CLIPPINGS
AND STUDIES
ACTING
TOO SOON: PSA:
INSIGNIFICANT TUMOURS:
WRONG
DIAGNOSIS: GLEASON SCORES:
ACTIVE
SURVEILLANCE
I
thought it might be useful to use this section to link to various bits and pieces
I have come across on the Internet or on Lists. All posts from Lists have been
made with the permission of the author: posts of news releases and articles from
papers and magazines which have been posted to Lists are assumed to be public
property. Acknowledgements are made where appropriate.
ACTING
TOO SOON: A paper published by researchers at Johns Hopkins
warns agaknst acting too soon and making an unwise choice of treatment. Better,
they say to
take weeks or even months, rather than days, to assess your options before you
choose conventional treatments which can have a significant impact on your quality
of life.
PSA
is such an integral part in the diagnosis and monitoring of prostate cancer. Yet
there seems to be such a misunderstanding about the enzyme and what it means.
Here are some pieces which may be helpful to those who want to broaden their
understanding:
This
article, published on 28 May 2003, describes a study at Sloan Kettering Memorial
Hospital which reinforces the view that a single elevated PSA test result should
not be used as the basis of a biopsy, since many PSA numbers will revert to normal
levels without treatment. Ralph
Valle is man dedicated to helping men with PCa. A long time survivor himself,
he has a depth of knowledge unequalled by many. He is always prepared to share
this knowledge and recently - 28 July 2003 - posted this piece on the PPML List.
I think it summarises the key issues on PSA very well and succinctly.
INSIGNIFICANT
CANCER is a term used quite frequently in discussions on prostate cancer
on the Internet. The usual definition is a T1c diagnosis - that means that nothing
was felt during the digital rectal examination - with a PSA of less than 10 ng/ml,
a free PSA greater than 15% and a Gleason Grade of 6 or less. Although this kind
of diagnosis as very common, many men are not aware of the term "insignificant
cancer" since it is not often referred to by their medical advisors. This
piece, written by Donna Pogliano, gives some solid advice to a man who most likely
fits the "insignificant cancer" mould.
Donna
Pogliano, a prostate cancer activist wrote the piece on Objectified
Observation and also has some Advice
to the Newly Diagnosed which is well worth reading and printing to keep. Donna
felt some years ago that there was not enough basic information available about
prostate cancer and wrote A
Primer on Prostate Cancer. This grew into a book which she co-authored with
Dr Strum and which is a wonderful source of very detailed information. It is not
an 'easy read' to glance through while lounging by the pool, but it allows laypeople
to get a good understanding of complex medical issues. The full title of the book
is A Primer on Prostate Cancer. The Empowered Patients Guide. The ISBN
number is 0-9658777-6-0 and it has been available at Amazon and Barnes & Noble
as well as at the Life Extension Foundation
site, whose support saw the book published.
Temporarily
Deferred Therapy
A
study was published in November 2003 describing a retrospective analysis of men
electing Watchful Waiting at nine military institutions. The result of the study,
a first in the US, was of interest to anyone considering Watchful Waiting as a
choice. Although many of the men did not fit the criteria normally used for selection
of suitable Watchful Waiting candidates, 26% of them were still following this
choice after four years and, the study concluded: "If a patient remained
on WW after 4 years, there was little probability of moving to definitive therapy.
" I have written a commentary
on this study, the Abstract of which is on the
site as is the Full Paper. The Full Paper is in pdf
format and will require Adobe
Reader to access.
WRONG
DIAGNOSIS
One
of the problems with prostate cancer is definition. The pathologists may label
it as prostate cancer, but they will not usually indicate whether this is likely
to be the aggressive form or the more normal form that may take years to develop
and may never become life threatening. This
extract from the Presentation by Dr. Christopher Logothetis
shines a light on When A Cancer Diagnosis Is Wrong
GLEASON
SCORES
Undergrading
and Overgrading
The
process of grading the biopsy specimens is a subjective one, yet it is at the
core of all decision making processes as to prognosis and choice of treatment.
One of the regularly repeated statements is that pathologists usually under-grade
specimens. This is used as a justification for more aggressive treatment and/or
surgery, but it is not a universal truth. This study shows that, in broad terms,
only one third of diagnostic grades are matched after surgery: about one third
are higher and one third lower.
Gleason
Grade Migration
It
is clear that an upward drift in the Gleason grades and scores of prostate cancers
has been occurring over the past decades. Tumours
that would have been graded as 4 or 5 are now graded as 6 or 7. Recent
recommendations for changes to the grading system will most certainly cause further
migration to higher grades and total Gleason scores. This is in turn is affecting
the apparent clinical outcomes in patient studies, and will most likely continue
to do so for the foreseeable future. A greater understanding of this is essential,
especially when making treatment decisions and using nomograms.
it is just worth remembering that survival rates from ten years ago are not strictly
comparable with those produced today and are likely to be more pessimistic.
ACTIVE
SURVEILLANCE
The
Royal Marsden Hospital in Surrey, England runs a program for men diagnosed with
early stage prostate cancer. This program does not use conventional treatment
and the Royal Marsden does not use the term WW (Watchful Waiting). Instead they
call their program AS (Active Surveillance)
This
paper is in pdf format and will require Adobe
Reader to access.
