Dear vaac-ga;
Thank you for allowing me an opportunity to answer your interesting
question. As I’m sure you are aware, I am a researcher, not a
physician. I can tell you what is out there and what the general
consensus is but your best second opinion would obviously come from a
licensed physician who is knowledgeable about your disease. I
recommend you seek such an opinion for a definitive answer but in the
meantime I will try to help you by providing you with pertinent
information.
Your statement that your cancer was “aggressive” makes your question
fairly tough to answer because this can mean a number of things. If
you cancer is fast spreading, particularly difficult to eradicate or
already spread beyond the prostate some therapies can be more
effective than others while some therapies can be quite futile. I will
go on the assumption that you can is still localized to the prostate
and research it from that standpoint.
According to FAMILY PRACTICE NOTEBOOK it appears that Radical
Prostatectomy is GENERALLY indicated in those suffering from prostate
cancer who are under the age of 70 and who have at least a ten-year
life expectancy. In instances where a prostatectomy is performed in a
patient over the age of 70, virtually 100% of all patients experience
some degree of impotence if not total impotence and there were other
risks associated with this treatment as well.
FAMILY PRACTICE NOTEBOOK
http://www.fpnotebook.com/URO116.htm
Age BY ITSELF does not necessarily preclude you from having this
procedure done but it is a factor. Your treatment will be determined
based on a number of factors depending to a large extent on your age
"AND" your general fitness, the exact stage of the tumor(s), the level
of the PSA test, and YOUR WISHES after you have been counseled by the
doctor. You SHOULD be informed of the potential consequences and
success rates of all available treatments and you SHOULD have some
input into the treatment you receive. Conservative therapies, like the
kind you mentioned, are more appropriate in men older than 70 years of
age whose life expectancy is generally less than 10 years from the
time of diagnosis, but this does not necessarily mean that you cannot
have the more aggressive treatments. Studies have shown that a very
high number of men aged 60 have prostate cancer and almost all men age
90 have it even though it is may not be problematic for them. Many
elderly men adopt a kind of “wait and see” approach and in these cases
conservative therapy may be in order before taking the risks
associated with surgery. However, you have been told that your cancer
is aggressive (or progressive) which might mean that you should
probably address the disease as soon as possible. Depending on how
aggressive your disease is the risk doing little or doing nothing
might be much higher than the risk of having surgery.
THE UROLOGY DEPARTMENT AT THE EDITH CAVELL HOSPITAL
http://freespace.virgin.net/cd.1/ech/pif/pros2.htm
Of the more conservative therapies, Brachytherapy (the therapy wherein
radioactive “seeds” are implanted into the affected area) is indeed an
option for men over the age of 70. This therapy has about a 70%
success rate however some studies suggest that in the long term about
50% of patients experience a recurrence of their cancers within 7-10
years of the initial treatment. This is a conservative therapy though
and may or may not be suitable for an "aggressive" cancer like yours
(depending on your doctor's definition of "aggressive", of course).
PROSTATE CANCER INSTITUTE
http://www.prostate-cancer-institute.org/prostate-cancer-treatment/brachytherapy.html
I am by no means second-guessing your physician’s advice, but merely
acting upon my own hypothetical instincts if I were in your position.
From researching your question I tend to believe that what your
physician told you is probably correct, as he/she understands it, but
I also tend to believe that you might also be offered other options
should you choose to seek out a second opinion.
Having said that, I urge you to seek a second opinion and ask
specifically about a minimally invasive procedure called “cryosurgery”
(Also called “cryotherapy” or “cryoablation”). Let me tell you a bit
about what I learned while looking into your problem since this
therapy will be of particular interest to a man of your age who is
suffering from multiple diseases including heart disease and prostate
cancer (assuming your cancer has not spread):
Cryosurgery is a “minimally invasive procedure [that] uses very low
temperatures to freeze and destroy cancer cells in and around the
prostate gland. A catheter circulates warm fluid through the urethra
to protect it from the cold. When used in connection with ultrasound
imaging, cryosurgery permits very precise tissue destruction.
Traditionally used only in patients whose cancer had not responded to
radiation, but now approved by Medicare as a primary treatment for
prostate cancer, cryosurgery can safely be performed on older men, on
patients who are not in good enough general health to undergo radical
prostatectomy, or to treat recurrent disease. Recent studies have
shown that total cryosurgery, which destroys the prostate, is at least
as effective as radical prostatectomy without the trauma of major
surgery.”
HEALTH A TO Z
http://www.healthatoz.com/healthatoz/Atoz/ency/prostatectomy.html
“Researchers continue to study the results of cryotherapy treatment.
Now, with ten-year data available, the results indicate that
cryotherapy is more effective than a radical prostatectomy or
radiation therapy in treating localized prostate cancer. A study
published in the November 1999 issue of the journal Urology reported
that 97.6% of patients treated with "cryosurgery" were cancer-free
after six months. A 12-month follow-up study showed that 97% were
still cancer-free.”
PROSTATE CANCER INSTITUTE
http://www.prostate-cancer-institute.org/prostate-cancer-treatment/cryosurgery.html
Ask your physician to be direct and forthcoming with you. If your
disease is “aggressive” but not yet life threatening in the sense that
radical treatment is not urgent, you should know that his/her
recommendation was based on that premise. If he/she feels your
situation is bleak and his/her recommendation of conservative therapy
is based on the likelihood that the form/stage of prostate cancer you
now have is most likely terminal, you should know that the
recommendations are based on that premise as well. I assure you that
if your doctor is a true professional he/she will not be offended by
additional questions or by your desire to seek a second opinion. I
suggest you take this information to your doctor and also to a second
physician and seek more detailed advice based on what you now know.
Good luck.
I hope you find that my research exceeds your expectations. If you
have any questions about my research please post a clarification
request prior to rating the answer. Otherwise I welcome your rating
and your final comments and I look forward to working with you again
in the near future. Thank you for bringing your question to us.
Best regards;
Tutuzdad-ga
INFORMATION SOURCES
CEDARS-SINAI HOSPITAL
http://www.cedars-sinai.edu/923.html
HEALTH A TO Z
http://www.healthatoz.com/healthatoz/Atoz/ency/prostatectomy.html
PROSTATE CANCER INSTITUTE - CRYOSURGERY
http://www.prostate-cancer-institute.org/prostate-cancer-treatment/cryosurgery.html
THE UROLOGY DEPARTMENT AT THE EDITH CAVELL HOSPITAL
http://freespace.virgin.net/cd.1/ech/pif/pros2.htm
PROSTATE CANCER INSTITUTE - BRACHYTHERAPY
http://www.prostate-cancer-institute.org/prostate-cancer-treatment/brachytherapy.html
FAMILY PRACTICE NOTEBOOK
http://www.fpnotebook.com/URO116.htm
SEARCH STRATEGY
SEARCH ENGINE USED:
Google ://www.google.com
SEARCH TERMS USED:
Prostate cancer “over 70”
Prostate cancer treatments
Cryosurgery prostate
Brachytherapy prostate |
Request for Answer Clarification by
vaac-ga
on
29 Oct 2003 21:14 PST
Dear tutuzdad-ga:
Thanks for your very good answer, especially the info on cryosurgery.
In order not to risk being identified by my urologist by giving too
many details about myself and encounter his displeasure for going to
Google instead of trusting him blindly - I have omitted some details.
But since your answer is so extraordinary good and comprehensive this
risk is worthwhile, since you might be able to give me more, or more
specific advice.
Impotence is no issue since my wife has a dropped uterus, no interest
in sex and I too have difficulties getting an erection. But
incontinence would make the quality of my life very poor.
Not knowing that radiation, if ineffective, will render prostatectomy
in the future more dangerous or impossible - I agreed to radiation and
received an injection (probably of an antitestarone compound) a week
and a half ago. This is supposed to shrink my prostate and enable more
accurate aiming of radiation and more accurate brachytherapy. I assume
that this injection will not preclude cryosurgery if I choose to
change course. I also wonder if radiation will interfere with future
cryosurgery?
I am 76 year old, have the heart condition IHSS (idiophatic
hypertropic subaortic stenosis) with left ventricle outflow tract
obstruction and the insulation on the atrial electrode of my pacemaker
is faulty making it useless and relying only on the ventricular
electrode for the dual-chamber-pacing-therapy.
I had 2 TURP operations for BHP. The 1-st done with a spinal and for
the 2-nd they considered a spinal more dangerous than general
anesthesia which they gave me. The prostate is very large and I have
some difficulties passing urine.
I had a precancerous polyp on colonoscopy several years ago. It was
removed and did not reappear.
My urologist said that he thinks that the cancer has not spread
outside the prostate.
The aggressiveness is rated 8. I did not ask on what scale. Presumably
the Gleason score. I do no recall the PSA no. which was somewhere
between 5.5 and 6.
Other, probably irrelevant information is: I have had a hernia
operation, a bleeding ulcer now cured, excess stomach acid, irregular
bowel movement and a little arthritis.
While the above suggests that my urologist knows what he is doing and
my general practitioner also considers him good -- since an
acquaintance claims he "messed him up" I would like to check further
and also seek a 2-nd opinion. Could you suggest a way how I can find a
urologist familiar with cryosurgery in the Baltimore or nearby states?
For this reason I also placed a 2-nd question on Google how to check
the qualifications of a physician. If still unanswered could you
please answer it
After receiving your final answer I will give it the rating it
deserves. In the mean time I will inform Google that the time waiting
for your answer was worth while waiting for.
Thank again
Vaac-ga
|
Clarification of Answer by
tutuzdad-ga
on
30 Oct 2003 08:02 PST
Dear vaac-ga;
Without a doubt I would first turn to the University of Maryland
Medicine (UMM) and other nearby academic institutions for potential
recommendations for specialists in this particular field of medicine:
UNIVERSITY OF MARYLAND DIVISION OF UROLOGY
http://www.umm.edu/urology/
THE UNIVERSITY OF MARYLAND GREENEBAUM CANCER CENTER
http://www.marylandprostatecenter.com/#resources
http://umm.edu/cancer/
UNIVERISTY OF PITTSBURGH CANCER INSTITUTE
http://www.upci.upmc.edu/
Which has a notable prostate and urologic cancer program:
http://www.upci.upmc.edu/internet/prostate/center/accomplishments.html
As for the success rates of dual treatments and follow-up treatments,
this article by UMM (peer reviewed by physicians from some of the most
notable academic institutions in the world) suggests that cryosurgery
is indeed still an option following other treatments such as
external-beam irradiation or interstitial implantation.
WHAT ARE THE TREATMENT OPTIONS FOR PROSTATE CANCER BY GRADING AND
STAGING CATEGORIES?
http://www.umm.edu/patiented/articles/treatment_options_prostate_cancer_by_grading_staging_categories_000033_10.htm
This same peer reviewed series of articles however suggests that
cryosurgery, when used as a treatment secondary to failed radiation
(“salvage treatments”), comes with increased risks, but is still
probably not as risky as a prostatectomy secondary to failed radiation
and/or interstitial implantation
“Salvage Prostatectomy. Salvage prostatectomy is sometimes performed
after unsuccessful radiation treatment if the cancer is still local.
The odds of the procedure's success are only 10% to 64%. Many experts
recommend against salvage prostatectomy in most cases of radiation
failure. Severe complication rates for salvage prostatectomy are very
high: 10 times that of men who have not had radiation. For example,
incontinence after salvage prostatectomy is often untreatable with
medications, collagen implants, or other standard treatment measures.”
“Salvage Cryosurgery. Salvage cryosurgery may be effective in certain
patients who fail external beam radiotherapy. The best candidates are
those with Stage II cancer or less and PSA levels below 10 ng/mL.”
http://www.umm.edu/patiented/articles/what_options_if_localized_treatments_fail_000033_14.htm
So, yes, cryosurgery is still appears to be an option after other
treatments have been employed and even prostatectomy is still an
option, albeit a somewhat more risky one.
ABOUT THE GLEASON SYSTEM
The Gleason system (developed in 1966 by pathologist Dr. Donald
Gleason) is the method most often used for summarizing how abnormal
the cancerous tissue appears under a microscope. The Gleason system
assigns grades on a scale of 1-5 and scores on a scale of 2-10. A
Gleason 2 tumor is almost normal looking, while a Gleason 10 is the
worst looking kind. This is a generalization however since every case
is different and evaluated on it’s own. The “staging” of the disease
also plays a large part in the prognosis and the treatment plan. About
70% of Gleason 8 and up tumors have spread to lymph nodes and other
places when the staging is done. That is why they start with the
Gleason scale, to get some idea of what they are dealing with before
developing an appropriate treatment plan. If in fact your physician
“is” using the Gleason Scale when referring to your cancer as an “8”,
then clearly you are in the higher ranking of those who are at the
greatest risk from the disease. It should also be noted here however
that a Gleason 7 is considered an intermediate risk, so while you
would officially be in the higher bracket of risk, you are in the
lowest portion of the higher bracket if that provides some consolation
to you. As you might imagine then, HERE is where your second opinion
may vary, and as such so may your treatment options. Another physician
might find you in the Gleason 6-7 range or in a worst-case scenario,
find you in the Gleason 9 range.
ASK DOC TRISH
http://www.askdoctrish.com/cancer.html
You can learn a great deal more about the Gleason System and how it
works by reading this easy to comprehend article (pay little attention
to the title; I assure you the article it is VERY informative):
PROSTATE CANCER FOR DUMMIES
http://www.dummies.com/WileyCDA/DummiesArticle/id-1856.html
I wouldn’t be too concerned about offending my physician with an
expressed interest in a second opinion. What you are dealing with here
is the preservation of your life and ultimately the quality of your
remaining years of life. I think his/her personal feelings pale in
comparison to your responsibilities to your own preservation and in
fact, would cause me more concern if he/she were offended by it, than
would unsubstantiated rumors that he “messed someone up”.
I hope this adds some significance to my earlier research and as I
said before, I wish you luck with the obstacles you are currently
faced with. Thank you for bringing your question to us.
Best regards;
Tutuzdad-ga
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