I think that most failures of conventional treatments with a Gleason 3+3=6 is due to the mis-reading of the Gleason score or other diagnostic items. It is my belief that if we had a true 3+3 and nothing else, no 4 or 5, no spread, nodes not involved, no extra capsular penetration, no margins (in surgery), small volume of tumor - at the hands of an "expert" the person is 100% curable.
Every failure may the fault of mis-diagnosis or unknowns.
PSA is a very unreliable gage of the cancer at the time of early diagnosis. The higher the Gleason the lower the PSA. For example we can have a Gleason score of 8, 9 or 10 and have a PSA of 1 or so. On the other hand we could have a PSA of 10 or so with a Gleason of 3+3=6.
We look at doubling time of PSA as being an important findings. However with a Gleason score of 8, 9 or 10 and a low PSA - the doubling time may be very long. With a Gleason 3+3=6 the doubling time can be short or long.
Why the difference - the difference may be in the tertiary grade. For example if we had a high Gleason (8, 9 or 10) and no tertiary grade we would always have a low PSA and probably a low doubling time. In addition there are places in the Gland that cannot be reached by our normal needle biopsy. These could have lots of tumor of high grades and we don't even know it.
If any gland had any Gleason grade 3 in it (regardless of reported grades) than we could have a higher PSA and a higher doubling time.
Two more important variables:
1. The volume of the tumor could make a large difference and what is the grade of that volume. One could have a 3+3=6 with a very small spot and a 3+3=6 where their is a lot of cancer. Two different diagnosis with two different treatment considerations.
2. Prostate cancer has many different cell variations. We know that some cell types will respond differently to different treatments (this is never taken into consideration by the doctors in their diagnosis - there is no lab tests that are commonly used to show this. I believe the cell types would apply to different Gleason Grades and perhaps different growth patterns and different production of PSA. There may be 30 or more different types. And there is no known attempt to type cells and study the differences.
The doctor only works with the known diagnostic information and makes decisions, based on studies, of these known findings. If there is no higher Grades reported, if there is no reported volume of all grades, if there is no known "variants" (see http://www.cancer.prostate-help.org/capathl.htm), etc., etc. etc. he is very limited in recommending treatments based on studies.
Any study based on the initial diagnosis is short of diagnostic information and is only as reliable as the doctor or doctors who report the findings. If you show a sample of gland tissue to 10 different pathologist you would get many opinions and readings. If you send the same blood to many different labs you would get many different readings. And these differences could all be significant.
Now when you consider that a CT scan is worthless unless there is massive tumors growing elsewhere in the body. Then you consider there may well be bone tumors (prostate cancer of the bone) that are yet too small to be seen with our present procedures. One may well have a spread of the disease that can not be seen or diagnosed with any reliability. In these procedures the only thing you know when they report negative findings is simply that they did not see any - not that it wasn't there.
With the guessing game we have - you see why I believe that prostate cancer should always be treated with more than one modality of treatment.
We simply don't know with our present diagnostic procedures how really sick a man might be with this disease and why sometimes a man is only diagnosed when he experiences a high level of bone pain - and then it is too late.
Showing posts with label Diagnosis. Show all posts
Showing posts with label Diagnosis. Show all posts
Tuesday, October 16, 2007
Wednesday, June 27, 2007
PSA - What does it measure?
To All
This is a rather long post with a lot of references to pages on my websites about PSA. It should be read by anyone who has started this prostate cancer process and those who are on line helping others with their decision making process. Every person dealing with prostate cancer should have a full understanding of the PSA as to what it is and what it isn't.
As we all know (but some never seem to get in their mind) that the PSA is not a good marker for prostate cancer - but it is about all we have so we have to use it.
For example we know that most biopsies are made when the PSA climbs over 4.0 yet we know that many prostate cancers are found with a PSA of less than 4.0. We also know that biopsies only catch cancer about 30% of the time - and the men who do not show cancer go away thinking they have no cancer. Yet we know that a biopsy is like sticking a needle in a haystack and could miss a lot more than it finds. We know men who have high PSA's and multiple biopsies and the cancer is not found. They may or may not have cancer - we just don't know. Now these decisions on the diagnosis of prostate cancer are made on the basis of PSA's - any PSA. At the same time we know there are many things that will cause the PSA to rise that have nothing to do with prostate cancer.
After we are diagnosed we watch the PSA and the slightest movement up scares us that the cancer has returned. We seem to forget at that point how inaccurate the PSA is to track our disease. We follow it like a God when in fact it may be more like a devil because it tells us so little. As we get into metastatic disease it is all we have and we do follow it closely.
But lets forget, for a moment, all of the other things that cause the PSA to go up and down and concentrate on only one thing - the use of the various assays for measuring PSA - they are a long way from being the same and even inaccurate among themselves.
PSA results vary considerably due to several factors.
The first is random lab error which is always present because nothing can be measured with 100% accuracy.
The second factor is called systematic error. These are errors that result because one lab may use a different analytical technique (assay) for reading the PSA, or a particular labs may calibrate differently.
Lastly, other events may, and do, influence the PSA level in the blood. Ejaculation, bike riding, or any manipulation of the prostate, such as a DRE, all have the tendency to raise the PSA in the blood. Furthermore, there are theories that the time of day a sample is drawn and the day within a 28 day cycle may affect the PSA level. Also, inflammation of the prostate (prostatitis) is also a frequent source of raised PSA.
LAB TESTING ON STANDARD SAMPLES
The one factor we cannot control is random lab error. Periodically a survey is taken of 1000's of labs to detect their random error in measuring PSA. Identical blood samples are sent to all labs for a PSA reading. In the study available to us at this time, six samples were sent to over 2500 labs, each sample contained a blood sample of a different PSA level from about 0.2 to 19.4. The results reported be each lab were analyzed to obtain the mean reading, the standard deviation from the mean for each lab and for each PSA level (of the six different samples sent to each lab). This allowed for the determination of a 95% confidence range -- a range around the mean value reported that there is a 95% chance the real PSA value falls within (hence, 1 in 20 reported readings will be out of this range). Here is a sample of their data.
Remember each of these labs got the exact same sample to test and report on. They had no idea as to what it should be. Note the Range and compare them against the Mean. Just look at the last line for example the mean was 0.24 and the range was as low as 0.1 all the way to 0.8. The upper range alone is 8 times the lower range. I think that this is perhaps due to the low numbers we are dealing with and is out of line somewhat with the others but it gives you an idea of the variance.
More information on this can be found at
http://www.cancer.prostate-help.org/capsava.htm .
LAB TESTING ON HUMAN SUBJECTS
Now let us look at what it does when it is applied to humans and in addition lets look at the different assays used. Here we want to concentrate on the range within an Assay and the difference between the assays.
This is a rather long post with a lot of references to pages on my websites about PSA. It should be read by anyone who has started this prostate cancer process and those who are on line helping others with their decision making process. Every person dealing with prostate cancer should have a full understanding of the PSA as to what it is and what it isn't.
As we all know (but some never seem to get in their mind) that the PSA is not a good marker for prostate cancer - but it is about all we have so we have to use it.
For example we know that most biopsies are made when the PSA climbs over 4.0 yet we know that many prostate cancers are found with a PSA of less than 4.0. We also know that biopsies only catch cancer about 30% of the time - and the men who do not show cancer go away thinking they have no cancer. Yet we know that a biopsy is like sticking a needle in a haystack and could miss a lot more than it finds. We know men who have high PSA's and multiple biopsies and the cancer is not found. They may or may not have cancer - we just don't know. Now these decisions on the diagnosis of prostate cancer are made on the basis of PSA's - any PSA. At the same time we know there are many things that will cause the PSA to rise that have nothing to do with prostate cancer.
After we are diagnosed we watch the PSA and the slightest movement up scares us that the cancer has returned. We seem to forget at that point how inaccurate the PSA is to track our disease. We follow it like a God when in fact it may be more like a devil because it tells us so little. As we get into metastatic disease it is all we have and we do follow it closely.
But lets forget, for a moment, all of the other things that cause the PSA to go up and down and concentrate on only one thing - the use of the various assays for measuring PSA - they are a long way from being the same and even inaccurate among themselves.
PSA results vary considerably due to several factors.
The first is random lab error which is always present because nothing can be measured with 100% accuracy.
The second factor is called systematic error. These are errors that result because one lab may use a different analytical technique (assay) for reading the PSA, or a particular labs may calibrate differently.
Lastly, other events may, and do, influence the PSA level in the blood. Ejaculation, bike riding, or any manipulation of the prostate, such as a DRE, all have the tendency to raise the PSA in the blood. Furthermore, there are theories that the time of day a sample is drawn and the day within a 28 day cycle may affect the PSA level. Also, inflammation of the prostate (prostatitis) is also a frequent source of raised PSA.
LAB TESTING ON STANDARD SAMPLES
The one factor we cannot control is random lab error. Periodically a survey is taken of 1000's of labs to detect their random error in measuring PSA. Identical blood samples are sent to all labs for a PSA reading. In the study available to us at this time, six samples were sent to over 2500 labs, each sample contained a blood sample of a different PSA level from about 0.2 to 19.4. The results reported be each lab were analyzed to obtain the mean reading, the standard deviation from the mean for each lab and for each PSA level (of the six different samples sent to each lab). This allowed for the determination of a 95% confidence range -- a range around the mean value reported that there is a 95% chance the real PSA value falls within (hence, 1 in 20 reported readings will be out of this range). Here is a sample of their data.
95% Confidence
Labs Low Med. High | Mean S.D. %rekSD Range
2672 10.8 19.4 34.5 | 19.67 2.14 10.9 15.39-23.95
2653 7.2 9.8 18.0 | 9.92 1.11 11.2 7.70-12.14
2689 5.3 7.3 12.8 | 7.36 0.79 10.7 5.78- 8.94
2509 2.1 3.0 4.7 | 3.03 0.33 10.8 2.37- 3.69
2504 0.6 0.7 1.5 | 0.73 0.11 14.5 0.51- 0.95
2591 0.1 0.2 0.8 | 0.24 0.10 40.2 0.04- 0.44
Remember each of these labs got the exact same sample to test and report on. They had no idea as to what it should be. Note the Range and compare them against the Mean. Just look at the last line for example the mean was 0.24 and the range was as low as 0.1 all the way to 0.8. The upper range alone is 8 times the lower range. I think that this is perhaps due to the low numbers we are dealing with and is out of line somewhat with the others but it gives you an idea of the variance.
More information on this can be found at
http://www.cancer.prostate-help.org/capsava.htm .
LAB TESTING ON HUMAN SUBJECTS
Now let us look at what it does when it is applied to humans and in addition lets look at the different assays used. Here we want to concentrate on the range within an Assay and the difference between the assays.
These figures come from the study as follows:
Clin Chem. 2006 Jan;52(1):59-64. Related Articles, Links
Interchangeability of measurements of total and free prostate-specific antigen in serum with 5 frequently used assay combinations: an update.
Stephan C, Klaas M, Muller C, Schnorr D, Loening SA, Jung K.
Departments of Urology and Laboratory Medicine and Pathological Biochemistry, University Hospital Charite, Berlin, Germany.
In this study they looked at the PSA and the %Free PSA in 314 prostate cancer patients (PCa) and 282 non prostate cancer patients (NPCa) and how there blood was read by 5 different Assays. If you want to read the actual numbers you will have to get the actual study but let me give you a few of the findings:
For the PSA they found a overall range in PCa of a low of 4.98 to a high of 7.27. For NPCa they found an overall range of 2.8 to 5.03.
Within the same Assay for PCa there seems to be a difference of about 0.7 across the board. For example the same specimen was measured from 6.5 to 7.27 in one Assay. For NPCa the difference varied from about 0.6 to 1.2 in the individual Assays.
But perhaps the most upsetting is not the range in the PSA as shown above for which we are fully aware of but the range in the %free PSA. For example across all ranges the %free PSA ranged from a low of 8.07 to a high of 14.9 for those patients with prostate cancer and for those non prostate cancer patients the range was 14.4 to 25.3. In each assay the same sample was measured within 2 to 3 points. Look at these carefully and see what differences it might make in the decision making process depending on which Assay was used.
You can see yet another table showing the differences in the PSA by various Assays at http://www.diagnosis.prostate-help.org/assays.htm
I think we will look at the %free PSA in a little different light and wonder where the Assay that was used stands in the line.
When you consider both the LAB TESTING of standardized samples and on human subjects it adds a whole new complexity of trying to understand the PSA measurement. It does make it very clear as to why one needs multiple PSA's using the same LAB and the same ASSAY before making decisions that effect your health in one way or another.
For additional reading on the PSA read:
http://www.cancer.prostate-help.org/capsava.htm
http://www.cancer.prostate-help.org/popsacli.htm
http://www.cancer.prostate-help.org/popsafl.htm
http://www.diagnosis.prostate-help.org/pcpsaid.htm
http://www.diagnosis.prostate-help.org/pcpsaot.htm
http://www.diagnosis.prostate-help.org/assays.htm
Friday, May 25, 2007
Diagnosis - is it?
This is another one of those "the longer I have been involved with the groups and PCa, I have some strong feelings" type posts.
This one is about mono treatment of any kind, surgery, radiation, seeds, HDR, Cryo, etc., etc. I do not believe there is ever a time to risk mono treatment in the fighting of this disease. Let me list the reasons why.
1. To begin with the diagnosis itself is so uncertain in terms of the cancer in the gland, the Gleason. PSA and the staging - all very inaccurate.
A. We get 6 or more needles put into a gland that may be anything from 20cc to 160cc in size. If we are talking about a 25cc gland then 12 needles cover it much more than 12 needles in a 100cc Gland. If 12 needles is sufficient for a 25cc gland then we should use 4 times that many needles for a 4 times larger gland to get the same coverage.
B. In addition there are areas of the Gland that a normal biopsy will not cover with even 12 or more needles.
C. Not all doctors are able to see the cancer in the gland and they put the needles in with a predetermined pattern. A skilled doctor looking at the gland will see areas that are suggestive of cancer and he will stick a needle in those areas. Then we have doctors who use a Color Doppler along with a Black and White that gives them an even better chance of seeing any cancer and sticking a needle in it. Now when we look at the totally needles and total positive the doctor who sees the cancer will have more positives and may do less other needles. Thus our guidelines may not apply to the biopsies done by that doctor.
D. Some tumors are so small that they can not be seen and a small chance of ever having a needle passing through them.
E. In any positive needle that maybe shows a Gleason grade of 3 - a fraction of an inch away may have been a 4 or even a 5.
The result of all this is uncertainty and confusion. Even with the very best doing biopsies we really do not know exactly what we have. So we begin this journey with something that may be just the tip of the iceberg.
2. There is a great deal of confusion about Stage.
What we usually want to know is what was the "clinical stage" - this is the stage when the doctor does the DRE and it is what he feels. The "pathological" stage is commonly thought to be the stage that is found when the gland is removed in surgery. About 50% of the time these will be different. Also the amount of the cancer that is found following surgery will be higher. And if you had 10 doctors doing a DRE they may feel 10 different things. So at best this is very iffy. Read about stage at Reference: 5 below.
3. And now for the Gleason score.
We know that better than 50% of the time the Gleason as given at your local clinic is wrong and it is usually lower than reported. Why is this - simply local pathologists do not have the experience in looking at prostate cancer slides and assigning a Gleason score. Then if we look at the gland following surgery we also find a large difference in what was reported from the biopsy. There is little chance that the Gleason that was assigned at the local level is, in fact, the Gleason you have. This is why we always insist the slides be sent to an acknowledged expert for review. Information at Reference 3, 4 and 5 below.
4. And then we have PSA.
PSA is caused by many things. When a biopsy decision is made base on the level of PSA it is wrong as much as 75% of the time - this means that they cannot FIND cancer in 75% of the men - does not mean it is not there just that they missed it! In prostate cancer PSA is almost a "fools paradise" because so many thing by controlling the PSA they are controlling the cancer - simply not true. We have studies that show the cancer continuing to grow as the PSA gets lower. For a better understanding of PSA and all of its ins and outs read the pages on PSA in the reference #5 below.
ARE YOU CONFUSED?
So we have a rather bleak and dismal look above at diagnosis and how inaccurate it can be and how unreliable the numbers you are given may be. The result of all of the above simply tells me that most are understaged and therefore should get treated as if they had a higher grade of disease.
The other thing that I so frequently see is those who have failed their initial treatment and the cancer has come back and they are in the fight for their lives - of which many will lose. As I view those who have advanced disease I note that an overwhelming majority of them has a mono treatment at the time of diagnosis. There are a few who were diagnosed with advanced disease and they go along and get treated and if it is a mono treatment - it is sure to fail.
And something else that has to be taken into consideration is the fact that the insurance companies have a set of rules that may dictate only a mono treatment because they simply will not pay for the combination. A practice that I believe is very short sighted on their part - in the long run it will cost them more. Since the doctors knows the insurance will not pay for it he/she has to convince you that the mono treatment is the best for you. They may be just signing your death warrant - especially if you might have a more advanced stage of this disease.
Therefore as I see it if you feel and your stats are such that you are convinced that you need treatment try always to get a combination for example surgery and radiation, seeds and external beam, and you can always add some kind of hormonal ablation therapy to any of them.
Now about that "do you need treatment" bit.
I believe there are times that one can get by without having any immediate treatment and perhaps some changes in the lifestyle and the addition of some supplements and meds may keep some control. This low grade cancer is sometimes referred to as "insignificant cancer". It is further defined as a low PSA, low Gleason, high %free PSA, very low stage, and someone past 65 with no family history of prostate or breast cancer.
If you have been given these numbers and you have checked and double checked them for accuracy (sent slides to an expert) and if you are willing to take a biopsy every year and be ready to move to an active treatment at any time those numbers change (and confirmed) - then you can consider Watchful Waiting.
The strange part of this is that frequently when one is diagnosed with "insignificant cancer" the doctor makes a recommendation for a mono treatment - WHY!!!! I personally believe that if your doctor recommends a mono treatment - you must check everything out carefully and see if you meet the qualifications of having no immediate treatment at all. If you do not meet these qualification then you need a combination treatment.
Even when we see men diagnosed with "insignificant cancer" we do see them start to fail and sometime, but rarely, quickly so you must be vigilant. For more information see References: 1 and 2 below.
Take Home
The take home of this long dissertation is simply that if you need treatment you should go all the way and have a combination of treatment. And if you think you qualify for a mono treatment - maybe you don't need treatment at all at this time!!!!
Now doctors are not going to like me for the above as it means loosing patients. They will simply say "what do you expect on the Internet". But remember that the survival rate for those who are diagnosed with localized cancer (including nodes and seminal vesicles) have a 100% success rate at 5 years. Other studies tell us that one can be as successful with WW out 15 years and at that time those who chose early treatment begin to be better off.
To successfully attack this disease and win the battle there are a number of steps that you need to go through and a lot of things you need to know about your history and your diagnosis. For more details go to the web site in Reference: 6 below and go through the step by step procedures. Then and only then will you have your full suit of armor on and ready to fight the battle.
References:
1. http://tinyurl.com/2apd97
2. http://tinyurl.com/2dm4oy
3. http://www.cancer.prostate-help.org/caglegr.htm
4. http://www.cancer.prostate-help.org/canames.htm
5. http://www.diagnosis.prostate-help.org/pcdiag.htm
6. http://www.diagnosis.prostate-help.org
And for everything prostate cancer start at:
7. http://www.prostate-help.org/
This one is about mono treatment of any kind, surgery, radiation, seeds, HDR, Cryo, etc., etc. I do not believe there is ever a time to risk mono treatment in the fighting of this disease. Let me list the reasons why.
1. To begin with the diagnosis itself is so uncertain in terms of the cancer in the gland, the Gleason. PSA and the staging - all very inaccurate.
A. We get 6 or more needles put into a gland that may be anything from 20cc to 160cc in size. If we are talking about a 25cc gland then 12 needles cover it much more than 12 needles in a 100cc Gland. If 12 needles is sufficient for a 25cc gland then we should use 4 times that many needles for a 4 times larger gland to get the same coverage.
B. In addition there are areas of the Gland that a normal biopsy will not cover with even 12 or more needles.
C. Not all doctors are able to see the cancer in the gland and they put the needles in with a predetermined pattern. A skilled doctor looking at the gland will see areas that are suggestive of cancer and he will stick a needle in those areas. Then we have doctors who use a Color Doppler along with a Black and White that gives them an even better chance of seeing any cancer and sticking a needle in it. Now when we look at the totally needles and total positive the doctor who sees the cancer will have more positives and may do less other needles. Thus our guidelines may not apply to the biopsies done by that doctor.
D. Some tumors are so small that they can not be seen and a small chance of ever having a needle passing through them.
E. In any positive needle that maybe shows a Gleason grade of 3 - a fraction of an inch away may have been a 4 or even a 5.
The result of all this is uncertainty and confusion. Even with the very best doing biopsies we really do not know exactly what we have. So we begin this journey with something that may be just the tip of the iceberg.
2. There is a great deal of confusion about Stage.
What we usually want to know is what was the "clinical stage" - this is the stage when the doctor does the DRE and it is what he feels. The "pathological" stage is commonly thought to be the stage that is found when the gland is removed in surgery. About 50% of the time these will be different. Also the amount of the cancer that is found following surgery will be higher. And if you had 10 doctors doing a DRE they may feel 10 different things. So at best this is very iffy. Read about stage at Reference: 5 below.
3. And now for the Gleason score.
We know that better than 50% of the time the Gleason as given at your local clinic is wrong and it is usually lower than reported. Why is this - simply local pathologists do not have the experience in looking at prostate cancer slides and assigning a Gleason score. Then if we look at the gland following surgery we also find a large difference in what was reported from the biopsy. There is little chance that the Gleason that was assigned at the local level is, in fact, the Gleason you have. This is why we always insist the slides be sent to an acknowledged expert for review. Information at Reference 3, 4 and 5 below.
4. And then we have PSA.
PSA is caused by many things. When a biopsy decision is made base on the level of PSA it is wrong as much as 75% of the time - this means that they cannot FIND cancer in 75% of the men - does not mean it is not there just that they missed it! In prostate cancer PSA is almost a "fools paradise" because so many thing by controlling the PSA they are controlling the cancer - simply not true. We have studies that show the cancer continuing to grow as the PSA gets lower. For a better understanding of PSA and all of its ins and outs read the pages on PSA in the reference #5 below.
ARE YOU CONFUSED?
So we have a rather bleak and dismal look above at diagnosis and how inaccurate it can be and how unreliable the numbers you are given may be. The result of all of the above simply tells me that most are understaged and therefore should get treated as if they had a higher grade of disease.
The other thing that I so frequently see is those who have failed their initial treatment and the cancer has come back and they are in the fight for their lives - of which many will lose. As I view those who have advanced disease I note that an overwhelming majority of them has a mono treatment at the time of diagnosis. There are a few who were diagnosed with advanced disease and they go along and get treated and if it is a mono treatment - it is sure to fail.
And something else that has to be taken into consideration is the fact that the insurance companies have a set of rules that may dictate only a mono treatment because they simply will not pay for the combination. A practice that I believe is very short sighted on their part - in the long run it will cost them more. Since the doctors knows the insurance will not pay for it he/she has to convince you that the mono treatment is the best for you. They may be just signing your death warrant - especially if you might have a more advanced stage of this disease.
Therefore as I see it if you feel and your stats are such that you are convinced that you need treatment try always to get a combination for example surgery and radiation, seeds and external beam, and you can always add some kind of hormonal ablation therapy to any of them.
Now about that "do you need treatment" bit.
I believe there are times that one can get by without having any immediate treatment and perhaps some changes in the lifestyle and the addition of some supplements and meds may keep some control. This low grade cancer is sometimes referred to as "insignificant cancer". It is further defined as a low PSA, low Gleason, high %free PSA, very low stage, and someone past 65 with no family history of prostate or breast cancer.
If you have been given these numbers and you have checked and double checked them for accuracy (sent slides to an expert) and if you are willing to take a biopsy every year and be ready to move to an active treatment at any time those numbers change (and confirmed) - then you can consider Watchful Waiting.
The strange part of this is that frequently when one is diagnosed with "insignificant cancer" the doctor makes a recommendation for a mono treatment - WHY!!!! I personally believe that if your doctor recommends a mono treatment - you must check everything out carefully and see if you meet the qualifications of having no immediate treatment at all. If you do not meet these qualification then you need a combination treatment.
Even when we see men diagnosed with "insignificant cancer" we do see them start to fail and sometime, but rarely, quickly so you must be vigilant. For more information see References: 1 and 2 below.
Take Home
The take home of this long dissertation is simply that if you need treatment you should go all the way and have a combination of treatment. And if you think you qualify for a mono treatment - maybe you don't need treatment at all at this time!!!!
Now doctors are not going to like me for the above as it means loosing patients. They will simply say "what do you expect on the Internet". But remember that the survival rate for those who are diagnosed with localized cancer (including nodes and seminal vesicles) have a 100% success rate at 5 years. Other studies tell us that one can be as successful with WW out 15 years and at that time those who chose early treatment begin to be better off.
To successfully attack this disease and win the battle there are a number of steps that you need to go through and a lot of things you need to know about your history and your diagnosis. For more details go to the web site in Reference: 6 below and go through the step by step procedures. Then and only then will you have your full suit of armor on and ready to fight the battle.
References:
1. http://tinyurl.com/2apd97
2. http://tinyurl.com/2dm4oy
3. http://www.cancer.prostate-help.org/caglegr.htm
4. http://www.cancer.prostate-help.org/canames.htm
5. http://www.diagnosis.prostate-help.org/pcdiag.htm
6. http://www.diagnosis.prostate-help.org
And for everything prostate cancer start at:
7. http://www.prostate-help.org/
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