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Terry,
Thanks for the very thoughtful recounting of your take on my question of gleason score and PSA doubling time. Not much rant in there at all.
In my case the PSA went rather smoothly from 3 to 7 over five years, so that's a rather slow doubling. But my Gleason at biopsy (at the end) was a nasty 4+3. And I have sure seen others on this site whose PSA rose more rapidly yet they had a more favorable Gleason. My sense of the missing factor is the environment of the host, meaning ourselves. Our physical health, what we eat and such.
I could suggest that the cancer will mutate at a rather steady rate and thus the Gleason will increase accordingly. But the body chemistry will be good or bad at slowing the expansion of the tumor size. Thinking the tumor size will directly relate to PSA numbers. (More volume of the same thing will correspondingly increase the PSA production.) On that thought basis maybe the younger men who get diagnosed with higher gleason grades yet low PSA's might be a reflection of their very good overall health. The tumor evolves yet isn't able to gain the upper hand against the body's defenses, hence its volume remains low. This is only a proposition, without evidence.
But maybe body chemistry also affects the rate of mutation, the rate of increase in Gleason score? Seems like there should be some info out there about such things. Or some theories getting tested.
Like you it is unconvincing to me that highest grade Gleason tumours would have trouble generating PSA. Just look at the very high PSA numbers that regularly come with advanced cancer.
PS. Watching the live TV coverage of the Australian Open at night here alerts me to the tremendous heat in Melbourne. That seems surprising and distressing.
Yes, it has been very hot here – we usually have these very hot spells in January and February, but they don’t normally last as long as this one – or hit quite the same high temperatures. Of course everyone is pointing to global warming, while us old sceptics, who lived through the ‘global freezing’ scares of the sixties (which was then said to be caused by greenhouse gases!) point out that the last time we hit these temperatures was in 1939, when it was slightly hotter, and in 1908 when it lasted slightly longer – must have been all those Model T Fords, I guess.
It may sound off the subject to bring in a contentious subject like global warming, but to me it illustrates how theories come and go in the scientific world; theories that often overlook some pretty basic information – in the case of global warming the historical cycles of warming and cooling that have no more to do with man’s activities than the tides do – as poor King Canute tried to demonstrate all those years ago – a wise man he was.
The way I look at the issue of PCa in its broadest terms is that it is a natural occurrence and in nature, there is either progression or regression – there is no stasis. At times an occurrence might appear to be static, but that is only because the movement forwards or backwards is so slow that it cannot be identified in the short term. Progression and regression can vary and alternate, depending on the factors that are involved in such movements.
So I agree with you wholeheartedly that the progression of PCa can depend on any number of issues within the host body – which is why I believe so emphatically in maintaining the body and the immune system in the best condition possible – eating well, exercising appropriately, avoiding or dealing with stress etc etc.
There are very few discussions on these issues in the accepted scientific journals although, of course, they are widely discussed in arenas that ‘true scientists’ look down on They are all very difficult to prove, but by searching around it is possible to find material that seems to fit this approach. For example:
Yakovlev A; Boucher K; DiSario J. Modeling insight into spontaneous regression of tumors. Mathematical Biosciences, 1999 Jan 1, 155(1):45-60.
The abstract opens by saying The phenomenon of spontaneous regression of benign and malignant tumors is well documented in the literature and is commonly attributed to the induction of apoptosis or activation of the immune system. We attempt
at evaluating the role of random effects in this phenomenon. To this end, we consider a stochastic model of tumor growth which is descriptive of the fact that tumors are inherently prone to spontaneous regression due to the random nature of their development.
At one stage I used to try to get discussions going on spontaneous regression. They never went very far but it was always interesting to see the classic denial arguments coming to the fore: the initial reaction was that this did not happen – that all cancers progress unstoppably (unless there is direct intervention by accepted scientific procedures, usually physical removal, radiation or chemotherapy ). My response to this was that there were studies that demonstrated that there were recorded cases of cancers regressing spontaneously, and quoting some of them.
The response to that was along the lines that while some cancers (including very dangerous ones like melanoma) might regress spontaneously, PCa didn’t. Again I would quote relevant studies – and point out that with most PCa being treated within a median time of six weeks, the tumour didn’t have much time to regress even if it wanted to. That usually ended the discussion, with no response from the other side.
The problem of course is that it is very difficult to explain how spontaneous remission occurs – and even more dangerously for the medical profession, it undermines their entire raisin d’etre – if people get better without doctors, what would they do?
Here’s another relevant study – sorry they are all so old, but they were current when I was investigating this phenomenon:
Papac RJ.: Spontaneous regression of cancer: possible mechanisms. In Vivo, 1998 Nov-Dec, 12(6):571-8.
Abstract: Spontaneous regression of cancer is reported in virtually all types of human cancer, although the greatest number of cases are reported in patients with neuroblastoma, renal cell carcinoma, malignant melanoma and lymphomas/ leukemias. Study of patients with these diseases has provided most of the data regarding mechanisms of spontaneous regression. Mechanisms proposed for spontaneous regression of human cancer include: immune mediation, tumor inhibition by growth factors and/or cytokines, induction of differentiation, hormonal mediation, elimination of a carcinogen, tumor necrosis and/or angiogenesis inhibition, psychologic factors, apoptosis and epigenetic mechanisms. Clinical observations and laboratory studies
support these concepts to a variable extent. The induction of spontaneous regression may involve multiple mechanisms in some cases although the end result is likely to be either differentiation or cell death. Elucidation of the process of spontaneous regression offers the possibility of improved methods of treating and preventing cancer.
Isn’t it interesting to see that one of the mechanisms proposed for spontaneous regression is “psychologic factors” Hmmm! Can that means that since you can ‘think’ yourself sick, you can ‘think’ yourself well?
Excellent info Terry I might just throw out this spare change (pennies) another parameter on PCa:
There are atleast 18 different variants of PCa's and a few of those are the worst ever, like 'small cell' and others. The prognosis on some of those, rarer PCa's is so ominious that you feel better about yours in comparison (not kidding).
Do you think you uro-doc knows what the heck you got??? He does not until he reads the pathology report and hopefully it was reviewed by the experts whom already have identified that these 18 types exist. The average patho-doc probably could miss on this one big time, it is an art and not pure science.
'PCa-combination of the jungle and Twilight Zone' We need to know how to navigate and get street smart if possible and we can, but it take work and effort to be envolved in your own case as a warrior.
Another thing to throw in the mix: some of the most aggressive PCa's do not give off psa's to measure...i.e. you could have a low psa and be found with highly aggressive PCa, it is a rarer thing to see than normal cases...they exist...usually the pathology will show a huge Gleason score or a bizzare variant type of PCa, not the norm type usually found in the majority of PCa patients.
PCa- full of inconsistencies and land of the bizzare
