Prostate Cancer

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Spider Savage

Mountain climber
The shaggy fringe of Los Angeles
Apr 24, 2014 - 08:49pm PT
Be sure to get the 2nd test. Maybe not now but ten or so years ago they were pulling prostrates at the first test.

If were mine, I'd get three, from different institutions.


BEST of LUCK to you. I hope this goes well in your favor.


SC seagoat

Trad climber
Santa Cruz CA
Apr 24, 2014 - 08:51pm PT
Stay on top of it. Cancer treatments are growing by leaps and bounds in their effectiveness and side effect management.

Susan
stevep

Boulder climber
Salt Lake, UT
Apr 24, 2014 - 11:38pm PT
Yes, find a urologist in your area and get a second test. Most prostate cancers are very slow growing, and side effects of treatment might end being worse than doing nothing.
jstan

climber
Apr 25, 2014 - 12:38am PT
pulling prostrates

Hmmm.

Freudian.

Definitely Freudian.
GLee

Social climber
MSO
Apr 25, 2014 - 02:42pm PT
Check your email.....
donini

Trad climber
Ouray, Colorado
Apr 25, 2014 - 02:58pm PT
I was treated for prostate cancer a year ago. I had the type of non-aggressive cancer that gave me options....treat it or monitor it. After a year of monitoring, including two biopsies, I decided to be more aggressive. I thoroughly researched the options: surgery, and two types of radiation. After much deliberation I chose to have radioactive seeds implanted at The Huntsman Cancer Center in SLC. Best choice I ever made.
My physician was Dr. Jonathan Tward. He took an hour to personally explain the options based on the very latest research. Tward has a PHD in addition to his Medical Degree and his intelligence shines through. The Huntsman Center has a culture where everybody from the receptionist to your doctor makes YOU feel special....not the case in most hospitals.
My latest PSA was 0.6 and I have had very few side effects. I heartily recommend Dr. Tward and the Huntsman Cancer Center.
zBrown

Ice climber
Brujo de la Playa
Apr 25, 2014 - 03:25pm PT
Always forthcoming and straightforward, Donini. Thanks.

I know one other person who went with the seeds Jim mentioned and was very pleased with the result.

There are other treatments that I have not seen mentioned here, cryotherapy and proton therapy.
Seamstress

Trad climber
Yacolt, WA
Apr 25, 2014 - 04:09pm PT
Best wishes. Be an intelligent collaborator in your treatment.

I have been working with my dad and his prostate cancer. The cure has been difficult, and I wish that he had made better use of his borrowed time.

Dad's prostate was removed 13 years ago, and they followed up with radioactive seeds. This was not positioned optimally or he was fragile. In any case, he ended up with severe urinary incontinence. They attempted several surgeries to fix that. None of it worked well. Now he has a permanent bag.

He suffered from lack of energy due to no testosterone. They prescribed a cream. He was not a compliant user, used less and less because it wasn't working (in all actuality it was because he was failing to take enough). Thus began the injections to ensure that he got enough testosterone and had energy. This worked for awhile - until the cancer recurred. Now it has spread to his spine. He is in a new immuniological therapy to slow the growth of those tumors. At this point, the prognosis is for 28 months of life, though not all high quality as the disease progresses in his spine.

Overtreatment can be a problem. I don't think Dad was overtreated, but I do think that perhaps a more skilled surgeon could have reduced the frustrating years and painful surgerues which failed to address his plumbing issues. He has lived a long time with this disease, and some of that time we thought that the cancer was gone. It must be tough to live a life trying to squeeze out as much joy as possible while also being very vigilent.
colasanti

Trad climber
Denver, CO
Apr 25, 2014 - 06:00pm PT
Here's an excellent reference regarding prostate cancer: "Guide to Surviving Prostate Cancer" by Dr. Patrick Walsh. I was able to purchase it at Barnes & Noble.

I had an elevated PSA last November, had a follow-up PSA which was also elevated. My urologist recommended having a biopsy which I did in early January of this year. The biopsy showed the presence of cancer with a Gleason score of 7 (on the cusp of being an aggressive cancer). I had robotic laparoscopic surgery in early February to remove my prostate with a successful outcome. The cancer was totally confined to my prostate and I have had minimal side effects. A follow-up PSA test 3 months after surgery showed an undetectable PSA reading.

Hope my experience helps.
zBrown

Ice climber
Brujo de la Playa
Apr 27, 2014 - 10:58am PT
Vitamin D3 supplementation has a large number of beneficial effects, including apparenly impacting prostate cancer. The combination of low dose aspirin (83mg) and vitamin D3 is even more beneficial.

I'd suggest getting your serum D3 measured.


The results of this clinical study suggest that supplementation with vitamin D3 at 4000IU per day may benefit patients with early stage, low-risk prostate cancer on active surveillance, because of the improved outcome (a decreased number of positive cores at repeat biopsy) in more than half of the subjects enrolled in the trial.

http://www.ncbi.nlm.nih.gov/pubmed/23220550
donini

Trad climber
Ouray, Colorado
Apr 27, 2014 - 11:29am PT
You are 55 which is a bit young.....be very aggressive about diagnosis. Go to the BEST and get multiple opinions. Early onset PC can be more aggressive!
MikeL

Trad climber
SANTA CLARA, CA
Apr 27, 2014 - 11:48am PT
Don't know your ability to assimilate scientific information, but I would (i) favor physicians who talk and can explain the latest research studies; (ii) read as much as you can about it yourself. Google scholar can help. Research studies can overwhelm you, but the days of putting your faith fully in the hands of your doctor are over. You're not in charge of executing the procedures, but you are in charge of making the decision on your treatment.

BTW, each and every cancer and its treatment tends to be idiosyncratic in its effects. Just because something worked for someone doesn't mean it will work equally for you.

Be well, and best of luck.
Ezra Ellis

Trad climber
North wet, and Da souf
Apr 27, 2014 - 12:31pm PT
Ditto what Donini says, radiation may be the best treatment in most cases.
There is a lot of complex and conflicting data, but at your age treatment is probably wise.

In men over 80 most men die with, not because of prostate cancer!!!!

steve shea

climber
Apr 27, 2014 - 01:23pm PT
I was diagnosed at 59. Had surgery. I had been getting tested annually and was always found to have low PSA. Then at 59 the number spiked up but still within safe criteria. They said come back in three months. I did and it was up again but still normal. My Doc was very aggressive and did further tests, biopsies which were found cancerous! The acceleration of the numbers, even though "normal" is what got his attention. Other's may not have been so on top of it. I had some follow up radiation and was tested every few months for five years. I was declared cancer free about two years ago. PSA is now 0.02...nothing almost.
johnr9q

Sport climber
Sacramento, Ca
Apr 27, 2014 - 03:44pm PT
Check out the PCA3 test. It is a urine test and in many cases it is a better indicator than PSA test. It is newer and some insurance companies won't pay for it. I had it and the results showed I had a 40% chance of having Prostate Cancer. I had a biopsy which showed no cancer present. This was my second biopsy. My PSA was always under 2 until I was 64 years old then it started going up, eventually ending up at 9.2 at age 68. Last test was 6.8 at age 69. As was previously pointed out the total PSA number isn't as important as how rapidly the numbers rise over time. Prostate Cancer is tough to diagnose but things you can do are get yearly Digital Rectal Exams, the PSA test and, if possible, the PCA3 test. Biopsy is a good test but probably not one that is done without other indicators pointing toward it. I haven't looked into the effectiveness of CAT or MRI's. Bottom line is you are going to live till you die so get out and climb. (or whatever it is that you do) I volunteered for a clinical trial to help provide better information so that you younger people would have a better idea of how to prevent Prostate Cancer. The study was called SELECT. It was initiated because there was some evidence that Selenium or Vitamin E might help prevent Prostate Cancer. The study was stopped early because it found that rather than prevent it, in certain groups of men, it encouraged it. Hope this helps.
Mateo Pee Pee

Trad climber
Ivory Tower PDX
Apr 27, 2014 - 04:11pm PT
Zip,

There is much good advice posted in this discussion and would only reiterate that: 1) each individual is unique in terms of their need and response to different treatments, 2) do your research, 3) find the best doctor available, and 4) pursue a clear diagnosis ASAP.

As a point of reference, I was diagnosed at age 46 and only later discover a fraternal uncle had died of PC at age 52. In his case, our family was under the false impression that his death was caused by the cancer's re-manifestation in another part of his body.

A PSA test by a nonconventional doctor (i.e., a doctor who gave all males over 40 a PSA test as part of their physical) saved me and I have since recommended my nephews to get tested after age 40. I had a prostatectomy - the right choice in my case - and was clambering up Cotopoxi 6 months later.

Best of luck.

Keith
jstan

climber
Apr 27, 2014 - 05:37pm PT
You see a lot of advice concerning "watchful waiting". If you are younger than 70 or other family members have had it, get on it right away. Post haste. Ask yourself what you will say when you are 65 and the hot CTI test shows you have it in your bones.
phylp

Trad climber
Millbrae, CA
Apr 27, 2014 - 08:46pm PT
Sorry to hear this Zip.

GLee is pointing you in the right direction. Reagan UCLA Medical Center has fantastic cancer docs of all kinds.
zBrown

Ice climber
Brujo de la Playa
Apr 28, 2014 - 03:19pm PT
A b s t r a c t
ERG rearrangements (most commonly
transmembrane protease, serine 2 [TMPRSS2]:ERG
[T2:ERG] gene fusions) have been identified in
approximately 50% of prostate cancers . Quantification
of T2:ERG in postdigital rectal examination urine, in
combination with PCA3, improves the performance
of serum prostate-specific antigen for prostate cancer
prediction on biopsy. Here we compared urine
T2:ERG and PCA3 scores with ERG+ (determined
with immunohistochemical analysis) and total
prostate cancer burden in 41 mapped prostatectomies.
Prostatectomies had a median of 3 tumor foci (range,
1-15) and 2.6 cm of summed linear tumor dimension
(range, 0.6-7.1 cm). Urine T2:ERG score correlated
most with summed linear ERG+ tumor dimension and
number of ERG+ foci (rs = 0.68 and 0.67, respectively,
both P < .001). Urine PCA3 score showed weaker
correlation with both number of tumor foci (rs =
0.34, P = .03) and summed linear tumor dimension
(rs = 0.26, P = .10). In summary, we demonstrate a
strong correlation between urine T2:ERG score and
total ERG+ prostate cancer burden at prostatectomy,
consistent with high tumor specificity.
jstan

climber
Apr 29, 2014 - 12:24pm PT
Great lead z!

http://www.nature.com/pcan/journal/v16/n2/full/pcan20134a.html

Abstract
Background: The TMPRSS2-ERG gene fusion resulting in ERG overexpression has been found in around 50% of prostate cancers (PCa) and is a very early event in tumorigenesis. Most studies have reported on selected surgical cohorts with inconsistent results. We hypothesized that ERG gene rearrangements impact tumor development and investigated the frequency of ERG overexpression in the context of clinicopathological tumor characteristics.
Methods: ERG overexpression (ERG+ or ERG-) was determined by immunohistochemistry (IHC) in 1039 radical prostatectomy (RP) tumors and association with PSA, D’Amico risk score, histopathology, biochemical recurrence, body mass index and age of PCa cases was analyzed.
Results: ERG+ was associated with younger age at diagnosis (P<0.0001), lower serum PSA (P=0.002) and lower prostate volume (PV) (P=0.001). It was most frequent in the youngest age quartile (55 years, 63.9% ERG+) and decreased constantly with increasing age to 40.8% in the oldest age quartile (67 years, P<0.0001). In the PSA range <4 ng ml−1 the frequency of ERG positivity was 60.2% compared with 47.5 and 49.1% in the PSA ranges 4–10 and 10 ng ml−1, respectively. In the first age quartile, ERG+ patients had lower median serum PSA and fPSA% and smaller PV. In the highest age quartile tumor volume (TV) was increased. Similar differences were observed in the low PSA range. Multivariate analysis identified the first age quartile as a predictor for ERG status (odds ratios (OR) 2.05, P=0.007). No association was found with the D’Amico progression risk score and with biochemical tumor recurrence.
Conclusions: ERG+ tumors manifest clinically at lower PSA levels and their prevalence is age dependent. This suggests acceleration of tumor development by ERG overexpression that results in earlier tumor detection in young patients. Long-term results are warranted to determine the impact of ERG overexpression on disease outcome.
Keywords: age; ERG frequency distribution; ERG overexpression; early-onset prostate cancer; PSA screening

Introduction

Prostate cancer (PCa) is the most common solid neoplasm in the developed countries accounting for almost 30% of cancer incident cases in men. It is the third leading cause of male cancer deaths in Europe1, 2 and second in the USA although an estimated 90% of newly diagnosed cases are local or regional with a 5-year relative survival approaching almost 100%.3 A frequently occurring genetic alteration of prostate tumors is a gene rearrangement involving transcription factors of the E26 transformation specific (ETS) family and an androgen-regulated gene. The most common event found in 40–60% of PCa cases results in the fusion of the transcription factor ERG and the androgen regulated transmembrane serine protease 2 (TMPRSS2) gene and leads to androgen-stimulated overexpression of ERG.4 Less common are rearrangements involving the ETS transcription factors ETV1, 4 and 5 or other androgen regulated 5′ partners such as SLC45A3.5

An ERG rearrangement regardless of the 5′ partner is highly specific for PCa and only found in tumor cells or a subset of high-grade prostatic intraepithelial neoplasia lesions.6, 7 Therefore, analysis of an ERG rearrangement is beginning to have a role in routine pathology.8, 9 The fusion status can reliably be determined using fluorescence in situ hybridization detecting the gene rearrangement,4, 10 by PCR measuring expression of a fusion transcript4 or using IHC detecting the overexpressed ERG protein.11 Positive immunohistochemical staining highly correlates with the ERG gene rearrangement status determined by fluorescence in situ hybridization or mRNA analyses.11, 12

The ERG rearrangement occurs early in prostate carcinogenesis7 and is then present at around the same frequency through all tumor stages up to metastatic, therapy-resistant disease.13 Despite numerous studies the implication of this common genetic alteration on tumor progression and consequences for the management and treatment of PCa have yet to be defined. This may in part be due to relative few studies that have focused on large well-characterized patient populations. The majority of studies reported no association between biochemical recurrence and ERG rearrangement status.14, 15 Conversely, population-based Watchful Waiting studies have found associations with PCa specific death.16, 17 Recent investigations suggested that gene-fusion driven ERG overexpression increases self-renewal and stimulates epithelial to mesenchymal transition.18, 19

We hypothesized that ERG overexpression is an early driver of tumor development and investigated the frequency of ERG overexpression in dependence on patient age and clinicopathological characteristics. The prevalence of ERG overexpression was investigated retrospectively in a large cohort of the Tyrolean PCa patients, the majority of whom have been diagnosed in an age-adjusted PSA-based screening program for early detection and treatment of PCa.20, 21 We observed an increased frequency of ERG overexpression in younger PCa patients and association with lower serum PSA.

Conclusions
ERG overexpression is significantly more frequent in tumors detected at a younger age and is associated with lower PSA levels in this age group. In tumors detected at an older age, ERG overexpression is significantly associated with a higher TV but not with differences in PSA. ERG overexpression seems to accelerate carcinogenesis and drive prostate tumors to early clinical manifestation and detection but have no effect on tumor progression.
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