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Posts Tagged ‘Prostate prognosis’

URO TODAY: There is no evidence that tumour volume is an independent predictor of prostate cancer outcome and it should not be considered as a marker of tumour risk, behaviour or prognosis. READ MORE>

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JULY 31: URO TODAY: What’s the most accurate way your specialist can predict your fate when you first learn you have prostate cancer? Using something called a nomogram, according to latest analysis. READ MORE>

Researchers at the University of Montreal Health Center reviewed tools available to clinicians involved in treatment decisions in newly diagnosed prostate cancer and examined their accuracy to provide individual life expectancy.

“…nomograms provide the most accurate health-adjusted life expectancy prognostication,” they conclude.

What’s a nomogram?

It’s a calculation that gives an estimate – in this case, of life expectancy – after known information is fed into it.

The Memorial Sloan Kettering Cancer Center in the US has one for prostate cancer on its website. Anyone who knows the results of PSA, biopsy and Gleason grade can use it: CLICK HERE>

Here’s an example:

Nomogram

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JULY 24:  RENAL & UROLOGY NEWS: A protein that shows up in the urine of men with prostate cancer, but not those who don’t have it, may be an effective screening test by 2011, UK researchers believe. READ MORE>

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PART 17 of My PC Adventure (see full story HERE> )

Am I cured of prostate cancer?

I don’t know. The signs are already good, but I’ll just have to wait. I’m officially in limbo for the next 17 weeks.

I have no further appointments with the medical profession until late August, when I need to get a PSA blood test and then a few days later have a followup visit with the surgeon. Then we’ll know more.

It seems the magic “c” word is elusive. My prognosis is good, excellent even, but saying I’m cured is simply not possible, because this is a very complicated business.

About 30% of men who have a radical prostatectomy like I did will have what the profession calls “biochemical recurrence”.

Here’s the US Cancer Institute’s explanation of what that means:

A rise in the blood level of PSA (prostate-specific antigen) in prostate cancer patients after treatment with surgery or radiation. Biochemical recurrence may occur in patients who do not have symptoms. It may mean that the cancer has come back. Also called biochemical relapse and PSA failure.

How likely am I to be among the 30%?

Highly unlikely, it would seem. The reason is the cancer in my prostate was caught early, before it had time to surface at any of the margins of the organ, which is the bad thing that can happen as the cancer grows.

Once there are “marginals”, there is the chance of the tumour spreading into lymph nodes and the nearby seminal vesicles.

Here’s how MedicineNet.com defines seminal vesicles:

Seminal vesicle: A structure in the male that is about 5 centimeters (2 inches) long and is located behind the bladder and above the prostate gland. The seminal vesicles contribute fluid to the ejaculate.

Wikipedia says this about lymph nodes:

A Lymph node…is an organ consisting of many types of cells, and is a part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells. Thus they are important in the proper functioning of the immune system.

So, if you get cancer into nearby parts of the body like the vesicles or into the lymph system – and thereby spread through the body – the chances of advanced cancer increase.

There are drug and radiotherapy treatments for such eventualities, but the chances of long-term cure are proportionately lower.

Why am I waiting 17 weeks for the PSA test, and why is it done after the cancerous prostate has been removed?

To rehearse some earlier facts from my case, my PSA levels have never been high. The test prior to diagnosis showed .77, when up to 4 or 5 would have been acceptable for my age.

I have a friend whose PSA has been rising and is now about 20, but three biopsies have failed to find any sign of cancer. In my case, low PSA did not mean I did not have cancer (I did).

The wait is to allow my system to settle down, since surgical intervention can release the antigens into the system and temporarily raise the PSA in a way that is not helpful to diagnosis.

After five months (the operation was on March 25), that all should have settled down and an accurate reading should be possible.

What are we hoping for? Well, a nil result. Zilch. That would mean no biochemical recurrence…and no cancer.

The other thing in my favour is the low Gleason grade given to my tumour: at 6/10 it is the lowest meaningful result used. That means the cancer was of a low aggression type. It would have taken years to migrate out of the prostate.

So. I’m hopeful of the nearest thing to a cure you can get.

No doubt I’ll need to continue with the PSA tests for a few years just to be sure. Biochemical recurrence can occur some time after surgery. But in my case, it seems unlikely.

Here’s hoping…

A recent web item said spouses and partners end up more worried about cancer recurrence than the patients. So it’s time to find out what Lin thinks of all this.

NEXT: Another side to the story

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