1. It is a sad reality that the experts disagree on treatments and results are skewed and biased. Most guys diagnosed (majority) are with "insignificant PCa or indolent PCa" and defined by The Brady Institute of John Hopkins (do search engines) or see www.prostate-help.org for real information without biases. Seldom mentioned for guys with little higher than normal stats is: straight hormone therapy similar to Dr. Leibowitz protocol of ADT3= Lupron(ZOladex)+Casodex+Proscar for 13 months, then drop the major drugs and take proscar only as a maintenance drug. I know a guy who's psa was 11.1 and found with 2 positive biopsies with low grade gleason scale on each of 5 (2+3) it was said. He did this regime and quit and takes only proscar, it has been over 9 years now and no cancer is detected, psa is below normal, and best of all total sexual function is same. Ask him if he is glad he did not have surgery, radiation and other treatments???? He lives in Michigan too. Naturally all the doctors wanted to do surgery etc., and make $$$$$$$ and leave him the side effects. You can read more about Dr. Leibowitz and this type of protocol at www.prostate-pointers.org (Leibowitz)
There is more than one way to skin a cat. Or treat us cats for PCa disease.

Posted at 2:45PM on Sep 12th 2006 by Robert Parsons

2. Robert -- you and I are reading from the same pages. Thanks particularly for relating the story of your friend's experience. Have you read the notes/graphs for the presentation Dr. Leibowitz and his colleagues Tucker and Roundy made at the special ASCO meeting on prostate cancer in Orlando, Florida, in February 2005? They document stunning success with low risk patients, and I'll bet their patients are as pleased as the friend you mention. You can access the notes and graphs at www.doctorleibowitz.com under the button on the home page for the Orlando presentation. Unfortunately, that group has not been able to have their results published in a major peer-reviewed journal.

Did you know that the Strum/Scholz/Lam (and others) collaborative group has had an article published on their experience with intermittent triple blockade in the May issue of the Journal of Urology? They finally cracked the publication barrier in a very major journal! To me, the paper fairly conclusively demonstrates that intermittent triple blockade is markedly superior to intermittent two-drug blockade (LHRH-agonist plus an antiandrogen without a 5-Alpha Reductase Inhibitor). I inserted the word "fairly" because their results are from a single practice and involve only about 100 patients. We really need to see confirming results from other practices.

Of course, another option often given inadequate attention by doctors we consult is deferred therapy. It's not the same as waiting to see if you get clobbered with side effects and metastases, which is more or less the classic description of watchful waiting. Deferred therapy is about disciplined surveillance plus preventive tactics and a switch to therapy if the numbers go south. Since just 2002, studies from major cancer centers including the U. of Toronto, Johns Hopkins, Memorial Sloan Kettering, Erasmus in the Netherlands, and a major UK institution (and others) have endorsed deferred therapy as a reasonable option for low-risk cases.

I was not very impressed with the University of Michigan study that kicked off this blog. I looked at the abstract, and their definition of low risk was very loose. They focused on the Gleason Score, but they did not look much at key variables like PSA, PSA change, whether the PSA rose by more than 2.0 in the year prior to diagnosis, or stage. For instance, some of us have low Gleasons but cancer that is already at the edge of the prostate capsule or beyond. That is clearly not low-risk cancer, but apparently the study guidelines would have classified it as low risk. I agree with the general conclusion that prostate cancer is often overtreated, but I don't agree for the reasons and evidence stated in the study.

Jim (website: http://www.mycancerplace.com/profile.php?id=147)

Posted at 5:18PM on Sep 12th 2006 by Jim Waldenfels