GREG'S LEGACY

Specialising in the human experience of Living with prostate cancer – warts and all

P.C in the News with Greg’s summary – 3/05/12

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Health Status:  Finally, a month after leaving hospital, things appear to be improving.   Pauline is off to S.A. until next Monday and David will fill in for her whilst she is away.  I woke at 6.00 am (exceptionally early) and it only took about 30 minutes to get the air passages operating.  The muck on my lungs is definitely reducing and, at last, I can visualise getting back to my pre-hospital status where I can live to fight another day.  Now, that would be exciting for me.

The following information comes from yesterday’s news bulletins

Testing for PSI is under scrutiny again.  Recent trials have indicated that more harm can be done by misdiagnosis than good that can be achieved.  As a result many doctors no longer endorse regular PSA screening.  So they are trialing alternatives.

Among the most promising new molecular tests for PCa screening is PCA-3, a non-coding, large-chain RNA over-expressed in PCa. PCA3 is detectable in urine and independent of prostate size and PSA.

In nearly 1,000 men undergoing initial or repeat biopsy, these investigators found that urinary PCA3 prior to a prostate biopsy improved the prediction of PCa and high-grade disease with a high positive predictive value (90%) in the initial biopsy setting and a high negative predictive value (88%) in the repeat biopsy setting. The investigators conclude that counseling men undergoing prostate biopsy in the context of PCA3 would reduce the burden of prostate biopsies.

In the past, CT scans and bone scans have been the mainstay of imaging to find tumors.  Now, the MRI scan has been improved to give a far more detailed image.  Furthermore, the crystal-clear images of the inside of the body have changed cancer treatment for ever.

At University College Hospital London, urologists have been carrying out MRI scans on men before they have had a biopsy for possible prostate cancer for the past eight years.  I had this procedure at the Peter McCallum Cancer Centre in Melbourne.

The fact is that a biopsy without an MRI is like digging around in the dark in men’s nether regions. The results are used to decide whether to do a biopsy, where and how to take the biopsy, as well as planning treatment and monitoring treatment response.  ‘Biopsies miss one in two tumours while a high-quality MRI scan can rule out important cancer — tumours that require urgent treatment in 95 per cent of men with prostate cancer,’ says lead researcher, Professor Mark Emberton, a urologist at University College Hospital.

A new study has shocked experts by showing that prostate cancer surgery is no more effective than simply leaving the cancer alone.  Prostate cancer is a slow growing tumor that allows most men to lead a pretty normal life without radical treatment.  In my case, I established that chemotherapy and/or radiation would not give me any extra time because it was too far gone.  Now, we find that surgery is no better.  (It was too late for me anyhow).

The statistics on sub-populations of race and sexual preferences raise some interesting results.  Some of the factors to consider, for example, include increased risk of urinary and bowel function decline in African Americans regardless of treatment received and differing sexual expectations and social support in gay men.  Today, many of these confounding factors are poorly documented and poorly addressed by medical practitioners when discussing treatment, be it radical prostatectomy, radiation or androgen deprivation therapy. There is also scant research about prostate-cancer-related quality of life effects in men who have sex with men (MSM).

MSM with prostate cancer have additional social and sexual challenges often overlooked. MSM are typically diagnosed later in life and may be reluctant to divulge their sexual preference to their caregiver.  This may preclude them from discussing their quality of life expectations and sexual practices.

One reason for poorer quality of life may also be attributed to a lack of social support group, the researchers discovered in their analysis. As MSM men are less likely to have long-term partners, they might not have the same level of support at home and might look for support in other places.

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Written by Greg Naylor

3 May 2012 at 12:00 pm

Posted in Greg Naylor, my fight, psa, surgery

Tagged with ,

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