John Swanson, MD
staging is extremely important in assessing mortality and morbidity risk for any cancer. The diagram, table and this discussion are meant to help illustrate and explain some of the difficulties associated with prostate cancer staging. First, clinical staging in the absence of pathology reports of the prostate gland is frequently inaccurate. One study found that 66% of clinical stages were upgraded (worsened) after pathologic examination. Information given in Table 1 shows the need for pathological staging. Clinical staging often involves guesswork. This has particular importance for us in underwriting as external radiation therapy, brachytherapy and watchful waiting gain in popularity.
Next, there is the problem of 2 different staging classifications. The American Urological Association established he modified Whitmore-Jewett A through D staging system. For consistency with other cancers, the American Joint Committee on Cancer (AJCC) recommends use of the TNM system. T1 equates with stage A, T2 with stage B, and T3 and T4 with stage C. Table 1 compares the 2 classifications
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Bob Leibowitz, M.D, Isaac Gorbaty, M.D, Mary Duong, P.A.-C
The package insert that accompanies any type of prescription for testosterone replacement products states that testosterone is “contraindicated in men with prostate cancer.” This means that you should never use any form of testosterone if you have prostate cancer. 99.9% plus of all physicians believe that if you give testosterone to a patient with prostate cancer, it’s “like adding gasoline to a fire.” We are taught that testosterone will markedly stimulate the growth of prostate cancer cells, cause widespread metastatic disease, and greatly hasten death. Testosterone replacement therapy has also been reported to cause permanent paralysis.
A number of years ago, I reviewed the medical literature regarding the relationship between testosterone and prostate cancer, especially in men who were previously treated for prostate cancer. I previously discussed this subject in detail in my September 2003 paper, “High-Dose Testosterone Replacement Therapy,” and the interested reader is directed to this paper.
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