OBJECTIFIED
OBSERVATION
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 - he had one biopsy needle positive with 1 mm of material with a
Gleason of 3+3.
Donna Pogliano is a very determined prostate cancer advocate.
She is the co-author of "A Primer on Prostate Cancer, The Empowered Patient's
Guide", probably the best book on prostate cancer. A web version of the book
is at "A Primer on Prostate
Cancer" and is well worth reading. You can usually get the book at Amazon
or Barnes and Noble or at the Life Extension
Foundation site, whose support saw the book published.
Here's
Donna:
From what I'm reading here, you're thinking of undergoing local treatment
for one silly millimeter of prostate cancer?
If what you posted about your situation is correctly stated, this is what
is meant by "insignificant disease". When they talk about prostate cancer being
overdiagnosed and overtreated, they're talking about YOU!
The medical profession may have lured you into the medical mill with a positive
biopsy, but you DO still have the option of removing yourself from the treadmill
of diagnosis-by-biopsy followed by immediate-local-treatment. I'm sure that either
a surgeon or a radiation oncologist would be delighted to treat you because if
they only treated patients with your extent of disease their stats would be lookin'
REALLY GOOD!
So I have a suggestion. Why don't you start with your evaluation of your options
with the simplest and least invasive - Watchful Waiting, otherwise known as Objectified
Observation. There isn't a lot of support for that option in medical circles,
because it isn't going to result in your insurance company paying thousands of
dollars for a treatment you might well have been able to do without. And no one
is going to get rich from treating you for the collateral damage resulting from
your prostate cancer treatment if you elect Watchful Waiting either. So from a
financial standpoint, this is a lose-lose proposition for everyone involved, except
for perhaps, YOU.
Before you do anything else, I would get an expert
pathologist to review your biopsy material. You can find a link to a list of those
in the web version of "A
Primer on Prostate Cancer" and also in the book version, "A Primer on Prostate
Cancer, The Empowered Patient's Guide". If your 3+3 holds up under expert review,
the next step I would take if I were in your situation would be a color-doppler
ultrasound with Fred Lee in Michigan or Duke Bahn in Ventura, California. Either
of these expert ultrasonographers will be able to see your true extent of disease
and make sure that your tumor burden is truly as small as your biopsy report would
indicate. Dr. Lee often counsels patients regarding what he feels is the best
disease management strategy for the patients he evaluates. Most doctors will outline
your options and let you figure it out for yourself, so I think Dr. Lee is a true
gem.
The location of the tumor is also an important consideration in determining what
course of disease management is appropriate, and this will be evaluated using
the color-doppler ultrasound as well. A slow-growing transition zone cancer, for
instance, would be unlikely to penetrate the capsule anytime soon, if ever, so
Objectified Observation would be even more appropriate for patients with a small
tumor located deep within the gland as opposed to a tumor found to be located
where they usually are found, at the periphery of the gland.
Periodic ultrasound monitoring and keeping track of the PSA doubling time and
velocity will help to keep a handle on what your prostate cancer is doing while
you are on a Watchful Waiting regimen. This is why we call it "Objectified Observation".
Because you're watching the situation closely so that you can alter the strategy
as appropriate.
Objectified Observation, should you be found by expert staging to be a good candidate
for it, doesn't mean doing nothing. It means incorporating diet and lifestyle
changes designed to make you an inhospitable host to your cancer. It takes work
and discipline and not every man is a good fit with this strategy. It also takes
some emotional wherewithall to know there is a disease in your body and you aren't
taking steps to totally eradicate it, just to control it. On the other hand, men
who are good candidates for Watchful Waiting gain peace of mind by undertaking
that strategy with a plan for monitoring in place and a contingency Plan B in
their back pocket to be used if there is disease progression beyond their comfort
zone and beyond the level at which common sense would indicate that treatment
is appropriate.
"Eating Your Way to Better Health-The Prostate Forum Nutrition Guide" by Charles
E. (Snuffy) Myers, Jr., M.D. Sara Sgarlat Steck, R.T. and Rose Sgarlat Myers,
PT., Ph.D. is a great book on nutrition and prostate cancer and is an excellent
resource for all prostate cancer patients, not just those who have chosen Watchful
Waiting. Here's a link where you can get more information on the book at The
Prostate Forum. You can also click on a link at that page to get to a sample
issue of the newsletter and there is also a link to use to subscribe.
Obviously,
I have no financial interest in whether or not you do that, but I think it will
give you a sense of control and mastery over your situation regardless of what
disease management strategy you elect, to know what things prostate cancer patients
should put into their bodies vs. what things prostate cancer patients would do
well to avoid
Back
to Clippings.