BLOGGERS: MARK SCHOLZ, MD & RALPH H. BLUM

The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, July 17, 2012

“Good” Prostate Cancer, “Bad” Prostate Cancer

BY MARK SCHOLZ, MD

How can anyone call a cancer “Good?” As time goes by, it seems that prostate cancer is becoming more confusing, not less. Many of us have heard the statement that, “Men die with prostate cancer, not from it.” Or another commonly repeated statement, “The treatment is worse than the disease.”

But then we hear about Merv Griffin or Dennis Hopper, men with immense financial resources, dying from prostate cancer.  How can we say that prostate cancer is “Good?”

When someone hears the word CANCER, they think they know what you are talking about.  Cancer is so common that it now vies with heart disease for being the most common cause of death in men. Cancer has touched the lives of most people, usually in a very negative way.

Perhaps the best way to get a feel for prostate cancer is to compare the “Bad” type of prostate cancer with cancer of the lung or colon, the other two most common types of cancer in men. Other cancers of the brain, bone, stomach, pancreas, kidney and bladder tend to behave in a way that is similar to lung or colon cancer.



Lung, Colon Cancer
“Bad” Prostate Cancer
Blood test available for early detection
no
yes
Hormone therapy available
no
yes
Spreads to liver or brain
Yes
no
10-year survival rate
10-50%
90%
Average survival after relapse
1-2 years
More than10 years


Since the table tells us that it’s far better to have a “Bad” prostate cancer than just about any other type of cancer, imagine how confusing it is when people are told they have a “Good” type of prostate cancer.  What the heck does that mean?

Men are encouraged to refrain from fearing Low-Risk or “Good” prostate cancer because their life expectancy is identical to or even better than that of men who have never been diagnosed with prostate cancer, even without treatment. Since the survival rate is excellent, immediate administration of toxic therapies that ruin sexual and urinary function is inappropriate and often reprehensible.

There is a question that frequently arises: “How accurately can doctors discriminate between the good and bad types of prostate cancer? Do they ever make mistakes and advise men with “Bad” prostate cancer to forgo immediate treatment?

Until fairly recently, men with “Bad” prostate cancer were misdiagnosed because standard prostate biopsy techniques do not routinely sample the front half of the prostate gland.  While cancer in the front of the prostate is uncommon, and because the area is not routinely biopsied, high grade cancers could be missed.  Fortunately, recently developed imaging with multi-parametric Magnetic Resonance Imaging (MRI) can now detect high grade disease in the front or anterior half of the gland with a high degree of accuracy.

Imaging with MRI is so improved that preliminary studies presented in Atlanta at this year’s meeting of the American Urology Association indicate that multi-parametric MRI may be able to replace biopsy altogether.  I am planning to review these exciting reports in my next blog.

2 comments:

Elinor Phillips said...

Thanks for differentiating. Good or bad I still don't want any member of my family to have that. Just a question, where does alternative prostate cancer treatment takes place? Is it used in the treatment for bad or good cancer?

william smith said...

Doctors generally treat cancer of the gallbladder that has come back (recurred) in the same way as stage 3 or 4 gallbladder cancer. But your treatment will depend on whether you have had radiotherapy or surgery in the past. And on where your cancer has come back. There is a maximum amount of radiotherapy that you can have to any one part of your body. If you have too much it can cause damage to healthy body tissues. So if you have had radiotherapy before, you may not be able to have it again. Gallbladder Cancer Symptoms