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PROSTATE CANCER, A CASE STUDY
DAVID MOORE, CDR, USNR, Retd.
This brief is intended to summarize the important points of prostate cancer so that all men may have a better understanding of the problem and can ask their doctors effective questions. As a group, the retired military men are older and should pay attention to this health problem to collect on their well deserved retirement.
Prostate cancer is common in men. Science has discovered that about a third of the men around age 50 have some microscopic cancer. At age 75 around a half or more have cancerous changes in the prostate. These are important mileposts of health.
The following historical outline tells the story of the development and solution to my cancer problem. After my story, I have reviewed significant points of this cancer problem guided in part by the book, The Prostate, by P.C. Walsh, M.D., Urologist-in-Chief at Johns Hopkins Hospital. I strongly believe this book should be in possession of men with a prostate problem to determine a course of action. I have found a used medical dictionary helpful to decipher medical jargon, but Dr. Walsh’s book is very basic with terms.
Personal History With Prostate Cancer
This brief tells the progress and solution of a deadly disease illustrating that knowledge may save your life.
Dr. Mangelson, at the LDS Hospital, removed my prostate and during the operation found that the cancer had spread to the seminal vesicle gland and one lymph gland which were also removed. The Gleason count was 7 and moderate.
Wow! What did this really mean? If the cancer advances beyond the prostate, you are in deep trouble and generally incurable (Walsh’s book, page 101). As you can see from the biopsy (only one needle was cancerous), the ultrasound data, the finger exam, and a low PSA count, the cancer was supposed to be confined to the prostate. Dr. Mangelson would not know the true condition until he personally examined the organs in the operation which he did and took the proper corrective action by removing the cancerous glands. His expertise has saved my life, and this knowledge is why you need the best doctor. The cancerous organs must be removed and cancer cells killed to stop the generator of cancer.
The oncologist who looked at the biopsy and recommended the seed treatment was wrong. Only the prostate would have been affected, and the seminal vesicle along with the lymph gland would not have been treated. The biopsy did not tell the whole story. The needles missed some cancer in the prostate misleading to a low content in that tissue. The PSA count dropped from 38 to 0.6 (before the operation) indicating cancer activity was likely at a low level and contained – which was not the case.
In the Spring of 2001, the hospital used a new pain intervention method, and there was no pain during or after the operation. Amazing! I used a catheter to drain the urine, which was not a problem, lasting for about 10 days. When the catheter was removed, I had no problem controlling the urine, and at my age, sex was also no problem. But a person undergoing treatment should discuss these matters with his doctor.
Post operation tests reveal my cancer is under control. There is no tiredness and my appetite is satisfactory. On September 2001, my PSA count was below 0.1; December 2001, below 0.1. With my false sense of security in mind and a review of my case, I highly recommend you do your homework well to collaborate medical advice.
Prostate Cancer Facts
This section is separated into examination for prostate cancer and treatment of the disease. Additional information on the main points of my discussion is treated in detail in Dr. Walsh’s book, The Prostate, and are given a page number from that book which appears in my margin. This information will permit a man with the prostate cancer problem to discuss the approaches (solutions) with his doctor.
It is common knowledge among doctors that in testing for prostate cancer, the elevated count of PSA in a blood test points to a cancerous condition. When your PSA count is over 4.0 nanograms per milliliter, it means you have some prostate "trouble." PSA levels are about 10 times higher in cancerous tissue. It is believed younger men should have blood tests with their physical, and those over 50 should have tests each year – or twice a year, especially if the condition is in the family.
Page 42: PSA count is not perfect. Some one-fourth of the men with prostate cancer can have a low PSA count of below 4. And about one-fourth of those with a 4 to 10 PSA also have cancer. A count is over 10 PSA shows a good chance of cancer.
Page 44: Most cancer found from PSA tests is significant (needs attention) and is not considered incidental.
Page 46: IMPORTANT: An important indicator for a cancerous condition is the "PSA velocity" or its rate of change from year to year. This is the upward slope in the PSA points from year to year, because most likely it will go through the 4.0 level and the doctor will become very excited. The patient may have a cancerous condition. It is shown that men with a big difference in the PSA velocity have cancer.
Page 47: Let us say over a 2-year period the PSA went from 1.0 to 2.0 to 3.0. Then, something is going wrong in the prostate, and you do not need to reach 4 before more testing should be done by your doctor. An increase near the count of 1.0 PSA each year over a 3-year period needs deep concern in order to catch cancer early.
Page 39: A finger examination by the doctor through the anus will check the prostate for enlargement indicating if a tumor of cancer is present. Not all cancers of the prostate are found by this method as witnessed by a friend.
This test is done in the doctor’s office and is directed through the rectum to the prostate. The biopsy instrument contains six needles which are positioned by ultrasound and a scope. They are used to take samples of the prostate which are sent to the laboratory to determine the extent of the cancer as shown by the amount of cancer in the needles, and the degree of cancer activity which limits the life span.
Page 52-53 During the biopsy, a tube is directed through the rectum to the prostate. Dr. Mangelson called from his trip to California to share the results of the biopsy test; aside from cancer in one needle, the activity of the cancer was rated 6 by a Gleason method. To me this shows the quality of this gifted doctor. The biopsy was uncomfortable but not painful.
Rating the cancer from biopsy tests is done by a Gleason score. A grading number is assigned to each of the two largest areas of cancer and then added together to get the score which is graded up to 10. The high score indicates fast cancer growth and big trouble.
Page 57: Accuracy – Currently identification of this cancer is subject to guesswork, based on how thousands or more cells look under a microscope.
Page 62: The true value of the PSA cannot be determined until the Gleason score is determine. And this score is important to identify the seriousness of prostate cancer. My cancer was a 6 score and considered moderate.
Page 67: For high PSA the doctor may request a bone scan to determine if cancer has spread to the bones. A radioactive liquid is given to the patient and the patient is placed on an x-ray table. The x-ray pictures will show "hot spots" if there is a cancerous growth. It also checks out the kidneys for cancer. My bone scan taken at the time of my biopsy proved favorable which gave great comfort.
Positive cancer tests of the prostate have four main treatments: Watch & Wait; Surgery, Radiation, and Freezing the Prostate. Hormone medicine is used to control the products of the prostate gland and lower cancer activity.
Watch & Wait
Pp. 74&83: It is estimated that roughly a third on the men with this cancer are treated by this method. Beware and study the facts regarding this option. Once you have cancer it can get worse ( increase in activity) with age. And when you are old, poor health limits treatments.
Page 81: In some 25 percent of the men with prostate cancer see no rise in the PSA number. To me, this will remain a mystery.
Page 85: Prostate removal or radical prostatectomy is major surgery. In my view, the best way to health is to completely remove a contained cancer that is curable.
P 109&112: The downside of surgery is urinary incontinence or leakage (a small number) and impotency (lack of sex); but many regain potency.
Page 95: Choosing the best surgeon is important. Questions to ask: does he operate several days a week? And what is his success rate? Information from your friends is helpful.
Page 130: After surgery, the PSA level should be unobservable. If there is a return in PSA then radiation is a choice, but the doctors are NOT proponents of surgery after radiation, and this is a consideration.
P 121&124: This treatment is an x-ray beam focused on the cancer. The x-rays change the DNA of the cancer causing the cell to die; electrons in the DNA atoms of the cancer are changed with the beam treatment. Sometimes not all cancer cells are changed in the area and a growing cancer returns. All cancer cells must die for a successful treatment. The doctor should be consulted on complications, such as possible future urinary problems like blood clots.
Page 127: After radiation, many regain sexual potency.
Page 128: About a quarter of those with radiation treatment can have a low PSA count in about 5 years, but survival rates at 15 years do not show any real difference between surgery and radiation.
Page 130: Radiation may be considered for men with a Gleason score of 7 or less and a cancer confined to the prostate with a PSA less than 10.
Page 132: Implanting radioactive seeds is radiation. This is done to get the radiation directly into the tumor of the prostate. The seeds do not work if the cancer cells are beyond the prostate. An uneven distribution of seeds may not catch all of the cancer areas. But advances in science has offered an upgrade in this treatment.
Page 138: Seed treatment is considered Number 3 – lower than surgery or the x-ray beam.
This treatment is the freezing of the prostate gland by liquid nitrogen causing cancer cells to rupture and die as they thaw.
Page 141: The tissue around the urethra is protected by heat, and cancer cells may harbor in that area.
Page 142: After treatment, some 20 percent of the men treated have cancer positive samples.
These are chemicals (medicine) used to control testosterone and other products of the glands serving the prostate.
Page 147: Using hormones will cause some shrinkage in the prostate. Different hormones shut down various glands to lower their input in making testosterone giving some control over this type of cancer.
Page 148: Cancer is made of many different cancer cells and scientists know that some grow in the absence of male hormones which are sensitive in some cancer cells. So, using hormones may not stop the growth of all of the cancer cells in the prostate. Thus, some cancers are reduced, as indicated by the lowering of the PSA number, while others will expand in time depending upon the cell sensitivity to hormones.
Page 160: On this page in The Prostate by Dr. Walsh, there is a list of hormone medicines and an explanation on how they work. Hormones are usually given in the later cancer stages. For containment, they work surprisingly well for the older men I know who are suffering from the disease permitting several years of life.
I trust this work will offer technical guidance to the men climbing out of the dark hole of prostate cancer. Further, it is estimated that 90 percent of the cancers are due in part to poor eating habits, smoking, and exposure to hazardous chemicals. A health program of a low-fat, high fiber diet with plenty of fish and fowl (not red meat) along with beta carotene (Vitamin A) from different vegetables is helpful in lowering the cancer risk. The National Cancer Institute said that tomato based foods will help with the containment of prostate cancer, and I eat a tomato a day. Linus Pauling said somewhere that Vitamin C aids in holding the cells together; thus, I reason that it will aid in resisting cellular enlargement of the tumor. So I take a significant share. In closing I wish the best of luck to those interested in successfully battling this deadly cancer. I believe prayer can provides scientific guidance in this deadly medical dilema.
P.C. Walsh, M.D. and J.F. Worthington, The Prostate, Johns Hopkins University Press, 2715 North Charles Street, Baltimore, Maryland 21218-4319, University of Utah Bookstore (801) 581-3536.
Prostate Cancer Education Program Feedback Kit (includes prostate glossary).
NIH National Cancer Institute, 31 center Drive, RM 10A03 MSC 2580, Bethesda , MD 20814-9692, toll free 1-800-4-cancer or 1-800-422 6237, http://www.nci.nih.gov