Question about prostate cancer (long)

[accuratehorn]

The thread about cancer prognosis made me think, because I have a relative and a friend diagnosed with prostate cancer.
The relative did not have surgery, engaged in some vitamin and supplement self treatments, and his PSA (which I don't understand exactly) went down for a few years.
Now his count is back up, but he is over 80 and his doctor says not to do anything about it because prostate cancer is so slow-growing that most people die of something else before it becomes really bad
My friend is younger, although over 60, had prostate surgery, and his doctor said there is still more cancer, and recommends radiation and chemotherapy, and that his cancer is fatal. He is engaging in a self administered vitamin and supplement treatment, thinking he will beat the disease this way. His PSA went down for some months, but is now back up again. He had a tough time bouncing back from the surgery, but now can ride his bike over 60 miles at a time.
The other thread made me realize that the radiation and other treatments may be much improved and survivable than they used to be, and maybe I should encourage one or both of these guys to try them?
Does anyone have specific knowledge of the treatments and chances of success regarding prostate cancer?
What is PSA, and why does it go up and down like it does? Does it really mean anything?
I'm thinking of my fear of back surgery, and I suffered pain with a disc problem that impinged on a nerve for three years, then had a micro surgery one day, and left a couple of hours later pain free.
We don't always know how much advancement has been made in medical techniques, and may delay treatment due to outdated knowledge about problems resulting from various treatments.

 

[orangecat]

I don't know, but your friend is lucky. My dad, in excellent health his entire life, developed prostate cancer, had the operation, did all of the kegel exercises, etc. and has never regained control. He is still very active, carries diapers every where he goes. He doesn't appear to be bitter, just goes on with life.

I know if I'm going that way, I will not do the surgery.

I will investigate the bead thing.

 

[Summerof79]

My dad had it a few years back, and he used a tchnique they were just pioneering at the time. Basically radiation "seed" implants placed into the prostate. It is less invasive than the normal surgery and the seeds have a short half life so the radiaiton dose is very targeted and brief. For him it worked out well. Took a while to get back. His biggest problem was thinking he was OK enough to take out his catheter and then being unable to urinate.

Not really sure what the PSA measures though my dad's was higher than most because his prostate is apparently larger than average. past that I don't know a whole lot.

 

[WithoutAClue]

PSA = Prostate Specific Antigen

the higher the number, the more advanced the cancer will be.
currently, surgery, radiation and chemo-therapy are the only
FDA approved therapies.

there are a couple of new therapies in testing but probably will not
be available for 1-5 years. and the current chemo companies/doctors
are fighting hard to defend their turf against the new therapies.

 

[accuratehorn]

So maybe I should say nothing, and let them choose their own paths. I didn't know if this was one area where there were new advanced treatments.

 

[Perham1]

In reply to:

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[DallasCMD]

I do treatment planning at a radiation oncology facility here in Dallas. Most of what I do involves giving external radiation to patients with all types of cancer. For prostate cancer, the radiation oncologist outlines the area at risk (prostate / seminal vesicles) on a "cat" scan (done on a computer), hands it off to me, and basically says I want to give "x" amount of radiation to this, avoid giving the rectum / bladder / penile bulb as much radiation as possible.

External radiation is the "IMRT" method that is painless, 15 minutes a day, for 43 treatments as a primary therapy. Yes, this delivery is much different than the "Cobalt - 60" radiation given from about 1950-1990. The drawback here is the commitment for 2 months to come everyday for treatment. Normal everyday activity is not affected from the get go, although some patients (low) can get temporary diarrhea or incontinence towards the end of treatment. In your friends' cases, the regimen might be different for cancer that has recurred or is at an advanced stage. More likely a shorter course of therapy with a higher daily dose.

Prostate seed implants are a one time deal that involves sticking needles through the perineum ("taint") into the prostate. Now, this is a pretty big deal, and there is some recovery from having 15-20 needles shoved through that area. And the target coverage with seeds is dependent on the skill level of the radiation oncologist doing the procedure. There is also the risk of general anesthesia.

Here is a link to an article about age related treatment options from Fox Chase in Philadelphia that was published in the Cancer journal:

Link

It was long thought that surgery should be the gold standard for young patients (<60 yrs) and radiation be used if the cancer recurred. With what we know now about the long term effects of radiation to the pelvis, more and more doctors are recommending radiation because the chances of long term incontinence / impotency are greatly reduced with radiation and modern techniques. Damage to normal tissues and the accompanying side effects are negligible at best.

By the way, chemotherapy for prostate cancer patients is androgen (male hormone) deprovation. No hair loss, sickness, etc.

Whatever your friends decide to do, get advice from a physician that they feel they can trust. Natural supplements are just that, supplements for a healthy body. They do nothing to the cancer cells themselves but can help greatly in the healing process.

 

[accuratehorn]

Thank you for the thoughtful response, Dallas CMD. I will read the material you linked. Maybe I can get my friend and relative to read some more about it, as well, although they may not take any well-meaning advice.

 

[Uninformed]

I found it interesting, but I have heard that prostate surgery is more difficult (skill-wise) than CABG (coronary bypass).

I could go through the history of prostate cancer markers, but it would be easier for you to look it up. I'm sure wiki has something. I can tell you that I've analyzed what appear on the surface to be better prostate cancer markers but I don't know where they are in development.

In general PSA is not a great marker and there is a lot of room for improvement. If you want to read an abstract on the positive predictive value of PSA, see below.The Link

 

[accuratehorn]

I still don't know what PSA is exactly, and why it seems to go up and down over long periods of time. These two guys take their nutritional supplements, and the PSA goes down for months or years, and they believe they have cured themselves. Then one day the PSA is way up and it indicates the cancer is there still.
Why doesn't it always read an alarming number if you have the cancer?
It would appear the bottom line is that one guy is doing nothing, and his PSA is up, and has been told he can do nothing, and might get away with it.
The other guy had the radical prostatectomy, and his PSA is up, and has been told he needs radiation treatments.
All this doesn't make sense.
I read the links you guys provided, and learned something. I will try to read up some more by googling.
It does sound like the radiation technique is quite different than is used to be.

 

[Uninformed]

The national cancer institute gives some information.
The Link

Let me know if you want something more technical. I could write it up (which I don't feel like doing) or I can give you some technical journal review articles to read.

 

[accuratehorn]

That's a great link, uninformed-I printed it out to show my friend and relative, although they may already have the information from their doctors. I now see the limitations of PSA testing, and that is naturally rises and falls.
It would appear that prostate cancer is difficult to diagnose, difficult to decide when to do a biopsy, and then difficult to decide whether to undergo either the surgery or other therapies. Some forms are very slow growing, but others are agressive and spread rapidly. I think my relative has the former, and my friend the latter.