Positive surgical margins following radical prostatectomy

Three Harvard physicians explain what this pathological finding means and what patients should consider next

For some men, what they hope will be the end of their prostate cancer story turns out to be just an early chapter: with the radical prostatectomy complete, they head home from the hospital believing they have been cured, only to learn that some cancer may have been left behind. Today, about 10% to 20% of patients who have their prostate surgically removed receive this news.

Performing a prostatectomy requires a delicate balancing act. The surgeon aims to cut out the gland and enough surrounding tissue to completely remove the cancer yet leave enough of the nerves in the surrounding tissue to preserve erectile function. To the naked eye, it can look as if all of the cancer has been removed, but when a pathologist examines tissue samples, cancer cells may be lurking right along the edge of the cut tissue. This means that some cancer cells may have been left behind, in what doctors and pathologists term a positive surgical margin.

At this point, patients’ questions abound: Does a positive margin mean that my cancer will come back? If so, when will the recurrence take place? Will it recur in the space where my prostate once was, or will it have spread to distant sites? If it does come back, what are my treatment options? To help answer these questions, editors at Harvard Health Publishing convened a roundtable discussion with three physicians from hospitals affiliated with Harvard Medical School. They talked about minimizing the likelihood of a positive margin, explained how pathologists process tissue samples, and described the use of radiation therapy, also called radiotherapy, to prevent and control recurrences. The panelists were

  • Clair J. Beard, M.D., a radiation oncologist at the Dana-Farber/Brigham and Women’s Cancer Center. During her 18-year career, she has treated thousands of prostate cancer patients. She has a particular interest in how cancer treatment affects bowel and bladder function and quality of life.
  • Elizabeth M. Genega, M.D., a pathologist at Beth Israel Deaconess Medical Center. An assistant professor of pathology at Harvard Medical School, she is interested in tumors of the genitourinary tract, particularly prostate, bladder, and kidney tumors.
  • Andrew A. Wagner, M.D., the director of Minimally Invasive Urologic Surgery at Beth Israel Deaconess Medical Center. He is an expert in the field of minimally invasive surgery for prostate cancer, including robotic assisted laparoscopic radical prostatectomy.

Marc B. Garnick, M.D., editor in chief of Harvard’s Annual Report on Prostate Diseases and HarvardProstateKnowledge.org moderated the session.

Surgical planning

What do you do to lessen the chances that a patient will have a positive surgical margin?

WAGNER: Most prostate cancer surgeons develop a preoperative game plan to help reduce the incidence of positive margins. We consider whether the tumor can be felt during a digital rectal exam, the Gleason score, the volume of the tumor in biopsy cores, and any preoperative MRI findings. This improves our chances of preserving the neurovascular bundles, the nerves that control erections, and the striated sphincter, which controls urinary function. But these goals can weigh against each other. Sometimes, the more nerve tissue that is spared, the greater the likelihood that the surgeon will cut into the prostate and leave cancer behind, creating a positive margin.

So, although there are no guarantees, we plan what we’re going to do ahead of time and counsel the patient appropriately. For example, if a patient has a large tumor on one side of the prostate and no cancer on the other side, we would plan to preserve nerve tissue on the side without the cancer by cutting closer to the prostate. On the side with the cancer, we’d have to cut farther away from the prostate, so there’d be no — or only partial — preservation of nerve tissue there.

Even when the disease is extraprostatic, or extracapsular, meaning that it extends beyond the prostate capsule, it doesn’t often extend more than one or two millimeters beyond the capsule [see Figure 1, below]. That often makes a partial nerve-sparing procedure an option for some patients. In this situation, I will often remove a few extra millimeters of tissue around the prostate and try to save some or most of the nerve tissue. This way, the patient might recover erectile function over time.

Figure 1: Extracapsular extension

Extracapsular extension

The incidence of positive surgical margins increases in cases of extracapsular extension, which occurs when cancer cells break through the prostate capsule. To eliminate the cancer, the surgeon may need to make a wider cut around the prostate, possibly sacrificing the neurovascular bundle.

Directions, please

When talking about prostate anatomy, doctors may use terms like these:

anterior: toward or at the front of the body

apex: the bottom of the prostate

base: the top of the prostate

lateral: away from the center of the body and toward the sides

posterior: toward or at the back of the body.

What exactly is the prostate capsule?

GENEGA: What’s referred to as the prostate capsule is a band of fibrous tissue and smooth muscle. But it’s not a true capsule because it does not completely envelop the prostate gland, and its components intermingle with the tissue that forms the framework of the prostate. It is somewhat better delineated around the posterior and lateral surfaces of the prostate [see “Directions, please,” above], but as you move around toward the apex and anterior prostate — well, it’s generally accepted that there is no capsule at those two locations. So although we use the term capsule, it’s not a well-defined, complete structure.

How far away are the nerves from the edges of the prostate? Why are they important?

WAGNER: The entire nerve bundle is only millimeters away from the edge of the gland, or capsule. On an endorectal MRI, you can see this tract of tissue. It contains many little nerve fibers that run toward the penis, and they control erections. Depending on how close you cut to the prostate, none, some, or all of them can be spared.

During surgery, can you see anything that might make you change your preoperative plan?

WAGNER: When I’m operating, it’s unusual to see the actual tumor invading grossly beyond the capsule [see Figure 2, below], even with the magnified view we have during a laparoscopic procedure. More often the disease is inside the prostate. That’s why it’s important for us to know the various anatomic planes in and around the capsule of the prostate. The capsule is most often white; the prostate tissue inside the capsule itself is actually more tan and glandular in appearance, so I can often see a subtle change in the character of the planes of dissection during surgery. If I see such changes with magnification, I readjust and take more tissue from around the prostate to avoid cutting into the capsule and having a positive margin.

Figure 2: A cancerous prostate before surgery

Cancerous prostate before surgery

The prostate sits below the bladder and just in front of the rectum. Nerves that control erections run through surrounding soft tissue. Although cancer (shown in red) may lurk at the edges of the prostate, the surgeon can’t see individual cells. Cutting too close to the prostate can leave cancer behind, creating what doctors call a positive surgical margin.

Can you feel anything that might make you think the cancer is more significant than you thought based on the biopsy?

WAGNER: During a traditional “open” procedure, surgeons rely less on visual cues and more on tactile clues from their fingers. If you feel a particularly firm area, it can suggest that the cancer is there, but it doesn’t necessarily tell you whether it extends beyond the prostate and into the neurovascular bundles. Feeling firm areas might suggest more aggressive disease, prompting you to take a little bit more tissue at the expense of the nerves.

Is a laparoscopic prostatectomy better than a robotic prostatectomy or vice versa?

WAGNER: The robotic and laparoscopic approaches are improvements over open surgery because there’s less blood loss, less pain postoperatively, and probably less scarring around the urethra. Each has advantages and disadvantages, but the reality is that the chances of having a positive margin — regardless of whether the procedure is open, laparoscopic, or robotic — are about the same, as long as it’s done by an experienced surgeon.

BEARD: That’s an important point. There’s strong evidence that, biology aside, positive margins are inversely related to the surgeon’s experience. This is particularly true after robotic prostatectomy.

What percentage of patients undergoing radical prostatectomy, whether open or laparoscopic, will end up having positive surgical margins?

WAGNER: It’s very hard to compare across hospitals. They have different pathologists, and they might judge what constitutes a positive margin differently. But the rate of positive margins at our hospital is between 10% and 15% for patients with T2 and T3 disease. And it doesn’t make a difference how the prostatectomy was performed. Whether it’s an open procedure or laparoscopic, we have found that the rates are the same.

BEARD: That’s typical. Institutional reviews of carefully selected patients reveal the risk of positive surgical margins can be as low as 10% for patients with T2 cancers and 20% to 30% for those with T3 disease. But you have to understand that these patients were carefully selected for surgery, and these data do not reflect outcomes for all T2 and T3 patients or for all surgeons. I think that when most surgeons see a bulky cancer, they suggest a different primary therapy, knowing that the chances of a positive surgical margin are high.

Assessing the tissue

How should a tissue sample be handled in order to accurately determine if there is a positive surgical margin?

GENEGA: The first thing we do is paint the external surface of the prostate with ink [see Figure 3, below]. Often we use different colors to designate the right and left sides. This is done prior to any slicing of the specimen.

There are several different standard methods to evaluate margins. One method is to take a shave margin, which is done by slicing the sample parallel to the inked tissue edge or margin to be assessed. But tissue slices can also be made perpendicular to the inked tissue edge. Exactly how the specimen will be sliced depends on the specimen we’re dealing with and the particular margin that we have to evaluate.

Figure 3: The inked edge

The inked edge

The black ink applied to the outside of the prostate can be seen on the edges of this whole-mount tissue slice.

Can shaving a specimen create a false positive margin, where the tumor looks like it’s at the edge of the tissue but really isn’t?

GENEGA: At a lot of institutions, pathologists will take a shave margin at the bladder neck, which links the prostate and the bladder. This technique might be more sensitive in terms of detecting a positive margin, but it also increases the potential that a “close margin,” where there’s a little cushion between the tumor and the edge of the bladder base, will be classified as a positive margin. There are advantages and disadvantages to each of the different methods; it really depends on the specimen.

What percentage of a prostate’s surface do you actually evaluate in the lab?

GENEGA: Well, it depends on how the specimen is processed. Are you going to submit the entire prostate gland for microscopic evaluation, or are you going to put in three or four sections from both the right and left lobes? When you submit the entire gland, people think you’re evaluating every aspect of the prostate, but you’re not. (You will, however, see more of the surface area than if the specimen is not submitted in its entirety.) When you slice the prostate for routine, non-whole-mount sections, each slice ranges from 2 to 3.5 millimeters in thickness, but from each of those slices, the histology lab takes slices that are only about 5 microns thick to make slides. [A human hair is 100 microns thick.] So there’s actually a relatively large surface area that you don’t see. If you were to look at the entire prostate, that would mean looking at hundreds of slides, and that’s not done.

How wide is the space between the “capsule” and the surgical margin?

GENEGA: It varies. It depends on how much tissue the surgeon decided to take based on the likelihood of extraprostatic extension. Often, the amount of soft tissue around the prostate is minimal, sometimes less than a millimeter. Therefore, in some areas, it can appear as if the ink is right at the edge of the prostate gland, so it may just be a few microns. In other areas, there might be a few millimeters between the capsule and where the surgeon cut, but probably not more than a centimeter.

Figure 4: A positive margin

A positive margin

This slide shows what prostate cancer looks like under the microscope. The arrow points to cancer cells touching the inked edge of the prostate, which indicates a positive margin.

What are the criteria for a positive surgical margin? Is there any correlation between the patient’s Gleason score and the likelihood of a positive surgical margin?

GENEGA: For a shave margin, which is a slice taken parallel to the true margin of the bladder neck, the inked tissue edge is irrelevant; tumor presence anywhere in the tissue of a shave margin is considered a positive margin. In contrast, to evaluate a margin as positive when the tissue has been sliced perpendicular to the inked tissue edge, the tumor has to touch the ink [see Figure 4, above]. This is how we evaluate the apex and other areas of the prostate gland.

As for any correlation, there are multiple pathologic and clinical features that are predictors of positive margins, including a high Gleason score — specifically a Gleason score greater than 7.

WAGNER: And the higher the Gleason score, the higher the risk that the patient has extraprostatic disease. This is the real crux of whether or not the patient might have a positive margin: how likely is it that the cancer is going to penetrate beyond the prostate borders into the surrounding tissue, and will the surgeon have cut far enough away from it? At the apex of the prostate where there isn’t much surrounding tissue, the tumor can go all the way up to the cut edge of the sample. So the higher the Gleason score, the greater the likelihood of aggressive, invasive cancer, which means the likelihood of positive margins is higher.

BEARD: We also consider perineural invasion, which describes cancer that tracks along or around a nerve. I know that’s controversial, and not everybody agrees that perineural invasion [PNI] correlates with either a higher Gleason score or extraprostatic disease, but our surgical data suggest that it does.

Are the nerves affected by perineural invasion the same nerves in the neurovascular bundle outside the prostate?

GENEGA: Yes. Nerves that are affected by PNI can be located outside the prostate gland or inside of it. The neurovascular bundles, which are the nerve “bands” and blood vessels that are out in the soft tissue surrounding the prostate can be involved by cancer. Smaller nerve twigs inside the prostate gland can also be affected by PNI.

What’s the significance of focal positivity?

GENEGA: In the pathology report, I’ll say that there is “margin positivity.” The urologists will then want to know the extent of the margin positivity. Is it unifocal, meaning a single positive margin or single area, or is it multifocal? That’s usually on the report, but they sometimes want to know how large the involved area is. Is it a 2-millimeter area or a large, 5-millimeter area?

WAGNER: I think it’s important for patients to know that information. A few studies have looked at the prognosis for patients who’ve had a focal, or single, positive margin versus those with multiple positive margins. I don’t think everyone agrees, but at least one published report says that the chance of recurrence is greater with multiple positive margins. An abstract of a study on this question was presented at the 2008 American Urology Association [AUA] meeting by researchers from the University of Michigan. They looked at the risk of recurrence with extensive positive margins compared with focal margins in their T2 patients — that is, patients whose cancer was confined to the prostate. They found that the patients with extensive positive margins had a 45% risk of recurrence at 10 years compared with a 15% risk of recurrence for the patients with a focal margin.

Can any of those patients be identified preoperatively?

WAGNER: Potentially. You could look at their MRI and attempt to predict outcome based on the number of positive biopsy cores and their Gleason score. But it also depends heavily on surgical technique and the degree to which nerves are spared. There are lots of different factors at play.

Does the location of the positive surgical margin make any difference?

WAGNER: Positive margins are more common at the apex, where there’s much less surrounding tissue, but they can occur in other areas, such as the bladder neck. A positive margin at the bladder neck probably has the highest likelihood of leading to biochemical recurrence, meaning that the PSA has risen to a detectable level, usually greater than 0.2 ng/ml.

Another abstract at that same AUA meeting described a study that looked at the anatomic location of the margins. The researchers found that patients with a positive margin at the bladder neck were three times more likely to have biochemical recurrence than patients with negative margins. Positive margins at the apex or laterally were equivalent in terms of recurrence, with patients twice as likely to experience biochemical recurrence as those with negative margins. That’s just one study, so I think the question is certainly open to debate.

Is the whole-mount technique any better or more accurate than the traditional way of handling prostatectomy specimens?

GENEGA: The whole-mount technique is very similar to routine processing in many ways. With both techniques, we paint the prostate gland with ink, the apex and bladder base margins are removed, and then the prostate gland is sliced, apex to base, perpendicular to the posterior surface. At that point, the whole-mount technique is different. Instead of cutting each one of those large prostate slices into multiple pieces, which would be the routine method, the individual, large slices are kept intact with the whole-mount method.

Regardless of the method, the pieces or slices of the prostate gland are then embedded in paraffin [see Figure 5, below] and processed in the histology laboratory, where slides are made for microscopic review. The routine method [see Figure 6, below] would typically yield about 50 to 60 slides. With the whole-mount method [see Figure 7, below], we typically have 10 to 15 slides to examine.

The whole-mount technique makes lovely slides that are quite useful for teaching prostate anatomy to medical residents, but I can’t truthfully say that the findings are more accurate. Some studies have shown that there’s no difference between the pathologic findings with the routine and with the whole-mount methods when the entire prostate gland is submitted for microscopic examination. But there are also studies that have shown the opposite. There are advantages and disadvantages to both techniques. Personally, I believe that it is much easier to orient each slice and to determine more precisely the location of the tumor with the whole-mount technique. I think that determination of extraprostatic extension is somewhat easier, especially when the tumors are in the anterior aspect of the prostate. And I think the determination of the percentage of tumor volume, while subjective, is somewhat easier to do with whole-mount sections.

Figure 5: Tissue in paraffin

Tissue in paraffin

Before slides are made, prostate tissue is preserved in blocks of paraffin wax. The top block is a routinely processed prostate sample; the bottom block is a whole-mount specimen.

Figure 6: Routine processing

Routine processing

Pathologists review at least four routinely processed slides to evaluate one entire slice of the prostate gland.

Figure 7: Whole-mount technique

Whole-mount technique

This slide shows a whole-mount slice of a prostate gland. The cancerous areas are delineated by red dots. The letters R, L, A, and P stand for right, left, anterior (front), and posterior (back).

Next steps

Obviously, the patient having a radical prostatectomy thinks it will be a curative procedure. What do you tell him when the pathology report shows positive margins?

BEARD: We tell him that his life is not at risk for the next five years, but if he wants to be disease-free between five and 10 years, his chances are best if he receives radiotherapy sooner rather than later. There are three variables that correlate with biochemical failure after prostatectomy: T3 disease, a high Gleason score, and positive surgical margins. One of the best publications on this comes from a pooled analysis of almost 2,000 patients. Patients with a positive surgical margin are one-and-a-half-times more likely to experience biochemical recurrence.

WAGNER: I agree with that. If a patient with high-risk disease comes out of surgery with a positive margin, I tell him that we’ll use all the weapons that we have at our disposal, and that we’ll take a team approach to beating the cancer. And I tell him that he’s unlikely to die from prostate cancer. Studies show that most prostate cancer patients don’t die from the disease, even if they have positive margins or extraprostatic disease.

How do you treat a patient with a positive surgical margin?

BEARD: That depends on the patient. We wait a minimum of six weeks after the prostatectomy and then ask the patient to have an MRI. We’ll determine whether his PSA is at a detectable level and review the results of the MRI. We wait at least 12 weeks after the prostatectomy to start treatment with radiation. If a patient has a simple positive margin and a reasonably good-looking tumor, and PSA was not detectable after surgery and the level isn’t rising, we might give him radiotherapy after 16 weeks, but that’s an unusual circumstance in our clinic. We tend to see high-risk patients with positive margins and Gleason scores of 8 and higher. We normally end up giving them radiotherapy combined with hormones, especially in cases of seminal vesicle involvement, persistent PSA, and broad or multiple positive margins.

Do you stratify patients based on whether their PSA falls to an undetectable level and then rises, or whether the PSA never becomes undetectable?

BEARD: Yes. It’s much more serious if your PSA never becomes undetectable. An undetectable PSA is considered 0.1 ng/ml or less.

WAGNER: If the PSA never becomes undetectable after surgery, it probably means that the disease has already spread beyond the prostate area. And that raises the question of whether the patient will really benefit from radiation. If the PSA becomes undetectable and then starts to rise, I think it’s more likely to be a local recurrence, a recurrence of cancer where the prostate used to be, especially in a patient with a positive margin. Those patients will almost certainly benefit from postoperative radiation.

Do you factor in the number of positive margins?

WAGNER: Yes, but that’s not necessarily the decision-maker. We take Gleason score into account, too.

What do you look for on the MRIs?

BEARD: We look for spots where the prostate used to be that light up or enhance when the patient is given a contrast agent. Occasionally, we’ll see an unmistakable local recurrence near the spot where the penile urethra was attached to the bladder neck during surgery. Occasionally, we’ll see prostate tissue that was left behind after surgery; that usually happens with a robotic prostatectomy and an inexperienced surgeon. The MRI also shows how much of the seminal vesicles were left behind and helps in planning treatment.

How often are the MRIs positive postoperatively?

BEARD: In our practice, they’re positive about 10% of the time.

Do you recommend MRIs in patients with positive margins after surgery, Dr. Wagner?

WAGNER: No, I don’t. I’m fairly confident that there’s not going to be residual tissue, so my approach is to check PSAs postoperatively. In a high-risk patient with a positive margin, I’ll check a postoperative PSA a little bit earlier than three months, which would be the standard time frame. If the PSA is undetectable, I’m comfortable waiting for at least six months — until the patient regains his urinary function and possibly some sexual function, assuming he was sexually active prior to surgery. Then I re-evaluate the situation. If his PSA is still undetectable but he’s at high risk for recurrence, I’ll refer him to the radiation oncology team to discuss the potential need for radiation.

Your practice sounds more conservative than Dr. Beard’s.

WAGNER: For low-risk patients, I’m more conservative. If someone has a positive margin but the tumor is confined to the prostate, or if someone has a positive margin and a limited amount of extraprostatic disease, I will wait and follow the PSA. If the PSA becomes detectable, then I’ll refer them to radiation.

When it comes to patients with positive margins and T3 disease — cancer that extends beyond the capsule or invades the seminal vesicles — I refer them to radiation relatively soon. Often they will be candidates for radiation therapy combined with hormone therapy.

BEARD: For high-risk patients, our practices really are not that different. They get combined therapy with at least six months of hormones — two months before radiotherapy, two months during radiotherapy, and two months after.

The traditional thinking has been that radiation following a prostatectomy exacerbates erectile dysfunction and incontinence. Can you comment on those issues?

BEARD: I think a lot of that goes back to the old days, when the technology didn’t deliver radiation as precisely as it does now. Now with carefully delivered IMRT [intensity-modulated radiation therapy], I see few patients who have significant complications. Studies of side effects from radiation therapy reveal that the risk of significant problems is low. People do very nicely with regard to their continence. Erectile function is a whole different story. It can take men two years to really know what’s happening with their erectile function after surgery, and we’re often treating these patients with hormones and radiotherapy during that period.

WAGNER: I agree. The reason to wait at least a few months before starting radiation is to allow the patient to regain continence; that usually takes three to six months. But after radiation, urinary incontinence is not a big problem. There can be some urinary irritation, which is usually temporary. I tell patients to expect it because the urethra and bladder receive some radiation.

As for erectile dysfunction, if they’ve had surgery and they’re going to get radiation after that, I tell them that they are likely to have permanent erectile dysfunction so they’ll be fully prepared for it.

What’s the prognosis for someone who’s had postoperative radiation due to positive surgical margins?

WAGNER: A recent retrospective study actually compared prostate cancer–specific survival in patients with positive margins who received radiation with those who hadn’t. As with some of the prospective studies that have been done, they found an increase in prostate cancer–specific survival in patients who received radiation within two years of biochemical recurrence. Even though patients had rapid PSA doubling times, they benefited from radiation. Most of them had localized disease and not metastatic disease, despite their rapid PSA doubling times. I think this study and others may change a few minds about whether patients should get early radiation.

BEARD: There are a number of studies that have looked at this question. They stratify outcomes according to several factors: Was your PSA undetectable after surgery? Was your Gleason score an 8, 9, or 10? How high was your PSA when radiation therapy started? The people with positive margins who had the best outcomes had lower Gleason scores and got radiation when their PSAs were low.

Is the radiation field different for a patient having radiotherapy after a prostatectomy versus one who opts for radiation as the primary treatment?

BEARD: Completely different. The field is based on images, and before the prostatectomy, you have the prostate to look at. When the prostate is gone, absent a mass or an area of enhancement, what you see is the bladder and bladder neck where the prostate used to be. So planning the radiation field becomes much more complicated. We look at what’s there, take measurements, and try to re-create what was cut out. We look at where the margins were positive. We can see where there’s any residual seminal vesicle. But the planning is rigorous.

WAGNER: Yes, definitely. You’ve got to worry more about the bladder, because it’s now drawn down into your field.

BEARD: I’ll allow a certain volume of the bladder to get a specific dose of radiation, and that will typically exceed what we’d normally do for a patient receiving primary radiation therapy because the bladder is right where the prostate was. So it can be really challenging to get enough radiation into the area to take care of the cancer without overdosing the bladder.

Any final comments?

GENEGA: Pathologists put a lot of effort into determining whether or not there’s a positive margin. But having a positive margin does not necessarily mean that a patient’s cancer is going to recur, even if he doesn’t have radiation therapy. Many other factors have to be considered, such as extraprostatic extension, Gleason score, and changes in PSA.

BEARD: Prostate cancer management requires a team approach. By working together across specialties, we’ve learned how to manage the surgical surprises and unexpected outcomes — and how to improve patients’ prognoses while minimizing side effects. Patients should be optimistic.

WAGNER: I agree with my colleagues. For patients with positive margins, it’s important to realize that this outcome is not a death sentence. When properly treated, most prostate cancer patients survive and lead fulfilling lives.

Originally published April 1, 2009; Last reviewed April 20, 2011


  1. Doug Hensley

    I have been scheduled for Rad Prostatectomy in 6 weeks. I have obstruction using self catheters for 18 mo. I have not done TURP. My biopsy says Gleason 6 and 7 confined to prostate. I have median lobe. I chose RP as a better option compared to TURP, wait 2 mo., then hybrid brachytherapy, weeks of robotic Ext Beam Radiation. I’m told after TURP/Radiation, RP is not a good option. I am 75 yr old in good health. My surgeon has performed over 2000 RP w. with Devinci Robots. My first goal is to remove the prostate completely with NO positive surgical margin. Second, fast recovery of continence (no more catherters!). Finally, sexual function returns but not the highest priority. My surgeon says he is confident I have made the right decision. I know the skill of the surgeon is very important to success. Have I made the right decision? What questions should I ask my surgeon.?

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  3. doug orton

    i would like to thank you for your info it helped me because i was talked into prostate surgery but have since refused 33 radiation tretments and will not take any hormon treatments i was so upset by nurses that i walked out of the hospital with cathitor and drainage tube still in me a nurse told me that i could not leave to witch i said jest watch me now my psa is at .33 and i am tired all the time i am 69 years old and live in canada bc i have tryed many viamins and potions but the psa is still going up after 4 years.i do have type 2 diabetas and take neetals for it. again thanks for the info

  4. Jim

    Men beware!

    Created January 5, 2016. Revised July 18, 2017

    Read the sad truth about prostate cancer testing and treatment, exploitation and dangers.
    Your life or your quality of life may depend on reading this document.
    Prostate cancer lies, exaggerations, deceptions, elder abuse and dirty secrets.
    A prostate cancer survival guide by a patient and victim.
    Men, avoid the over diagnosis and unnecessary treatment of prostate cancer.

    The man who invented the PSA test, Dr. Richard Ablin now calls it: “the Great Prostate Mistake, Hoax and a Profit-Driven Public Health Disaster”.

    In my opinion:
    Read the hard facts about prostate cancer testing and treatment that no one will tell you about, even after it’s too late. This is information all men over 50 should have. Also, anyone concerned about cancer in general, dangers from clinical trials, injuries and deaths from medical mistakes, exploitation, elder abuse, HIPAA laws and privacy issues should read this document. Prostate cancer patients are often elderly, over treated, misinformed and exploited for huge profits by predatory doctors. The testing, treatment and well documented excessive over treatment for profit of prostate cancer often results in devastating and unnecessary side effects and sometimes death. At times profit vs. QOL (quality of life).

    Facts per some studies:
    1. Multiple studies have verified more harm and deaths caused from prostate cancer testing and treatment then from prostate cancer itself.
    2. Extensively documented unnecessary testing and treatment of prostate cancer for profit or poor judgment by some doctors in the USA.
    3. Medical mistakes are the third cause of deaths in the USA (over 251,000 deaths a year, over one million deaths in 4 years) more then suicide, firearms and motor vehicle accidents combined.
    4. About 1 man in 6 will be diagnosed with prostate cancer in his life.
    5. About 233,000 new cases per year of prostate cancer.
    6. 1 million dangers prostate blind biopsies are performed per year in the USA.
    7. 6.9% hospitalization within 30 days from a prostate biopsy complication.
    8. About 1.3 to 3.5 deaths per 1,000 from prostate blind biopsies.
    9. .2% to 1.2% deaths as a result of prostate cancer surgery.
    10. A study of early-stage prostate cancer found no difference in surviving at 10 years whether men had surgery, radiation or monitoring.
    11. Black men are at an increased risk of prostate cancer.
    12. Prostate cancer patients are at an increased risk for chronic fatigue, depression, suicide and heart attacks.
    13. Depression in prostate cancer patients is about 27% and 22% at 5 years, for advanced prostate cancer patient’s depression is even higher.
    14. 75% to 90% of oncologists would refuse chemotherapy if they had cancer.
    15. The National Cancer Institute says approximately 40 to 50% of men with low to moderate grade Prostate cancer will have a recurrence after treatment.
    16. 62% to 75% of bankruptcies in America are because of medical bills.

    Excuse the generally accurate humor and sarcasm. Its intent is to entertain and educate while reading this possibly laborious text.

    Prostate cancer patients are often elderly and exploited for profit, the treatments offered has horrible side effects, and newer treatment options are either unavailable or not offered to patients or available outside the USA. Prostate cancer is often slow growing and of low risk and can just be monitored. Often no treatment is the best treatment. Over testing and treatment has been verified by numerous experts, studies and investigations, documentation, etc.

    Follow the money: If a surgeon is financially responsible for a building lease, a large staff or an oncologist is also responsible for a lease on multimillions of dollars in radiation treatment equipment, do you think they would be more or less honest about the benefits and hazards of treatment? Do you think the profit margin would compromise some doctor’s ethics? Typically, what is the purpose in over testing and treating a cancer that often will not spread and the testing and treatment frequently causes lower QOL (quality of life), ED, incontinence, depression, fatigue, suicide, etc if it was not extremely profitable. The medical field is alluding to the fact that prostate cancer testing and treatment may do more harm then good. The U.S. Advisory Panel is now recommending for prostate cancer PSA testing and screening: for men 55 to 69 “letting men decide for themselves after talking with their doctors”. For men over 70, no testing at all is recommended. However this may not protect men from predatory doctors exploiting them. Patients usually follow a doctor’s recommendation. Do you think any regulatory agency will stop the exploitation of elderly men with a high PSA or prostate cancer or approve new treatments at the risk of financially bankrupting thousands of treatment facilities and jeopardizing thousands more jobs? Do you think any regulatory agency will set guidelines for testing and treatment at the risk of upsetting the doctors who are profiting from over treating? Older drugs and treatments for prostate cancer and ED are kept very expensive and newer or less expensive and effective drugs and treatments are seldom approved, for maximum profit. Prostate cancer patients are often elderly and exploited for profit, the treatments offered has horrible side effects, and newer treatment options are either unavailable or not offered to patients or available outside the USA. Prostate cancer is often slow growing and of low risk and can just be monitored. Often no treatment is the best treatment. Over testing and treatment has been verified by numerous experts, studies and investigations, documentation, etc.

    A 12, 18 or 24 core blind biopsy, holey prostate! One million dangerous prostate blind biopsies are performed in the USA each year and should be banned. Men with a high PSA tests result are often sent to an urologist for a blind biopsy. Men should be told about other options: Percent free PSA test, 4Kscore test, PCA3 urine test or a MRI, 3D color-Doppler test before receiving a blind biopsy. These tests can often or always eliminate the need for a more risky and invasive blind biopsy. Insertion of 12, 18 or 24 large holes through the rectum into a gland the size of a walnut, a blind Biopsy can result in (per studies) pain, prostate infections, a risk of permanent or temporary erectile dysfunction at about 24% (causing about 240,000 cases of ED a year), urinary problems, hospitalization from infections and sometimes even death from sepsis (About 1.3 to 3.5 deaths per 1,000 from blind biopsies). There is also debate that a biopsy may spread cancer because of needle tracking. A blind biopsy can also increase PSA reading for several weeks or months, further frightening men into an unnecessary treatment. Blind biopsies are almost never performed on other organs. One very prestigious hospital biopsy information states “Notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen”. Another large prestigious hospital states “Blood, either red or reddish brown, may also be in your ejaculate.” These statements are often an extreme exaggeration (mostly lies). Very often after a biopsy a man’s semen will turn into a jet black goo. This could be an unpleasant surprise for a man and especially for his unsuspecting partner. However if a biopsy is performed before Halloween or April Fools’ day this may be of some benefit to a few patients. If some very prestigious hospitals are not factual about the color of semen, what other facts is not being disclosed or misrepresented?

    Bone scan scam: Prostate cancer patients are often sent for a bone scan. A bone scan has about a 13% chance of having a false positive and only 3 men in 1,000 have bone cancer who have a bone scan. Bone scans may often be unnecessary in lower risk prostate cancer patients.

    Low risk cancer patients or patients with advanced age are often sent for aggressive treatment by some doctors when monitoring is usually a better option. An extreme example of overtreatment is one SBRT radiation clinical trial. Prostate cancer patients (victims) where intentionally treaded (fried) with a huge dose (50Gy total, 5 fractions) of radiation resulting in disastrous long term side effect for some of these men. The typical SBRT dose is 35 to 36.35 Gy, 5 fractions. A large percentage of prostate cancer patients in this clinical trial had low risk prostate cancer and may have not required any treatment at all.

    Clinical trials may or may not be hazardous to patients. The goal of a clinical trial is to gather information; the intent is not necessarily to help or cure patients. In a clinical trial, if someone is given a treatment that will harm them (as in the above example) or given a placebo in place of treatment or needed treatment is withheld, the patient may be deceived or harmed. Investigate before you participate in any clinical trial. Often drug company’s get your information from medical databases and pharmacy information to lure people into clinical trials, soliciting people with letters and postcards. This is often a HIPAA violation. If you call about a clinical trial your phone conversation may be recorded “Calls may be recorded for training and quality purposes” including your medical and personal information. Even if you do get a safe and effective treatment, it may not be available to you after the clinical trial is over. If the trial is for a drug, you will not be told if you are getting a drug or a placebo until after the trial is over.

    Your privacy and confidentiality is just an illusion: You may have little privacy and confidentiality! Under the HIPAA law all access to your records is allegedly by a “Need to know” basis only, this is another exaggeration (lie). Prostate cancer patients are asked to fill out a series of EPIC questionnaires and other standard questioners. The EPIC questionnaire asks several intimate details about patient’s sex life, urinary and bowl function. By a prostate cancer patient completing an EPIC questionnaire may be able to assist his doctor, nurse, office workers or database track his progress or decline. By refusing to fill out these questioners and supplying other unnecessary information one can help insure his privacy, dignity and insure he do not unknowingly become part of a study or clinical trial or other collective survey or have his information forwarded to multiple databases. He may be told these questioners and records are “strictly confidential” (as stated in some EPIC questionnaires); this statement is misleading. Most of the time a patient has no idea who has access to medical records or why the records are being looked at. Who has access to your medical records? Probably everyone that works in a medical office or building has access to the records, except you (often you the patient may have limited or no access without a formal request). Access may include/however not limited to non-medical employees, office workers, bookkeepers, janitors, insurance companies, temporary high school or college interns, volunteers, etc. This may also include other medical facilities, programmers, hackers, researchers, etc. Usually records are placed on a Health Information Exchange (HIE) or servers. Dozens, sometimes even hundreds or thousands or more people may have access to medical records. Some major databases like SEER (Surveillance, Epidemiology and End Results) are linked to Medicare records to determine “end results” for researchers, studies, drug companies, clinical trials offers, etc. Servers, both government and privet are sharing information AKA “health surveillance”. Health information may be shared and downloaded by millions of entities and servers all over the USA and the world to countries that do not have any regulations for privacy.. Your prescription history can also be tracked. Records may be packaged with others and offered for sale, this does often happen on “the dark web”. If a doctor, patient or insurance company is involved in a criminal or civil case, medical records may become public court or law enforcement records. Your records can be acquired by insurance companies. If a patient has radiotherapy he may have a photo taken before treatment to verify identity. All patients should get a copy and read any confidentiality disclosures statements (HIPAA statements). Financial and medical Identity theft is a growing problem, often expensive and difficult to correct. Under the HIPAA laws you are entitled to a copy of all your medical records, however if you try to obtain a copy of extensive records as in a hospital stay you may be met with resistance. I recently went to a new optometrist for glasses and I was given a form that asked details about my heritage, including my mother’s maiden name and a form for my complete medical history. Your records can also be accessed by anyone (trainees, volunteers, students, high school interns, minors and adolescent people as young as 16 years of age, etc) “for training purposes” or any other reason, all without your consent. This gives kids a chance to play doctor and nurse in a real doctor’s office with real patients. A list of what a high school intern is allowed to do to patients: “learning simple medical procedures, watching surgeries, shadowing doctors (including seeing patients, possibly you), working in hospitals, interacting with patients, and more.” They can also read all records about your prostate problems, your wife’s hemorrhoids and your daughters yeast infections or any files for any patient, all within the HIPAA guidelines. These people do not have to be employed by the facility or have a background check. My family doctors office has summer time high school interns with full access to all records. One high school intern signed me in, took my temperature, weight, blood pressure and logged it in my file. Would you like to have a high school or college student that possibly lives in your neighborhood or attends school with your children read over your extensive family member’s medical records and personal information? How much curiosity or self control does a high school or college student have? I also went to a hearing aid center in a department store to get a free hearing test and was given forms inquiring about personal information and my complete medical history. This is information I do not want filed in a department store. All patients should avoid supplying unnecessary information whenever possible. Supply relevant information only when filling out forms. In the USA identity theft is very common, growing problem and is often financial devastating. Medical forms can be a good source of information for thieves. Recently my friend with arthritis in her hips received a letter offering a clinical trial for a new medication; coincidently looking for patients with hip and knee arthritis. How did this company determine she and not her husband or other family member was a prime candidate for this new drug study without violating any HIPAA privacy laws? Numerous exceptions (loopholes) appear within the HIPAA laws regarding you privacy. Even without HIPAA privacy law violations, records can be accessed by multiple people and appear in multiple databases. Sometimes medical phone calls are recorded “Calls may be recorded for training and quality purposes”. Calls about a clinical trial, calls to a large clinic toll free number, calls to drug companies and calls to insurance companies may be recorded. These conversations can include confidential or medical information. Some of the Obamacare goals sought to have everyone’s medical records on servers so they could be accessed by any medical facility or doctor. HIPAA laws are deficient and often will not protect your privacy. Your privacy and confidentiality is not that secure. I believe the medical field has little regard for our privacy, especially if it is in conflict with training, research, studies, profit or other objectives. If you’re a public figure, celebrity, rich or famous you may be subject to numerous people wanting to see your medical records. Also if you are known to or an acquaintance of anyone with access to your records (neighbor, co-workers spouse, etc) they would possibly (or probably) want to have a look at your medical records. On May 6, 2017 Dear Abby did an article on this subject, “Snooping into medical records”. You are naive if you believe otherwise or that your records are secure. The same also applies to pharmacies and your prescriptions, labs, etc.

    A patient’s dignity (or lack of dignity): Prostate cancer testing and treatment is stressful, degrading, demoralizing and often unnecessary. EPIC questionnaires can be counterproductive impact a patient’s dignity, privacy, confidentiality, and self image. EPIC questionnaires probably have an increased potential and greater impact on patients for privacy violations because of its format, nature and personal content (potential for HIPAA privacy law violations). Patients may mistakenly believe the EPIC questionnaire is a requirement to be filled out. Also the term “strictly confidential” can be misleading and ambiguous. One blogger patient posted he filled out and turned in his “strictly confidential” EPIC questioners only to have every female office staff member read it and ogle him. Resulting in him not filling out any more EPIC forms or any other forms and he stated that he became very uncomfortable and evasive with the entire office staff. The drawbacks of this form seem to outweigh any potential benefit for some patients. Medical tests and procedures can be degrading and embarrassing for both men and women. Many women prefer or will only see female doctors or gynecologists, about 50% to 70%. Over half of men prefer a male doctor. (Per some respected doctors: Men stay away from medical care in large numbers because of privacy and dignity. Many men still avoid medical care because of embarrassment. Honest answers will often not be given if asked by a female doctor or nurse.) What percent of men will feel comfortable consulting a female doctor, nurse or office worker about his prostate problems, ED, etc or would want an invasive test or procedure performed by a female?

    The most common treatment options for men with prostate cancer are radiation, Brachytherapy, surgery, cryotherapy and hormones (ADT). Sometimes chemotherapy, immunotherapy and castration (orchiectomy) are used. A combination of treatments is often used. Most or all of these treatments have long term or short term side effects. Often men are not told about all of the true risks and side effects or they are downplayed for both a blind biopsy and treatments.

    LDR Brachytherapy is permanent radioactive seed implant. This treatment procedure implants about 40 to 100 radioactive seeds in the prostate, sometimes resulting in urinary problems. The patient will literally become radioactive for months and up to 2 years. The patient may set off radiation alarm and also possibly metal detectors at airports. He will also be required to use a condom, have no close contact with pregnant women, infants, children and young animals or pets for months or longer. Occasionally he may even eject radioactive seeds during sexual activity or urination. The patient will become like a walking Chernobyl, having radioactive scrap metal and emit radiation from his crotch. He will also be required to carry a card in his wallet stating he is radioactive. The videos of this procedure seem to be disturbing and bizarre. A catheter will also be required for a short time. However, allegedly LDR Brachytherapy seems to have less sexual side effects than some of the other treatments available.

    Men are sometimes prescribed hormone therapy (ADT therapy), AKA chemical castration as an additional or only treatment. Hormone (ADT) therapy is sometimes over prescribed for profit, per some studies. Hormone therapy is often very expensive (may be profitable for doctors if provided at the doctors office and not a pharmacy) and can have horrible, strange and devastating side effects, feminization, fatigue, weight gain, depression, etc. His penis could shrink and his testicles can completely disappear, he may grow breasts. This treatment can have so many mind and body altering side effects that doctors will often not inform patients about all of them. Men are sometimes castrated (orchiectomy) as a cancer treatment to reduce testosterone. Amnesty International calls chemical castration “inhuman”. ADT therapy is often used in sex reassignment surgery, male-to-female transsexuals. Studies (Medicare and financial) have documented doctors do over prescribe ADT therapy for profit (depending on Insurance payout rates/profit margin). When insurance payment reimbursement for ADT decreased so did the number of patients being prescribed ADT therapy! Per Wikipedia: “in patients with localized prostate cancer, confined to the prostate, ADT has demonstrated no survival advantage, and significant harm, such as impotence, diabetes and bone loss. Even so, 80% of American doctors provide ADT to patients with localized prostate cancer.” Overtreatment with ADT is extremely profitable, unfortunate and avoidable.

    Nerve sparing Robotic-assisted DaVinci surgery is touted as being a better treatment and having fewer side effects, this is usually an exaggeration. The nerves can not always be spared. Robotic surgery can result in a faster initial recovery. Long term risk of incontinence, fatigue, ED, etc is about the same as conventional surgery. Patients undergoing surgery are at a very small risk of developing post traumatic stress disorder (PTSD) and about a 22% chance of long term or permanent fatigue. Also .2% to 1.2% risk of deaths as a result of prostate cancer surgery or medical mistakes. Patients can have unrealistic expectations about the results and regret the surgery treatment option. The ED rates and other side effects are often understated to patients.

    Patients should not be naive: Medical mistakes are the third cause of deaths in the USA (over one million deaths in 4 years). Medical mistakes cause more deaths then suicide, firearms and motor vehicle accidents combined. Countless other patients have been harmed by medical mistakes. If you are having surgery, brachytherapy, a biopsy or a procedure take precautions if possible. Have someone qualified or knowledgeable monitor you and your medications, etc. Doctors, nurses and technicians can be profit motivated, use obsolete procedures, be lazy, incompetent, make mistakes and be apathetic or rushed. Occasionally harm can be done or not prevented with intent. Drug abuse is often a problem with some medical workers because of easy access. Doctor’s offices and clinics can see many patients in a relatively short amount of time. This may be a disadvantage to patients, empathy and quality of care can sometimes be compromised. Sometimes a nurse, medical assistant or an office staff member may be the person that overseeing much of a patient’s care. I personally know of or have hade contact with at least 10 nurses and other medical staff that I would consider dangerous: incompetent, dishonest, lazy, abusive, mentally disturbed, drug abusers that work in doctor’s offices and hospitals. Most of there people did not have a name tag and supplied me with a first name only when asked for a name. I am now sure modern medicine protects the blameworthy and incompetent, also victimizes the naive patients. I now understand why medical mistakes are the third leading cause of deaths in the USA. I now believe some or most of the deaths and injuries are preventable or intentional. TV and sometimes the public seem to idolize doctors, nurses and caregivers; however the health care profession has about the same amount of abusive or incompetent workers as other occupations. I have also had excellent doctors and nurses. However this may not protect you from the bad ones. What are the main reasons nurses get fired: 1. Prescription drug abuse (because of easy access to drugs). 2. Too many mistakes. 3. Code of conduct and privacy violations. 3. Bad attitude. 4. No proper licenses 5. Abuse of patients. Patients should be aware that sometimes QOL (quality of life) may be secondary or an absent goal in treatment. Sometimes overtreatment for profit or to prevent an unlikely death or metastization from low risk cancer may be the primary or the only goals of prostate cancer treatment.

    A blind biopsy or treatments are often worse then the disease: Resulting in Chronic/permanent fatigue, incontinence, depression, sexual dysfunction and sometimes death. Hormone therapy does have an extensive list of side effects that can be devastating for men. Biopsies and treatment are degrading, stressful and often unnecessary. Many men may not be prepared or have unrealistic expectations about the outcome, physical and psychological impact of testing and treatment.

    The risk of long term chronic and permanent fatigue (that can result in depression) is almost always understated if mentioned at all too many patients. Per some studies and depending on your treatment; the risk of long term or permanent fatigue is about 25% to 60%. Radiation with Hormone therapy has a high risk of fatigue. Long term fatigue also increases the risk of clinical depression and suicide.

    In my opinion: Castration, ADT hormone therapy (chemical castration), LDR Brachytherapy (radiation seed implant), radiotherapy, surgery, chemotherapy and blind biopsies are often psychically and emotionally brutal, traumatic and disturbing. These types of treatments are primitive and almost beyond belief in today’s world of advanced technology. Newer treatments like, HIFU, hyperthermia, Boron Neutron capture therapy, PARP Inhibitors, Platinum, focal Ablation (only treating the cancer and not the entire prostate) and orphan drugs should be approved and used when appropriate. Biopsies should be limited to selective MRI guided samples only; blind biopsies should never be performed.

    Lipstick on a pig: Approved advances in prostate cancer treatment mostly consisting of newer more accurate radiation treatments, robotic surgery and new drugs. These advances sound like greater strides have been made. However most of these approved advances are of limited benefit to prostate cancer patients and still have about the same amount of long term side effects. Compared to other technologies, computers, communications, electronics, aviation, etc, cancer treatment approved advances have been dismal. The National Cancer Institute wastes about 3 billion dollars a year on PSA screening that can be used for research and true cures. QOL (quality of life) issues have not been adequately addressed. Profit often outweighs QOL.

    Prostate Radiotherapy (EBRT-external beam radiation therapy) for cancer treatment. New technology consists of: IMRT, SBRT, IGRT, VMAT, TrueBeam, Cyberknife, etc. This newer, faster, more accurate and easer to setup radiation equipment is of much benefit for doctors, staff and a good selling point to patient’s. However as far as reducing long term side effects, only small gains have been made with the newer radiotherapy equipment. A patient should be skeptical if exaggerated claims are made about reduced long term side effects, especially fatigue and ED rates. About 25% of radiotherapy patients can expect an alarming temporary “bounce” (spike) in the PSA value after treatment. Patients should inquire as to the treatment plan: Gy dose and fractions, margins, testicular dose, constraints and age of radiotherapy equipment to insure excessive radiation exposure treatment is not given that can result in additional side effects. Patients should be aware that pelvic shaving, permanent tattoo markers, fiducial marker (small seeds) are sometimes placed in the prostate, MRI, CT scan, photographs, catheters and other procedures may or may not a be required. Radiotherapy can also occasionally result in secondary cancers and damage to “organs at risk” (organs close to the prostate). Radiation has high probability of sexual dysfunction and fatigue. ED rates estimated at 35% to 75% or higher, 93% at 15 years. Sometimes radiation can also cause bowel and urinary problems. Per some studies radiotherapy causes moderate-to-severe gastrointestinal effects in 17%. A 5 day SBRT radiation treatment is now commonly available with about the same results and side effects as a 9 week radiation treatment. A doctor with a multimillion dollar lease and maintenance agreement on radiotherapy, CT scan and MRI equipment and a large staff may or may not be influenced by his or her financial obligations when deciding to recommend over testing and treatment.

    Prostate radiotherapy (EBRT) can result in a 5% to 30% temporary or permanent drop in testosterone levels, excluding hormone therapy. This drop is determined by the testicular radiation dose (treatment equipment and planning). A below normal drop in testosterone can result in fatigue, depression, sexual dysfunction and other symptoms. Always ask for a printout of testicle dose and constraints before and after prostate EBRT to insure your testicles are not over radiated, also dose include the CT scan exposures.

    It seems all of the best treatments for prostate cancer have not been approved and most are only available outside the USA. Treatment options outside the country or under development are HIFU, Laser, Hyperthermia, Boron Neutron capture therapy and orphan drugs, just to name some. Focal Laser Ablation is a good option with fewer side effects however it is not widely available in the USA and sometimes not practical.

    Chemotherapy can be extremely toxic and sometimes deadly: Any cancer patient (man or woman) who are being offered chemotherapy should be particularly cautious. Without genomic testing or proof of the effectiveness of the specific drug being used on the exact cancer type being treated, chemotherapy can often be more toxic to the patient then to the cancer. Chemotherapy may be extremely expensive, profitable for some doctors (if dispensed by the doctor and not by a third party) and can be misused or overused, sometimes for profit. A doctor may purchase a quantity of chemo drugs for $10,000 and charge a patient $20,000. A doctor can also receive a percent kickback from the drug company for prescribing the drug. What is the motive for some doctors to perform Genomic testing and giving a patient a different and more effective treatment at an unknown or no profit versus a guaranteed profit with a probable worthless or harmful treatment? This is a well documented and common practice. 75% to 90% of oncologists would refuse chemotherapy if they had cancer. Chemotherapy fails upwards of 93 and 98% percent of the time depending on which study you look at. One Michigan oncologist who committed fraud and gave $35 million in needless chemotherapy (for profit) to patients, some who did not even have cancer is now in jail for 45 years. He was running his own in-house pharmacy. The nursing staff was indifferent and the state regulatory agency initially cleared him of any wrongdoing (a cover up). Many or most chemo drugs are considered a biohazard.

    Often few good choices exist for treatment. A prostate cancer patient treatment choice often ends up being the least worst choice or the choice with the side effects a patient thinks he can tolerate. Patients can sometimes be mislead about the expected side effects and results of the treatment being offered. The risk of chronic fatigue and depression is often not disclosed.

    Long term care consists of regular PSA testing for years. Long term care for side effects is often lacking or exploitive or ineffective. Often complaints of side effects are disregarded by nurses, doctors and sometimes referred out to other doctors. The patient is sometimes left to figure out what to do about his side effects with the resources available to him. Long term side effects often consist of fatigue, bowel or urinary problems, sexual dysfunction, depression and other symptoms. Patients with complaints of chronic fatigue are often told to exercise, get plenty of sleep, pace your self and eat a healthy diet; this advice is of limited help for chronic fatigue. Often treatments for long term side effects are embarrassing, degrading, unavailable, nonexistent, costly, not effective, not offered or bothersome. Prostate cancer treatment often results in fatigue, depression, isolation and sometimes suicide. Billions of dollars are profited from ED drug and other ED products, catheters, pads and diapers, drugs for depression or pain or insomnia or incontinence, additional treatments and surgeries for side effects. Also treatments for the multiple and bizarre side effects from hormone ADT therapy (chemical castration) is sometimes required.

    Men, ageing, exploitation and elder abuse: If any man lives long enough it is very likely he will have a prostate problem, low testosterones or some form of sexual dysfunction. In my opinion modern medicine often has been exploitive, abusive and has provided substandard care for older men in general due to all of the explanation given in this text. I believe much of the attitudes toward older Americans need improvement and they are sometimes viewed as being subhuman and exploitable by various groups and individuals. If documented cases of unnecessary surgery and radiotherapy or blind biopsies on children by doctors for profit were released, the vast majority of Americans would be outraged and this practice would quickly end. However for older men it dose not seems to be of great concern! As defined by some or all state laws, exploitation of elderly men by overprescribing treatment for profit is a crime or an offence of various guidelines and regulations. It is extremely unlikely any doctor will ever be prosecuted or have a medical license suspended for this common and extensively documented abuse or crime. It is well documented that all forms abuse do occur to the elderly and disabled in nursing homes and other facilities including, neglect, theft, starvation, torture, harassment, sexual assault, etc. One patient after recovering from a brain injury testified that he was repeatedly abused, slapped and hit, forced to drink boiling hot tea by multiple caregivers and sexually assaulted by one female caregiver. I personally know of an elderly lady that is living in an expensive assisted living home that has had all of her possessions (radio, clothes, underwear, shoes) repeatedly stolen and replaced by her family including the sheets off of her bed, even after the sheets where marked with her name using a larger permanent marker pen.

    Depression in prostate cancer patients is common, about 22% at 5 years (per some studies) and for advanced prostate cancer patient’s depression is even higher. Prostate cancer patients are at an increased risk of suicide.

    ED, no bathtub included: Almost all prostate cancer treatments usually result a high percentage of erectile dysfunction. Loss of libido estimated at about 45%. Excluding hormone therapy, lower libido is almost never disclosed as a treatment side effect and sometimes it is completely denied as a problem. Blind biopsies can often cause temporary or permanent ED. Often claims of prompt effective treatment for ED or other side effects if they occur after treatment are often misleading. Statistics for ED percentages from treatment are usually quoted after treatment with Viagra, Muse or other ED treatments, therefore most statistics are very misleading. ED rated at 5 years may be as high as 50% to 80% or higher for most treatments. ED rated at 15 years may be as high as 90% or higher for most treatments. For cryotherapy, ED rates are extremely high. The cost for ED drugs like Levitra, Cialis, Viagra and Muse are deliberately kept very expensive by drug companies, about $10 to $45 per 1 pill. At these prices Lilly could consider including a free bathtub featured in its advertisements for Cialis. The cost of a 30 day supply of Cialis is usually well over $320 and the cost of an inexpensive bathtub is about $200. Generic PDE5I ED drugs in Canada and other parts of the world sell for about $0.50 to $2 a pill. Many insurance companies will not pay for ED drugs or treatment. Less expensive generic drugs are usually unavailable in the US. Viagra should have already become available in a generic (in the USA) form for about $1 a pill. This is further exploitation by the drug companies of men in general. Men are also exploited by counterfeit mail order ED drug sales. ED drugs are not always effective and may have side effects. ED treatments can also be embarrassing, not offered, not practical, painful, expensive/not covered by insurance. Men will often not seek treatment because or these reasons.

    The numbers game (more exaggerations and lies)-: A doctor may state a patients chances of ED is about 35% with EBRT radiotherapy (or some other treatment). A patient may think, 35% is not too bad and if I do get ED I can always take Viagra. What a doctor may not tell a patient is that the ED rate is 35% at fewer than 2 years for a patient under 65 years old and with an ED drug treatment option. For a patient over 3 years, over 65 and no ED drugs the ED rate may be about 75% or higher, after age 70 your chances of ED is over 85% or higher. Obviously, a man is more likely to refuse treatment at a 75% ED rate verses a 35% ED rate. Some side effects may not be disclosed at all. If side effects (low libido, chronic fatigue, depression, increased suicide risk, etc) are not disclosed, no percentages will usually need to be quoted. Results are often worse for a surgery option, the main difference in ED results between surgery and radiotherapy is; with surgery ED will start out bad and may or may not get better with time, however with radiotherapy ED will get worse over time. With both treatments together or with ADT hormones also you’re in real trouble with ED percentages. Cure rates are often quoted at the 5 years mark for most treatments. 5 years is not a magic number, anyone can have a treatment failure before or after 5 years. A cure rate for a treatment at 5 years may be quoted at 85%; however the cure rate at 7 to 10 years may be only 70% and 50%. The 85% at 5 year rate was quoted to me. I was never told about my 50% at 10 year cure rate. Always ask what is the “biochemical recurrence” (AKA rising PSA or treatment failure) rate for well beyond 5 years with your computer software simulation and Partin tables. Ask your urologist or radiation oncologist for a 10-year cure Rate. If the physician is unable to provide one, consider finding another doctor. Studies and clinical trials results, side effects percentage claims, etc can be biased. Watch out for terms like “age adjusted” or ambiguous or excluded facts as given in the above examples. ED rates for radiotherapy are usually quoted at under 1 or 2 years and for surgery over 1 or 2 year to give the appearance of a more positive result. I have read and have been given some extremely exaggerated claims (mostly lies) concerning cure rated, side effects, etc.

    In conclusion: Prostate cancer patients are sometimes elderly and exploited for profit (per documented studies). A blind biopsy is unsafe and newer test methods should be used. The treatments offered have horrible side effects. Some doctors are treating patients with low risk cancer or advanced age when monitoring is often a better option. Patience with low risk cancer or advanced age should often be offered “watchful waiting” or “active surveillance” instead of treatment. Aftercare for long term side effects is frequently ineffective, expensive, not offered, degrading or nonexistent. Prostate cancer patients are seldom told about chronic fatigue and the true risk of side effects are usually understated. Modern medicine often fails and victimizes prostate cancer patients.

    If a patient has intermediate or high risk prostate cancer and dose not have advanced age he may need treatment. He should consider genomic testing and look into other advanced treatments if available. Also he should try and avoid hormone therapy if possible because of the multiple side effects especially if the cancer is organ confined. If laser or other advanced treatments are not available a 5 day SBRT radiation treatment may be considered (In my opinion SBRT could be the least worst of the bad choices, still a poor option). SBRT seems to be fast, least invasive or traumatic. ED and fatigue is still a high long term risk. Radiation with hormone therapy has a higher risk of ED and long term fatigue. However, I now believe conventional prostate cancer testing and treatment is a mistake in most men.

    The short version of my story: I was referred to an urologist by my family doctor after a high PSA test. I will refer to the urologist as Doctor “A”; he used old and dangerous testing technology (18 core blind biopsies), his nurse seemed to have a mental defect exhibiting arrogant, rude, strange and abusive behavior and was intent on inflicting psychological harm to me. Shortly after my Dr. “A” visits ended, his nurse was no longer employed at his office and no person in that office would refer to her employment or her existence. I now believe this nurse was high because of drug abuse being common among nurses (the easy access to drugs). I was diagnosed with prostate cancer by Dr. “A”. I refused his surgery and hormone therapy recommendation because of the eminent side effects and his unprofessional nurse behavior, so Dr. “A” referred me to Dr. “T”. Dr. “T” was outside of my insurance network; however his office manager stated she was willing to work with my insurance, offered me a doctor consultation and would accept any insurance payment as a full payment. When I arrived in his office the waiting room was empty. He also had a large staff. Dr. “T” used older conventional technology, offered me overtreatment, hormone therapy, unnecessary procedures and testes. One week after my consultation with Dr. “T” I received an $850 bill for the consultation, in conflict with what was agreed upon with his office manager. After a recommendation from a friend, I called clinic “O” and met with the nurse. She offered me treatments with a verbal guarantee of “no side effects from the radiation”. However this nurse could not answer any of my basic questions, lacked any credibility and sounded like an unscrupulous used car salesmen. Most of these office visits caused me multiple problems with offices workers processing paperwork for tests, insurance forms and billing, etc. Two of these doctors offered me an unnecessary bone scan. Two of these doctors recommended unnecessary hormone therapy ADT (overtreatment) for my organ confined cancer. After I absolutely and utterly refused hormone therapy, both doctors admitted it probably would not help me in my final outcome because of the computer estimate run on me with my organ confined cancer, PSA, biopsy report, etc. Having no advance treatments (laser, etc) available to me at that time, I decided on SBRT treatment with Dr. “K”, he could answer my questions and had new equipment. Before my treatment could start I was referred to “W” lab for an MRI. “W” lab had a trainee assisting and it took over 2 hours to complete my MRI. 2 days later after receiving a copy of my MRI report, I examined the MRI report; it had my name and some other patient history information. I wasted 2 more days verifying it was the correct MRI of me and not some other prostate patient MRI before my treatment could start. I did receive treatment from Dr. “K”. I did have a relatively fast and noninvasive treatment (SBRT), resulting in several months of fatigue, a large PSA bounce 18 mothers later and some other short term side effects. At this time I am doing okay, however I’m not sure what the future will bring? I also no longer trust modern medicine, doctors, nurses, etc. Modern medicine seems to be more of a gamble then a science. I have wasted hundreds of hours and thousands of dollars. I feel modern medicine has abused and failed me (and others) due to the lack of guidelines and regulation, still approved obsolete technology, better unapproved treatments, exploitation, greed, apathy and incompetence. Hindsight is 20/20. I was never offered Genomic testing. I also believe I should have had no PSA testing or treatment. If I could do it over again, I would also consider no PSA testing and treatment or traveling for advanced treatments from a competent provider if practical and available. I believe if I did take the two doctors recommendations and received unnecessary hormone therapy in addition to the radiotherapy my quality of life (QOL) would have been severely impacted for years or permanently and could possibly have resulting in my early death. I did seem to have a lot of bad luck in picking providers or is this just the new standard in medical care?

    “Do no harm”, unless you can make a lot of money and get away with it: I was harmed physically and verbally by Dr. “A” 18 core blind biopsy and verbally abused by his nurse. I was potentially exploited and financially harmed ($850) by Dr. “T” and offered unnecessary testing and overtreatment. Clinic “O” nurse attempted to misinform and deceive me about the treatment outcome of “no long term side effects”. I was harmed by “W” lab by mistakes and incompetence. I did also have numerous other billing and paperwork problems probably due to mistakes and apathy. A few of the office staff were incapable of completing some very simple tasks like filling out lab work request or insurance forms. At least 40% (probably substantially more, 50% to 60%) of the health care workers I came into contact with did or attempted to do some form of harm to me or provide substandard care, attempted excessive testing and treatment, mistakes, billing overcharges, blind biopsy, false statements, deception, misinformation, apathy and abusive behavior¬¬¬, as explained in this text. I have also observed several medical facilities do not require workers to wear name tags and when asked for a name most will give a first name only; this may also be a factor in health care workers not acting in an ethical manner. To me, it seems that this prostate cancer nightmare maze was intended for maximum physical, psychological, financial harm and to be of questionable benefit and maximum profit for doctors. My prostate cancer experience has been one of the worst events that has happened to me in my lifetime. Also seeking testing and treatment is one of the biggest mistakes I have ever made. I specifically blame modern medicine for not protecting patients from predatory doctors, substandard technology and a lack of regulations that would protect patients. I would have been much better off going to a Voodoo or witch doctor. I would have saved thousands of dollars, time, had no side effects, no paperwork, more confidentiality and privacy, and probably received better advice. I could have received a nice amulet or a good luck charm to protect against sorcery or magic (PSA testing, blind biopsies and treatment) and evil medicine men (predatory doctors).

    My treatment choice: In my opinion, I feel LDR Brachytherapy and hormone therapy (AKA chemical castration) seemed to be completely degrading, disturbing and bizarre. Hormone therapy would not have been an effective treatment for me. Surgery and Brachytherapy are to invasive. Surgery has an imminent danger of incontinence and ED. 9 week EBRT radiotherapy was just too long and laborious. Because castration (orchiectomy), ADT hormone therapy (chemical castration), Chemotherapy, LDR Brachytherapy and blind biopsies are what I consider “Frankenstein medicine” (Harmful, strange, bizarre, brutal, twisted, degrading or a perverted nightmare) I would avoid all of them. Unfortunately, I was deceived and misguided into having a blind biopsy. I do not believe other conventional treatments like radiotherapy are good or great choices either, just not as horrific. The choice I made was a 5 day SBRT radiotherapy. A 5 day SBRT also has numerous drawbacks and side effects, about the same as a 9 week EBRT radiotherapy. I also had no advanced treatment options available to me. As I have stated above, If I could do it over again I would also consider either no PSA testing and treatment or traveling for advanced treatments from a competent provider if practical and available. I am now sure I made the wrong choice by receiving conventional testing and treatment. With prostate cancer, the testing or treatment is often worse then the disease. I am not implying anyone should make the same choices as I did. I am only giving the motives for my decisions. I was also the victim of profit motivated and substandard providers. 3 years later I now believe my prostate cancer testing and treatment greatly accelerated my ageing (through the stress, testing, treatments and physically from the radiation and was also a financial burden). Per a new SBRT studies my 4+3 Gleason score is considered “unfavorable”. I now have about a 50% chance of a treatment failure in 8 to 10 years. My previous long term cure rate was originally quoted at 85% before my treatment started. I am also sure prostate cancer testing and treatment is mostly smoke and mirrors (lies). The man who invented the PSA test, Dr. Richard Ablin now calls it “the Great Prostate Mistake, Hoax and a Profit-Driven Public Health Disaster”. When asked: “How did you live so long?” A 99 year old woman stated “stay away from doctors and don’t take anything they prescribe for you”. With some exceptions, I now believe this advice to be mostly true.

    Always protect yourself: It should not be up to a patient to protect himself or herself from harm from doctors, however the new or common standard in medical care seems to be substandard. Do not let the sterile, friendly and professional environment of a doctor’s office detour you from protecting yourself from overtreatment or any unnecessary life changing tests and treatments. If you are concerned about misuse or privacy issues, refuse to fill out EPIC questioners and limit the information given to relevant information only. If you have a high PSA or prostate cancer, educate yourself. A patient should be extremely skeptical if exaggerated claims are made about minimal long term side effects from conventional treatments or blind biopsies. Also exaggerated cure rates or the need for immediate treatment. Bring someone educated or astute with you to your consultations and appointments. Insist on Genomic or advanced testing if you have prostate cancer. Avoid doctors that are mostly profit motivated. Do not submit to a prostate blind biopsy. Get a second or third opinion if you are being offered treatment with low risk prostate cancer. Learn about all your treatment options, testing and side effects. Verify everything you are told. Under the HIPAA law you are entitle to a copy of all your medical records and bills. Always ask the name of the person assisting you. If they refuse the request for a name leave immediately (you may or may not be in extreme danger). Be very cautious if you are ever refused a copy of your records; demand a copy of your records and a reason for any denial and seek other advice. Get a copy and keep a file of your test results, biopsy report, Gleason score, PSA, MRI report, treatment plan, bills, insurance payouts, etc. Carefully monitor your PSA. Expect a temporary increase (for weeks or months) in PSA after some procedures. Verify the accuracy of paperwork. If treatment is necessary talk to your doctor in advance about side effect management, chronic fatigue, ED, etc. Doctors that provide treatments often have computer software to predict the outcome using test results and different treatment options. Ask to see your computer predicted cure rate outcome with your treatment options if available. This may give you some insight to your options, cure rate and also to avoid overtreatment. Always ask what is the “biochemical recurrence” (AKA rising PSA or treatment failure) rate for well beyond 5 years. 5 years is not a magic number. For help contact a good prostate cancer support group without a conflict of interest. A wise man once told me “you need to learn to think like your doctors and nurses (or other providers)”. What are the motives of your providers, place them in order that you observe at your doctors office: to profit, to cure, to get high on the backroom drug supply, to do less work, to take an extra long lunch or get off work early, to help people, to cover up their incompetents, etc? This exercise may give you some insight into the care you may receive.

    A medical holocaust: Multiple studies have verified more deaths caused from prostate cancer testing and treatment then from prostate cancer itself. Medical mistakes are the third leading cause of deaths in the USA, over 251,000 deaths a year or over one million four thousand (1,004,000) deaths in 4 years. More then suicide, firearms and motor vehicle accidents combined. These statistics do not include many more people that have had their lives destroyed or shortened by modern medicine or a reduction in QOL (quality of life). Per the FDA, 100,000 deaths per year (one million people in 10 years) from prescription drugs.

    Strict guidelines for prostate cancer testing and treatment need to be created and enforced because of the extensive and documented abuses of prostate cancer patients: 1. Blind biopsies should be banned. 2. Strict standards and gridlines for testing and treatment need to be created. 3. Full mandatory industry standard disclosure forms need to be created for tests and treatment to include realistic risk factor disclosure. 4. Newer testing and treatments need to be created and approved. 5. Dignity, privacy and confidentiality need to be standardized and enforced in addition to the HIPAA laws. 6. Aftercare needs to be available, standardized and regulated. 7. The cost for drugs needs to be regulated to end financial exploitation by drug companies. 8. Medical workers should be identifiable and be required to wear name tags with first, last names and job title. 9. A new standard “Ethical Code of Conduct” needs to be created and enforced to end patient exploitation and abuse. 10. Genomic or genetic testing should be required before any patient is sent for treatment, to avoid overtreatment and insure the correct treatment. 11. A truthful and accurate standardized education book or PDF needs to be created and distributed to all high PSA and prostate cancer patients. It is unlikely any of the above recommendations will be implemented unless prostate cancer affected a larger percent of the population or enough prominent people are affected. Prostate cancer patients must protect themselves as the only alternative!

    Clarification: The above text may probably anger and upset some people for various reasons. The intent of this document is not to imply all doctors are dishonest or to condemn all medical providers. The intent is to educate men of the consequences and dangers that may await them so they can take appropriate action and to inform patients of real world, typical or worst case scenarios. I have also tried to include most scenarios a prostate cancer patient should be cautious of. Would some health care providers harm a patient for profit or by accident or some other reason? Yes, absolutely! We just don’t know who or what percent would. Shockingly, for me it was will over 40% (probably 50% to 60%) that intended to do me some form of harm or provided substandard care as explained in my story. Are some other doctors and nurses exceptional? Yes! I have also had excellent doctors and nurses, however this may not protect you or I from the bad ones. Differences in opinion, variations in semantics do not invalidate this document or its intent. The information in this document is a sum of my experience, other patient’s experiences and hundreds of videos, documents, books, conversations, clinical trial, blogs, studies, articles, etc.

    Recommended reading. Investigate for yourself:
    1. Hardcover book, The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster. by Richard J. Ablin (Inventor of the PSA test).
    2. Internet search or Google: prostate cancer overtreatment or scam or hoax, useless PSA, Prostate biopsy sepsis or dangers. Medical mistakes, etc.

    Often prostate cancer testing and treatment is harmful and a big scam for profit! The evidence is overwhelming.

    Disclaimer: I have no conflict of interest. I do not represent any support group or other organizations. I am not a doctor. I do not prevent, treat, diagnose, cure or advise on medical matters. The information in this document is for educational purposes only. If you need treatment or medical advice, consult a competent and trustworthy medical doctor.

    Anyone may copy, email or distribute parts of or this entire document without changing or modifying it.

    I have been extensively criticized by some for creating this document and its blunt content. In order to insure my privacy and avoid any potential reprisals, further abuse or exploitation, I will remain Anonymous.

  5. Tom

    I had a radical prostatectomy 2 years ago. After surgery my PSA quickly went down to .008. My Gleason score was 3 + 4 = 7. The surgeon said the cells close outside the membrane looked angry, but not cancerous. My PSA stayed at effecrively 0 for a year but has climbed to .17 now, and the radiologist says I need to have a 8 weeks of pelvic radiation. He’s having an MRI done but doubts he’ll see anything on it. I’m told this is still very small, and the side effects of this radiation seem rather high. Wouldn’t it be better to wait a bit till I reach .2 or higher so it can be seen on an MRI and the cyberknife can be directed more effectively and not this general all encompassing beam? I feel like were jumping the gun a bit.

  6. Lola Díaz

    My husband is shortly going Da Vinci. MP MRI shows desease in left-hand side, bulging the capsule. Seminal vesicles andnodes normal.Possibility of minimum extraprostatic afectation.

    Bone scan and TC normal

    Gleason 4+3=7. 2 cores positive.
    (Sorry for my English, hope it can be understood)
    I’m worried about the “Possibility of minimum extraprostatic afectation.
    Can you give me some information or expectations?

    • Hi Lola,

      My husband just had rp. Gleason 4+3
      Tumor was bulging capsule on MRI.
      Pathology was positive surgical margin of 3 mm. He had nerve sparing procedure.
      In hindsight – seems bulge indicates extraprostactic disease, and perhaps surgery was not the best choice for him. We will not know until he gets PSA test in 12 weeks.
      The decision to have surgery must consider size and location of tumor as well as PSA
      Higher PSA is usually associated with EPE, which is not as favorable as confined disease. Do you have a surgeon who is extremely experienced? If possible, I would consult with Johns Hopkins prior to treatment.

  7. dave howell

    Prostrate removed last Jnuary. PSA .008 september 20th pathology Gleason 3+4 one of 9 lymph nodes had small amount of cancer Dr. says chance of being cured. Anyone have any thoughts not on any treatment now

  8. Robert Loreaux

    I recently had Robotic Prostatectomy. Gleason Score of 4+3 , Pathology report 3+4. complete Erectile Function and No leakage right after Surgery. Positive Pathology report, MRI pre-surgery indicated that the cancer was contained. Three months after surgery, PSA of 4.5 rising to 5.7 in 2months. Presently going through Imaging procedures to detect the remaining cancer. Looking at all alternatives. Any suggestions.

  9. Phil Hynes

    Thank you for this informative series.
    I am trying to understand a (RPP-both nerves preserved) surgical pathology report that was not covered in your panels discussion. The EPE was negative on all except Equivocal on Left mid Posterior with addendum identifying a single foci positive margin (2mm). Does this suggest CI vs. EPE and why is a second surgery to get the 2mm not possible vs. radiation and associated side effects. It would seem that nerve sparing, to preserve sexual function ends up creating higher risk of recurrence and with adjuvant radiation loss of sexual function.
    Would a second opinion be advisable in these type of situations?

  10. Elizabeth Dunmore

    My husband had a radical prostatectomy 10 years ago, he now has End stage kidney disease 14 % renal function due to bladder and bone spread, lost one kidney , large midline incisional ventral hernia post ARDS surgery, right kidney nephrostomy. Although very tired he still loves boating and his electric bike , is dialysis worth it or just a sad way to live now?

  11. Nick

    I had robotic surgery several years ago (GS 3+4, PSA 6.2, and positive margin). My first post op PSA was undetectable. Since then it is staying at 0.1. Prior to surgery my doubling time was 4 years. My oncology urologist said to wait until I hit 0.2 before salvage radiation. Will waiting increase my risks of metastases?

    Thank you,

  12. Lisa

    My husband was recently diagnosed with prostate cancer, Gleason scale 9. All 13 tissue samples were 4+5 or 5+4. Overall tissue involved by carcinoma is 65 to 70%. His PSA is 50 right now. Extraprostatic extension identified and perineural invasion is present. He goes for his CT and bone scan= later in the week. Doctor started him on hormone therapy already.

    Any suggestions or comments about his situation? Reading everything I can get my hands on or find on the internet. We just found out last week.

    Thank you very much.

  13. roger davies

    I had robotic prostatectomy in Oct 13 and pathology showed positive margins in 3 areas including one lymph node.I had radiation treatment 7 months after the operation and have been on hormone treatment since then. So far PSA has been undetectable. I have no idea what my prognosis is. I feel fine so far but intend to stop the hormone injections in Feb after 2 years as I don’t like taking medication in any form.

  14. dhirendra

    aftrer cancer APR surgery ,(rectum- resection) the biopsy reports says A)apr specimen+B) Right Plnd+C) Left Plnd-mucinous adenocarcinoma; 3.5cm; High-grade(poorly differentiated to undifferentiated);pT4aN1bMnot applicable; all the margin free of carcinoma; closest radial margin 7mm; perineural invasion present ; no lymphovascular invasion; metastasis in lymph node present with perinodal spread (2/25), what are the further treatment

  15. Kathy Boone

    My husband had bladder cancer in 04, and was treated with one dose of chemo. 4 years later he was diagnosed with prostate cancer in 09. He chose da Vinci surgery. It’s been 5 years now. He used to go every 6 months to have a PSA test, now he goes once a year. His last PSA was .01
    He has also been diagnosed with rheumatoid arthritis, so he takes a lot of medication. He is only 59. In the past few months, it it really hard for him to get an erection and he has to urinate 4-5 times a night. His back and stomach hurt almost everyday. He has pain in his hips also, but no swelling that I can tell. He has lost a total of about 35 pounds in the last year for no apparent reason. I know they do blood work at his Family Doctor and his rheumatologist. My questions are:
    1. Is the bladder cancer the primary cancer source ?
    2. Could the cancer metastasized either from the bladder cancer or prostate cancer ?
    3. Why is he losing weight ?
    4. He has told both his family Dr. and his Urologist and no one seems to be really concerned. But I am.
    5. What is the percentage chance of a recurring cancer from either the bladder or prosate cancers, and do any of these symptoms warrant concern?
    Thank you

  16. Tammy Conlley

    With a PSA of 13.44, My husband had robotic radical prostatectomy and bilateral pelvic lymph node dissection (4). Tumor was approx. 50% of entire gland. Gleason 4+4=8. (100% pattern 4). Extraprostatic extension was established measuring 5 mm in length and extending up to 2mm past the prostatic capsule. One section of the right anterior apical surgical margin is positive for transected Gleason pattern 4 tumor glands for a length less than 1 mm. Remaining margins are negative. Seminal vesicle invasion was not identified. Perineural invasion was identified extensive. Angiolymphatic invasion was not identified. Lymph nodes 0/4.
    What does this mean in layman terms? Doctor said 50-50 chance that cancer is still present and possible radiation. Will check PSA in 6 weeks then 3 months.

  17. robert marcucio

    I recently had robotic davinchi procedure before my surgery gleason 7 score 4+3 went my psa was 46 just went back to 4 weeks follow up my doctor my psa is zero my doctor is telling me did not go outside of prostate but is telling are some spots that were outside of prostate and that my gleason score 7 was more like gleason 9 and is associated with a t-3 score that I’m probally going to have radition treaments I’m kinda really confused could you put some of light on this nightmare and I’m still having leaking problems is this normal after surgery 4 weeks later 1 week cather was st ill in please forgive my spelling as I’m totally nervous

    • rajinder

      hello robert
      well its untreatable so thr best option for you is to start praying daily to god and read bible everyday. best of luck

  18. Cynthia Sloan

    My husband had surgery six weeks ago. He had a positvie margin after surgery. He just had his PSA and it is now o.o3 . They are telling him that he will have to have radiation and we are wondering exactly what is involved with this . How many treatments do they do. What are the side effects? His Gleason was a 7 before and after surgery. He had robotic surgery. How long should he wait to have the radiation?

  19. Mark Oliver

    Hello, I am a Iraq war veteran and I had my surgery to remove my prostate on June 15, 2015, my pathology report came back positive margin line of microscopic cancer cell on the right side only, everything else was negative, my Gleason score was 3+4=7 and my PSA was 4.5 post surgery. It is now 0.04, I really don’t know what to do, my urologist said to just wait, but I just don’t think I should wait on my cancer to grow larger.

  20. zorro

    The reason why I am hesitating to receive radiotherapy is that except for the the biopsies, which showed two small focies of cancer,neither the dissected prostate nor the MRI or bonescan 6 months post-op showed any signs of cancer.

  21. zorro

    After using antibiotics and anti-inflammery drugs my psa dropped to 6.4 and after using just anti-inflammery drugs alone for another 10 days,my psa dropped to 6.04.I know this is still a very high psa for 10 months after a radical prostatectomy.The urologist recommended yesterday ART.I am not willing to do that.

  22. L. R. White

    50YO husband had robotic prostatectomy 2 weeks ago. Confirmed Gleason 9 (4+5). T3a N0. Angiolymphatic invasion. Negative margins. Wondering if he’ll need additional therapy. I’m assuming he’s at high risk for biochemical reoccurrence due to the aggressiveness of cancer. Pre-op bone and CT scans were clean. No MRI performed. Opinions? Thank you!

  23. zorro

    I had a robotic prostatectomy 9 months ago.My psa pre-op was 2.38.My psa started to decrease from forty-five, 17, 1.24,to eventually 1.19 at 6 months post-op.Now at 9months it is 7.44.
    The MRI showed residue tissue left behind in both the left and right posterolateral regions of the lobes.The pathological report of the dissected prostate read the same.Is it possible that prostatitis of the residue tissue or the proses of healing of the residue tissue like regeneration is causing the rapid increase in psa value.

    • rajinder

      No its not due to prostatitis . actually the cancer has widespread in whole of your body . the best treatment for you now is to start praying to the almoghty god and read bible daily .

  24. david j. beeson

    my e mail address was wrong on last comment!! this is correct now

  25. david j. beeson

    very informative!!! I had gleason score 7 and robotic surgery!!~ results were seminal vesicle involved and positive margin! 12 months later, psa went from .1 to .23!! started Lupron treatment and than 2 months I get radiation!! pray for me!!!! is there anything else I should do or should have done????

  26. It’s really a great and helpful piece of info.
    I am glad that you just shared this useful information with us.

    Please stay us informed like this. Thank you for sharing.

  27. Sylvia Herrera

    How much of a worry do I have, my husband had prostate cancer, they removed it now they he has cancer on the Bladder Neck Margin. T3a. Is radiation the answer. We go on the 22, of July. for a lot of information we need. He is 68.
    He has pain on one of his testicles. Inflammation they say, have him on Ibuprofen .give us any input we need please.
    Thank you.
    Sylvia Herrera

  28. bert junghans

    I had my prostate taken out 15 month ago with a gleason score of 7 but my psa has gone up from 0.01 to 0.27 in the meantime. I cant have radiation as both of my hips were replaced with ceramic implants.
    Had a bonescan recently which was clear so there is a residue in the lymph nodes. Is there any other method apart from radiation to attack these lymph nodes as my specialist here in Australia did not give me any other option at all where he said to let the psa go up to 8 or 10 and then he will give me a hormone injection? Thank you in advance

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