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I guess I was just wondering Terry if an extra 6 months would be important if salvage radiation is eventually required. My son gave me a copy of Dr. Peter Scardino's book entitled 'Prostate Book' for Christmas ( unusual gift ). Dr. Scardino is Chairman of Urology at Memorial Sloan-Kettering Cancer Center. On page 241 it mentioned that " Virtually all cancers large enough to be detected on Biopsy constantly shed cells into the bloodstream and lymphatic system." That is the first time I had heard that particular theory but coming from someone of his background it captured my interest. That same page discussed a watchful waiting group that was monitored there with rather encouraging results. Enjoy your get away Terry. Thanks for what you do for us all.
One of the memorable quotes attributed to Dr Scardino was in the Wall Street Journal some years back when he said that about 30% of the prostates removed at Sloan Kettering showed either no sign of prostate cancer (despite the positive biopsies) or only an insignificant amount that would never threaten the man’s life. He also had this to say on another occasion:
Thanks to regular PSA screening, we're diagnosing more prostate cancers these days. Many of these are very small; some are so early that it's reasonable to look on them not as actual cancers but as histological indicators that early malignant changes are going on. What we have then is a problem with language; we call these areas ‘cancers,' and it scares people to death. As a result, many men want aggressive treatment when the benefits would actually be extremely small.
Radical surgery and radiation are great forms of treatment if a patient has prostate cancer that's posing a threat to his health. But for tiny, early cancer, you are trading your worry about a lesion that may never become a problem for the immediate complications of surgery or radiation. It's important to remember that even the best, most modern techniques of brachytherapy cause about 50% of men to become impotent over five years; radiation can also cause radiation proctitis, strictures, and long-term bowel problems. People also underestimate the morbidity factor of surgery.
Was Scardino perhaps discussing the issue of potential spread after biopsy in the chapter to which you refer (I haven’t read his book). Studies show that the biopsy releases cancer cells into the bloodstream but there is no evidence that these cells ‘take up residence and grow’ – they are dealt with by the immune system. But of course it is unlikely that you will have any such cells being shed if your prostate has been removed.
My personal view is that six months ‘head start’ wouldn’t make any real difference to the outcome if you had 12 monthly tests instead of six monthly tests, but, as I said, you should do what you feel happy with, not what I feel happy with – or anyone else. We’re all different, physically and mentally, and all our diseases are variants. The Golden Rule of Prostate Cancer - There Are No Rules.
Good luck
All the best
Prostate men need enlightening, not frightening
Terry Herbert - diagnosed in 1996 and still going strong
It was from the chapter on 'watchful waiting' Terry. He went on to say that from a study of 84 patients at Memorial Sloan-Kettering Cancer Center on watchful waiting " on average" they lost only 1% a year probability of their cancers remaining curable. Results varied of course. Small study yet sounds like a positive one for the option of watchful waiting to me - but you would be able to better guage this than myself. This book is the best I've ever read on this topic of Prostate cancer as he takes the time to explain things in such a way that non medical people can better grasp.
