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Re: hormone therapy and braccy therapy

John,

Before responding to your specific questions I have to say I was puzzled by your statement:

…. going for radiation next month i assume ill have brachy therapy w/ ext beam radiation….

It seems that you are not aware of what therapy you are having. The combination of Brachytherapy with EBRT (External Beam Radiation), whilst not unknown is not the most common of therapies and not even the most common of radiation therapies. So the assumption that you will have this therapy may not be correct. I believe it is very important to understand what therapy you are being sent for and why this is considered better than all other therapies or, indeed, as Lorenzo Squarf suggests, not doing anything.

It is also a puzzle as to why you have had ADT (Androgen Deprivation Therapy), given the diagnosis you gave us in your last post:

I believe im t1c gls score 6 psa under 10 3 spots of cancer out of 12 cores one spot is 100 per cent other 2 spots 6 an 8 per cent respective ly cancer cant be felt boswick lab says it getting magressive.

On the face of it, that would not point to ADT as an initial therapy. I am not sure if you have sought, or wanted, a second opinion, but were I in your position I’d be cancelling the proposed therapy, whatever it is, and seeking other views.

Based on your posts, my opinion (a layman’s one, but based on all I have learned in the past 16 years) is that you are about to join the 1.2 million US men who are estimated to have been over-treated.

I have not read the piece in Science Daily suggesting that men over 70 who had hormone therapy before brachytherapy have a 20 pc chance of premature death. It is important to understand that

1. these summaries of studies in the media often do not reflect accurately what the original study actually found
2. the studies themselves are usually hedged with ‘it appears’ and ‘maybes’ and ‘further work is needed to verify’. That is because science advances by testing and retesting theories until they are proved or disproved. The media ignores these qualifications in favour of dramatic headlines and stories.
3. a substantial number of studies are just plain wrong with the data cherry picked to demonstrate the importance of a project that requires further funding
4. it is also important to understand what the terms used in the study mean as they can change. For example, just what does ‘premature death’ mean. Given that there is no possible way of knowing when anyone is scheduled by the Fates to die, how on earth can any death aid to be premature? This phrase can only refer to an estimated life expectancy being matched against another estimated life expectancy with no knowledge as to how accurate either is
5. even if none of the above points apply, it is important to look at the precise details of the cohort of men in the study to see what the match was between their diagnoses and your diagnosis – and then
6. to understand that all studies report on the median numbers. So, if this study says what you say it does, it means that the median survival time of the men in the study (who may or may not have diagnosis matching yours) is lower than the median survival time of a similar group of men. But, of course, there will be a range of survival times within the study. Half of the men will have died earlier than the median survival time and half will have survived longer – because the median states the middle of a series of numbers.

It is important then to ascertain how long the survivors lived and what factors influence the survival of those over the median. My guess is that they might have had a diagnosis similar to yours, which appears not to be life threatening in the short term, while those who failed to reach the median had more aggressive forms of the disease.

Hope this is not too complicated, but I felt yo deserved a full answer since clearly your medical advisors are not giving you information that you need to understand.

All the best no matter what path you choose,

Terry in Australia

Re: hormone therapy and braccy therapy

the reason for lupron shot that igo and two shots of firmagon was to reduce my prostate for radiation but as you see i have second thoughts about it i really thank you for your wisdom im now thinking to go for ww i did get a second opinion and ww was his advice what botheers me is the boswick report said it was getting agressive so you see where i stand thanks for all the good work you are dioing god bless john q

Re: hormone therapy and braccy therapy

Glad to have helped in some way John.

Do you know why Bostwick made the comment about a move towards aggression? Was there any note in your biopsy report that allude to a specific issue? Usually a signficant change in Gleason Scores between two biopsies might be regarded as a developing aggression if the second is higher (although oddly enough no one accepts that a lower Gleason Score in the second is evidence of reression) but that would normally be the only indicator since Gleason Score is really the only indicator of aggression that we have.

Good luck and let us know how you go.


All the best

Terry in Australia

Re: hormone therapy and braccy therapy

Hi john q,

While I can see that Terry has done a good job of persuading you to re-think treatment based on your circumstances, I am going to add to his voice to show you that even doctors that are pro-treatment in arguably too many cases, believe that treatment is not the right way to go for someone your age. More specifically, what follows is a direct quote from Dr. Patrick Walsh’s "Guide to Surviving Prostate Cancer”. (Note: it refers to a man in his 80s, but I figure at age 79 you are close enough for it to apply to you as well. In fact, the rule of thumb, if you will, for Dr. Walsh is that you don't need treatment if you "are too old or too ill either to undergo the rigors of treatment or to live another 10 years").

"Even if his cancer is organ-confined and curable, it's not likely that he will live long enough for aggressive treatment to be worthwhile. Older men are less resilient; as we mentioned before, aggressive treatment is much harder on them. What's the point of risking incontinence, a result of surgery, or rectal bleeding, a result of radiation, in an 85-year-old man? If his disease progresses to the point where he has difficulty with urination, there are many ways to treat such symptoms, ranging from a transurethral resection of the prostate (TUR) to hormonal therapy. For most older men, the number of years of life –the long-term survival – is not nearly as important as the life in those years – the quality of life". (

Okay it's back to me now. Like Terry, I would be interested to know what Bostwick saw to make them think that a Gleason 6 T1c cancer was getting aggressive. While it is true that a 100% core and 3 cancerous cores out of 12 is considered a lot of cancer, it doesn't change the fact that Gleason 6 is considered to be non-aggressive. Also, while the amount of cancer you have is outside of recommended active surveillance guidelines, that really doesn't matter in your case because of your age. Another way to look at it is this. Unless you have a family history of relatives living well into their 90s with their mental faculties intact and normal urinary and bowel functions, then seeking treatment is going to do you more harm than good.

BTW, if you're still not content with doing nothing, and want to know if your cancer is truly getting aggressive, then I recommend a CDU (Color Doppler Ultrasound) with a targeted biopsy (Dr. Bahn in Ventura California is the physician that I went to see for this procedure). You can learn more about it on his website: pioa.org. The bottom line is that since he can see the tumor, he can inject a needle directly into it and that allows him to get what is regarded as a more accurate Gleason score.

I hope this helps, and that you have many quality years ahead of you. Good luck.

Alan M in the USA

Re: hormone therapy and braccy therapy

thanks for your input i cant say advice but ill use it anyway i emailed boswick to explain why they considered or my uro considered agressive the y are to get back to me hopefully monday and ill let you mall know thanks to you and all my other friends for your love and patience john q

Re: hormone therapy and braccy therapy

If I could add a few more points to what others have said. G6 cancers are not aggressive. They rarely matastize and the 20 year death rate for untreated g6 is about 5%. G6 cancers have a built in DNA that makes them a G6. G6s don't mature to a higher grade, any higher grade are due to new tumors, not G6s changing; a G6 cannot get more aggressive, it is what it is.
Any doctor that treated a 79 year old for a newly Dxed G6 should be prosecuted for malpractice.
You should definately get a second opinion from a respected doctor that specializes in prostate cancer and cancel your treatments until you have had a chance to learn more about your situation.

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