive. I learned a couple of days ago of the husband of an associate who underwent HIFU in Germany 8 years ago and is doing great. I understnad that this treatment is not yet available in the US. Does anyonw know where I can 1) find docs in Europe to consult with and 2) find more information on the efficacy of this treatment. Any additional info would be much appreciated. Thanks - excellent article and thread - even if it is really confusing… (;-) </p> <p><cite>— Posted by TZ </cite></p> </div> </li> <li class="clearfix" id="comment-24675"> <div class="index">88.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24675" title="">1:03 pm</a> </div> <div class="comment"> <p>For those of you who mention “what about PREVENTION?” - a very valid question that Devra Davis asks in her book, The Secret History of the War on Cancer - look into selenium and vitamin D, among other nutritional issues. D deficiency is linked to many cancers, including prostate. To learn: Pull up <a href="https://web.archive.org/web/20080224222815/http://www.vitamindcouncil.com/" rel="nofollow">www.vitamindcouncil.com</a> and link to ‘research’. Further link to ‘cancer’ (and other topics, too!) and then specify prostate. This will get you to some great PubMed articles. Wow. This might not be a cure, but it sure as heck should be included in treatment (D3, cholecalciferol is unpatentable and therefore off the radar of doctors, who tend to be “educated” by Pharma). As John Cannell MD, who runs the site, notes: why should anyone die of vitamin D deficiency while they are being treated for cancer?<br/> Also use PubMed, while you are there, to investigate the association of selenium deficiency and prostate cancer.<br/> And to prevent toxins that seem to lead to prostate cancer, check out bisphenol A. You can google it or use the excellent search engine for <a href="https://web.archive.org/web/20080224222815/http://www.ourstolenfuture.org./" rel="nofollow">www.ourstolenfuture.org.</a> Again, wow. Lots to learn, so little time.<br/> Best wishes to all!<br/> Micki </p> <p><cite>— Posted by Micki </cite></p> </div> </li> <li class="clearfix" id="comment-24687"> <div class="index">89.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24687" title="">1:40 pm</a> </div> <div class="comment"> <p>Great comments,<br/> At age 60 my doctor discovered I had Prostate Cancer. After going over all of the options available to me my wife and I decided that a prostactomy was a better option over the others offered not an easy decision. that decision was on doc recomendation my age psa count and gleason score gleason led doctors to believe that cancer had not spread. which proved them correct. I’m now 72 - annual PSA still .02 or some other very low number. And I still feel fine. just be sure it’s a silent killer I was in great physical shape excercised daily went for my yearly physical and they discovered my psa a little high doc recomended i see a urologist he did biobsy and that’s how it was diagonised and fortunatly i was left with without any side effects but it was not an easy decision and went through hell for many weeks, and I was devestated when diagonised </p> <p><cite>— Posted by jim </cite></p> </div> </li> <li class="clearfix" id="comment-24766"> <div class="index">90.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24766" title="">5:24 pm</a> </div> <div class="comment"> <p>Add me to the list of men who refuse to have a PSA test. Until we learn which cancers are going to spread and which will remain in the prostate for decades, routine prostate cancer screening remains a counterproductive strategy, subjecting countless men to potentially unneeded and harmful procedures. </p> <p><cite>— Posted by doctorz </cite></p> </div> </li> <li class="clearfix" id="comment-24792"> <div class="index">91.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24792" title="">7:02 pm</a> </div> <div class="comment"> <p>Older Doctors tend to promote surgery and younger Doctors are a little more willling to recommend other prostate treatments. When I, at 55, elected to have my prostate “glow in the dark” my urologist (old school) dropped me like a hot potato. A asked for and got area radiation treatment as well. So far so good - 10yrs. </p> <p><cite>— Posted by Jack </cite></p> </div> </li> <li class="clearfix" id="comment-24802"> <div class="index">92.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24802" title="">8:21 pm</a> </div> <div class="comment"> <p>The publication date of this article (Feb.5) is the first anniversary of my robotic prostatectomy and I am thrilled with my results– undectable PSA, total continence and terrific sexual function. Despite this great outcome, there is no doubt that the initial diagnosis was frightening and the evaluation of the number and complexity of treatment options was overwhelming. However, my situation– family history of PC, PSA velocity, but relatively young (52), otherwise good health and active– led my wife and I to select the robotic surgery.<br/> That choice, however, was only the beginning of the decision-making process. Those considering robotic surgery have to know that the results improve dramactically when the robot is in the hands of an experinced and capable surgeon. There are plenty of these machines being used around the country, but outcomes improve the more times a surgeon uses the robot. When interviewing surgeons, the question one must ask is, “How many robotic prostatectomies have you done in the past 12 months?” The range of answers will surprise. </p> <p><cite>— Posted by DH </cite></p> </div> </li> <li class="clearfix" id="comment-24806"> <div class="index">93.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24806" title="">8:51 pm</a> </div> <div class="comment"> <p>For posting #72: My husband received treatment at Hopkins this past summer for prostate cancer, and I think the best thing is that you are evaluated by a TEAM of doctors who determine what is the best route for you and your particular PC situation. It is truly a wonderful, amazing place with so many caring and qualified physicians and staff. An added advantage is that there are so many support groups, as well as a fellowship among those being treated. I cannot recommend it more highly! </p> <p><cite>— Posted by Anita </cite></p> </div> </li> <li class="clearfix" id="comment-24807"> <div class="index">94.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24807" title="">8:51 pm</a> </div> <div class="comment"> <p>My 56-year-old husband was diagnosed with prostate cancer a few weeks ago. His father died last year at 92 years of age with or from the disease. We have been married for over 30 yrs. and I would like to spend the next 30 years with him by my side. </p> <p>One of my professions is as a Librarian and since the diagnosis I have read everything I can get my hands on written in the last few years by reputable sources hoping to get the right answer, only to find there isn’t one. The statistics list 5 or 10 yr. survival rates. What about 30?</p> <p>My priority has been to look for the best cure rate. Again, not a clear choice as to options. I am also a selfish woman and the thought of being celibate statistically being a flip of the coin scares me. I cried for days. Now I know some will argue that you can have sex in other ways, like Bill Clinton, it depends on your definition of sex.</p> <p>The intimate time I spend with my husband is precious to me. Though not as frequent as when we were in our 20’s we get better together every year. We know things about each other that I cannot express in words. I am having a hard time dealing with the change this can mean to our lives.</p> <p>My father-in-law spent the last years of his life dealing with this illness, incontinence, bone pain and crushing depression based on what that dreaded PSA number was. I would do anything to avoid this happening to my own husband. I wish someone would have a crystal ball and could tell me what to do.</p> <p><strong>From TPP — I wish I could advise you. A lot of the advise you receive will depend on your husband’s gleason score. I think it’s wonderful that you and your husband have the relationship you describe and there is nothing selfish at all about your sadness at the potential change this may mean for your life. Thing i want to impress upon you here is that your father in law’s cancer really tells you nothing about your husband. He was 92. It’s estimated that 50% of men in their 90s have prostate cancer. People in their 90s get cancer and they die of cancer. When you worry about hereditary risk it’s when things happen at a young age — if your mother had breast cancer in her 40s for instance, that is far more meaningful in terms of heredity than if she had cancer in her 70s. What you need to focus on is finding the numbers that are relevant to your husband. What are his Gleason scores, what is the PSA velocity, what is the free testosterone level — talk to his doctors about markers that can indicate less aggressive or more aggressive disease. having that information should help you make a more informed decision. The final thought I want to leave with you — the chances of your husband having a strong sex life after treatment are strongly correlated with his sex life now. If he has strong erections without aid of erection drugs, then he has a stronger chance for a reasonable sex life post treatment, if he chooses to pursue active treatment (vs. watchful waiting) But what’s really really important to his recovery is the support of his partner. A patient loving partner is essential to his recovery and clearly he has that. Many many couples have told me that while prostate cancer has taken away something from their lives, it has also given them an opportunity to reconnect with each other and redefine their physical relationship in a way that can be very positive. Good luck to you.</strong> </p> <p><cite>— Posted by Sally </cite></p> </div> </li> <li class="clearfix" id="comment-24824"> <div class="index">95.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24824" title="">10:10 pm</a> </div> <div class="comment"> <p>WHAT A WONDERFUL COMPILLATION OF EXPERIENCES, REFERENCES AND FACTS. JUST HAD MY 5TH BIOPSY AS A RESULT OF PAS/FREE PSA VALUES. TEN YEAR PERIOD. 65 YEARS OLD. LAST 18 MO VALUES WENT FROM 7.1 TO 12.3 TO 13.1. TWENTY TWO SAMPLES THIS TIME. NEGATIVE RESULTS FOR ALL FIVE BIOPSYS. AROUND 50 SAMPLES IN TOTAL. COMMENT #17 FROM THE PATHOLOGIST RINGS TRUE BECAUSE HE UNDERSTANDS THAT 80% OF HIS SAMPLES COME BACK NEGATIVE. GREAT FOR THE PATIENT (IN THAT HE HAD NO PC),AND GREAT FOR THE PATH AND UROL(THEY PAID ALL THEIR BILLS. GRANTED IT IS THE ONLY TEST WE HAVE BUT IT IS TERRIBLE. SO TERRIBLE THAT THE US GOVT HEALTH AND HUMAN SERVICES MANUAL WHICH RATES ALL MEDICAL DIAGONOSTIC TEST FOR EFFICACY WITH GRADES OF “A” (EXCELLENT) TO “D” (EXTREMELY POOR) RATES PSA TEST AS “D”. HANG ON, SYRUM BASED TEST MAY BE AVAILABLE WITHIN THREE YEARS AND IF EARLY TRIALS CONTINUE TO BE POSITIVE THEIR MAY BE A PROSTATE CA TEST THAT IS OVER 90% EFFECTIVE. GOOGLE “EPCA-2 ANTIGEN TEST” (EARLY PRO.CA ANTIGEN) OR ONCONOME.COM. ONOCOME HAS BEEN LICENSED BY JOHNS HOPKINS (WHO DID THE INITIAL RESEARCH) TO DO THE TESTING AND HOPEFULLY BRING IT TO MARKET. TO GO FROM A TEST 20% EFFECTIVE TO ONE 90% EFFECTIVE WILL BE A GIANT LEAP IN PC SCREENING. THANK GOODNESS WE AT LEAST HAVE PSA TESTING, PRAY IT WILL EVOLVE INTO SOMETHING THAT WILL IMMESURABLY MORE ACCURATE. </p> <p><cite>— Posted by ALEX </cite></p> </div> </li> <li class="clearfix" id="comment-24840"> <div class="index">96.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24840" title="">11:37 pm</a> </div> <div class="comment"> <p>i also am a physician who has thus far avoided psa testing after following the conundrum for years in the medical literature. definitely go for screening procedures such as mammograms, paps and colonoscopy which have pretty well-demonstrated benefit. still waiting for proof of the overall value of the routine psa. </p> <p><cite>— Posted by dave </cite></p> </div> </li> <li class="clearfix" id="comment-24841"> <div class="index">97.</div> <div class="commentmetadata"> February 7th,<br> 2008<br> <a href="#comment-24841" title="">11:40 pm</a> </div> <div class="comment"> <p>This article strikes me as irresponsible and dangerous, because it is liable to encourage watchful waiting over active intervention by younger men who do not read the fine print. Buried in the article is the vital information that “The benefit, if any,[of surgery] appears to be limited to men under 65.” The reason why watchful waiting gets such good statistics is that prostate cancer is primarily a disease of geezers who die of other causes before their prostate cancer kills them. But this does not imply that younger men should choose watchful waiting over surgery or other forms of active intervention that can and does save lives. </p> <p><cite>— Posted by Barry Cooper </cite></p> </div> </li> <li class="clearfix" id="comment-24863"> <div class="index">98.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-24863" title="">1:31 am</a> </div> <div class="comment"> <p>I had my first PSA test on turning 50, as my Dad had been diagnosed. It was a shock to learn it was significantly elevated at 8.6, but I went ahead with the biopsy (relatively painless during and after, with local anesthetic) which showed extensive Gleason 7 grade cancer. </p> <p>I saw a urologist, who recommended brachytherapy (radioactive seed implants). The radiation oncologist, to my surprise then recommended surgery as the better option! Another 2 urologists also then agreed with that, so after some more research of my own I decided this would be the best choice. </p> <p>I had a radical prostatectomy within 2 months, which was also surprisingly painless, and I had totally recovered totally within 6 weeks. I lost about 4 pints (2L) of blood but escaped without a blood transfusion, hemoglobin level dropped to 82.</p> <p>I had an erection the next day, and have had no problems with that at all (90% of previously?) - although of course nothing comes out, kind of “dry-cleaning” now I guess, and less mess anyway! Haven’t noticed my penis is particularly shorter, but haven’t measured it either though!</p> <p>I had very mild dribbling for a few weeks only, now very rarely I get a drop soon after a pee, never enough to change my underwear. The prostate is part of the sphincter mechanism for the urethra (tube from the bladder), and removing it makes the valve less efficient. I had done the pelvic floor strengthening excercises religiously as instructed before the surgery, perhaps that helped? One small bonus is the fact that there is absolutely no hesitancy at all and a stream like a horse, so I can stand at the urinal and usually finish peeing before the guy next door has even started lol.</p> <p>My PSA dropped to zero and has remained there for every test I have had, so far 4 years. I am also a doctor, and did not obsess about every possible aspect of it before I sought help, and went with my colleagues’ recommendations - although possibly as an anesthesiologist I had some advantage in knowing how good they seemed to be, and was able to pick the one I thought looked the best <img src="https://web.archive.org/web/20080224222815im_/http://well.dblogs.nytimes.com/wp-includes/images/smilies/icon_smile.gif" alt=":)" class="wp-smiley"/> Unfortunately there is indeded WIDE variation in surgeons’ technical ability and attention to detail, and also I suspect with their actual results - but it can be very difficult to find out from the outside the profession, or even inside! A study of colo-rectal surgeons results some years ago showed a several fold variation in their patients’ survival and major complication rates after bowel cancer surgery for instance.</p> <p>Good luck if you have been recently diagnosed, and don’t be so frightened or become obsessed with the “right” treatment. Trust your doctors but do get a second or even third opinion, one from a radiation oncologist as well as urologist. And I would have the PSA test if you are worried about it, or at a higher risk - I’m glad I did. And I honestly don’t think diet makes a big difference, nor can you cure it with a special diet or some herbal medicine - why take the chance ? </p> <p><cite>— Posted by JOHN </cite></p> </div> </li> <li class="clearfix" id="comment-24871"> <div class="index">99.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-24871" title="">2:33 am</a> </div> <div class="comment"> <p>A question for TPP</p> <p>Did you examine the actual complete report by the Agency for Healthcare Research and Quality (AHRQ) or the executive summary thereof before writing your article?</p> <p>I ask because my rather cursory perusal of both the executive summary and the complete article lead me to question the very validity of the study itself based on their own statements and the paucity of the details about, and quantity of, reports used to “evaluate” and compare treatment modalities, e.g.:</p> <p>Regarding the randomized controlled trials (RCTs):</p> <p>“Few randomized trials directly compared the relative effectiveness between (rather than within) major treatment categories.”</p> <p>“Many randomized trials are inadequately powered to provide long-term survival outcomes, with the majority reporting biochemical progression or recurrence as the main outcomes.”</p> <p>Most damning, IMO,</p> <p>“No trial enrolled patients with prostate cancer primarily detected with PSA testing.” and</p> <p>“Some randomized trials were old, conducted prior to prostate cancer detection with PSA testing . . . and used technical aspects of treatment that may not reflect current practice; therefore, their results may not be generalizable to modern practice settings.”</p> <p>So much for relevancy, let alone scientific methodology, by their own admissions.</p> <p>The “numbers game” in the study:</p> <p>Radical prostatectomy compared with watchful waiting — 2 RCTs (1 “underpowered to detect large differences”, the other reporting “RP reduced prostate-cancer-specific mortality compared with WW” and “reduced the incidence of distant metastases compared with WW.”</p> <p>Hardly conclusive “evidence” of no treatment “as superior to doing nothing at all.”</p> <p>The penchant you show for evidence-based, scientific proof of efficacy is hardly supported by the study upon which you report. To my reading, the study is akin to the “studies” of an elephant by 5 blind men groping different parts of the beast.</p> <p>Some clarifications in your article are needed:</p> <p>“But some men have aggressive prostate cancers, and last year 27,050 men died from the disease.”</p> <p>This figure is the ESTIMATED PCa deaths in 2007 by the American Cancer Society in their “Cancer Facts & Figures 2007″ — not actual deaths in 2007. But you drew your statement from the executive summary of the article and it is simply wrongly stated.</p> <p>“The lifetime risk of being diagnosed with prostate cancer has nearly doubled to 20 percent since the late 1980s, due mostly to expanded use of the prostate-specific antigen, or P.S.A., blood test.”</p> <p>I would like to know their source for this statement, as the most generally quoted lifetime chance of being diagnosed with PCa has been 1 in 6 for years (roughly 17%) even before the late 80s. </p> <p>While the incidence of diagnosed cases did rise rather dramatically beginning in 1985 (115.5/100,000) when the PSA test was introduced and screening began to take hold, it peaked in 1992 at 237.1. Since then it has declined to 159.4 in 2004. The 1993-2004 incidence: 150.7. From 1986 to the peak year of 1992 the incidence did double, but has since slid back significantly.</p> <p>[Rates are per 100,000 and are age-adjusted to the 2000 US Std Population.]</p> <p>One probable reason for this increase then decrease is that the PSA based screening (more aggressive than presenting with symptoms) was “harvesting” latent PCa that sooner or later would have shown up in the doctors’ offices. Once the harvesting got PCa down to the early local/regional variety for the most part, the decline in incidence rate was inevitable.</p> <p>“But the risk of dying of prostate cancer remains about 3 percent.”</p> <p>This one remains steady despite the PCa mortality rate declining 35.4% from the peak of 29.9/100,000 in 1991 to 25.4 in 2004. And this is always trumpeted as “proof” that there is no advantage in screening or treating PCa. But odds of dying from PCa must be measured by the NUMBER of those deaths against ALL deaths in the US in a given year. Using the 27,050 estimated PCa deaths for 2007 and the estimated total deaths in the us of 2,238,600 yields a percentage of 1.21% as the chance of dying from PCa. Perhaps the base for coming up with 3% was not ALL deaths but rather all disease deaths??</p> <p>Again using that 27,050 PCa death figure as an artificial base, and applying the 35.4% reduction of mortality to it artificially, the reduction of the annual number of PCa deaths could be guesstimated at 9,576. When this is measured against the roughly 2,238,600 US deaths in a year, that comes to 0.43% — hardly an insignificant percentage when compared to the 1.21% of all deaths. Something is working.</p> <p>Considering how difficult it is to reach males in the US regarding any health matters, and especially prostate health matters, any press is good press. To a point. Sadly, when bias drives reporting, the press can be damaging even when it at least raises awareness of the need to look after the prostate gland. I see in your article and comments on the blog a decided bias that (a) treatment harms and, (b) there is no “proof” that treatment makes any difference.</p> <p>The bottom line is that fewer men are dying of prostate cancer each year, as reflected in the ACS annual estimates, and,IMO, real numbers. And some medical people are finally beginning to acknowledge that the logical cause for this is the combination of aggressive screening and improved treatment modalities.</p> <p>Consider, for instance, that those diagnosed in 1980-1984 had a 73.6% 5-year survival rate, while those diagnosed in 1999 had a 99.3% survival rate.</p> <p>Consider, too, that 91% of cases diagnosed from 1996-2003 were diagnosed as local/regionalized with a virtual 100% 5-year survival rate. Then consider that before the PSA test and aggressive screening some 75% of diagnoses were of advanced PCa, other than local/regional.</p> <p>I should think that an evenhanded reporting on a study on the efficacy of treating prostate cancer should have an element of devil’s advocate in it, “the rest of the story” as one journalist famously put it.</p> <p>Rick Ward<br/> <a href="https://web.archive.org/web/20080224222815/http://www.pcaawareness.net/" rel="nofollow">www.PCaAwareness.net</a></p> <p><strong><br/> From TPP — This is such a long post — i’m not even sure what your question or point is. I can tell you that i read the entire report, not just the press release. I’m amused how often people tell me I only read the press release. I actually have a strong policy of NEVER reading a press release until after I have read the actual study. I was quoted by the Columbia Journalism Review on this very issue. (for the article click <a href="https://web.archive.org/web/20080224222815/http://www.cjr.org/behind_the_news/tara_parkerpope_on_avoiding_th.php" rel="nofollow">HERE</a>) And for hte number on cancer detection and deaths, i went to the original American Cancer Society statistics — i never rely on secondary sources and go to the original whenever possible. As far as this study is concerned, I not only read the entire report, I went back and read many of the original trials (obviously not all of them as there were hundreds) but in several cases I went back to the original source. the review by AHRQ was complex and involved and I couldn’t replay all of it in a news story. the bottom line is that this agency concluded there is no clear answer. the studies are flawed or limited, and many of them didn’t involve men who detected cancer by PSA testing (as i noted in the original post.) There is no conclusive evidence to show that any single treatment option is superior. I honestly am not clear what you are criticizing me for, but i can tell you that your outrage should be directed at a medical establishment that has shamelessly neglected this issue, and men’s health in general. Women have lobbied for years for better care and evidence-based treatment for breast cancer. We have spent billions researching hormones and calcium for women, mastectomy vs. lumpectomy and tamoxifen and other breast cancer drugs. What have we done for men? This is it — a report from AHRQ that says ’sorry, we can’t help you make a decision because the evidence isn’t there.’ It’s an outrage.</strong> </p> <p><cite>— Posted by Rick Ward </cite></p> </div> </li> <li class="clearfix" id="comment-24897"> <div class="index">100.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-24897" title="">3:52 am</a> </div> <div class="comment"> <p>Comments on some posts:</p> <p>Post #1: A classic picture of what WW can sadly lead to. The sad part is that this man’s doctor took the slow-growing, don’t-worry position and in essence doomed this man. All the doctor could do after that was play equally doomed catchup.</p> <p>Post #65: Another classic. A doctor who grabbed his knife when the Gleason score of 9 by itself should have told him that he couldn’t “get it all” with his magic scalpel. He relied on a bone scan, apparently, to tell him it hadn’t metastasized and surgery was the way to go. He even relied on a bone scan when it came back, and that one was clear. Duh. Bone scans are notorious for not catching mets. MRI (using the right marker) would have shown where the cancer was, especially the latest MRI/CT enhanced scans. Then the doctors compounds his bumbling by castrating the guy. Talk about permanent damage, not only to any outside possibility of sex but a very predictable attitude change. And the saddest part of all is that the castration that was supposed to cut off all the “food” for the cancer actually left about 45% of the food available for nourishing the PCa, because the doctor apparently didn’t know that over 40% of the DHT “food” comes from adrenal sources, not at all affected by the castration. And that, friends, is why it is imperative that the doctor you choose should be knowledgeable, and you have to know enough to determine if he is or not.</p> <p>But not all such decisions are made by the doctors:</p> <p>Post #21: A macrobiotic diet will do the trick. Would that that really is true, but a man in his early 60s diagnosed in 12/94 opted for that approach to “not jeopardize the bedroom” and was buried in July ‘97. In between morphine shots in a moment of lucidity he said to me, “I guess I goofed.” I was diagnosed 10/94 and aggressively treated my PCa with androgen deprivation, external radiation, and implanted radiation (brachytherapy), with minimal stress continency problems (mostly just urgency) as I come up on my 71st birthday still blessed with some “assisted” potency. I only wish he could have been as lucky as the man 9 years+ from diagnosis and still going in Post #79.</p> <p>Post #47: There’s more truth in that smart*** comment about breast cancer being sexier than the poster meant. PCa is only lately coming out of the dark corner and even then it can’t present itself nearly as compellingly as breast cancer. Add that little boys are raised to “stopping crying — be a man” and you have the dismal picture of trying to get men to pay attention to their prostate health. Still, headway is being made. In 1994 mention of prostate cancer in a bar would get an automatic reaction of crossed legs and someone saying, “How about them Cowboys?” Even in 2001 at a screening at a car show the big question was, do I have to have that finger thing? And by 2004 at that car show many men were asking if they would be able to get a DRE as well as the PSA.</p> <p>And that’s a lot of what’s behind the cogent observation of Post #64 that PCa is the most diagnosed but least researched cancer. Breast cancer, for instance, gets 4-5 times the federal research dollars that PCa gets. Why? See comments about Post #47 above. Women band together and DO it. Men tend to mope in solitary splendor. In fact most of the PCa awareness efforts are done by women. That car show I mentioned is the brainchild and passion of a woman (and it’s the largest one-day car show in the US , already spawning several others like it across the country). Maybe we should do what we do best and turn over prostate matters to the ladies. They’d get us bucks in Washington! Those politicians are survival oriented and know that the ladies will bury them if they don’t do what they ask.</p> <p>Post #82: I’m with you, friend — the ladies are going to save our sorry butts, so why not join them? It’s why I’ve put up a ribbon pin that is blue on one leg and pink on the other, combining the blue of PCa and the pink of PCa, a “family pin” to recognize that both of those cancers impact the family heavily, at a visceral level. There are a couple of million families living with PCa in the US, and probably a like number living with BCa. Even when you allow for the families that are living with both, it’s upwards of 4 million families. That’s a lot of clout! And considering that the afflicted are all of voting age, even without considering extended families, thems a passel of votes!</p> <p>Post #95: Alex, I think you might have had some things of interest in your post, but I COULDN’T BE SURE BECAUSE OF YOUR ALL-CAPS RUN-ON POST.</p> <p>Rick Ward<br/> <a href="https://web.archive.org/web/20080224222815/http://www.pcaawareness.net/" rel="nofollow">www.PCaAwareness.net</a> </p> <p><cite>— Posted by Rick Ward </cite></p> </div> </li> <li class="clearfix" id="comment-24935"> <div class="index">101.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-24935" title="">6:43 am</a> </div> <div class="comment"> <p>I was absolutely shocked this summer when I was diagnosed with PC at the age of 46. I had no family history and no symptoms. After seeing 7 surgeons and researching my options I selected a robotic prostatectomy. My resuts were wonderful, 0 PSA, no sexual dysfunction and no incontenience. The robotic prostatectomy allows the patient a less invasive option combining increased magnification for the surgeon with a quicker recovery period for the patient</p> <p><strong>From TPP — I’m happy that you had such a good outcome but your experience is highly unusual and likely due in no small part to your young age. Many men go to the top robotic surgeons in the country and still suffer severe erectile dysfunction problems after surgery. You are the exception, not the rule.</strong> </p> <p><cite>— Posted by Paul </cite></p> </div> </li> <li class="clearfix" id="comment-24990"> <div class="index">102.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-24990" title="">9:25 am</a> </div> <div class="comment"> <p>At age 72 my father underwent a prostate removal.<br/> He needed follow-up treatment (reaming) to remove scar tissue in his urethra. The whole thing was an ordeal involving catheters and multiple follow-up visits. The surgery left him impotent and weak.<br/> In the 8 years since he has developed Parkinsons disease and had a stroke.<br/> I think he would have chosen a few good active years over the kind of life he has had since his prostate surgery. </p> <p><cite>— Posted by Taylor.R </cite></p> </div> </li> <li class="clearfix" id="comment-25009"> <div class="index">103.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25009" title="">10:21 am</a> </div> <div class="comment"> <p>Actually if you look outside mainsteam medicine, there are those who could tell those with prostate and most other kinds of cancer how to beat it and keep it at bay without the barbaric and failed, yet highly profitable, mainstream methods of trying to cut out (surgery), burn out (radiation) or poison out (chemo) the symptoms of cancer without addressing and correcting the underlying causes that enabled it to gain a foothold in the first place.</p> <p>I began searching for an answer to cancer many years and tens of thousands of hours of research ago. Amazingly I found many answers - just not where I expected them to be, which was in mainstream medicine or in little brown bottles with RX on them.</p> <p>Getting rid of cancer is often not that difficult when it comes to nature. My favorite natural solution to cancer is an aqueous extract of the oleander plant (highly toxic when raw, but not so when properly boiled and strained). It is the basis of a patented medicine named Anvirzel available from Honduras, a dietary supplement called Sutherlandia OPC from South Africa, and essentially the same thing can be made at home about as easily as a pot of beans.</p> <p>I know for an absolute fact that a great many people who have had all kinds of cancers, including prostate cancers, have used oleander as part of a natural anti-cancer protocol and beaten it, often after mainstream treatments have failed. How do I know? I researched it, wrote a book about it and I host a Yahoo health group of over 350 members centered around oleander (none of whom have died, btw, and most of whom are cancer free).</p> <p>And that is just one example among a great many that nature has to offer. More often than not, a combination of one or more of the best cancer fighters and immune boosters, combined with a healthy diet, proper nutrition and supplementation, and a healthy lifestyle will beat cancer and keep it at bay.</p> <p>As I said, I was a believer in mainstream medicine until I took a much closer look. Now I am firmly convinced that mankind will look back at the past half century of the failed war on cancer as the true dark ages of mainstream medicine.</p> <p>Once man had the wisdom to look to nature first and only use surgery and radical treatments as a last resort. Now, medicine and drugs are a huge industry whose only market place is out bodies. Unpatentable natural alternatives and healthy diets and lifestyles are not profitable, and they are not only ignored, they are suppressed and persecuted - but that does not make them ineffective.</p> <p>Live long, live healthy, live happy! </p> <p><cite>— Posted by Tony Isaacs </cite></p> </div> </li> <li class="clearfix" id="comment-25026"> <div class="index">104.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25026" title="">11:42 am</a> </div> <div class="comment"> <p>to number 103. if you think taking Oleander extract will cure cancer, that’s great. But please dont suggest to others who are battling caner to do the same. You dont even say that you have cancer. </p> <p><cite>— Posted by k Fenderson </cite></p> </div> </li> <li class="clearfix" id="comment-25036"> <div class="index">105.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25036" title="">12:37 pm</a> </div> <div class="comment"> <p>I find it amusing that some people recommend a low fat diet as a cure or treatment. A recent study show that nonfat milk increases your chances of prostate cancer while whole milk decreases it.<br/> <a href="https://web.archive.org/web/20080224222815/http://www.pcrm.org/news/archive080109.html" rel="nofollow">http://www.pcrm.org/news/archive080109.html</a> </p> <p><cite>— Posted by Simon </cite></p> </div> </li> <li class="clearfix" id="comment-25038"> <div class="index">106.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25038" title="">12:47 pm</a> </div> <div class="comment"> <p>10 months ago I had symtoms of an enlarged prostate. Which included blood in urine, pain after sexual intercourse and trouble urinating. I am thankful that I did not have to rely on conventional medicine, but found help with a natural doctor who prescibed homeopathics and an healthy diet. After 6 months of this regiment, I was back to normal. I know of another male friend who went 5 yrs on synthetic drugs and still had to have surgery. I don’t know if he is back to normal, but I am.<br/> Maybe someone needs to do a study on natural remedies. </p> <p><cite>— Posted by mnjrupp </cite></p> </div> </li> <li class="clearfix" id="comment-25040"> <div class="index">107.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25040" title="">12:57 pm</a> </div> <div class="comment"> <p>Hello,</p> <p>I have read with great interest the many article shared with you on prostate cancer. My comments are not shared to dispute of affirm any of the experiences shared. I choose to only share my experience of being diagnosed with Prostate cancer and the results after four years.</p> <p>I was diagnosed with prostate cancer in 2004 after having had a high PSA level on several occasions and one biopsy. The second biopsy involved more samples being taken and the cancer was discovered with slow growing tumors contained within the prostate. I was 58 years old at the time of my diagnoses, in good physical shape and not obese. My wife accompanied me to every discussion I had with my doctor and she asked questions also. We had a healthy sex life and wanted to continue to have some form of sex life in the future. We started doing research on the different treatment options at the suggestion of my Urologist. He explained what options he performed and the risks associated with radical prostatectomy, the option he provided plus all the other options. We did our research and found the Laparoscopic Radical Prostatectomy to be the most interesting to us.</p> <p> We scheduled an appointment with an appointment with Dr. James R. Porter surgeon in this field at the University of Washington Medical Center. After much discussion and many question from my wife, sister and my self. Dr. Porter provided me with names of patients that had this surgery for me to talk with. I scheduled the surgery with Dr. Porter and everything went just as we had discussed it in his office. My hospital stay was two days primarily because I was from out of town and had a long way to travel back to eastern Oregon. </p> <p>Everything healed great and I use Calais and Lavetra for a period to have sex but after 21 months I no longer needed any medication and everything is functioning well. Orgasms are not as they were but that appears to be the only thing missing. There is some minor urine leakage but hat is the extent of my problems associated with this surgery.</p> <p>Being healthy, good physical condition, a positive attitude about your decision and spousal and family support are great assets to have when going through this or any type of cancer. </p> <p>I have had great check ups and Dr. James R. Porter had moved to the Swedish Cancer Institute in Seattle, Washington. My wife and I are very satisfied with the decisions and research we made on this issue. </p> <p>Bill Ward</p> <p>Secretary/Treasurer</p> <p>Eagle Feather Men’s Cancer Chapter</p> <p>2100 W. Scenic Dr.</p> <p>The Dalles, OR 97058 </p> <p><a href="https://web.archive.org/web/20080224222815/mailto:lamar2@charter.net">lamar2@charter.net</a></p> <p>541-296-3485 - Office</p> <p>541-980-2737 - Cell </p> <p><cite>— Posted by Bill Ward </cite></p> </div> </li> <li class="clearfix" id="comment-25053"> <div class="index">108.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25053" title="">2:48 pm</a> </div> <div class="comment"> <p>I priced proton radiation therapy at proton-pioneer Loma Linda Univ CA: $137K if you have insurance, $37K if you don’t have insurance. </p> <p>At the time, eg, AETNA wouldn’t pay proton for its victims, claiming the much higher price didn’t offer any more effectiveness than non-proton radiation.</p> <p>NYT had an excellent article a couple weeks ago about the race to build $100M+ proton machines, if you’re wondering why it costs $137K for an out-patient procedure.</p> <p>This blog entry condenses exactly what I’ve been finding as I’ve researched prostate cancer treatment since I was diagnosed in 08/2006, age 59, my father having gotten it in his early 50s. The treatment decision is horribly complex, outcome is totally unknowable, with the docs and researchers continually coming up with prognosis tools, epi-gentics, nomograms, etc, to try to predict which course of treatment to follow. Molecular, genetic, microRNA, biomarkers are advancing rapidly but,eg, good luck trying to find a lab that can look for the level of biomarker AZGP1 (indicates that surgery will fail).</p> <p>The USA is widely known to be very aggressive, overly so, in detecting and treating prostate cancer, compared to Europe. Cancer treatment is primarily a business, not health care. </p> <p>Famous study done in Sweden some years ago. With radical prostatectomy, the 10-year mortality was something like 15%. With “watchful waiting” aka do nothing (with no damage to erectile functioning or continence), the 10-year mortality was … 18%, IIRC. Of course in the RP group, you had guys with some/total erectile dysfunction and/or some/total urinary incontinence for those 10 years. </p> <p>Often the urologist/oncologist will recommend the treatment that he’s selling, rather than the treatment that could be better. Dishonest? No, the differences in cure rate and progression-free-survial (PFS) among the various treatments to amount to a few percent. It’s all a gamble with the health care providers’ “house” winning every round. 600K+ players lose every year.</p> <p>btw, responding to comment 1., I have a friend whose father got CaP at age 80. Being already testosterone deficient at that age, he was given hormones every several months. He died at 102 from non-cancer-specific-cause. You, and the docs, just never know. </p> <p>What you do know is that the medicals bills will arrive with absolute certitude. </p> <p><cite>— Posted by len conrad </cite></p> </div> </li> <li class="clearfix" id="comment-25063"> <div class="index">109.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25063" title="">4:01 pm</a> </div> <div class="comment"> <p>What even qualifies you, Tara, to comment on this complex health subject? You are not a biochemist, you are not a physician, you are not a health professional of any kind. From what I can tell from your biography, you were a political reporter for the Houston Chronicle before you got this job. How does that entitle you to give medical advice?</p> <p><strong>From TPP — i think this is a fair question and I’m pleased for the opportunity to answer it. Let me say first that i don’t give medical advice of any sort. I do give readers medical information. There is a big difference. In this particular post, I reported on the findings of a major medical journal. And I, like every other health consumer and tax payer, am certainly qualified to be concerned that there is so little quality research to help men make informed decisions about prostate cancer. Every prostate cancer doctor I know is frustrated by this issue as well. I am also happy to share with you my professional experience. Before joining the New York Times, I worked for the Wall Street Journal for more than 14 years, and I spent 8 of those years as the paper’s personal health columnist. Prior to that you are correct that I wrote for the Houston Chronicle and The Austin American Statesman. I am not a medical professional nor have ever claimed to be one. I’m a journalist who is fortunate to work for a great newspaper. That gives me access to top doctors, researchers, scientists and other experts and allows me to share their knowledge and insights with readers. My goal is to share information with readers and help them ask informed questions of their doctors. Is there a particular comment I made on this post that you felt i was not qualified to make? I’m always interested in reader feedback. I am also passionate about helping readers make informed decisions and I am personally, quite interested in prostate cancer. I think the screening and treatment of this disease exacts a devastating toll that is often not understood or appreciated, and I don’t think the disease gets the advocacy that it deserves.</strong> </p> <p><cite>— Posted by Bill Holbing </cite></p> </div> </li> <li class="clearfix" id="comment-25086"> <div class="index">110.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25086" title="">6:09 pm</a> </div> <div class="comment"> <p>I appreciate the thoughtful responses from Tara and the other participants on this blogg. My husband’s numbers reflect a very early stage cancer. We have many options. Which only makes the decision more difficult. I was not aware of the extremely limited research on this very common disease. </p> <p>Post # 98: I appreciate your comment stating not to be afraid and trust your physician. I am glad your experience has gone well. Can you foresee what your response would be if your outcome had not been as successful? As a physician I would expect you to hope your patients would trust you. I have been in several situations with physicians that have led me to mistrust. I am not one who scares easily. I have followed my husband riding my own motorcycle over the continental divide in Glacier Park riding in a fog so dense that all I could see was the light from his single taillight on a curvy, wet, steep road. I would trust him with my life and have. I am more afraid of this. </p> <p><cite>— Posted by Sally </cite></p> </div> </li> <li class="clearfix" id="comment-25116"> <div class="index">111.</div> <div class="commentmetadata"> February 8th,<br> 2008<br> <a href="#comment-25116" title="">9:32 pm</a> </div> <div class="comment"> <p>Earlier, Tara asked, “Is there a particular comment I made on this post that you felt i was not qualified to make?”–As I read it, the main message of Tara’s article is that, based on the scientific literature, men with prostate cancer might as well engage in watchful waiting as use active intervention (surgery, radiation, etc.), since it isn’t clear which approach is more effective. Is that information? Is that advice? Is it something in between? I believe it is a crude interpretation of the literature which ignores the fact that younger men stand to benefit more from active intervention than older men, due to the slowness of prostate cancer growth. Younger men who read Tars’ article are liable to get the impression that watchful waiting is a good approach for them, too–which it is not. </p> <p><cite>— Posted by Bill Holbing </cite></p> </div> </li> <li class="clearfix" id="comment-25177"> <div class="index">112.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25177" title="">2:33 am</a> </div> <div class="comment"> <p>I’m sorry I confused you, TPP, but now, after your answer and your answer to #109, I’m confused even more than you. You see, my point in my post was that there were inaccuracies in your article, and the article you were “reporting” on itself was poor “science.” I committed the error of assuming that you were reporting on a published study, with all that would entail, i.e., *independent* verification of the points and items from the study that you chose for your article. But I can see that your article was more in the nature of a book review piece.</p> <p>My confusion now is that you claim to have gone to sources to verify your choices, but, for instance, merely clipped in from the study (without quotation marks or attribution) the comment about 27,050 prostate cancer deaths last year without verifying it.</p> <p>In the Columbia Journalism Review piece you directed me to, a 2005 interview with you, you said, “I also think that as reporters, we should never take anything at face value.” But, as in the example above (as well as others I pointed out) you did just that.</p> <p>In your answer to #109 you flatly state that you are a journalist, yet journalists traditionally independently very what they report and ALWAYS attribute and set apart with quotation marks when they use the sentences or phrases of others, at peril of the wrath of their editors. Don’t your editors check your work to see what is your writing and what is cut-and-paste from others?</p> <p>Though you protest to me and to #109 that you only report and take no position, your comment in your answer to #109 says you have very definite positions:</p> <p>“I think the screening and treatment of this disease exacts a devastating . . . .”</p> <p>Certainly those positions are the ones making the rounds of journal articles dutifully reported in the general press. But as you point out in your Columbia interview it is the matter of emphasis that often shapes what is printed, be it true reporting or simply reviewing, and emphasis is shaped by biases held even if not stated.</p> <p>You see, as a prostate cancer survivor, I am equally passionate about what is fed to men and their families about the issues of prostate cancer. And I have my biases, too. Screening, for me, is an intelligent part of what it takes to protect one’s fragile mortality. To me it is not per se harmful. And if there is some anguish associated with screening, it pales alongside the true harm that comes from not screening and ending up with prostate cancer beyond treatment with curative intent. And the harms done by treating prostate cancer, IMO, also pale alongside the hell of dying of prostate cancer. If there are assaults on quality of life by treating PCa, to me the greater assault on quality of life is death, the agonizing death prostate cancer visits on the unwary. In an impromptu TV interview, responding to a comment about “sexual issues” from his PCa treatment, Rudy Giuliani retorted that one had to be alive to have sexual issues.</p> <p>But I digress. Suffice it to say in regard to your reporting (and the media trumpeting of sundry articles on PCa), as a prostate cancer survivor I keep looking for true journalism, if not investigative reporting, to challenge what is being offered, to dig for the other side of the issues, present a more balanced picture. But then one of my heroes is Don Quixote. “To dream the impossible dream . . . .”</p> <p>Rick Ward<br/> <a href="https://web.archive.org/web/20080224222815/http://www.pcaawareness.net/" rel="nofollow">www.PCaAwareness.net</a></p> <p><strong>From TPP — The post I wrote was based on the findings of a study by the Agency for Healthcare Research and Quality. It was published in the Annals of Internal Medicine, a peer-reviewed medical journal. The 27,000 prostate cancer death statistic I cited is from the American Cancer Society.</strong> </p> <p><cite>— Posted by Rick Ward </cite></p> </div> </li> <li class="clearfix" id="comment-25204"> <div class="index">113.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25204" title="">4:42 am</a> </div> <div class="comment"> <p>I would like to thank Tara for creating this forum, for everyone that has responded and most importantly for those that have found value in reading this collection of diverse experiences. A year ago when I was diagnosed with prostate cancer, this dialogue would have been extremely helpful. </p> <p>In January, 2007 I was 52 and father of a 4-year old daughter, when I received the news of being rejected for a life insurance policy because my PSA was 7.75. “What is PSA?” I asked my broker, offering an insight into what I suspect (at least in my conversations with many men my age) is a not an atypical response. After all, I had run a marathon two years before and was “healthy”.</p> <p>With no symptoms and no family history of cancer, it was a sobering experience listening to the data points of the biopsy: 2 tumors identified, one 3+3 the other 3+4 and a probable third area of concern. The good news: the tumors appear contained and with my age and good health, the likelihood of a successful radical prostatectomy with minimal side affects is high. The bad news: I was advised to make a decision sooner than later.</p> <p>After a very thorough and human series of exams by the team at Marin Urology, followed by a discussion with my urologist, surgeon, radiologist and prostate cancer survivor/support group leader, I agreed that their recommendation for a radical prostatectomy made the most sense. But they did not offer robotic surgery and I was led to Dr. Peter Carroll and his team at UCSF. They confirmed the diagnosis and we proceeded to schedule the next available robotic surgery for 2-months later. But then I took a slightly different route and asked for second biopsy before the surgery. “Why would you do that,” a young surgeon asked. “You have cancer and will have it until we remove it or kill it”. </p> <p>I was not surprised by this response, and I was prepared to have the surgery, but I also felt deeply in my body that this was not the only path. I had been working with a healer – who was careful not to advise against the doctors’ advice – who felt we were making progress shrinking the tumors. And then three different colleagues from varying backgrounds recommended a place called the Optimum Health Institute (www.optimumhealth.org) that advocated a raw/vegan diet and a holistic approach to healing. Again, no one promised me anything, and I am not lobbying for anyone to follow this path. But something shifted here for me; I was actively participating in my healing, not just waiting for others to heal me.</p> <p>I took a sabbatical from my work, completed a week at OHI and returned home to continue a very rigorous raw/vegan diet, daily yoga, meditation and minimize my stress. Two weeks later, I went in for the second biopsy and the results confirmed what I felt was happening: analyzing 16-samples they identified 2 tumors, now both 3+3 and no indication of a third area of concern. I was elated at the news and yet still prepared for what I thought would be their recommendation for surgery. When Dr. Carroll called to discuss the changes, he was careful to point out that I still had cancer and that there was a strong likelihood of some 3+4 being present, but that if I were willing to take a small risk and continue to actively attend to my lifestyle and diet changes, he was now recommending active surveillance.</p> <p>I have had PSA tests every three months since and the scores have dropped significantly from the last score of 8: 3-months = 3.1, 6-months = 4.01 and 9-months = 2.21. I will have my annual biopsy in about a month and I am optimistic the trend will continue. I realize that this time frame and sample size is too brief to be considered scientifically valid for a population, but it is working for me. As others have pointed out in this blog, Dr. Dean Ornish (Dr. Carroll was part of this and ongoing studies) has published articles on the affect of lifestyle and diet in Urology and other journals where you can read the science, I am just relating my story. So I end where I began, thanking Tara for opening this space of conversation, giving us the chance to tell our stories and listen, without judgment, to the stories of others. </p> <p><cite>— Posted by Bill </cite></p> </div> </li> <li class="clearfix" id="comment-25215"> <div class="index">114.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25215" title="">6:01 am</a> </div> <div class="comment"> <p>Fascinating stuff — though troubling in its revelation of how little we still know regarding these dreadful things. Given a choice of two uncertain outcomes, I think I would rather we had spent $500 Billion dollars on definitive cancer studies over the past five years rather than, say, in Iraq. I mean, if we we were going to spend the money anyway…</p> <p>I see allot of mention here about shopping for the best doctor or medical team; sounds like good advice. Being presently uninsured, I was wondering how one would recommend doing that sans coverage. Are there federal or state programs that allow for such things, or is it a matter of accepting massive debt as the cost of reduced chance of side-effects or death? </p> <p><cite>— Posted by Morris </cite></p> </div> </li> <li class="clearfix" id="comment-25259"> <div class="index">115.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25259" title="">10:05 am</a> </div> <div class="comment"> <p>I agree with #34. Ever since I turned about fifty ten years ago, every symptom seems to result in drawn out scary incredibly stressful tests.</p> <p>The toll of this stress on my quality of life has been enormous. As the worst example, last year a doctor put me thru about five months of various tests, all the while telling me I likely had an immune system problem or leukemia, only to find out I had neither.</p> <p>I am sure that if stress shortens life, doctors have shortened my life. They have certainly ruined long stretches of it for nothing. It is very hard for me to go to a doctor now for anything. </p> <p><cite>— Posted by jackie </cite></p> </div> </li> <li class="clearfix" id="comment-25270"> <div class="index">116.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25270" title="">11:31 am</a> </div> <div class="comment"> <p>I am a 63 year old who was diagnosed with PC in 2006. I have read every entry along with the insightful comments by TPP and I thank each of you for sharing your comments.<br/> I am currently following an active surveillance model. In 2004 I had a psa of 12 which went down to 9 after I took medicine for infection. Still too high so my doctor scheduled a biopsy. In November, 2004 I had a biopsy of 12 cores which was cancer free. In September, 2005 I had another test which showed a psa of 11. Another biopsy…this time 14 cores. Cancer of Gleason 3+3 was found on the 13th core excised. It was less than 5% of the core. 26 cores had now been excised with cancer found in 1/20 of one core. I opted for brachytherapy and took a 3 month Lupron shot to shrink my prostate. The effects were devastating. Complete loss of sexual desire. Deep depression. Shrinkage of sexual organs. Extreme hot flashes. I began to read voraciously about the subject and cancelled my brachytherapy. In 2006 my psa went to 13. I retook it and it stayed high at 12. (Without thinking, I had sex the evening before the second psa-not a doctor recommended practice!) I had another biopsy done in March 2007. The results were negative on 12 cores. So now I have had three biopsies in three years with 38 cores excised and cancer found in less than five percent of one core. I am scheduled for another biopsy in July, 2008.<br/> I love to exercise but I also love to eat so I have never been able to follow through on any long term diets. I keep my weight in line and I eat ten servings+ of fruit daily. I also take pomegranate extract, Zyflamend and fish oil. I do not know if they are useful but, if not, they are great psychological placebos. I hope I am doing the right thing with AS. It is what I want to do and my wife is supportive of my decision.<br/> Tony </p> <p><cite>— Posted by Anthony </cite></p> </div> </li> <li class="clearfix" id="comment-25299"> <div class="index">117.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25299" title="">1:34 pm</a> </div> <div class="comment"> <p>I would like to take this opportunity to deviate slightly from this blog’s focus on existing available therapies to discuss avenues that should be available to patients but aren’t, due primarily to a recalcitrant and moribund FDA. Specifically, I speak of immunotherapy Provenge which is not presently available to AIPC patients (androgen independent PC or hormone refractory PC – i.e., patients with late stage disease) despite an overwhelmingly positive recommendation from the FDA’s own Advisory Committee (AC) convened last March 29th. The AC review of the data from two Provenge studies (9901 and 9902A) clearly demonstrated a substantial survival benefit over the existing treatment (Taxotere, which is manufactured by Sanofi-Aventis), with NONE of Taxotere’s horrific side effects. In fact, the AC panel voted 17-0 that Provenge was safe, and 13-4 that there was “substantial evidence of efficacy” (this vote was taken after the efficacy question was changed from the absolute statement “Is Provenge efficacious” to the statutorily mandated question “is there substantial evidence of efficacy”, which in and of itself begs the question “who put the wrong question in the draft in the first place and why did they do so” – but the answer to that question is only a small part of the overall story of the delay of Provenge availability).<br/> The FDA had never previously overturned the recommendation of its ACs when they have come back with a recommendation for approval of a treatment of late stage cancer, and in fact the FDA has approved a number of drugs (most notably Gemzar for ovarian cancer or Iressa for lung cancer) which do not confer any additional survival. But on May 9th of this year, the FDA went against precedent and good judgment, and kicked back the Provenge application by issuing an “approvable” letter, which basically means that they say they need more data, and resubmit the application when you have it. Dendreon, the company which makes Provenge has an ongoing study (9902B, also known as IMPACT), which has now completed enrollment. Unfortunately, the very earliest that patients can hope to see Provenge on the market would be after interim results from the 9902B study, which are expected at some point in the middle of this year, or after final results which will probably come in 2010. In the meantime, 80+ men die earlier than they would, and are denied the opportunity to receive a therapy that extends their chances for long term (more than 3 years) survival by 34%. Please bear in mind that we are talking for the most part about old men with advanced disease.<br/> Why did the FDA not approve Provenge after the AC recommended it do so? We don’t know for certain, but it appears that several actors within the FDA and cancer community had at least something to do with the delay. At least two of the doctors on the AC, Howard Scher and Maha Hussain, had serious conflicts of interest which they did not disclose. In Dr. Scher’s case, he did not disclose that he was an advisor to and investor in Proquest Investments, a venture capital fund which invested in Novecea. At the time, Novecea was conducting a trial for its own therapy for AIPC, Ascentar. The lead investigator for this trial was also Dr. Howard Scher. On May 30th, a mere 3 weeks after the FDA issued the approvable letter, Novecea announced a partnership with Schering –Plough for the development and marketing of Ascentar, including a $60 million upfront payment from Shering-Plough. It would be generous to call this sequence of events a strange coincidence, especially considering that Dr. Scher hid his involvement by not disclosing it to the FDA.<br/> Additionally, between the AC meeting on March 29th and the announcement of the approvable letter on May 9th, three supposedly internal FDA letters were obtained and published by a newsletter called “The Cancer Letter” at different times in the month of April. The gist of the “leaked” letters was to dispute the findings of the AC and militate against the approval of Provenge. Two of these letters were written by none other than Dr. Howard Scher and Dr. Maha Hussain.<br/> Since May 9th, there has been a mounting public outcry against the FDA for refusing to countermand its previous decision and approve the marketing of Provenge. The FDA commissioner, Dr. Andrew von Eschenbach, met with patient advocates in early June and said that the FDA’s decision to request more data was “science based”, but other therapies with much worse side effects have been approved on less evidence of efficacy, and (again), the FDA has NEVER BEFORE rejected an AC panel which recommended approval. And they’ve never had such an overwhelmingly positive vote (unanimous on safety and hugely one-sided on efficacy).<br/> This situation is so outrageous that finally, on December 20th of last year, three members of Congress called for hearings into the matter, writing to House Energy and Commerce chairman John Dingell. To date at least three other congressmen have sent letters supporting this call. A drive to widen congressional support through a letter writing campaign is being spearheaded by an organization called “Care to Live”; you can get more information about the effort and the Provenge story in general at their website, <a href="https://web.archive.org/web/20080224222815/http://www.caretolive.com/" rel="nofollow">www.caretolive.com</a> . I am so personally outraged at what is nothing less than an effort to stop a potentially paradigm-changing therapy from reaching patients that I am lobbying my congressman to join the call for immediate hearings into this matter, and I would ask that everyone who reads this blog to write and call their congressional representative as well.<br/> Finally, a little bit more about Provenge, Dendreon and cancer. Provenge works by “educating” a patient’s own immune cells (the dendritic cells) to recognize a specific form of cancer through an antigen, and to activate the immune system to attack the cancer cells. Provenge is made by taking a sample of the patient’s blood, separating the appropriate cells out of the blood, exposing them to the antigen for the targeted cancer, and reinfusing that treated blood into the patient. It takes three reinfusions given over 4 weeks, and the only side effects are mild chills, achiness and general flu-like symptoms which go away in a few days and which are only experienced by a minority of patients. Importantly, this therapy is thought to be scalable to many other types of cancers, including breast and colorectal. Dendreon would like to conduct studies into these other cancers, but being a biotech startup; they are unable to raise sufficient funds to do so. Also, Provenge is being studied for treatment of earlier stage prostate cancer (the study is P-11), and the initial interim results are (as expected) very promising. All of this would represent a paradigm shift in the treatment of cancer, and it boggles the mind to think that this advance in cancer treatment could be delayed by a small cabal of bureaucrats within the FDA. Please visit Care to Live and write your congressman today to demand hearings into this matter. </p> <p><cite>— Posted by Mariner78 </cite></p> </div> </li> <li class="clearfix" id="comment-25322"> <div class="index">118.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25322" title="">2:59 pm</a> </div> <div class="comment"> <p>Re Rick (#100): Believe it or not, your point is actually along the lines of what I meant (post #47). Breast cancer is a fashionable, politically correct cause; prostate cancer is not (acronym notwithstanding).</p> <p>The attitude of many breast cancer crusaders that they are championing a “women’s issue” seems, frankly, to imply that they think cancer is somehow sexist, as if funding breast cancer research is the same as funding battered women’s shelters. This attitude, I think, is more than a little juvenile and, perhaps, even a bit sexist in itself. </p> <p><cite>— Posted by Michael Tashman </cite></p> </div> </li> <li class="clearfix" id="comment-25413"> <div class="index">119.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25413" title="">10:20 pm</a> </div> <div class="comment"> <p>To me it’s as easy as pie; when I get it I pull the plug.</p> <p>Of course it’s easy for me to say because I’m a bachelor with no close relatives. </p> <p>I began thinking about a comfortable way to commit suicide a few years ago and have been preparing myself for it all along. Incontinence and importance are unacceptable. </p> <p>Mind you, at 50, I have no symptoms, but I’m ready. If told I have it tomorrow I’ll be able to deal with it, quick and efficiently. </p> <p>What me worry…?</p> <p>anonymous </p> <p><cite>— Posted by TheShadow </cite></p> </div> </li> <li class="clearfix" id="comment-25416"> <div class="index">120.</div> <div class="commentmetadata"> February 9th,<br> 2008<br> <a href="#comment-25416" title="">10:41 pm</a> </div> <div class="comment"> <p>I lost my healthy- as- a- horse soccer player husband to prostate cancer at 51. To say that it’s being over treated and tested isn’t true. Younger men should be tested earlier. I wish he was tested routinely, rather than when the gleason score was 9 and there was little hope of surviving a year or 2. The lupron makes the psa look low and that you are ok. That’s not always true. He was told he was beating it. There’s a large percentage of a secondary site in the abdomen that can go out of control and doesn’t affect the psa. My husband’s last wish was to tell all men to get tested earlier. It could have saved his life. I wouldn’t have cared about the loss of sex. I lost my best friend and he didn’t get to see his grandkids. </p> <p><cite>— Posted by Annette Miller </cite></p> </div> </li> <li class="clearfix" id="comment-25432"> <div class="index">121.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25432" title="">12:31 am</a> </div> <div class="comment"> <p>TPP — Yes, all you did was a book review piece on the AHRQ study, including passing on its inaccuracies, as I previously noted, singling out the death figure for one. Apparently to show that you verify items in studies you are reviewing, you now write, “The 27,000 prostate cancer death statistic I cited is from the American Cancer Society.” Hello, that’s what I said in my first post (#100) — see below.</p> <p>The FIGURE is correct, and it does come from ACS, but it is NOT for actual deaths, as I previously wrote in clarifying youor statement in your article:</p> <p>“But some men have aggressive prostate cancers, and last year 27,050 men died from the disease.”</p> <p>This figure is the ESTIMATED PCa deaths in 2007 by the American Cancer Society in their “Cancer Facts & Figures 2007″ — not actual deaths in 2007.<br/> ============</p> <p>Had you really gone to the above cited source document, you would have found the title of the page in that document was “Estimated New Cancer Cases and Deaths by Sex for All Sites, US, 2007″</p> <p>ESTIMATED. And in common English syntax, the ESTIMATE refers to BOTH the cases and deaths. This is materially and significantly different from your statement that claimed that “last year 27,050 men died from the disease.” If you can’t see the difference, I’m afraid I can’t help you. If you simply missed the distinction, I would suggest some work on reading for comprehension. You owe the public accuracy at the very least.</p> <p>But you were not alone in this faux pas (to be kind). This is what the article you reported on wrote about this:</p> <p>“In 2007, prostate cancer was diagnosed in an estimated 218 900 men in the United States, and approximately 27 050 men died of the disease.”<br/> – as found in the version posted in the Annals of Internal Medicine, as you cited in your article</p> <p>They got the new cases right — “estimated” — but blew it on the deaths by claiming that “27,050 men died.”</p> <p>TPP, you have suggested that my outrage should be directed at doctors, and I assure you that I am outraged by the sloppy, unprofessional, all too often ignorant, unscientific work of doctors, both in research and clinical work. But I have enough outrage to include journalist of similar traits because they widen the distribution of the deplorable mistakes into the general population. </p> <p>This is the reason I always advise people that their lives are in THEIR hands and they MUST educate themselves or the doctors will maim or kill them. And I ALWAYS counsel them to go to source documents (media “reportage” being all too often inaccurate and less than true to the substance of the articles from the journals). And even if they do go to the source, I tell them to check and recheck from other sources and/or refernce materials what they read in the source articles in the scientific journals. Until someone is granted access to venues like NYT or WSJ and writes even handed and well researched articles and reportage on scientific journals, that’s the way it has to be. </p> <p>Pretty sad commentary on the “scientific” community, and not that flattering to the media, either. But that’s reality for you.</p> <p>As the old sarge on Hill Street Blues used to say, “Hey — be careful out there.”</p> <p>Rick Ward<br/> <a href="https://web.archive.org/web/20080224222815/http://www.pcaawareness.net/" rel="nofollow">www.PCaAwareness.net</a></p> <p><strong>From TPP — I have given you ample space to express your views and am not going to continue a debate back and forth. However, I do want to clarify an inaccuracy in your post. I’ve never said outrage should be directed at doctors, most of whom are doing the best they can with the information that is available to them. The problem is that men’s health gets short shrift in this country. Our outrage should be about the fact that we still know so very little about the best way to treat the most common cancer in the country, which also happens to be a men’s cancer. Much of the treatment of this cancer is being driven by makers of robotic surgical devices and various therapies, not objective scientific research. </strong> </p> <p><cite>— Posted by Rick Ward </cite></p> </div> </li> <li class="clearfix" id="comment-25437"> <div class="index">122.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25437" title="">12:55 am</a> </div> <div class="comment"> <p>Michael (Posts #47 and #118), yes, there is a definite sexist element in the disparity of treatment of BCa and PCa as causes celebre. Actually, perhaps more a maternal thing, Mom-and-apple-pie. NFL football players mug “Hi, Mom” on TV, not “Hi, Dad.” The result is that it’s fashionable to wear pink and support breast cancer causes, while it’s somehow not even acceptable to wear blue and press prostate cancer issues. This in spite of the reality that more men are diagnosed with PCa in a year than women with BCa — in fact, PCa is the most diagnosed of all cancers (either sex) excluding skin cancers.</p> <p>Still, without the fashionable acceptance of PCa promotion, our disease has gone from one that afflicted most men with advanced PCa when diagnosed, to some 90+% being diagnosed with treatable disease. And somehow we have achieved a 35+% REDUCTION of the PCa mortality over the most recently reported 14 years. All this without the enthusiastic embrace of the public, even in spite of the anti-screening, anti-treatment hue and cry in the media.</p> <p>Rick Ward<br/> <a href="https://web.archive.org/web/20080224222815/http://www.pcaawareness.net/" rel="nofollow">www.PCaAwareness.net</a> </p> <p><cite>— Posted by Rick Ward </cite></p> </div> </li> <li class="clearfix" id="comment-25451"> <div class="index">123.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25451" title="">1:48 am</a> </div> <div class="comment"> <p>I agree with # 118. If the impression is this cancer only effects men. You are very wrong… </p> <p><cite>— Posted by Sally </cite></p> </div> </li> <li class="clearfix" id="comment-25464"> <div class="index">124.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25464" title="">3:38 am</a> </div> <div class="comment"> <p>Although HIFU (High Intensity Focused Ultrasound)is not yet legal in America it is accessible in Mexico, Carribean, Canada, Europe and Asia. A couple weeks ago the NYT had an article on it. The device is manufactured in USA–another one in Europe. Is it better? Not really sure, but looks promising. </p> <p><cite>— Posted by Ron </cite></p> </div> </li> <li class="clearfix" id="comment-25503"> <div class="index">125.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25503" title="">8:02 am</a> </div> <div class="comment"> <p>My primary care physician began adding a PSA to my annual physical after I hit 40. My my PSA was “normal” for a couple of years, and then started rising. At the age of 45, my PSA went from 3.9 to 7.6, and my doctor recommended a prostate biopsy. Bingo - of 12 total cores, 3 turned up positive. The urologist recommended surgery. I did my homework (it’s good to be a librarian). From all I could gather, surgery did seem to be the best approach, given my situation. I had RP surgery done 3 hours from my home at an NCI “Center of Excellence” institution by a surgeon who had performed hundreds of RP procedures (and who offered nerve sparing surgery, which my local doctor did not).</p> <p>18 months later, I am not without side effects. I have stress incontinence and wear a pad daily, have only had 1 incident where my bladder voided, and that was during the first week that I slept in my bed after surgery. I started experiencing erections less than 7 months after surgery; they have gotten better, but aren’t near what they were, though functional. But I feel pretty fortunate, considering some of the stories I have heard.</p> <p>Guys, don’t get stampeded into surgery. But do your homework, ask EVERY question that you want to ask, and make the deision that seems best for you and your family’s circumstances. If you choose surgery, find the best surgeon and facility that you have access to. Certainly the options will get better as more and more studies are done. Demand the best possible treatment options that are available to you. Demand adequate funding be put into prostate cancer research. Most of all, live the best and most normal life that you can. Beat this thing, and don’t let it beat you! </p> <p>Hopeful </p> <p><cite>— Posted by Scott </cite></p> </div> </li> <li class="clearfix" id="comment-25510"> <div class="index">126.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25510" title="">8:45 am</a> </div> <div class="comment"> <p>Dear TPP,<br/> Just as i finished reading the wonderful response you sent to Sally (post#94), another reader castigated you for not being qualified to write about ‘ this complex health subject”.<br/> We live in a brave new world, where quality ( and junk) information is available to laypersons with a click of the mouse.<br/> At least on the basis of your efforts in the article and your posts, i would gladly give you an honorary MD !!<br/> At the end of the day, i believe, as a physician myself, that all these healthcare related debates will only raise the standard of care/advice to which the medical profession will be held up.</p> <p><strong>From TPP — Thanks for your kind words. My views often reflect and are shaped by the collective wisdom of readers and the many informed experts I speak with everyday, so I am always grateful when physicians such as yourself and patients take the time to comment and add to the discussion.</strong> </p> <p><cite>— Posted by sanjeev </cite></p> </div> </li> <li class="clearfix" id="comment-25549"> <div class="index">127.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25549" title="">11:25 am</a> </div> <div class="comment"> <p>I am amazed at the stong, heated emotions this forum has ellicited from a large number of posters, even to the point of ad hominem attacks on the moderator! What is it about prostate cancer that provokes such reactions? This is not the first time I have witnessed this phenomenon in relation to this one cancer. Many comments are dogmatically stated in terms of right and wrong, responsible versus irresponsible, naive versus informed. Would we be seeing the same intensity if we were discussing colon cancer or diabetes?<br/> But really, the comments about the right of the moderator to be even reporting on this topic are just ignorant. </p> <p><cite>— Posted by Andrew Mitchell </cite></p> </div> </li> <li class="clearfix" id="comment-25577"> <div class="index">128.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25577" title="">2:23 pm</a> </div> <div class="comment"> <p>I agree completely with comment 127 by Andrea. One of the reasons I generally avoid blogs about prostate cancer is the arrogance of people who have all the answers not only for themselves but for others. </p> <p><cite>— Posted by Anthony </cite></p> </div> </li> <li class="clearfix" id="comment-25580"> <div class="index">129.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25580" title="">2:33 pm</a> </div> <div class="comment"> <p>A thousand pardons, TPP, I thought that doctors were part of the medical establishment. On one thing, though, we are in agreement: men are poorly served by the medical establishment. Perhaps you in your concern can become proactive and hold their feet to the fire instead of passively passing on their studies. You have the venue to contribute positively to the health of men. I only ask that you lose that screening-is-harmful bias (there are studies supportive of screening, you know, and something is driving the reduction of mortality from PCa).</p> <p>Thanks for the fun in your sandbox.</p> <p>Rick Ward<br/> <a href="https://web.archive.org/web/20080224222815/http://www.pcaawareness.net/" rel="nofollow">www.PCaAwareness.net</a> </p> <p><cite>— Posted by Rick Ward </cite></p> </div> </li> <li class="clearfix" id="comment-25628"> <div class="index">130.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25628" title="">6:01 pm</a> </div> <div class="comment"> <p>Making a treatment choice is tough enough given the lack of data, and the abundance of subjective medical opinion, but the main criteria that we are encouraged to use to make this choice is the Gleason score which appears to be a real crapshoot.<br/> The same biopsy material can be assigned a wide variety of Gleason numbers depending on the pathologist. Before making a decision regarding treatment mode or selecting a physician, find out who the real “artists” are in the field of prostate pathology and have your slides reviewed by at least two of them. Having confidence in the Gleason number can make the choice of treatment a little easier.</p> <p><strong>From TPP — Agreed. Which is why I always tell men to get a second opinion on their prostate pathology. research out of Johns Hopkins shows a high error rate — not so much in the general cancer diagnosis but in the details that make all hte difference in deciding the best course of treatment. </strong> </p> <p><cite>— Posted by Ian M </cite></p> </div> </li> <li class="clearfix" id="comment-25695"> <div class="index">131.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25695" title="">11:02 pm</a> </div> <div class="comment"> <p>What is the success rate over 85 year man<br/> being treated with taxiter 10 treatments</p> <p>had 43 radiation </p> <p><cite>— Posted by Ben Thylan </cite></p> </div> </li> <li class="clearfix" id="comment-25707"> <div class="index">132.</div> <div class="commentmetadata"> February 10th,<br> 2008<br> <a href="#comment-25707" title="">11:44 pm</a> </div> <div class="comment"> <p>Regarding post 28 from family physician - Where do you get the info on 40% of forty year olds have some form of prostate cancer? I am a newly diagnosed 51 ear old and struggle with the idea that maybe everyone has a little and I just happen to know about it. I don’t want to be in denial, but I don’t want to over react either. </p> <p><cite>— Posted by James </cite></p> </div> </li> <li class="clearfix" id="comment-25716"> <div class="index">133.</div> <div class="commentmetadata"> February 11th,<br> 2008<br> <a href="#comment-25716" title="">12:49 am</a> </div> <div class="comment"> <p>The US HIFU Machine is the Sonablate, while the older machine is the French EDAP Ablatherm. Both are used outside of USA for 1000s of prostate ablations but the FDA insists on ignoring the world’s experience and delaying the machines into the USA by 3 - 5 years. Not being FDA-approved, if you get treated outside of USA, the US insurance companies won’t pay for non-FDA approved treatment. Runs about $30K. The first long-term studies, 7+ years long, have become available recently.</p> <p>About over-diagnosis and over-treatment. If your 51-year old husband had no history of CaP in his family, not every urologist would recommend annual DRE/PSA at age 50. Perhaps every 2 years. There is enormous discussion and controversy and on-going research about CaP screening. There are new tests, using urine, to help decide if the cancer is present. There are also genetic tests and bio-markers that show propensity for developing CaP. PSA/DRE should look as primitive as they are when these new tests are available.</p> <p>Earlier detection is always better, but as the Swedish study in particular and the European experience in general show, if it’s gonna get ya, it’s gonna get, no matter when you detect it and no matter which treatment.</p> <p>Millions of PSA and millions of DRE per year are really good, steady business for the urologists, only 230K/year actually have cancer/year, so that’s many many millions of tests wasted. Urologists themselves are not unanimous on CaP screening. Note that similar controversy exists for breast cancer screening. </p> <p><cite>— Posted by len conrad </cite></p> </div> </li> <li class="clearfix" id="comment-26244"> <div class="index">134.</div> <div class="commentmetadata"> February 12th,<br> 2008<br> <a href="#comment-26244" title="">1:39 pm</a> </div> <div class="comment"> <p>Wake up folks. Good health is all about trying to be fluoride free. We were all taught by our parents not to over indulge in food and drink. Over indulgence will make you sick. Fluoride is a toxic mineral. It is rated between arsenic and lead for toxicity. It is every were in the earths crust. We can handle what is here naturally but what we can’t handle, is when they add fluoride to our drinking water. Once they add it to our drinking water the fluoride level on average is five fold higher than what is in natural drinking water. Because we use water for most every thing we do in life we can not get away from it completely. Beer is loaded with it along with soda.<br/> Your bath water, laundry, toothpaste, processed foods, cigarette smoke, car exhaust. They don’t tell you about lung cancer and fluoride in cigarette tobacco. Bring up the MSDS on fluoride. It will shock you.</p> <p>When I was sixty the Doctors wanted to take biopsies of my prostate. I went to Mayo Clinic and Med Line web sites and did my research. I decided that no way were they going to play their game with me. I lost my erection at age of fifty from fluoride poisoning. Ninety five percent of americans are over fluoridated. One can tell by their yellow dirty looking teeth. That is the first visible tell tale sign of being over fluoridated. And a person can not cover it up by using whiteners. The tooth will have that two tone look. You can not whiten the dentin of the tooth. It will be visible threw the translucent enamel.</p> <p>I am now seventy two with a PSA of three. According to the obituaries, if I am lucky I could have another ten years of fighting this absurd practice of adding fluoride to the drinking. Fluoride is considered a drug by the FDA. Not all drugs do well together. Kick the fluoride habit before it is to late. </p> <p><cite>— Posted by Gerald Marsch </cite></p> </div> </li> <li class="clearfix" id="comment-26261"> <div class="index">135.</div> <div class="commentmetadata"> February 12th,<br> 2008<br> <a href="#comment-26261" title="">2:31 pm</a> </div> <div class="comment"> <p>Diagnosed (not aggressive) by biopsy (a non-painful procedure that put my prostate into painful shock for two months - non-invasive color Doppler is available and more reliable from what I read) after PSA reached 4.7 four years ago age 62. Next PSA (2 months later) was 2.7 after dropping all animal products except salmon and mackerel (and dropping most sugar and oils except olive) from my diet. It is now 1.5 and I’m not strict about the diet any more. This is essentially what Dean Ornish is doing in his study (without the fish).<br/> Supplements don’t seem to make much difference, but I take Zyflamend herbal blend from New Chapter just to be sure (see Columbia U study). UnivCalif San Francisco Med Center has a nice brochure outlining dietary studies.<br/> All my acquaintances who have had procedures have regretted the treatment and the effects. Pressure from family pushed them into treatment they really didn’t want.<br/> It seems that speed of increase of PSA is the factor to watch. Ya, it’s a risk to not act. Two urologists walked out of the room when I asked “Why have surgery when my PSA is dropping?”<br/> When is the AMA(US) going to allow HIFU, with statistically less “collateral damage”? If it weren’t for my insurer, I’d go to Canada if I ever felt I needed treatment. </p> <p><cite>— Posted by David </cite></p> </div> </li> <li class="clearfix" id="comment-26357"> <div class="index">136.</div> <div class="commentmetadata"> February 12th,<br> 2008<br> <a href="#comment-26357" title="">5:41 pm</a> </div> <div class="comment"> <p>Since 1998 when I started the reduced fluoride diet I have had four hair analyses test. In 1999,2000,2001,and 2002. From one test to the next my nine toxic elements went down and my eleven nutrient elements went up. Only once did the toxin Mercury go up. That was be cause my wife was on a Salmon kick for about a month. Salmon ever friday night for fish fry. She read some were that salmon were good for you. We no longer eat salmon. Those test proved to me that fluoride reduces the nutrients in the body. The body needs nutrients to build a strong immune system. </p> <p>Before 1998 I had prostate problems where I couldn’t do any thing stress full. I would feel shitty like and the feeling after sex wasn’t the greatest. I could always relate it back to doing some heavy lifting or pulling or pushing. The first time I had prostate problems I pushed a loaded wheel barrow up a steep hill. The next day it felt like I had a tennis ball between my rear cheeks. I went to the doctor and that was the beginning of a enlarged prostate for me. I asked him if wheeling that wheel barrow had any thing to do with my large infected prostate. OH NO he said. The following year I did the same thing. Same hill, same wheel barrow. Back to the doctor I go to get medication for a infected prostate. Ever since then when I go to a doctor and have an exam, it’s OH YOU HAVE AN ENLARGED PROSTATE. Oh boy, big deal. I just snicker to my self and think to my self. Dumb programed quack. </p> <p>I have friends who have prostate cancer and some I new have died of prostate cancer. I always come back to the same diagnosis. The person is over fluoridated, involved in some athletic sport, or over weight and on a diet or has been drinking to much beer or soda. All of the preceded relate to dehydration. It is all about fluoride and dehydration. I believe a person should never ever go on a diet unless it is a water diet of pure no fluoride water. Good health is all about pure no fluoride water. </p> <p><cite>— Posted by Gerald Marsch </cite></p> </div> </li> <li class="clearfix" id="comment-26366"> <div class="index">137.</div> <div class="commentmetadata"> February 12th,<br> 2008<br> <a href="#comment-26366" title="">6:01 pm</a> </div> <div class="comment"> <p>American College of Preventative Medicine, ACPM, addresses CaP screeing:</p> <p>“Results</p> <p>Applications of PSA screening tests used in clinical practice include<br/> (1) a PSA cutoff of 4 ng/ml,<br/> (2) age-specific PSA,<br/> (3) PSA velocity,<br/> (4) PSA density, and<br/> (5) percent free PSA. </p> <p>Prostate cancer screening can detect early disease and offers the potential to decrease morbidity and mortality. Prostate cancer screening benefits, however, remain unproven, pending results of ongoing trials. </p> <p>There is currently no convincing evidence that early screening, detection, and treatment improves mortality. </p> <p>Limitations of prostate cancer screening include potential adverse health effects associated with false-positive and negative results, and treatment side effects.<br/> Conclusions</p> <p>The American College of Preventive Medicine concludes that there is insufficient evidence to recommend routine population screening with DRE or PSA. Clinicians caring for men, especially African-American men and those with positive family histories, should provide information about potential benefits and risks of prostate cancer screening, and the limitations of current evidence for screening, in order to maximize informed decision making.”</p> <p><a href="https://web.archive.org/web/20080224222815/http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHT-4RKMM3H-F&_user=10&_coverDate=02%2F29%2F2008&_rdoc=11&_fmt=summary&_orig=browse&_srch=doc-info" rel="nofollow">http://www.sciencedirect.com/science?_ob=ArticleURL&_ud i=B6VHT-4RKMM3H-F&_user=10&_coverDate=02%2F29%2F2008&_r doc=11&_fmt=summary&_orig=browse&_srch=doc-info</a>(%23toc% 236075%232008%23999659997%23678517%23FLA%23display%23Vo lume)&_cdi=6075&_sort=d&_docanchor=&_ct=14&_acct=C00005 0221&_version=1&_urlVersion=0&_userid=10&md5=0c5a751840 a66c0e334b231bd28d625f</p> <p>Available online 15 January 2008. </p> <p><cite>— Posted by len conrad </cite></p> </div> </li> <li class="clearfix" id="comment-26388"> <div class="index">138.</div> <div class="commentmetadata"> February 12th,<br> 2008<br> <a href="#comment-26388" title="">6:47 pm</a> </div> <div class="comment"> <p>To post #87(TZ). Diet and natural supplements have been working for me. I had psa of 6 two years ago at age 52. Urologist insisted on a biopsy. Of 12 samples one came back cancerous gleason score 6. He wanted to do Radical Prostectomy. I began investigating other treatments (I had no other symptoms). I read Dr. Larry Clapps book ‘Prostate Health in 90 Days’ which I recommend. I also spoke with a couple holistic practioners. Eventually I found Dr. Robert Bard in NYC (www.cancerscan.com). ‘Prostate Cancer Demystified’ by Dr. Robert Bard. He uses Color Doppler Ultrasound and MRI to monitor my condition. On my first visit he found the tumor found by the biopsy (totally insignificant) and an additional tumor missed by the biopsy (more significant). He sent me for an MRI to confirm. One of the advantages of the color doppler is that it also shows vascularity (blood flow) to the tumor which indicates how aggresive they are. Mine showed low vascularity and are deemed not aggresive. He recommended high dose of COQ10 and another supplement he sells. He also can arrange for HIFU treatment out of the country which he promotes. I opted to try supplements and also change my diet. Cut out red meat, coffee (acidic) sugar, etc. Eat lots of fresh vegetables and generally do the things you know you should be doing anyway. I returned to Dr. Bard 6 mos. later. The original tumor was gone and the other was half the size. The story doesn’t end here however. I got a little cocky and lazy about my diet and supplements and put off returning for monitoring about 15 mos. When I did my prostate had enlarged somewhat and a lump was pushing against the capsule. He found the tumors to be larger and sent me again for an MRI to confirm. He again suggested HIFU but I felt I wanted to try again with diet and supplements which I did. I returned again last December 07 and my prostate itself is smaller and softer and the tumors are significantly smaller. To me this indicates pretty conclusively that I can control my cancer through good diet and natural supplements until more is known and other treatments become available in this country. There are a number of other supplements that seem to help also, selenium, D3, green tea, others. Hope this is helpful. Don’t panic. </p> <p><cite>— Posted by Dave </cite></p> </div> </li> <li class="clearfix" id="comment-26731"> <div class="index">139.</div> <div class="commentmetadata"> February 13th,<br> 2008<br> <a href="#comment-26731" title="">1:33 pm</a> </div> <div class="comment"> <p>After radical prostatectomy, both continence and erectile function returned during a 24 month period. Continence within 2-3 months.<br/> I had robotic surgery at the age of 48 and sexual function returned after approx 12 months and improved thereafter with the aid of ED meds. Now after 3 years, sexual function is fine and meds aren’t needed at all. Notes: orgasms are incredible considering the gland is totally gone. The short side of the surgery is loss of penis size- no pun intended! Second guessed for ever but undetectable PSA for the past 3 years. </p> <p><cite>— Posted by Joe </cite></p> </div> </li> <li class="clearfix" id="comment-26975"> <div class="index">140.</div> <div class="commentmetadata"> February 14th,<br> 2008<br> <a href="#comment-26975" title="">7:07 am</a> </div> <div class="comment"> <p>As a prostate cancer survivor out 7 years and with a PSA of .1, I suggest that anyone diagnosed MUST do their own research before treatment. Did you know that about 1/4 of those men who had a RP had residual cancer and needed follow up treatment? So RP as “the gold standard” is a simply not true. I had High Density Brachytherapy and external radiation as there was 67% probability on the Partin Tables that it had escaped the capsule. No urinary or other problems exist, I am now 70 and did have sexual problems that ED drugs helped. Yes, loss of the prostate seems to cause shrinkage of the penis, sorry guys. No one above has mentioned the Partin Tables and you better know your options as most urologists are surgeons and you know what that means. </p> <p><cite>— Posted by Ken </cite></p> </div> </li> <li class="clearfix" id="comment-27213"> <div class="index">141.</div> <div class="commentmetadata"> February 15th,<br> 2008<br> <a href="#comment-27213" title="">5:37 am</a> </div> <div class="comment"> <p>Prostate cancer deaths are down sinc PSA testing began . Yes, the disease varies quite a lot in the population and to decide on the truly best treatment would take randomizing (not giving any patient a choice) and stratification of huge numbers of people and 15 year follow-up. The large amount of information in the literature and antidotal information makes it difficult for patients to decide without a biased advisor assisting their decision-hopefully a physcian who will explain his own personal bias while explainig his recommendation. I do not know of any surgeon receiving more than 1500.00 for prostaectomy-a sum not worthy of being discussed as a potential for bias in my opinion considering the follow-up care and time it takesand liability risks. The government is spending more money each year on our aging population and is putting a negative spin on it all to save money in health care only to divert to other entitlements. One day we will have better genetic testing of the dna in the biopsy specimen and will be able to better predict those cancers that are more likely to progress and therefore are better treated sooner. In “low risk disease ” all treatments have similar long term survivals without eveidence of cancer so treatment depends on a person’s own choice, not the doctors’s. In high risk disease, none of the treatments are great.Watchful waiting in a low risk situation only works if one does not live too long as eventually all prostate cancer will progress and using psa velocity does help but is not perfect so you always have the chance that it will be a bad choice retrospectively for one individual. </p> <p><cite>— Posted by Patrick Hunter </cite></p> </div> </li> <li class="clearfix" id="comment-27249"> <div class="index">142.</div> <div class="commentmetadata"> February 15th,<br> 2008<br> <a href="#comment-27249" title="">11:49 am</a> </div> <div class="comment"> <p>I would be grateful for any comments, re experience or relevant information.<br/> I am 67, an athlete who rides a road bike hard for 8,000-plus miles a year. My most recent PSA was 4.73 (this after a gradual upward progression of 2.7 from 1999). My primary care doc sensed a “new” hardness and referred me to a urologist who confirmed the hardness factor and recommended an immediate biopsy based on the single 4.73 test (I noted that I was actually closer to 70, and that the normal range for that age was up to 5.5, or higher). I told him I wanted at least one more PSA test, if not a series over the course of a year, to which he shrugged and replied “Delay hurts only the patient, not the doctor.” Reassuring, eh?<br/> The more I read, the more it seems that biopsies carry their own dangers, including “activating” any cancer cells already present which, according to one study, is about 50% of men over 60. </p> <p>I have no symptoms at all, no pain of any kind, have normal urination. Is is possible that since I have always been on the high side of average (2.7 nine years ago) that 4.73 isn’t as serious an issue as it would be for someone who, say, went from 1.1 to 4.73? Would an MRI or Color Doppley Ultrasound be a better course to take at this point? Or nothing at all, instead monitoring PSA through tests over a year or so.</p> <p>Any thoughts, shared info/experience much appreciated.</p> <p>Doug </p> <p><cite>— Posted by Doug </cite></p> </div> </li> <li class="clearfix" id="comment-27383"> <div class="index">143.</div> <div class="commentmetadata"> February 15th,<br> 2008<br> <a href="#comment-27383" title="">5:51 pm</a> </div> <div class="comment"> <p>“… the risk of dying of prostate cancer remains about 3 percent.” This validates a decision that I made about a decade ago. Based on what I could find in the literature, I reasoned that taking the PSA does not increase one’s life expectancy, but it does increase the risk of acquiring impotence or incontinence. Accordingly, I have refused the PSA ever since. It’s a good marketing tool for urologists, but all of us should prefer evidence-based medicine to market-based medicine. If only it were always so easy to tell the difference. </p> <p><cite>— Posted by Phil </cite></p> </div> </li> <li class="clearfix" id="comment-27463"> <div class="index">144.</div> <div class="commentmetadata"> February 15th,<br> 2008<br> <a href="#comment-27463" title="">11:55 pm</a> </div> <div class="comment"> <p>Doug,</p> <p>In 1998 I went threw the same situation you did. I did my research on Mayo Clinic web site and decided they could take their biopsy and shove it. I also had a lesion or something on one of the lobes of my prostate. My PSA in 98 was 1.4. Last year it was 3.1. I have been giving my self a prostate finger job since 1998. I could feel the same thing the doctors where talking about and the prostate isn’t all ways the same size. There were times when I had a hard time finding it. If you are a biker I can under stand where you are coming from. Inventory your body and you will find you squeeze your buns together when you bike, run fast, lift, push and pull. Being a biker you most likely were dehydrated a good many times with out knowing it and drank a lot of fluid containing fluoride. </p> <p><cite>— Posted by Gerald Marsch </cite></p> </div> </li> <li class="clearfix" id="comment-27707"> <div class="index">145.</div> <div class="commentmetadata"> February 17th,<br> 2008<br> <a href="#comment-27707" title="">10:03 am</a> </div> <div class="comment"> <p>I know what I would do if diagnoised with protrate cancer. I would use the principles of orthomolecular medicine (see <a href="https://web.archive.org/web/20080224222815/http://www.doctoryourself.com/" rel="nofollow">www.doctoryourself.com</a>) including proper diet and meagavitamin (especially vitamin C) therapy to treat my conditon at home. No chemo or radiation for me. </p> <p><cite>— Posted by Robert Sarver </cite></p> </div> </li> <li class="clearfix" id="comment-27824"> <div class="index">146.</div> <div class="commentmetadata"> February 18th,<br> 2008<br> <a href="#comment-27824" title="">7:17 am</a> </div> <div class="comment"> <p>I was diagnosed with prostate cancer 18 months ago.<br/> PSA was 7.5. Urologist said it was an aggressive cancer. Oncologist agreed. I was 57 y.o.. I opted for radiation and seed implantation,with their guidance.<br/> PSA is 4.4 today. Incontinance was more urgency than anything. That ceased after four months. I have only partial erections. Rather that than dead! I say it’s better to know as soon as possible and to deal with it any way you have to. Sure! It’s confusing. But sort it out the best you can,and don’t cry-eye over hindsight. The bottom-line is to LIVE! </p> <p><cite>— Posted by richard smith </cite></p> </div> </li> <li class="clearfix" id="comment-28088"> <div class="index">147.</div> <div class="commentmetadata"> February 19th,<br> 2008<br> <a href="#comment-28088" title="">4:19 am</a> </div> <div class="comment"> <p>This article is much too limited to use as a guide to choices. Every case is different. Age, size of the prostate, results of the biopsy and lifestyle all play a part in the determination. Men who still engage in sexual activity would certainly want to have a “nerve sparing” technique employed if surgery is their choice. This technique is not well-known and I don’t recall it being mentioned. It is employed to retain the feelings surrounding orgasm. John Hopkins Brady Institute are the leading experts on this technique and many good surgeons employ it.<br/> Prostates with cancer still contained and removed in time have 100% recovery rates. The other methods cannot guarantee that success but the issue is far from settled and surgeons feel one way and radiologists another. Watchful waiting is fine if the cancer is not a fast growing variety and you are at least 70. No one enjoys prostate cancer treatments of any kind. Follow up with radiation and or hormones is sometimes required.<br/> Get regular PSA checkups after 40 if African-American and 50 otherwise is the latest recommendation.<br/> Finally choose the physician that has the most experience in Urology and prostate cancer. </p> <p><cite>— Posted by NYMARTY </cite></p> </div> </li> <li class="clearfix" id="comment-28118"> <div class="index">148.</div> <div class="commentmetadata"> February 19th,<br> 2008<br> <a href="#comment-28118" title="">9:05 am</a> </div> <div class="comment"> <p>Want more options ?? Get after the Government to approve Provenge and investigate why the FDA allowed Dr. Howard Scher on the Provenge Advisory (review) Committee last year when he was the lead investigator for Novecea’s (NOVC) Ascentar, a treatment that Provenge would have been a direct competitor for, and when he was a scientific advisor for Proquest Investments, an investment fund which held a substantial stake in Novecea??</p> <p>The first thing you can do to help yourselves have access to a wider range of treatments is to go to this link and sign in support of the “Physicians for Provenge” petition.</p> <p><a href="https://web.archive.org/web/20080224222815/http://www.petitiononline.com/provenge/petition.html" rel="nofollow">http://www.petitiononline.com/provenge/petition.html</a></p> <p>Then start lobbying the FDA to approve Provenge, and anyone else you can think of (such as your congressman) to initiate an investigation into why the FDA took the unprecidented step of failing to follow the overwhelming advice of it’s own advisory committee to approve Provenge. (The Advisory Committee voted 17-0 that there were no safety issues with Provenge and 13-4, and the 4 “no” votes included the votes of the seriously conflicted Dr. Scher and Dr. Maha Hussain, another committee member with serious undisclosed conflicts of interest).</p> <p>For more information on the story of this travesty, please visit <a href="https://web.archive.org/web/20080224222815/http://www.caretolive.com/" rel="nofollow">www.caretolive.com</a> and <a href="https://web.archive.org/web/20080224222815/http://www.arighttolive.com/" rel="nofollow">www.arighttolive.com</a></p> <p>Get angry. Then get active.</p> <p>M78 </p> <p><cite>— Posted by Mariner78 </cite></p> </div> </li> <li class="clearfix" id="comment-28448"> <div class="index">149.</div> <div class="commentmetadata"> February 20th,<br> 2008<br> <a href="#comment-28448" title="">7:12 pm</a> </div> <div class="comment"> <p>What did James Brown (Godfather of Soul) die of? </p> <p>In December of 2004 at the age of 71, he was diagnosed with Prostrate Cancer and “successfully” underwent cancer surgery to treat it. On December 25,2006 at the age of 73 he was in ill health and died of congestive heart failure. His death certificate did not mention Prostate Cancer.</p> <p>Is it possible that the treatment for the Prostrate Cancer contribute or possibly cause the death? You bet ya. These cancer treatments are not without major health risks both short and long term. Yet cancer mortality rates are based on cause of death on death certificates. </p> <p>It seems obvious to me that the supposed drop in Prostrate Cancer Death Rates are really a result of excessive, unnecessary cancer treatments that mask the questionable benefits of these treatments. </p> <p><cite>— Posted by RussellPoggensee </cite></p> </div> </li> <li class="clearfix" id="comment-28725"> <div class="index">150.</div> <div class="commentmetadata"> February 22nd,<br> 2008<br> <a href="#comment-28725" title="">6:18 pm</a> </div> <div class="comment"> <p>Hello,</p> <p>My father 56 years old was diagnosied with pc a few weeks ago. He noticed blood in his urine and being a very stuburn man waited 6 months before seeing a doctor. A PSA test showed 41.6 doctor thanking with that high of a number it may have been a false positive or some type of error at the lab. He did another PSA test one week later and the results had raised to 47.8 in just one week. The doctor did an imediated biopsy and pulled 12 samples. 9 of the samples were positive for cancer. The doctors recomended removing the prostate imediatly but wanted to do bone scans first. The bone scanes showed a spot on his spine that further tests determined his pc had spread to inside his spine. They know say no need to remove the prostate do to the inoperable canser in the spine. The samples taken showed gleason level of 9. The doctors are know talking about pills, shots, and radiation to slow down what they are calling very agresive pc. I am so confused. This is realy all the information I know except for the fact that they say the first shot runs a risk of boosting testosterone before decreasing which could cause the cancer in the spine to grow and possibly cause severe spinal cord damage. I gather from the rapid response of the doctors this is very serious but I dont know how serious. From what I have read the PSA levals listed above are unheard of. Can you help me with some specific questions I could ask my father to help me figure out just how life threatning this is. He is going to Illinois next week to cancer treatment centers of america. The will be running a weeks worth of testing to get a secound opinion on treatment options. I am 30 years on and talked to my family doctor about my fathers diagnosis and yearly PSA tests for my self. He stated that I should not worry about the PSA testing untill I am 40. Should I be getting tested now with my father being only 56 and no knowlage of how long he has had the pc before finding it? Please help me with these questions.</p> <p>Thanks in advance CDN </p> <p><cite>— Posted by CDN </cite></p> </div> </li> <li class="clearfix" id="comment-28733"> <div class="index">151.</div> <div class="commentmetadata"> February 22nd,<br> 2008<br> <a href="#comment-28733" title="">7:34 pm</a> </div> <div class="comment"> <p>Please can someone help me reconcile two seemingly conflicting claims. One is the data indicating a reduction in PC death rate since early detection via PSA testing became more common. The other is this article`s claim that doing nothing is just as effective statistically as surgery. This makes no sense to me..please explain. </p> <p><cite>— Posted by Phil </cite></p> </div> </li> <li class="clearfix" id="comment-28955"> <div class="index">152.</div> <div class="commentmetadata"> February 24th,<br> 2008<br> <a href="#comment-28955" title="">9:47 am</a> </div> <div class="comment"> <p>I don’t understand all the confusion: <a href="https://web.archive.org/web/20080224222815/http://www.nccn.org/professionals/physician_gls/PDF/prostate.pdf" rel="nofollow">http://www.nccn.org/professionals/physician_gls/PDF/pro state.pdf</a></p> <p>Those are the treatment guidelines. </p> <p>You can also look on the AUA’s website.<br/> <strong></p> <p>From TPP — I find those very confusing. it doesn’t advise men what to do. it just outlines the different options — but there is no evidence showing whether one is better than the other. that’s why men are confused.</strong> </p> <p><cite>— Posted by Daisy O'Neil </cite></p> </div> </li> </div>  <div id="add_comments"> <h3 id="respond">Add your comments...</h3> <form action="https://web.archive.org/web/20080224222815/http://well.dblogs.nytimes.com/wp-comments-post.php" method="post" id="commentform" onsubmit="return CommentsValidator.validateForm()"> <ul id="warnings" style="display:none"></ul> <label for="author"><span>Name</span> <input type="text" name="author" id="author" value="" size="22" tabindex="1" maxlength="255"/> <span id="author_info" class="required"><em>Required</em></span> </label> <label for="email"><span>E-mail</span> <input type="text" name="email" id="email" value="" size="22" tabindex="2" maxlength="100"/> <span id="email_info" class="required"><em>Required (will not be published)</em></span> </label> <label for="comment"><span>Comment</span> <textarea name="comment" id="comment" cols="30" rows="10" tabindex="5"></textarea> </label> <input name="submit" type="submit" id="submit" tabindex="6" value="Submit Comment"/> <input type="hidden" name="comment_post_ID" value="243"/> </form> <p id="disclaimer"><em>Comments are moderated and generally will be posted if they are on-topic and not abusive. 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</div>  <div class="side_tool"><h4>Comments of the Moment</h4><div class="pullquote"><blockquote><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/08/when-doctors-become-patients/#comment-25094"><img src="https://web.archive.org/web/20080224222815im_/http://graphics8.nytimes.com/images/blogs/well/quotes.gif" alt="“"/>I'm glad doctors are beginning to talk about these issues in the public sphere. Itt makes us both more humane to our patients and more human to them.”</a></blockquote><div class="comment_author"><span class="com-author"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/08/when-doctors-become-patients/#comment-25094" title="Posted by Greg">— Greg</a></span><span class="com-post"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/08/when-doctors-become-patients/">When Doctors Become Patients</a></span></div></div><div class="pullquote"><blockquote><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/under-the-influence-ofmusic/#comment-24229">“I am a high school teacher and I have seen how music affects my student's behavior. ...Whether the kids want to admit it or not, being constantly bombarded with negative messages has an impact on their day-to day lives and decision making. ”</a></blockquote><div class="comment_author"><span class="com-author"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/under-the-influence-ofmusic/#comment-24229" title="Posted by Treva">— Treva</a></span><span class="com-post"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/under-the-influence-ofmusic/">Under the Influence of...Music?</a></span></div></div><div class="pullquote"><blockquote><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/no-answers-for-men-with-prostate-cancer/#comment-24228">“As a Family Physician, this is a topic that I deal with daily and is one of the most challenging conundrum's of medicine. You can read all you want about this topic and still not know what to do if you are diagnosed with prostate cancer. ”</a></blockquote><div class="comment_author"><span class="com-author"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/no-answers-for-men-with-prostate-cancer/#comment-24228" title="Posted by Tim W">— Tim W</a></span><span class="com-post"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/no-answers-for-men-with-prostate-cancer/">No Answers for Men With Prostate Cancer</a></span></div></div></div><div class="side_tool"><div class="col2"> <div class="subCol"> <div class="story"> <div class="kicker">Healthy Consumer</div> <h5><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/24/can-yogurt-really-boost-your-health/">A Health Boost?</a></h5> <img class="callout wide" src="https://web.archive.org/web/20080224222815im_/http://graphics8.nytimes.com/images/blogs/well/posts/promos/yogurt165.jpg" alt="google"/> <p class="summary"> A lawsuit says the health claims of so-called "probiotic" yogurts dupe consumers.</p> <p><ul class="refer"> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/28/will-cholesterol-pills-save-your-life/">Will Cholesterol Pills Save Your Life?</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/28/resistant-bacteria-football-players-and-gay-men/">Resistant Bacteria, Football Players and Gay Men</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/15/the-skinny-at-starbucks/">The Skinny at Starbucks</a></li> </ul> </p></div> </div> <div class="subCol"> <div class="story"> <div class="kicker">Family Matters</div> <h5><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/04/child-or-caveman/">Child or Caveman?</a></h5> <a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/04/child-or-caveman/"><img class="callout wide" src="https://web.archive.org/web/20080224222815im_/http://graphics8.nytimes.com/images/blogs/well/posts/promos/baby165.jpg" alt="cheerleaders"/></a> <p class="summary">Parents can calm toddler tantrums if they're willing to take a more primitive approach. </p> <p><ul class="refer"> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/14/choking-game-deaths-on-the-rise/">'Choking' Game Deaths on the Rise</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/05/under-the-influence-ofmusic/">Under the Influence of…Music?</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/09/school-popularity-affects-girls-weights/">Popularity and Weight</a></li> </ul> </p></div> </div> </div> <div class="col2"> <div class="subCol"> <div class="story"> <div class="kicker">What's on Your Plate</div> <h5><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/12/hillarys-health-plan-hot-peppers/">Hillary's Health Plan</a></h5> <a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/02/12/hillarys-health-plan-hot-peppers/"><img class="callout wide" src="https://web.archive.org/web/20080224222815im_/http://graphics8.nytimes.com/images/blogs/well/posts/promos/peppers165.jpg" alt="vegetables"/></a> <p class="summary">Eating hot peppers may do more than just spice up your diet. </p> <p><ul class="refer"> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/17/an-omnivore-defends-real-food/">An Omnivore Defends Real Food</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/15/the-farmers-market-effect/">Farmer's Market Effect</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/09/a-pbj-for-the-planet/">A PB&J; for the Planet?</a></li> </ul> </p></div> </div> <div class="subCol"> <div class="story"> <div class="kicker">Body Work</div> <h5><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/02/local-gyms-outpace-the-national-chains/">Local Gyms vs. Chains</a></h5> <a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/02/local-gyms-outpace-the-national-chains/"><img class="callout wide" src="https://web.archive.org/web/20080224222815im_/http://graphics8.nytimes.com/images/blogs/well/posts/promos/gyms165.jpg" alt="gyms"/></a> <p class="summary">Consumer Reports surveys gym goers on likes and dislikes.</p> <p><ul class="refer"> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/11/when-fitness-means-life-or-death/">When Fitness Means Life or Death</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2008/01/08/rating-home-exercise-equipment/">Rating Home Exercise Equipment</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/2007/12/07/to-ink-or-not-to-ink/">To Ink or Not?</a></li> </ul> </p></div> </div> </div> </div><div class="side_tool"><div class="story"> <div class="kicker">In Science Times</div> <a href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/2008/02/12/health/12well.html"><img class="callout" src="https://web.archive.org/web/20080224222815im_/http://graphics8.nytimes.com/images/2008/02/12/science/12well.751.jpg" alt="well"/></a> <h5><a href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/2008/02/12/health/12well.html">Reinventing Date Night for Long-Married Couples</a></h5> <p class="summary">Brain and behavior researchers say many couples are going about date night all wrong.</p> <ul class="refer"> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/2008/02/05/health/05well.html">Coping With the Caveman in the Crib</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/2008/01/29/health/29well.html">Great Drug, but Does It Prolong Life?</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/2008/01/22/health/22well.html">What That Cholesterol Trial Didn’t Show</a> </li><li class="free"><a href="https://web.archive.org/web/20080224222815/http://www.nytimes.com/2008/01/15/health/15well.html">On Sex After Prostate Surgery, Confusing Data</a></li> <li class="free"><a href="https://web.archive.org/web/20080224222815/http://topics.nytimes.com/top/reference/timestopics/people/p/tara_parkerpope/index.html">All Past Columns</a></li> </ul></div></div> <div class="side_tool"><h4>About Well</h4><div class="story"> <p class="summary"><img class="callout" src="https://web.archive.org/web/20080224222815im_/http://graphics8.nytimes.com/images/blogs/well/tara75.100.jpg" alt="Tara Parker-Pope on Health"/>Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. That's the focus of Well, The Times's new health blog. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at <a href="https://web.archive.org/web/20080224222815/mailto:well@nytimes.com">well@nytimes.com</a>.</p></div></div> <div class="side_tool"><h4 class="left">Monthly Archives</h4> <div class="selector"> <select name="archive_chrono" onchange="goToURL2(this); this.selectedIndex=this.options[0]"> <option class="archiveform_option" value="">Select Month</option> <option value="/2008/02/01">February 2008</option> <option value="/2008/01/02">January 2008</option> <option value="/2007/12/03">December 2007</option> <option value="/2007/11/01">November 2007</option> <option value="/2007/10/01">October 2007</option> <option value="/2007/09/21">September 2007</option> </select> </div></div><div class="side_tool"><h4>What We're Talking About</h4> <div id="categorylist"> <ul> <li class="odd"><a href="https://web.archive.org/web/20080224222815/http://well.blogs.nytimes.com/category/aging-well/">Aging Well</a></li> <li class="even"><a 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