Saturday, March 30, 2013

Prostate cancer is to breast cancer like...

jock straps are to bras?
Blue is to Pink?

Sort of like those annoying SAT analogies but prostate cancer and breast cancer share many commonalities despite the dissimilarity of these glands.

How they are alike:

Incidence is about the same in the US with 200,000 new cases/year
Both are usually hormone mediated
Defects in the BRAC1 gene are associated with both cancers
Huge controversies  about screening as both screens (PSA levels versus mammograms) lead to many false positives and over treatment
Treatment is similar: blocking  the sex hormones being the first line of defense. Taxols are used in both treatments too as a second line
Pattern of mets are similar: bones, liver, lungs and brain
It is possible to live without either of these glands

How they are not alike:

Men can get breast cancer (interestingly it usually is hormone positive) but women can not get prostrate cancer
Breast cancer is twice as deadly killing 2/7 versus 1/7. n. b. these numbers are about 5 years old but I bet they haven't changed much. What has changed significantly is how long one can live with Stage 4 disease
Biopsy of and surgery to remove the prostate is much more difficult with more things that can go wrong
Much more controversy concerning treatment of non-aggressive cancer cells given that impotence and incontinence are common side effects of surgery with the prostate

I was reminded of this recently as I ran into my neighbor who has been battling Stage 4 prostate cancer for 6 years no. There is a larger range of scores that measure the aggressiveness of the cancer. Breast cancer is measured on a scale of 1 to 3 (3 being the most aggressive; almost all of TNBC is grade 3). Prostate cancer is measured on a Gleason scale from 1-10. If one's score is 8 or above, it will most likely spread. Very low scores are left alone and are monitored by PSA tests regularly. My neighbor is a 10 and was told that living beyond the next year was remote. He had no symptoms but his PSA levels were through the roof in a routine exam. The current advice is that asymptomatic men not bother with a PSA but this advice would not have helped my neighbor. And as for me, I felt no lump. My tumor was detected on a mammogram.

But 6 years later, he is still alive out taking long walks. The cancer is in his bones and liver. A drug will work for a while but then crappy cancer figures out how to grow any way. So a new drug is tried until progression begins. I have lost track how many clinic trials he has been on. The current one is so far preventing progression but the mets have not shrunk. He will be on some form of treatment until the rest of his life. But so far, he has outlived his expiration date by 5 years. The life of a Stage 4 breast cancer patient is similar. Right now though, they have been unable to stop the progression is momma sunshine's BC. And she just started her battle.

Ah Spring! Finally. I have crocuses in bloom and daffodils about to too. The bad bunnies have been eating my other bulb's shoots. Do they like red pepper?

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