Hello MNCC! Three and one-half years ago, I was diagnosed with prostate cancer after two slightly elevated PSA tests and two successive confirming biopsies. You can read my previous diary from 2013 here where I describe my experience with diagnosis, notably my choice not to immediately undergo radical prostatectomy (RP). This approach is called "active surveillance." Join me below the fold to read about a recent clinical study that may provide a new tool soon for making a better informed treatment decision for the most frequently occurring cancer in men, after skin cancer.
Monday Night Cancer Club is a Daily Kos group focused on dealing with cancer, primarily for cancer survivors and caregivers, though clinicians, researchers, and others with a special interest are also welcome. Volunteer diarists post Monday evenings between 7:30-8:30 PM ET on topics related to living with cancer, which is very broadly defined to include physical, spiritual, emotional and cognitive aspects. Mindful of the controversies endemic to cancer prevention and treatment, we ask that both diarists and commenters keep an open mind regarding strategies for surviving cancer, whether based in traditional, Eastern, Western, allopathic or other medical practices. This is a club no one wants to join, in truth, and compassion will help us make it through the challenge together.
One of the baffling and frustrating aspects of being diagnosed with prostate cancer is that it may not be a danger to you at all, depending on your age. Many of us know of men who have lived with a diagnosis of PCa for 10, 15, 20, or in the case of my partner's uncle, 25+ years without advancement or significant danger. Others have aggressive cancers that in a short period of time can leave the envelope of the prostate and invade other areas of the lower abdomen and/or bones, with catastrophic results. Currently, the only real measurement used to classify PCa is the Gleason score (see my previous diary for a link) which is a scale developed fifty years ago. The Gleason score is based on the appearance of the cancerous tissue in comparison to normal tissue in the prostate. The more abnormal the tissue, the more it is presumed to be "worse". The new study, published in a peer-reviewed journal in Britain, offers a potentially more powerful stratification of the types of prostate cancer, in that it offers an actual predictive value that is superior to the Gleason score. Yes, the study is small, but should this methodology prove to be true, it offers a more definitive way of determining whether or not aggressive treatment is indicated, possibly avoiding many cases of over-treatment. This is not a small issue. Many, many men opt for RP upon learning of their diagnosis, but sometimes this could be avoided with better information. Indeed, my own doctor strongly recommended I have my prostate removed in 2012. I chose not to, and 41 months later, my PSA test is lower than when I was first diagnosed, with no treatment at all, and my regular biopsies indicate no advancement. This is very, very preliminary, and obviously a ways off in terms of practical application. But I will be frank here: I believe too many men undergo RP when it may not be necessary, but I also understand the deeply emotional reaction to being diagnosed with cancer, and I don't blame any man who chooses RP as treatment. However, this study gives us a potentially powerful new tool to make that decision much, much easier at the time of diagnosis. This is a hopeful thing. Please stick around for the discussion tonight, and thanks in advance for everyone's participation. What do you think?