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hagsie
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   Posted 8/7/2008 3:36 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Antny10
I believe both Waukesha Memorial and Aurora St Lukes CK centers do prostates. I had mine at Waukesha.
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J4fun1948
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   Posted 8/11/2008 7:08 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
I was 59 when I was diagnosed. PSA 7.4 and Gleason score was a 6 on one side and a 7 on the other so my score was considered a 7. I asked my doctor about watchfull waiting. He stated if my gleason score was lower then a 6 that was an option to consider. But being that it was a 7 and the fact I was 59 a more agressive form of treatment was advisable.
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radsrus
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   Posted 8/12/2008 2:42 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Watchful waiting, in my opinion, is for men who have low volume, low stage disease and whose life expectancy is such that it is unlikely the prostate cancer will get them before something else does. In my view, it is a strategy of deliberately deciding not to treat, and is best reserved for men who, as a mentor of mine used to say "have one foot in the grave and one foot on a banana peel". There are some men who decide to wait in the hope of postponing side effects. That is not entirely unreasonable, but it does mean that they will be facing a more difficult treatment when they do get treated, because the trigger to go ahead with treatment is advancement of the disease.

W&W is absolutely inappropriate IMO for 59 year old men. Unless you are on your last legs from something else, you will live long enough to get into trouble, and you don't want to have metastatic prostate cancer. Trust me on that. It is also inappropriate for Gleason 7 cancers. Except in the elderly, I usually recommend it only for men with Gleason scores of 2-4.

This is of course a controversial subject. There are those who think we are too aggressive in screening and treating. THere may be some truth to that in the very elderly, but otherwise, someone needs to explain to me why death rates from prostate cancer have plummeted since the advent of screening and why that is a bad thing. Perhaps the best evidence of my way of thought is the following:

BJU Int. 2008 Apr;101(7):809-16. Links
Comment in:
BJU Int. 2008 Jun;101(11):i.
Tyrol Prostate Cancer Demonstration Project: early detection, treatment, outcome, incidence and mortality.

Bartsch G, Horninger W, Klocker H, Pelzer A, Bektic J, Oberaigner W, Schennach H, Schäfer G, Frauscher F, Boniol M, Severi G, Robertson C, Boyle P; Tyrol Prostate Cancer Screening Group.
Department of Urology, University of Innsbruck, Innsbruck, Austria. georg.bartsch@uibk.ac.at

OBJECTIVE: To evaluate the effectiveness of a well-controlled programme of early detection and treatment of prostate cancer in the population of Tyrol, Austria, where such a programme of early detection and treatment was initiated in 1988 and where prostate-specific antigen (PSA) testing was offered for free to all men aged 45-75 years from 1993. SUBJECTS AND METHODS: Comparison of prostate cancer mortality rates in Tyrol and the rest of Austria was accomplished through a generalized additive model. A piecewise linear change-point Poisson regression model was used to compare mortality rates in Tyrol and the rest of Austria. Standardized mortality ratios were calculated with reference to the mortality rates in 1986-1990. RESULTS: In all, 86.6% of eligible men have been tested at least once since 1993. Cancer deaths in Tyrol in 2005 were 54% (95% confidence interval [CI] 34-69%) lower than expected compared with 29% (95% CI 22-35%) in the rest of Austria. The decreasing trend in prostate cancer mortality was significantly greater in Tyrol compared with the rest of Austria (P = 0.001). A significant migration to lower stage disease occurred and radical prostatectomy was associated with low morbidity. CONCLUSIONS: In the Tyrol region where treatment is freely available to all patients, where widespread PSA testing and treatment with curative intent occurs, there was a reduction in prostate cancer mortality rates which was significantly greater than the reduction in the rest of Austria. This reduction in prostate cancer mortality is most probably due to early detection, consequent down-staging and effective treatment of prostate cancer.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

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Jerome J. Spunberg, M.D.
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   Posted 8/12/2008 2:55 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
I cannot justify watchful waiting in a healthy 59 year old with bilateral disease with a Gleasaon's score of 7 and any desire at all to be treated. There is simply too much risk in remaining untreated at that age with the life expectancy as it is.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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