Prostate Cancer Survivors

 

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Re: Re: Re: median lobe blockage

G’day Van,

In answer to the specific questions you pose:

What is meant by insignificant tumor? There has long been a recognition among some practitioners that there is a substantial difference between the very dangerous aggressive forms of this disease and the other, more indolent forms, which can be treated more like a chronic disease. Think of the difference between a heart condition where blocked arteries need immediate attention and high blood pressure that can be managed successfully for many years. Some institutes, in an effort to differentiate between the two main strains – the so called pussy cats and tigers started studies and suggested that men with the indolent form of the disease would benefit from keeping a close eye on the potential progression of the disease: they named this process Active Surveillance, although there are other names for the disease. One of the important studies was that the Johns Hopkins Institute where Dr Carter headed the program and, as I recall it was he who defined the term “insignificant tumour” as defined above, as a step towards reducing the number of unnecessary procedures and their unfortunate but inevitable side effects. There are, however other studies being conducted around the world and some of these use different definitions – you can see some of them at REVIEW OF SOME CRITERIA FOR AS


Does that mean it may never cause any problem? Or, that for now it does not pose any problem. Bearing in mind the Golden Rule of PCa as enunciated by the late Aubrey Pilgrim “There Are No Rules”, the short answer is that it is highly unlikely for such a diagnosis to pose a problem in the short term. Just how long that term might be is the subject of the studies, but present indications are that this could be for at least five years (the studies haven’t been running much longer than that). Never is a looooong time, but indeed the theory is that the indolent form of the disease may not progress to an extent that it is life threatening. There is a good article on the subject AS: WHAT ARE THE RESULTS AND HOW SAFE IS IT? which you may like to read if you are interested in this option.

Has there ever been a case where a prostate cancer, after diagnosis, went away? Yes. All tumours have been shown to regress spontaneously. The reported incidence of such regression is very low and the most commonly reported events related to melanoma (skin cancer). The reason for this is pretty obvious – melanoma can be observed more easily than virtually any other cancer. In contrast it is very difficult to diagnose PCa let alone observe and progression/regression. Despite this there are reports of spontaneous regression of PCa in the medical journals.

In considering these issues I believe it is vital to have a clear understanding that there is not one disease that we can label “Prostate Cancer” and expect it to behave in a certain way. There is a multiplicity of variants and of course, as individuals, the way our bodies deal with this invasion by the disease will also vary.

I hope this helps to gain a little more understanding of some of the complexities.

All the best

Terry in Australia (signing off until lunch time as the cricket is about to start)

Re: Re: median lobe blockage

I believe my doctor called the cancer finding incidental. I forgot to ask him what he meant by that. He did suggest Da Vinci surgery however, and that I did not need to rush into a descision.

van

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Replying to:

Radiation therapy is contra-indicated where there are urinary issues such as those you describe.

From what you have said you have what is termed an insignifcant tumour defined as being:
1. Nonpalpable
2. Stage T1c
3. Percent free PSA 15 or greater
4. Gleason less than 7
5. Less than three needle cores with none greater than 50% tumour.

As such you may wish to consider Active Surveillance


All the best

Terry in Australia

Re: Re: Re: median lobe blockage

The term 'incidental' used here means essentially that your diagnosis came about because of your elevated PSA or some other issue, other than a symptom related to PCa - see Stage 1 at STAGING OF PROSTATE CANCER

All the best

Terry in Australia

Re: median lobe blockage

Your diagnosis sounds similar to mine (see my story under cryo). You may have other treatment options.

Focal cryo has improved my urinary function, especially my nocturia.

Re: median lobe blockage

William, my original pre-op pathology was a bit like yours and my post op pathology confirmed it. I have a new uro now who thinks my situation was one where I could easily have watched and waited. So please listen to Terry and carefully weigh up that option before you act too quickly. I wish I had.

But the reason for me replying, as well as to say that, is that alarm bells rang when you said you have this median lobe obstruction. I have no clue what a median lobe obstruction is, but my own Da Vinci procedure was ruined because I had a previous TURP which left scar tissue that made it impossible for my highly experienced surgeon to remove the whole prostate.

What I am saying to you is to thoroughly check with your surgeon AND get a second opinion, as to how confident they are that when they do a Da Vinci, that your other "complication" will not cause them to "lose their landmarks" which is what mine told me happened to him in my case.

Also check with him that after doing so many with the robot, that he is confident that he can still switch to "manual" if he can't see clearly round the obstruction you have. The consequences of them shooting in the dark can be awful.

I may getting to be a bit of a bore on this topic, but I urge anyone who has any other conditions which might complicate the surgery to quiz the Da Vinci guys VERY thoroughly, to be sure they can handle it, as well as they can the relatively straightforward jobs.

Ted from England

Re: Re: median lobe blockage

Ted,

Thanks for the info. I did talk to one of the urologist about the obstruction and he acted as if there would be no problem during the Da Vinci surgery. If it were not for this obstruction I would consider radiation. Thanks again.

Van

--- --- --- --- --- --- --- --- ---

Replying to:

William, my original pre-op pathology was a bit like yours and my post op pathology confirmed it. I have a new uro now who thinks my situation was one where I could easily have watched and waited. So please listen to Terry and carefully weigh up that option before you act too quickly. I wish I had.

But the reason for me replying, as well as to say that, is that alarm bells rang when you said you have this median lobe obstruction. I have no clue what a median lobe obstruction is, but my own Da Vinci procedure was ruined because I had a previous TURP which left scar tissue that made it impossible for my highly experienced surgeon to remove the whole prostate.

What I am saying to you is to thoroughly check with your surgeon AND get a second opinion, as to how confident they are that when they do a Da Vinci, that your other "complication" will not cause them to "lose their landmarks" which is what mine told me happened to him in my case.

Also check with him that after doing so many with the robot, that he is confident that he can still switch to "manual" if he can't see clearly round the obstruction you have. The consequences of them shooting in the dark can be awful.

I may getting to be a bit of a bore on this topic, but I urge anyone who has any other conditions which might complicate the surgery to quiz the Da Vinci guys VERY thoroughly, to be sure they can handle it, as well as they can the relatively straightforward jobs.

Ted from England

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