statpearls.com/ArticleLibra...
Pre-biopsy, newly diagnosed, and advanced !
IMO very good comprehensive guide to ... - Advanced Prostate...
IMO very good comprehensive guide to all things PCa...for Docs, Nurses, students....and patients?? Seems current !
Written by
maley2711
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28 Replies
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Thanks!
You're welcome..... very good coverage of most things PCa....of course without the detail you might find in specific studies
Nice overview, yes; but perhaps non-professionals should be cautioned as to some of the conclusions regarding appropriate treatments. Some appear to be more from observational than RCT based studies.Ex., prostatecancer.news/2019/11...
Otherwise seems to offer much solid information regarding terminology and standards related to diagnosis and grading of progression, e.g., explaining Gleason scoring.
Thanks for sharing it here.
Agree.
Why not just tell us what you mean by " some" ? Instead, the reader must go to another source to see what you are talking about....apparently the overview I linked does not agree with RCTs for use of metformin? Perhaps you should inform the students who are apparently reading this?
I’d expect their professors are well equipped to convey all the specifics regarding best practices for SOC treatment of patients.
Meant no disrespect to you and appreciated your generosity in sharing this, even though I consider some of the treatment recommendations contained therein questionable relative to On Label SOC practices. I better understand some particulars about PCa after reading it; but also think it important to point out that Off Label use of medications isn’t generally validated as best practice for SOC.
RCTs are what bring validation to the SOC protocols overwhelming practiced by medical professionals. I think when patients, in particular, don’t understand that and also see conflicting information presented in a thesis such as this it can create unnecessary confusion and sometimes even distrust in the Dr. and Patient relationship. In either case unnecessary suffering can occur as a result, and that’s something I think everyone who comes to this forum seeks to avoid.
A thesis...gee, I missed that. Should I then remove the link?????? Maybe you can publish your own guide!!
again, my question to you was..... Why not just tell us what you mean by " some" ? Instead, the reader must go to another source to see what you are talking about..
Not finished reading but already YES this is a must for all of us. Really well written, thanks for posting.
I'm really sad though on the family history. I have 2 sons. I've done the Color saliva test and nothing found like BRCA but family history seems very significant (I'm adopted so no history). The medics and pharma I pray can find away to stop spread in those in a high risk group.
This is an excellent summary of information all pCa patients should read. BUT it contains no mention of bilateral orchiectomy as a very effective treatment for MPCa with fewer cardiac issues and osteoporosis associated with hormone therapy. Speaking from personal experience I would like to see this treatment used more widely. After my orchiectomy 18 months ago I took 1 1/2 days off work and have had no follow up treatments or medications since. And recent scans show no new cancer activity-- in fact significant shrinkage of both the cancerous prostate and lymph node.
Would you happen to have a link to a study showing better results with physical castration? I'm surmising that you previously were a chemical castration patient? what you are saying is that low T is not a cause of bone density reduction?
A study several years ago showed a lower rate of bone density loss with orchiectomy.
jamanetwork.com/journals/ja...
Personally, I chose the procedure after test results (PSA 246, Gleason 9-10 on all cores) showed the need for immediate treatment. Others on this site have taken this route after hormone therapy failed but to me it seemed reasonable to go with orchiectomy as a first step. My point in commenting was to note that orchiectomy is a viable option which should not be ignored.
agree....thanks for the link.....do you receive T boosts/shots??
No T shots--no treatment at all since the orchiectomy.
Low T consequnces QOL-wise?
None so far. I may have lost a bit of strength but not much more than I would expect with normal aging. I still do long bicycle rides and have plenty of stamina.
Dis you do other types of ADT before ochi? If so, SEs compared to ochi?? yes, I think always a possibility to blame any type of ADT for SE problems....when actually aging may be the main culprit...dammit!!
No, my only MPCa treatment has been the bilateral orchiectomy almost 18 months ago. Would I have had the same results with other procedures? Maybe. But I have spent one day in the hospital--as an outpatient--being treated for MPCa. That is not a claim that can be made for any other treatment.
But, yeah, age catches up with us all.
congrats, and best wishes that you continue to beat back the beast. Was your Doc checking , or advising that you have checked, your PSA in years prior to diagnosis? some folks are blaming the task force for increased metastatic cases.
Thanks. I had not had a physical in years so the first PSA check was shortly before the orchiectomy. Because of COVID I delayed going to the doctor for about a year after prostate issues began to be a problem. It seemed prudent to stay away from medical facilities in the early days of the pandemic.
yes agree...but we should have a system that reminds patients of such simple, cheap tests and the poteential benefit and the risk of not having such tests...that would be true healthcare...as it is now, the fall back is blaming the patient for not being prudent and informed. ...sucks IMHO.
Hope I'm not censored for that comment....currently being censored for another one.
This article highlighted my pet peeve about the USPSTF, namely that because they discouraged routine PSA screenings more men are turning up with advanced disease!
"Effect of the 2012 United States Preventive Services Task Force (USPSTF) Negative Recommendation on Routine PSA Screening
Since the USPSTF recommendation against routine PSA screenings in 2012, there have been a number of consistent changes in the clinical and pathological characteristics of prostate cancer, as reported in August 2018. These findings include the following:[91]
Drop in the diagnosed incidence of low-grade prostate cancer. Low-grade disease (Gleason 3+3=6 or lower) dropped from 30.1% before 2012 to 17.1%.
An increase in intermediate and high-grade disease; High-grade disease (Gleason 4+4=8 or higher) increased from 6.2% before 2012 to 17.5%.
24% increase in the number of patients identified with PSA levels over 10 ng/ml from 8.5% before 2012 to 13.2% after.
Patients identified with PSA levels over 20 ng/ml increased 44% overall, from 2.4% before 2012 to 4.2% after.
The incidence of seminal vesicle invasion, lymph node involvement, and positive surgical margins also increased after 2012.
In particular, the incidence of lymph node involvement more than doubled after 2012 to 7.5%.
These findings are not unexpected given the reduced number of PSA screenings and the adoption of active surveillance regimens for lower-risk cancers. "
maley2711 in reply to
I know that the current task force guidelines advise Docs to discuss the pros and cons of the PSA test. Many false positives leading to negative biopsies is a big one. I have read the task force report, and it listed in detail those pros and cons. Do Docs actually follow task force advice? that is another question!! Mine mentioned the test...little discussion......and I decided to have or not. I had previously read several articles about the pros and cons...I suppose most men haven't? We could CT scan all persons of a certain age and then biopsy all with nodules which might be lung cancer...but we don't !! My post-PCa diagnosis CT scan found lung nodules..... I have procrastinated on following up with quarterly chest scans !!! From DEXA scan, learned I have generated spine !! CT found 2 hernias, which didn't surprise me...doing nothing!! Continue to go about life until something truly stops me!!
in reply to maley2711
You can debate it but the statistics speak for themselves. Over-screening isn't the problem. Over-treating is. What the USPSTF did in suggesting relaxed screening was wrong and tragic for many men. It is a failure of the system when someone isn't diagnosed until symptomatic; he wasn't screened at all. I'm surprised that the insurance companies don't demand more comprehensive screening. Are they not allowed to require that?
maley2711 in reply to
so, you also want routine CT scans for all adults....for lung cancer,etc?
I simply disagree...no problem with advising that the GP discuss the test with patients... I want to know pros and cons for every treatment, test, drug that impacts me!! And nothing prevents the Doc from expressing his/her belief that the test should not be avoided.... in this age of malpractice concerns, see little positive for the Doc advising against the test !!
in reply to maley2711
We are talking inexpensive and readily available PSA testing, not more elaborate CT scans. So riddle me this: why do so many men / doctors avoid or decline PSA screening tests, with the net result that men are showing up with more advanced prostate cancer?
maley2711 in reply to
False positives .......fear of bad news(patients.not Docs)..... fear of biopsy.......we'd need to do a study for an accurate answer !! My opinion is just that!! as is yours!! Read the actual task force comprehensive report to understand how they arrived at their guidance......those folks not just a bunch of dummies!! Of course many urologists objected....but not exactly unbiased practitioners. I believe I passed on the test at least once....and I have not routinely visited a GP for annual checkups!! I was tested at 64.....PSA 4.1, which was below Kaiser's 4.5 guideline...then at 70, testing 7.5...just above Kaiser's 6.5 for age 70+.
You and I are individually statistical studies of one...task force of course reviews population studies of BIG numbers of men.....science.
I read the whole article which requires a bit of a commitment. But one I would very much recommend. It covers everything very well and matches the info my MO just gave me this week in a long telemedicine conference. Maley2711 - thank you very much.
Thanks you !! IMHO, something like that should be given to every man diagnosed...perhaps even evry man who is advised to have biopsy,etc. maybe evry man who reached 50?? with internet, almost a no-cost deal!!
