Howard Wolinsky a journalist based in the Chicago area, was diagnosed along with early prostate cancer in 2010. In part one of this collection he described his diagnosis and his decision to chose energetic surveillance. In the second part, he shared his experience throughout 5 years of energetic surveillance and in this portion he tells his continuing quest to make the most effective — and most informed — decision regarding his care.
A quiet revolution is unfolding in the treatment of early-stage prostate cancer.
A growing number of men along with Gleason 6 cancers are rejecting the urge to be whisked off to surgery and radiotherapy to seek cures. Likewise, men are knowing that these slow-growing tumors are unlikely to kill them. Also, they wish to steer clear of common adverse effects from treating a slow-growing tumor, such as erectile dysfunction and urinary incontinence.
In the Start …
I was diagnosed along with Gleason 6 prostate cancer at age 63 in 2010. At that time, fewer compared to 10% of men opted for energetic surveillance, which involves PSA examinations every 3 to 6 months and biopsies annually or biannually. I took my opportunities along with energetic surveillance.
Now, though estimates vary, as several as 40%-50% of men go for energetic surveillance, according to my urologist Scott Eggener, MD, that launched an energetic surveillance program at the University of Chicago Medical Focus in 2008.
Eggener cites research from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) study, a national registry accruing men along with prostate cancer diagnosed at 45 urology practices across the U.S. because 1995.
Also, he cited Michigan Urological Surgery Improvement Collaborative (MUSIC) study, finding that regarding half of men along with low-risk cancer initially adopted energetic surveillance though rates varied considerably in different practices.
When I started on energetic surveillance in 2010, the available research was a Canadian 10-year survival study that offered enough guide for me to be fairly confident that the odds beloved my tiny cancer would certainly look quite much the same in 2020 as it did in 2010.
So far, so good, 5 years in to energetic surveillance.
I’ve had four biopsies because 2010 As soon as my PSA started to increase. The very first was inconclusive. The second found a tiny adenocarcinoma, one millimeter in length, classified as a Gleason 6. My next two biopsies in 2011 and 2012 found no cancer at all of though Eggener informed me I still had cancer, however he put me on a biopsy holiday.
The good news continued in 2015 along with the publication of 15-year survival data from the Canadian researchers.
Writing in the Journal of Clinical Oncology, Laurence Klotz, MD, and colleagues from the University of Toronto reported in the diary of Clinical Oncology in January 2015: “energetic surveillance for favorable-risk prostate cancer is feasible and appears safe in the 15-year time frame. In our cohort, 2.8% of patients have actually produced metastatic disease, and 1.5% have actually died of prostate cancer.”
As a patient along with early prostate cancer, this was wonderful news. I appreciated being able to follow a group of patients Love me that have actually a 5-year head start.
Getting Personal
But while it feels good to have actually statistics on your side, they are still statistics. I had my eye out for anything offering personalized data to indicate whether I had gained the right choice along with energetic surveillance.
In April 2013, I read regarding a study in the Journal of Urology suggesting that genetic testing could offer some answers on PSA that would certainly indicate a requirement for a biopsy.
Brian Helfand, MD, [remember that name] a urologist from NorthShore University HealthSystem in the Chicago suburbs, and his colleagues found that four single nucleotide polymorphisms could be used to adjust a man’s measured PSA concentration and potentially delay or stay away from unnecessary prostate biopsies in Caucasian men.
“By utilizing a person’s genetic makeup we can easily personalize care As soon as he comes in for a PSA screening,” said Helfand. “We could be able to stay away from some men from having an unnecessary biopsy and stay away from a delay in biopsy for men that might have actually an aggressive disease.”
For 98% of the men, genetic adjustment of PSA levels did not adjustment the outcome of their screening. however the genetic correction was vital for the 17 men reclassified as no longer meeting biopsy criteria and the three whose condition was up-classified, and it was recommended they Get hold of a biopsy, based on their genetic adjustment.
I was excited to read that — finally here was something that could permit met to steer clear of some biopsies.
As it happens, I was an early adopter of DNA testing for family history and Good health reasons over the past 15 years or so. I was among the customers at FamilyTreeDNA and 23andMe. I used the SNP browser at 23andMe and pulled up the four markers specified in the study.
I shared the report and my markers along with Eggener, that informed me he was familiar along with it, however stressed that the test was not commercially available.
In June 2014, a friend sent me a report regarding yet another genetic test, which claimed to be the very first and only proteomic-based imaging biopsy test to differentiate accurately between aggressive and non-aggressive forms of prostate cancer at early stages of the disease.
Eggener was skeptical regarding the relevance of such examinations for me: “That test, along along with a few others (4K, phi) are new; data suggests mildly valuable for screening patients free of prostate cancer, not for guys Love you along with known diagnosis.”
Asking the Question
Then on Dec. 2, 2015, as a journalist that regularly wrote regarding DNA testing, I gained some appointments at the NorthShore University HealthSystem Focus for Personalized Medicine to learn regarding brand-new genomic approaches being commercialized and studied there.
I interviewed two physician-researchers, Charles Brendler, MD, and Jianfeng Xu, MD, DrPH, regarding translational genomic research performed at their hospital system, which has actually an academic affiliation the University of Chicago Pritzker School of Medicine.
Xu, formerly of the Focus for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, has actually been working on a genetic risk score to identify the likelihood of a patient creating prostate cancer (among others cancers). Data have actually shown that this genetic risk score might Likewise be associated along with the aggressiveness of prostate cancer.
Genetic data from a lot more compared to 100,000 patients along with or free of prostate cancer were used to develop a genetic risk score to predict prostate cancer. Xu said prospective studies still have to be conducted for the score to be commercialized. Patients along with mutations in several cancer genes are a lot more most likely to die of prostate cancer. Xu said 10-20% of prostate cancer patients along with aggressive illness had mutations in these genes.
But his approach is considered experimental, the personalized risk assessment is not prepared for prime time.
I met along with Brendler and Xu as a journalist, however I wondered if they would certainly recommend further testing for me, so I asked.
They did, including the genetic risk score.
Brendler said, “You already know your PSA and your Gleason score and your volume of tumor, however you don’t have actually genetic characterization of the tumor, which would certainly tell you Exactly how aggressive the cancer is.”
He Likewise suggested that I see urologist Brian Helfand, that runs NorthShore’s personalized risk-assessment prostate cancer clinic, which has actually 370 patients adhering to its protocol. (Yes, the same Helfand that led the study I specified earlier.)
It felt a little bit Love cheating on Eggener, my urologist of the past 5 years. I explained my hesitation and Xu helpfully noted: “This will certainly offer you a second opinion. You need to believe that means regarding it.”
I informed Eggener regarding my plan. He endorsed Helfand. The 2 urologists knew each others from their residencies at Northwestern Memorial Hospital in Chicago.
Pedal to the Metal
On Dec. 30, my wife Judi and I saw Helfand.
Helfand, that has actually a breezy style and fessed up to being a fan of the same Chicago hot canine joint I like, recommended that I have actually Beckman Coulter’s Prostate Good health Index assay, which was approved by the FDA in2012, the FDA as an aid to distinguish prostate cancer from benign prostatic conditions in men 50 years of age and older along with total PSA results in the 4 – 10 ng/mL range and negative digital rectal examination findings. The assay is supposed to bethree times a lot more accurate for prostate cancer detection compared to PSA testing by itself.
Helfand explained that “phi is not approved for prostate cancer screening. It is FDA approved only to predict biopsy outcomes. Therefore, phi has actually implied utility for men undergoing AS, due to the fact that it is associated along with high-grade disease.”
He said phi and 4kscore from OPKO Lab are two selections to predict the presence of aggressive disease. “higher grade/a lot more aggressive illness is one of the essential factors that we use in recognizing which patients will certainly do well while on energetic surveillance,” he told me.
On Jan. 8, 2016, I again drove 50 miles from my estate in the far south suburbs of Chicago to NorthShore University’s ambulatory care Focus in the far northern suburbs to undergo a phi. I was promised results in 3 weeks.
Helfand and Eggener the two recommended a focused MRI, which I have actually scheduled.
The phi and the focused MRI represent refinements to this brand-new course of energetic surveillance. These combined results will, I hope, guide my future path.
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