To Our Members:

I have just returned from my 56th high school reunion in Wynne, AR.  I had an interesting discussion with our class president, and I was able to suggest some things he needed to discuss with his doctor and why.  I hope this helped.  All of you members have this opportunity from time to time, and I know you welcome the instruction you get in the meetings to aid you in this regard. 

One area of cancer in general and prostate cancer in particular is stress.  Most doctors are not prepared to discuss stress and probably think they are not qualified to give a great deal of advice on the subject.  As a result, our May meeting will feature a doctor (PhD) who will give us some tips on how to handle our cancer and everyday living stress.  I know he will be a help to you.

See you at the May meeting.  Jerry Bylander

"My Cancer Preys on My Mind: How to Manage Newly Diagnosed, Post-Therapy, or Metastatic Prostate Cancer Stress"

Date:  Third Tuesday Evening, May 17, 2005
Time:  6:30 pm - Social & Coffee  7:00 pm - Program
Location:  Senior Center, Wilson N. Jones North Campus,
South Entrance, 3305 Calais Drive, Sherman, Texas

Speaker:  Dr. Robin McGirk, 2007 Texoma Parkway, Sherman, TX 

Program:  Dr. McGirk will discuss the nature of stress, sleep improvement, stress reduction techniques, and some nutritional therapies for stress.  He will also address your specific concerns.

About the Speaker:  Dr. McGirk is a member of a nationally-registered health service provider among other affiliations.  He has been in practice in Sherman since 1987 and has practiced in a variety of specializations.

Special Note: Two studies (one reportedly at Stanford) have shown members of a support group live longer and have a better quality of life.  Invite three people.
 

Topic:  Newly Diagnosed Prostate Cancer

Speaker:  Dr. Steven Johnson, Board Certified Urologist, Past President, Texas Urology Society.  Texoma Urology Associates, offices in Sherman and  Denison
 
Program:   Dr. Johnson discussed how a diagnosis based on PSA elevation, DRE, and your biopsy's Gleason score, leads to the choice of therapy.  He separated the patients into two categories, with a grey area between.  He showed that one category would likely be based on low Gleason, DRE, and Parton scores.

The meeting adjourned about 8:15 PM.

Jerry Bylander

Material posted here is intended for educational purposes only and must not be considered a substitute for informed medical advice from your own physician.

A case study of how to select a treatment

Henri has found that there is more to selecting radiation or surgery for a PC therapy than we have been considering.  He has visited Dr. Strum's web site www.prostatepointers.org and summarizes his findings as:  This digest is one that I find to be a  benchmark for understanding the reality of PC of a newly-diagnosed man.  First this man's original physician opinion is that he has 71%  organ-confined disease.  After Dr. Strum does the biology and really understands this man's case, the odds are nearly 50/50, which changes the whole case scenario of treatment this man should now start investigating.  This is where I want to start discussing what factors to consider in deciding upon a treatment option.

Henry Puckett.
Make an appointment for a one-on-one discussion with Henri at Hair by Henri in Denison.  henrylee@sysmatrix.com

Case summary from Dr. Strum's summary

Dr. Strum starts by noting that for men with PC "is they are asked to select a PROCEDURE or THERAPY but"...they must first understand their "STATUS prior to the decision making".  He emphasizes that one must logically define the status of the PC before deciding on a therapy.  He then tells his questioner that to decide between radical prostatectomy (RP) and seed implantation, "one must ask first what is your STATUS."

He then estimates the PSA doubling time (PSADT) to be more than "2 years so that there is no need to be
concerned about a very short PSADT that would be consistent with systemic PC."  He then considers the Gleason Grade (GG) Scores.  He argues that although the GG scores are in the 3+4 and 4+3 range that, using the size of the cores relative to the prostate size, the PSA contribution from the cancer (leakage) relative to the gland must be calculated.  And he recommends his book, A Primer on Prostate Cancer, The Empowered Patient's Guide (get it from Amazon.com).  One uses leakage to estimate the probability of recurrence following RP.  He then develops scenarios to estimate the five-year recurrence probability for each possible procedure.

He then calculates these probabilities:

Given your PSA, GS, CS, and using the Baylor nomogram, you have a chance for the following:

OCD (organ confined disease) 49%
CP (capsular penetration) 40%
SV (seminal vesicle involvement) 8%
LN (lymph node involvement) 3%

"Therefore, you have a serious issue with possible ECE (extra-capsular extension), and if you use the Freedland abstract shown above, I would guestimate that you have a significant chance of PSA recurrence post RP".  (Ed: I conclude he means you won't be cured and it is likely that the cancer will continue to grow.)  In the Baylor nomogram, the RP projected results, however, at 5 years are 83% freedom from PSA relapse with a range from 73-93%.

The Baylor nomogram would also have you at 5 years post brachy at 83% with a range of 53-88%. 

However, External Beam RT (3D conformal or IMRT) would predict 93% with range of 83-100%.  This most likely is related to the broader field of coverage of the RT & the ability to eradicate PC in those men who actually had ECE.  You should see the logic of this.

The bottom line is that your STATUS needs to be further refined before you consider either STRATEGY.

I expect that most physicians would not find the probabilities for the various therapies to be different enough to worry about the need to calculate them.  And brachy with the wider range of possible outcomes doesn't seem to be the therapy of choice anymore.

"Tests that could be of help to you include:

1. PAP (Prostatic Acid Phosphatase) since if above 3.0 greater risk of failure after RP or SI.
2. Endorectal MRI with spectroscopy or without spectroscopy to exclude ECE.
3. Thymosin Beta 15 immunostain on the biopsy tissue. Exciting but not yet commercially available.  You could check with Dianon to see if they could do this for you.
4. Additional lab testing of markers of tumor de-differentiation such as CEA, CGA, NSE.
5. Full nomogram evaluation: call PCRI at 310-743-2110 to get assistance regarding software for this."

Local physicians generally will not be willing to do the above tests.  Also one should note that no matter how many tests you have done, none of them will cure your cancer.  The advantage of various tests is to narrow down the treatment options.

I think that the source of the above can be found at www.prostatepointers.org.

Jerry Bylander, Editor