15 year survivial rate for men under 50

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Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 684
   Posted 7/23/2009 5:08 PM (GMT -6)   

 

Surgery Improves Survival For Prostate Cancer Patients Younger Than 50

ScienceDaily (May 15, 2009) — For men younger than 50 with prostate cancer, undergoing a radical prostatectomy can greatly increase their chances for long-term survival, according to a new study from Henry Ford Hospital.

Results from the study done on the National SEER database show that the surgical procedure improves the 5-, 10-, 15- and 20-year survival for younger patients, when compared with other standard treatments such as radiotherapy or watchful waiting.

"When given the choice between surgery, watchful waiting or external beam radiotherapy, patients younger than 50 with moderately and poorly differentiated prostate cancers have better long-term overall and cancer-specific survival when they opt for surgery," says study author Naveen Pokala, M.D., an urologist with Henry Ford Hospital.

Based on findings from the study, Dr. Pokala and co-author Mani Menon, M.D., director of Henry Ford's Vattikuti Urology Institute, strongly recommend retropubic radical prostatectomy – a surgical procedure that removes the entire prostate gland plus some of the tissue around it – as the treatment of choice for prostate cancer patients under the age of 50.

Prostate cancer affects one in six men in the United States during his lifetime, but according to the American Cancer Society only one in 35 will die of it.

Although the majority of all prostate cancer are diagnosed in men older than 65, its prevalence is growing among men younger than 50. In fact, about one in 10,000 men under the age of 40 will be diagnosed this year with prostate cancer.

To determine which treatment option offers the best chance for long-term survival for younger prostate cancer patients, Pokala and Menon studied more than 8,200 men under age 50 with prostate cancer.

Among the study group, 73 percent were white and about 22 percent were black. The mean age was 46, and over 70 percent had moderately and 22 percent had poorly differentiated cancers. Of the patients, 1,065 were managed with no definitive treatment (watchful waiting); 6,614 (79.9 percent) with radical retropubic prostatectomy; and 600 with external beam radiotherapy.

The cancer-specific survival in the NDT group was 78 percent at 16 years, in the radiation group was 63 percent at 17 years; and 94 percent in the radical prostatectomy at 21 years. On a subset analysis the outcome was significantly better after radical prostatectomy in patients with moderately and poorly differentiated prostate cancer.

Overall, the study shows the 5-year, 10-year, 15-year and 20-year overall survival and cancer specific survival is significantly increased in patients who were less than 50 years of age with moderately and poorly differentiated cancers in the surgery group.

The results were presented in Chicago at the recent American Urological Association's annual meeting.

 

One thing I don't quite understand is the NDT group (watchful waiting) that had a survival rate of 78% at 16 years while the radiation group survial was 63% at 17 years. Doesn't make sense!


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/23/2009 7:22 PM (GMT -6)   
Right. That's one of the frustrating things about learning about a study from a press release, which is often SIGNIFICANTLY distorted.

Forgiven that, note that this was a retrospective study. So guys weren't thrown with careful randomness into the different treatments. It may be as simple as that the guys in the radiation group had poorer prognosis than the watchful-waiting guys. Which maybe makes sense--would you do WW if you had serious, aggressive cancer? It may just show that radiation wasn't able to bring the guys with aggressive cancer up to the survival of guys with mostly indolent cancer.

Without reading the study--and maybe not even then--we'll never know.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 <0.01


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/23/2009 8:01 PM (GMT -6)   
Good news. Does this mean us stage 4 guys are going to be around 15 years from now? Darn right it does. Lets live it up.

peace and joy
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/23/2009 11:03 PM (GMT -6)   
Thanks, Squirm.

I like those odds! tongue

All the best,

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3666
   Posted 7/24/2009 11:42 AM (GMT -6)   
Capt Larry,
You a right on. Unless you know the selection criteria used the study is not of very much use. The other problem is that 15 years ago the treatments were much different than today's treatments. IMRT is much better than ERBT and better diagonistics can better classify high and low risk individuals.
If you are going to use retrograde studies then the Partin Tables are much more accurate as the sample size is larger and the selection is consistant. The Partin Tables show less favorable results than this study.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 2663
   Posted 7/24/2009 12:23 PM (GMT -6)   
Hi Guys and Gals:
 
This will probably label me as a bit of a skeptic but I guess I was not surprised that a study by two uro-surgeons would come out with surgery as a recommendation!  And, oh by the way, the robotic surgery center at Henry Ford Hospital is one of their big profit centers. 
 
I tried to find the actual study so I could understand why radiation patients did not survive as well as those who did nothing as that obviously does not make sense.  I couldn't find it so I'm buying into CapnLarry's guess that the study was not randomized... and/or the study was selective for initial diagnosis so that surgery won the contest.
 
By the way, while I was looking for the study in Science Daily, I ran across another study that was referenced on the same page.  That study was titled, "Radiation Seeds Effectively Cure Prostate Cancer in Young Men".  That study noted  "...studies have shown brachytherapy to be just as effective as surgery" and "Radiation seed implants (brachytherapy) are just as effective at curing prostate cancer in younger men (aged 60 and younger) as they are in older men, according to a new study".  This study was conducted by a radiation oncologist at MSK.  So, I guess I was not surprised at this conclusion either!
 
I guess the bottom line for me is:
 
1.  I can probably find a study that will prove almost any thesis...especially when economic motives are in play.
 
2.  While each man's cancer is different, most men with PCa can be equally cured by surgery or radiation.  This is especially true for early stage cancers. 
 
3.  It then becomes a trade off between side effects, pathology knowledge and the psychological makeup of the patient.
 
That is my two cents worth for a Friday!
 
Tudpock
 
 


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!
Tudpock's Brachytherapy Journey: http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Post Edited (Tudpock18) : 7/24/2009 11:27:48 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24044
   Posted 7/24/2009 12:30 PM (GMT -6)   
Tud, I completely agree with your logic and reasoning with your last post. Makes sense to me, and from what I have studied on my own.

David "Squire" in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
 
 


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 7/24/2009 1:22 PM (GMT -6)   
If we ignore radiation, (I think we can assume the radiation cases were more advanced) there is still a big difference between Surgery and doing nothing, 6 out of 100 vs 22 out of 100 is a 350% improvement the way I look at it. But there is still a large group of experts saying we should do nothing.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24044
   Posted 7/24/2009 2:13 PM (GMT -6)   
engineer,

and those experts probably don't have PC or even know anyone with PC, so easy for them to percentage ther rest of misfortuned ones away.

david in sc
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3666
   Posted 7/24/2009 2:16 PM (GMT -6)   
Engineer.
Doing nothing is appropriate is certain situations. A summary of all the Active Survelience studies showed that men meeting the AS Criteria over 75% had no progression in 7 years and only 1% died. In these deaths the PC progressed within 6 months and was probably already matastized when diagonosed.
The remaining 25% had a local treatment as soon as any progression was noted. There was no more progression in the treated group. 12% of the group decided on local treatment even though there was no sign of progression. This is a 99% success rate.
Again, it is selection criteria. If you are a good candidate for AS your chances of a cure is extremely high even if your PC progresses and your chances of non progression is 75%. The worst case senerio is that you have delayed treatment for several years. If you meet the AS criteria and choose to have immediate treatment your cure rate will still be 99%. Basically there is agressive PC and non agressive PC. Any cure, including doing nothing, works on the non agressive, and is included in all the stats for cure rates for all the various options. The real question is not what the cure rate is for low grade PC, but what are the cure rates for intermediate and high grade PC.
Tud,
Excellent post and reasoning.
Jt

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 2663
   Posted 7/24/2009 2:16 PM (GMT -6)   
Dear Engineer:
 
I'm sure you're right...."doing nothing" vs. either surgery or radiation is sure to show worse stats...and they could be considerably worse depending on the patient population (which we don't know from this study).  IMHO, the key to watchful waiting success is:
 
1.  Don't do it unless you meet some very strict guidelines.
 
2.  Only do it under the supervision of a doc who has experience with this and knows when to pull the trigger on treatment.
 
3.  Careful follow up, e.g. regular PSA testing and biopsies.
 
4.  If something changes for the worse...get treatment immediately!
 
Tud
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7650
   Posted 7/25/2009 12:07 PM (GMT -6)   
Squirm,
I saw this report before. The discussion adbout WW versus radiation within the advocacy groups is that the radiation arm consisted of those who could qualify for watchful waiting, but also those who had higher Gleasons, or more extensive invasions, that made watchful waiting less attractive. There is no distortion just a miss in the study to evaluation criteria. Most peopel with watchful waiting are G6 and low PSA's. The radiation arm could have Gleasons as high as G10 and T3 clinical evaluations.  But RP clearly won this race and I believe that a guy under 50 will benefir from this option better.

Tony


 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7650
   Posted 7/25/2009 12:18 PM (GMT -6)   
One more note...

For those in the twenty year catagory, radiation in 1989 was far different then that it is today. Advances in radiation have closed the gap. WW has remained the same. We do not have any sufficient study data on Cryo or HIFU after years 8 and 5 respectively...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/25/2009 12:35 PM (GMT -6)   
TC
I'm not sure that WW has remained the same since 1989. We have better PSA tests, safer biopsies and better ones (think color dopler.) and better information for the supervising doctors about when to "pull the trigger." I'm not sure about reading the pathology of biopsies, but I would bet that has improved too.

Probably the least improvement is in what WW does to the psychological state of the waiter.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7650
   Posted 7/25/2009 1:44 PM (GMT -6)   
An important note about SEER.  It is not a study.  It is a statistical database kept by the National Cancer Institute.  While tough to search, is has an abundance of information...this info is compiled in peg counts and percentages...If anyone would like to review the site here is the link...
 
 
Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

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