Auburn coach Freeze has prostate cancer.

[Eurocat]

Good luck coach.

Auburn's Freeze diagnosed with prostate cancer

Auburn coach Hugh Freeze has been diagnosed with prostate cancer but is expected to make a full recovery, the program announced.

www.espn.com

 

[d'son d]

Good luck. Most men will, develop prostate cancer in their lifetime but die with it, not from it. The options for treatment is large, i.e. surveillance, surgery, radiation, hormones, radiopharmaceutical therapy, targeted therapy, immunotherapy, and the newer clinical trials of cryotherapy, focused ultra-sound, photodynamic therapy, proton beam therapy. Mr. freeze has a plethora of options, guided by his stage. So, if one doesn't work the availability of others exist. His making a full recovery suggests an early stage although making a recovery and cure are different.

 

[hdhntr1]

Good luck. Most men will, develop prostate cancer in their lifetime but die with it, not from it. The options for treatment is large, i.e. surveillance, surgery, radiation, hormones, radiopharmaceutical therapy, targeted therapy, immunotherapy, and the newer clinical trials of cryotherapy, focused ultra-sound, photodynamic therapy, proton beam therapy. Mr. freeze has a plethora of options, guided by his stage. So, if one doesn't work the availability of others exist. His making a full recovery suggests an early stage although making a recovery and cure are different.

The problem is he is only 55 and the younger you are, the more dangerous generally it is, If you get it at 80 something else will kill you as it is pretty slow growing and you have an average of 10 more years anyway. But at 55 it is much more aggressive (and you are dealing with a remaining life of 25 years so it is much more urgent it be dealt with

 

[dmeinbach]

The problem is he is only 55 and the younger you are, the more dangerous it is, If you get it at 80 something else will kill you as it is pretty slow growing and you have an average of 10 more years anyway. But at 55 it is much more aggressive (and you are dealing with a remaining life of 25 years so it is much more urgent it be dealt with

That's not necessarily the case. If you have a genetically linked form, they can be more aggressive (eg BRACA gene +). However I see many men with low or intermediate grade, small volume disease. They are arguably the more challenging guys to treat because their longer timeline means you can't just blow it off, as it will eventually be a problem. Deciding on the right point at which to intervene vs continuing surveillance can be a difficult decision.

 

[hdhntr1]

That's not necessarily the case. If you have a genetically linked form, they can be more aggressive (eg BRACA gene +). However I see many men with low or intermediate grade, small volume disease. They are arguably the more challenging guys to treat because their longer timeline means you can't just blow it off, as it will eventually be a problem. Deciding on the right point at which to intervene vs continuing surveillance can be a difficult decision.

Everything I have seen indicates that early onset prostate cancer (55 and below) tends to be more aggressive. 5 year survival rates are lower the younger the person is diagnosed. Which makes sense as it tends to be hormone driven and hormones (testosterone) tend to be higher when a person is younger. There are always subsets within any age group that can be more or less dangerous

 

[techtim72]

Could one of the docs here explain the rationale around the lack of testing and physical examination related to prostate cancer? My understanding is that Medicare/Feds aren't fans of the PSA (That may be in part age based.) and the docs aren't fond of doing prostate exams (Difficult and best done by urologists and not GPs.). So how does your average doc know whether to do a biopsy for prostate cancer until your d... falls off? I think probably a third of the men I know including family have had prostate cancer. I am over 70.

 

[dmeinbach]

Everything I have seen indicates that early onset prostate cancer (55 and below) tends to be more aggressive. 5 year survival rates are lower the younger the person is diagnosed. Which makes sense as it tends to be hormone driven and hormones (testosterone) tend to be higher when a person is younger. There are always subsets within any age group that can be more or less dangerous

I'm a urologist, so allow me to clarify. It's only recently that there's been some suggestion that younger patients may harbor more aggressive disease than older men. Previously multiple studies had shown an association between older age and more aggressive cancer.

Patients < 55 may have a higher likelihood of having a genetic predisposition to an aggressive cancer than their older cohorts, and others may be caught at a later stage due to lack of screening since they're "young." Still, statistically speaking prostate cancers are more likely to be of a lower grade than a high grade in any age group. The idea that higher T levels may cause more aggressive cancer has been proven incorrect. For one, high levels of T have not been shown to increase cancer development, only that it can feed the cancer once it is present. Additionally, more aggressive cancers are often less dependent on androgens and have developed other pathways to feed their growth. Hence, they become castrate resistant more quickly.

 

[dmeinbach]

Could one of the docs here explain the rationale around the lack of testing and physical examination related to prostate cancer? My understanding is that Medicare/Feds aren't fans of the PSA (That may be in part age based.) and the docs aren't fond of doing prostate exams (Difficult and best done by urologists and not GPs.). So how does your average doc know whether to do a biopsy for prostate cancer until your d... falls off? I think probably a third of the men I know including family have had prostate cancer. I am over 70.

Sure, the rationale stemmed from the US task force on preventative screening recommendations released close to 20 yrs ago which were based on the results of the US PLCO trial and a similar European study. The panel (which did not include a urologist in creating these recommendations, incidentally) suggested that screening was not worth it from a cost benefits analysis. It basically conceded that some men would have preventable metastasis and death from prostate cancer, but concluded that the cost and side effects that result from treatment of a much larger number of men outweighed this. Understandable from a larger societal standpoint, but not very comforting if you're one of the ones dying of cancer as a result. The conclusions were also erroneously based on the premise that all men diagnosed would be treated, which is not the way that handling prostate cancer had been trending given the advent of active surveillance. The recommendations have since been amended, but screening fell out of favor for awhile.

Regarding rectal exams, many PCPs don't feel comfortable doing them, as you stated. I personally have diagnosed a number of men with high risk (Gleason 8-10) prostate cancer due to an abnormal rectal exam alone, as these tumors may often under produce PSA and can be missed if only PSA is checked. As the only cost to the exam is a few seconds of discomfort, I personally feel it is a mistake to abandon it.

Basically, I feel screening is worthwhile if you have at least a 10 yr life expectancy. If you're diagnosed with it, you don't necessarily have to have treatment but you are at least making an informed decision at that point. Otherwise you're just in the dark.

 

[hdhntr1]

I'm a urologist, so allow me to clarify. It's only recently that there's been some suggestion that younger patients may harbor more aggressive disease than older men. Previously multiple studies had shown an association between older age and more aggressive cancer.

Patients < 55 may have a higher likelihood of having a genetic predisposition to an aggressive cancer than their older cohorts, and others may be caught at a later stage due to lack of screening since they're "young." Still, statistically speaking prostate cancers are more likely to be of a lower grade than a high grade in any age group. The idea that higher T levels may cause more aggressive cancer has been proven incorrect. For one, high levels of T have not been shown to increase cancer development, only that it can feed the cancer once it is present. Additionally, more aggressive cancers are often less dependent on androgens and have developed other pathways to feed their growth. Hence, they become castrate resistant more quickly.

But I was not talking about the testosterone causing the cancer, I was suggesting that in younger people that already have Prostate Cancer, their higher levels of testosterone would tend to make it grow faster (or in your words feed it) therefore, more in need of being treated. There are whole therapies based on reducing testosterone production including castration and/or chemical suppression. The one I remember the most was a drug produced by Takada. I believe it was Leuprolide Acetate. (I was researching it for a possible investment about 20 years ago)

I am not trying to suggest I know more than you about it just that we ma be looking at it slightly differently. You are talking more or less aggressive based on type, I was looking at it from the prospective of a particular Prostrate Cancer already established and that once established is hormonally driven so once a person has it, higher levels of testosterone associated with being younger tended to make it grow faster.