An Opinion by Don Cooley

I can not emphasize enough the importance of not only part of your personal history but your complete medical history.  The information contained within your history may well make a major difference in your treatment decisions.  Certain parts of this history will give us some idea as to your prostate cancer, its treatment and your survival.  Without this information you may make wrong decisions.

This section covers the importance of this history, the gathering of this history, and a Form on which you can record and print out the history (it is not kept in storage due to security reasons).  This form is handy when you are going to doctors offices to give them a rather complete history.

Finally if you have questions about this web site, questions about its contents, questions about prostate cancer in general you can "Ask Don".  If you want information about your disease (or a loved ones disease) you we need a medical history form filled out.  You can access this form by clicking on"Questions - Let Us Help".

Remember in most areas you have the right to obtain copies of all your records, tests, lab reports, etc.  All of this diagnostic and treatment information should be kept in a three ring notebook.  This notebook would then be carried to all doctors appointments.  Ask each of your doctors for copies of the reports.  Some doctors may charge a small fee for duplication but it is your right to have them.  After all you are paying for them.

From here refer to the Table of Contents at the upper left and read the additional pages.

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 almost 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.

Originally posted 08/26/08

Page Reviewed and/or Updated:

September 20, 2008

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