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#19 - GO TO INDEX
FOR EARLIER LETTERS
Prostate men need enlightening, not frightening
have often mentioned in posts and these E-Letters the subject of depression and
the importance of recognising the issue so that appropriate help can be sought.
This thoughtful piece looks at what happens as time goes by and how anxiety can
build, especially in partners and carers - those people looking after or who are
close to people who have cancer - Anxiety Lingers Long After Cancer
seems that even though some forms of cancer, and particularly prostate cancer,
may be labeled as being indolent or a chronic illness, the fact that there is
no guarantee of a cancer-free survival creates the uncertainty that is at the
root of much anxiety.
The article makes the point that "Anxiety
is a persistent problem long after the cancer has been diagnosed" and
that in one study anxiety levels two to ten years after diagnosis grew to as high
as 28 percent in patients and 40 percent in their spouses. I recognized this issue
and tried to address it as well as a mere man can do with the site page For The Womenfolk which has links to other
sites where women can discuss their issues, including anxiety with other women
in the same boat.
There was one paragraph in the article with which I could
relate where it is said "...the husband doesn't want to worry his wife
with every ache and pain, so he doesn't mention them. And he doesn't want to be
micromanaged over every little symptom." That has been, and still does
represent my position. I know wonder if that is fair because the paragraph continues
"But if the wife finds out, she'll worry even more because he didn't tell
her." Seems you are damned if you do and damned if you don't! Perhaps
being very open at all times may reduce anxiety levels in a partner, but doing
that would make me more anxious, I think.
Perils Of Self Diagnosis
and I had some unusual correspondence in May and I thought I might provide an
edited version of this since the author declined to publish his experience on
the site. I think this illustrates clearly some of the dangers in doing your own
research. Although we certainly recommend this, there are pitfalls. On the Choosing a Treatment page we include a link
to some excellent general advice in "Cancerguide: Researching Your Options".
correspondent had a scientific background and it seemed that this gave him an
element of confidence to interpret complex data although we thought his interpretation
might be misleading. He had recently retired, so was presumably in his sixties.
Here are brief edited extracts from his mails:
I have been monitoring
my PSA religiously for over 15 years. When it took a blip a couple years ago,
thinking I needed a prostate biopsy, I saw a urologist who thought the blip was
due to some acute urinary obstruction and BPH (Benign Prostatic Hyperplasia) so
I decided not have the biopsy. My PSA stayed stable at 4.0 ng/ml for over a year
but my urologist still wanted to biopsy me (even though the free PSA was above
10% at 19% and PCA3 was low at 6.8). I said no, because the PSA was not elevated
and I didn't think a blind biopsy had a good chance of finding anything and there
was the risk of infection from the biopsy.
When my PSA jumped to 8.00 ng/ml
from 4.00 ng/ml in January, 2013, I realized I might have a problem. My urologist
of course wanted to blind biopsy me, and again I said no, I want a multi parametric
magnetic resonance imaging scan (M-P MRI). (This is a high definition MRI
scan which is carried out in a limited number of institutions).
us that he was one of the 10-20% of prostate cancer patients with anterior prostate
cancer that cannot be found with the routine TRUS biopsy because the 1.7cm needle
cannot reach them and that he probably had prostate cancer stage T2c and that
his Gleason Scores were likely to be 4+3 (7b), 3+4 (7a) and 3+4 (7a). He had decided
that surgery RALP (Robotic Assisted Laparoscopic Prostatectomy) - was his
best option and had met the surgeon who would carry out the procedure.
I asked him how he knew this detailed diagnosis without having had a biopsy he
From my research on interpreting M-P MRI scans I know I have
three lesions, 1.4, 1.4 and 1.3 cm in size. Two are in the anterior prostate.
The Gleason Grades of the lesions established by ADC (analog-to-digital converter
) and enhancement characteristics are 4+3, 3+4 and 3+4. No capsular extension
was noted but one lymph node 9mm (upper limits of normal) was noted in the right
external iliac region (same side as the more aggressive dominant anterior lesion)
which raises the question of a local metastasis or skip metastasis (stage T4
The emotional drain of having to face these prostate cancer realities
really is a load to handle and makes it difficult to find the energy to persist
with this research. I noticed the difference myself, when the reality sunk in
that I probably was not going to match my mother's longevity (she is 94 now and
I tried to comfort him with some relevant data concerning
the longevity of men diagnosed with prostate cancer and asked him to let us know
how things went. The last mail we had from him said:
Just wanted to
let you know I had my 25 core MRI guided biopsy and all were negative for prostate
cancer. They only saw BPH and chronic inflammation. What a relief and gift!!
It is hard to believe it.
I have been unable to find any studies which
demonstrate that it is possible to grade any lesions with any current scan. The
specialists at the institution where the scan was carried out only reported that
"... they saw something..."
more lies and media releases
of mine were concerned about a recent report in the local media. The
Herald Sun for example had this to say in
US scientists say they have confirmed a surprising 2011 study
that found a higher risk of prostate cancer among men who consume omega-3 fatty
acids, raising new questions about the safety of supplements.
in the Journal of the National Cancer Institute reported a 71 per cent higher
risk for dangerous high-grade prostate cancer among men who ate fatty fish or
took fish-oil supplements, which are often touted for their anti-inflammatory
The same story was repeated all over the world. Many men
of my age (and even younger men) take fish oil supplements to lubricate their
old joints; to stave off heart failure and for many other reasons. They don't
take fish oil to increase their risk of prostate cancer - so what to do?
of the things I suggested, to those who were computer literate, was to go along
to Media Madness: Fish Oil Supplements Cause Prostate
Cancer! from which they would see that not only was there no "proof"
that fish oil was linked to prostate cancer, but none of the men in the study
were recorded as having taken fish oil or omega-3 fatty acids. The entire media
storm was not based on any sound information. It was solely for the headline value.
many people with busy lives tend to remember headlines or don't have the time
or inclination to analyse media stories, good or bad. There is a small example
of this on the Yana Forum Lupron and Kidney problems where Don seeks
clarification on an issue, saying "A recent JAMA article says there is an increased
risk of kidney failure if one takes lupron or other such anti androgen drugs."
Perhaps Don had also seen an article like this one Kidney Failure a Possible Risk of Prostate Cancer
Hormone Treatment: Study which kicks off with this:
therapy for prostate cancer may dramatically increase a man's risk of kidney failure,
according to a new study. Use of androgen deprivation therapy was tied to a 250
percent increase in a man's chances of suffering acute kidney injury."
posted a response (which you can see on the Forum which I will not repeat here)
indicating that this was NOT what the study said and trying to emphasise the importance
of analysing such information more closely before letting the headlines worry you.