This newsletter is for the express purpose of entertaining and educating of my immediate male relatives and friends. The information provided is believed to be accurate but it is always wise to check with your own doctor(s).

In the first issue the reader was informed of my early stage prostate cancer (PC), its extent (PSA 5.7, Gleason 6, Type T2a), and what I was doing about it (seeing lots of doctors and attending our local PC support group to learn more.).

I visited the UCSF Cancer Center to consult with Dr. Peter Carroll. After examining me and looking at my other data, he was "neutral" regarding treatment, i.e. in my condition any treatment was likely to do the job. He referred me to Dr. Shinohara to gather more data that might eliminate or encourage one treatment over another.

Dr. Shinohara performed a TRUS (transrectal ultrasound) examination. This exam produces a color enhanced image of the prostate, its interior and surroundings. By manipulating the controls, Shinohara enhanced the image to highlight the "vascularity" within the prostate. Increased vascularity is indicative of cancerous activity. He found "an area with cystic degeneration in the right lobe of the prostate at mid gland" (most likely benign) and "slightly lateral to this area, an area with significantly increased vascularity. The rest of the prostate gland appears to be unremarkable. The seminal vesicles are normal." Good news, this confirms and is consistent with my earlier biopsy and staging. Bad news, the prostate is about 66 cc in volume (large) and pubic arch interference was noted. This means that to do "seeds" I will have to go on hormones for several months to shrink the prostate to a size that can be reached through the pubic arch.

Factor 5 Lieden is a blood anomaly the results in an enhanced propensity for forming blood clots. After receiving my PC diagnosis I went to my internist, Dr. David Straface to do a general physical and see what other systems might be failing. David treated me when I clotted in the right leg after the repair of my fractured left hip in 2000. After sharing with him that I had clotted in the left leg after left hip replacement in 2001, he decided to do as series of special blood tests and called in a hematologist, Dr. Grant Swanson. Grant concurred with David and added a couple of additional tests - they were checking all bases and it took a bunch of samples (only one stick) to fulfill their needs All but one test proved to be normal ­ Factor 5 (discovered in Lieden, Germany) was positive, enhancing my propensity for clotting by 50 times (there is also a version with only a 10 X enhancement). Both Staface and Swanson wanted me on blood thinners immediately to preempt any new Factor 5 activity.

So just five days after the last newsletter was sent out, I was on my way to visit Dr.

Abraham Kryger (Dr. K). If anyone would know a diet or supplementary way around having to take Coumadin (blood thinner) he would. But on my way to visit him I crashed (another story) and fractured my left wrist Thus I met Dr. Richard Ravalin and "good orthopedic noises" (while setting the wrist). Now the wrist and I are in physical therapy developing grip (45 lbs, should be 100+), and flexibility (65 degrees, should be 170 degrees).

There are three classes of treatment for one with my numbers: PSA 5.7 (<10), Gleeson 6 (<7) and stage T2a (DRE positive in one lobe only): External beam radiation, brachytherapy (seeds), and surgery. I quizzed friends, doctors and the internet to learn as much as I could about each treatment, their "cure rates," side effects, time required, recovery time, and other restrictions or advantages. The chart at the end of this newsletter is a summary of my findings. Note, there are also combinations of treatments as well ­ I have only included the combinations available here or at UCSF.

(1) any given doctor or clinic has a preferred treatment based on their history and expertise and in their mind it is the only way to go. (2) it is possible to find a study to support whatever you want to do!

I am going the external beam radiation route. Factor 5 creates a problem with surgery or seeds ­ since I am at high risk of clotting. Bike riding after seeds can cause them to migrate, thus mucking up the distribution of radiation. In my case, seeds would require about 4 months, 2 waiting for the prostate to shrink and 2 months to heal/radiate before bike riding. That doesn't leave me much time to get in shape to ride in France next summer.

Our hospital (CHOMP) has the very latest 3D conformal IMRT (intensity modulated radiation therapy) equipment. We will do the "planning" x-rays, CT, and ultrasound volume studies the last week of December or first week of January. Then in mid January I will begin daily trips to CHOMP for my 15 minutes of fame and radiation. This will go on for eight weeks. Meanwhile, all normal activities continue, including completing my wrist PT and getting back on the bike!

Questions, comments, suggestions send them along to me or give me a call (831-372-8323)!

Till the next issue, stay well! And if you are related to me, get your Factor 5 and PSA checked! Its a simple blood test, just a little stick ­ takes 5 minutes. Its important, cause Factor 5 is inherited and there is growing evidence that PC is inherited as well AND now we know its in the genes

Discovery Health Cancer Treatment Decision Tools - Cancer Profiler https://www.cancerprofiler.nexcura.com/Secure/Toolbox.asp?CB=189 Set up an account, then complete the questionaire which leads to treatments which lead to research reports on those treatments.

Medicalpike Headline Index 1998-2001 http://www.psa-rising.com/medicalpike/index.html Links to research reports

Monterey Prostate Cancer Group http://www.prostatecancer-mtrybay.org

Prostate Cancer Education Council http://www.pcaw.com

Prostate cancer evaluation, recommendations, and treatment options http://www.brachytherapy.com/prostate.html

Radiation Therapy May Improve Prostate Cancer http://www.newswise.com/articles/1998/12/prostate.rsn.html

Seattle Prostate Institute - Patient Information http://www.seattleprostateinst.com/patient-frames.htm Click on About Seed Implantation for a very thorough description of the process, outcomes, etc.

The Prostate Centre, U Toronto http://www.library.utoronto.ca/medicine/prostate/index.html Includes a cook book that supports the diet suggestions included with my Newsletter #1

U-M CCC - Prostate Cancer Home Page http://www.cancer.med.umich.edu/prostcan/articles/3D.htm

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