Does the fear of recurrence ever go away (or even subside)

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We can do this
Regular Member


Date Joined Jul 2014
Total Posts : 166
   Posted 10/4/2017 12:37 PM (GMT -6)   
It's like groundhog day every time you're in the lead up to another test. Almost like you're teleported back to the day when the doctor said those three words that changed your life (no, he didn't say "I love you" for all the smart asses out there, ha).

Do we just accept our situation, let the feelings wash over us rather than dominate or define us? That has been my strategy.

Would love to hear anyone else's successful coping strategies.
Age 49 at DX
Jan-14 - PSA 2.2 (priors 1.5, 0.9, 1.1, 0.7). Biopsy 2 of 12 +ve (3+3). Clear bone scan, MRI, CT scan
May-14 - Nerve sparing RALP. Prostate size 25cc. GS 3+3, <5% involved. -ve margins.
Oct-14 - Post incisional hernia repair (caused by RALP)
PSA Jun14 <0.1, Nov14 <0.1, May15 0.01, Nov15 0.02 Feb16 0.04 May16 0.01 May17 <0.002

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4764
   Posted 10/4/2017 1:00 PM (GMT -6)   
"It is what it is."

I'm way more concerned about getting killed driving home from work than I am a recurrence.
Age 62 - 5'11" 210lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 7
06/25/08 - Da Vinci robotic laparoscopy
09/19/17 - Nine Year PSA -> less than .01
Surgeon - Keith A. Waguespack, M.D.

“Nobody can go back and start a new beginning, but anyone can start today and make a new ending.”

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2460
   Posted 10/4/2017 1:11 PM (GMT -6)   
I'm not sure if this is a coping strategy or not, but I tell myself that as far as I'm concerned, I'm cured until someone tells me something different.
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 614
   Posted 10/4/2017 1:14 PM (GMT -6)   
We can do this said...
Would love to hear anyone else's successful coping strategies.



What really helped me was learning about prostate cancer...learning more than my doctor/surgeon told me. What I learned is that PC is one of the most frequently occurring, and least lethal of all cancers. It's lethal for a fairly substantial number of the small numbers of high-risk men, a very small number of the larger intermediate-risk men, and virtually unheard of for the very large group of low-risk men like my case (and yours; my case characteristics were a bit worse than yours). What I learned was that high-, intermediate- and low-risk cases are like completely different diseases; silly that they are all called the same thing. I learned doctors are fighting (arguing) over whether low-risk PC cases should even be called "cancer" since they are not lethal. I also learned that for cases like mine, treatment makes absolutely no difference on my longevity; there is no longevity benefit at all, only harms. I also learned that the "Say/Do" ratio of doctors who treat PC cases is poor. That is, the vast majority reply to medical surveys saying that low-risk cases should not pursue immediate treatment, but in practice they still mostly "nudge" patients, skillfully while portraying concern for the patient's best interests, towards the lucrative choice (for them) of treatment.

I wish I had learned most of these things before I pursued an immediate, unnecessary aggressive treatment (surgery) at age 50.

Now that I realize these things, I know that it's silly for me to worry about dying from PC (which really was a worry at one time!), or even recurring PC. My coping strategy was to look myself in the mirror a number of years ago and 'fess-up to the fact that I was never at risk...

Hope that my strategy also helps you. My PSA test result is not even the first thing I look for when I get my blood work results online in advance of my annual physical checkup.

Post Edited (NKinney) : 10/4/2017 2:19:29 PM (GMT-6)


alephnull
Veteran Member


Date Joined Dec 2013
Total Posts : 684
   Posted 10/4/2017 1:23 PM (GMT -6)   
What NKinney said!

But whether you are low risk PCa (no worries man)
or high risk like myself (it is what it is),
you should strive to live life to it's fullest.
PSA at diagnosis 20.6, age 54 in 2013, 12 out of 12 cores positive
My PSA Curve
Robotic prostatectomy 11/2013, all positive except bladder neck invasion
Degarelix two months, 2 years Lupron, Radiation after 18 months
GS 9 - 4+5 , Stage pT3b N1 M1c - Undetctable 41 months
PSA rise <0.1 to 0.18 to .71, last rise in 4 months
Csodex n Lupron

hogo2000
New Member


Date Joined Jun 2017
Total Posts : 12
   Posted 10/4/2017 1:31 PM (GMT -6)   
Hi We can do this...

I am right there with you. I have a question about your PSA history. you were May15 0.01, Nov15 0.02 Feb16 0.04 May16 0.01 May17 <0.002 Are those the same labs? Was there concern with G6 and neg margins as to why your psa was .04? is that <.002 a typo or real.

As you can see from my signature there is a bump in my psa.

As to the anxiety...I think its our new normal. We need to try to stay out of the rabbit holes as much as we can...
Age at DX and Surgery 48 (2015)
pre-surgery PSA 2.4
RALP 11/15
3+3, neg SI, Neg, nodes, PNI +, clear margins

5 week PSA <.02
06/16 <.02
12/16 <.02
06/17 .02
09/17 .02

rancherdave
New Member


Date Joined Jul 2017
Total Posts : 11
   Posted 10/4/2017 2:04 PM (GMT -6)   
From the first day of my DX through testing then surgery, recovery and first post psa I knew I could beat this cancer. I had a plan a good and caring urologist and was sent to a very competent surgeon. I felt great the post-op biopsy could have been better but the surgeon was pleased with results the urologist said I was doing great, no incontinence healing quickly and pushing to be fully active again. Then on February 21 the second psa .33. Reality hit and the glow faded, back to Mayo Clinic for more tests and consultations prostate bed looks good and unchanged no mets found. New plan SRT with IMRT with HT closer to home, RO and staff great, treatments pretty much a breeze and last day meeting with Dr was positive but he mentioned that we could not repeat RT to this area again. The next morning I was texting with a friend and my son came into house to see how I was doing and I feel apart, the first time I cried for myself over my cancer. A week after RT ended I had very upset bowels and extremely painful bowel movements, slow recovery from that, I was unable to sit in farm tractor for a month. I took a week vacation to see one daughter in Colorado, very relaxing felt like my old self again. I was returning home for a 30 day visit with RO and another 4 month Lupron injection, not even a third of the way back I had a major anxiety attack and spent 5 hours in ER and a few other tests. I am now on Xanax but still dread any upcoming medical test. I have a colonoscopy October 16 and next psa mid-November and am already nervous about results. I am doing massage therapy for Lurpon SE and meeting with counselor for anxiety and with PCP on Xanax results and dosages. This does seen never ending but I have a number of people caring, involved, and working toward improving my situation.
DX age 61 2-16-16 psa 85 biopsy 14 of 20 5 to 90% involved no mets started casodex G 3 +4=7 5-4-16 Mayo MRI 3 mo Lupron no casodex, 8-4 3 mo Lupron psa .24, 9-15 RARP & lymph 54 grams 3 of 23 & seminal vessicals involved. 12-16 psa .01 2-17 psa .33 4-17 Mayo MRI no mets 5-1 psa.91 4 mo Lupron 5-30 started 33 SRT, 7-7 psa .01, 9-11-2017 psa .01

We can do this
Regular Member


Date Joined Jul 2014
Total Posts : 166
   Posted 10/4/2017 2:31 PM (GMT -6)   
Thanks guys. Good suggestions, all appreciated.

Hogo, those tests came from four different labs - a function of moving house and then country. Yes that last number is real - 0.002. I didn't ask for an ultra-sensitive test, that was the standard one. I have mixed feelings about the level of specificity....double edged sword in my experience.
Age 49 at DX
Jan-14 - PSA 2.2 (priors 1.5, 0.9, 1.1, 0.7). Biopsy 2 of 12 +ve (3+3). Clear bone scan, MRI, CT scan
May-14 - Nerve sparing RALP. Prostate size 25cc. GS 3+3, <5% involved. -ve margins.
Oct-14 - Post incisional hernia repair (caused by RALP)
PSA Jun14 <0.1, Nov14 <0.1, May15 0.01, Nov15 0.02 Feb16 0.04 May16 0.01 May17 <0.002

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4801
   Posted 10/4/2017 2:38 PM (GMT -6)   
Dave, are you on any kind of anti anxiety meds, (that are taken daily, unlike xanax)? I'm anxious by nature, and after 2 years of my dr recommendin/g I go on Sertraline (generic Zoloft), I finally caved about a year and a half ago. It's made. a world of difference. I still get anxious pre-PSA, but not freak out anxious until the day I expect results.
Might be worth a try. Half of America is on these drugs.
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033
Decipher test, low risk, .37 score

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 172
   Posted 10/4/2017 3:31 PM (GMT -6)   
Good question and discussion. I have moments of pre-decision anxiety but I try to get busy and distract myself. Denis
65YO healthy man, PSA 4.1 for couple years PSA 5/17 4.6, MPMRI, 5/17 showed lesion. 13 core biopsy 3 positive 3+3 and one positive in a lesion, may be overlap All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. MRI in 11/17 to see if there are changes. Thanks Denis

Redwing57
Veteran Member


Date Joined Apr 2013
Total Posts : 2283
   Posted 10/4/2017 5:05 PM (GMT -6)   
"We can do this" - you have done it.

You had a very low risk case to begin with. It may have been a difficult decision whether or not to even treat that kind of case, and surgery is likely to be quite successful for you. The risk of recurrence is vanishingly low. You have done it. Do follow up, but in the spectrum of things you need to worry about, this is probably somewhere between getting hit by lightning, or maybe the next asteroid impact.

Some of us are at the other end of the spectrum, where recurrence is all but certain. To answer your question about scanxiety, I research until I can't think of any more questions. I bracket what the possible outcomes are of the next test, and explore responses to best and worst case scenarios. I google until every search I can come up with only return links I've already seen. Finally, distracting myself with work, hobbies, and family activities pushes the question into the shadows.

Until about a week before the test. Then nothing really helps. I get that roller-coaster-drop sensation every time I think about it. Finally, the day before I'm in a bit of a fog, a funk, going through the motions. Fortunately, my cancer clinic fast-tracks the PSA result, and I know the number within 2 hours of the blood draw. That's helpful!
55@Dx 4/16/13
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3T mpMRI: Bilateral EPE, NVB+, SV-, LN-)

Pre:
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31

Tx:
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex, ended 3/16

PSA <0.1 : 8/13 - 5/16;
steadying? - 0.2-8/16, 0.5-12/16, 0.7-3/17, 0.8-5/17, 0.8-7/17

rcroller
Regular Member


Date Joined May 2011
Total Posts : 318
   Posted 10/4/2017 6:06 PM (GMT -6)   
I used to be very anxious every time I came due for a PSA draw. At the five year mark the inevitable happened and I got the bad news...recurrence. My worst fears had been realized. I did the IMRT and again, post SRT the numbers started to climb. Once I got my head around the fact that I would never be cured of cancer, I decided I'd just live as long as practicable WITH cancer. Once I accepted my situation I no longer have that anxiety. I know I have cancer, so there's only one thing to do...as others have said, live life to the fullest and "it is what it is". I have a good medical oncologist and I have a plan. I just don't sweat it anymore since I realized that the death rate on earth is still 100%.
Age @ Dx: 53- G-8(4+4) PSA: 3.5 5/2011 ORP, Path Report: G-7(4+3) 7%, pT3a N0MX, EPE, +PNI, + Left margin, -SVI ED. PSA:6/2011 through 3/2016 all <0.1. PSA 7/12/16: 0.1. uPSA 8/16: 0.149. Bone PET Scan: possible inferior pubis ramus metastasis. SRT 9/16 -IMRT 38 sessions @ 68.4 Gy Post SRT uPSA 2/17: .048. 3/17:.037 6/17:.047 7/17.059. Bone scan repeated, pelvic bone biopsy 8/18.

Post Edited (rcroller) : 10/4/2017 6:19:14 PM (GMT-6)


Reltnie
Veteran Member


Date Joined Feb 2013
Total Posts : 674
   Posted 10/4/2017 6:23 PM (GMT -6)   
The first year with a PSA every three months was hell for me. I think I thought about it most every day. It will be 6 years for me this February and I must admit, it is better, but the week before the blood draw is still tough. At least I get the results 45 minutes later.
Tom
Age:64 Diagnosis January 2012 Age 58
Original PSA Level 3.9 ......Gleason: 3+4
Biopsy results: 3 of 12 tested positive for cancer
Da Vinci Surgery 2/10/12
Negative Margins, cancer contained to prostate
Continent after 3 weeks
Sexual function fine with Cialis and now without meds at allsmile
PSA undetectable for five years now.

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 7761
   Posted 10/4/2017 6:48 PM (GMT -6)   
I have less fear of reoccurrence and more fear of the phlebotomist missing the vein and leaving a big nasty bruise.
I'll be in the shop.
Age 57, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

rancherdave
New Member


Date Joined Jul 2017
Total Posts : 11
   Posted 10/4/2017 7:14 PM (GMT -6)   
Pratoman, .25 Xanax in AM .50 mg Xanax in PM, also75 mg Effexor pm to lesson hot flashes. Met with PCP today to consider Xanax dosage change or drug change. Before Xanax got 4 to 5 hours sleep max this has improved some but not consistently. no changes made but check back in 2 weeks.
DX age 61 2-16-16 psa 85 biopsy 14 of 20 5 to 90% involved no mets started casodex G 3 +4=7 5-4-16 Mayo MRI 3 mo Lupron no casodex, 8-4 3 mo Lupron psa .24, 9-15 RARP & lymph 54 grams 3 of 23 & seminal vessicals involved. 12-16 psa .01 2-17 psa .33 4-17 Mayo MRI no mets 5-1 psa.91 4 mo Lupron 5-30 started 33 SRT, 7-7 psa .01, 9-11-2017 psa .01

browntrout
Veteran Member


Date Joined Apr 2014
Total Posts : 528
   Posted 10/4/2017 7:28 PM (GMT -6)   
No! I have seen way too many AS guys change course to anything from low-intermediate to unfavorable intermediate and worse. I'm sorry to be so pessimistic but I personally believe it is a matter of time. Had urologist tell me that they do their best and hope we die of something else before recurrence occurs. Remember, this is just me based on what I see on this forum and no real peer reviewed research studies to back up my humble opinion.
Age 65, Steadily rising PSA with a jump from 3.32 to 4.3 in 5 months, April 2014 Bx May 9, 2014 4/12 cores 3%, 15%, 30%, .5mm, 3mm, 5mm G3+4=7 PI not id'd Vol25g Ultrasound Findings: No discrete nodules. BT 7/16/14 81 pSeeds, nausea, urine blood, burning, 1/2 day, bruising, mild urinary/bowel 2 wks PSA: 8/14 1.19, 10/14 .41, I/15 .36, 4/15 .33, 7/15 .37, 11/15 .35, 5/16 .15, 10/16 .16, 5/17 .04

Post Edited (browntrout) : 10/4/2017 7:35:52 PM (GMT-6)


halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3063
   Posted 10/4/2017 8:17 PM (GMT -6)   
I think it does get better (a little) over time. I'm 2 1/2 years out, and my last PSA was a ho-hum trip in to Labcorp for the draw. I didn't expect any issue, and I didn't have one. Anxiety, yes, a little. But not much. I may be unusual, but my biggest moment of relief was when I made the decision of how to treat. And that is still true.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

CuriousCharles
Regular Member


Date Joined May 2017
Total Posts : 159
   Posted 10/5/2017 1:44 AM (GMT -6)   
I am nearly 4 years since initial very metastatic diagnosis, and a ridiculously high PSA to start. I get monthly blood work and PSAs. I have naturally been pleased when PSAs drop or remain stable on treatments. I've been on pins and needles wondering when PSA might start up again. I've been very concerned when PSA has risen a lot. It comes with the territory. I try to focus on getting to the best doctor(s) and exploring as many treatment option(s) as I can, and then making treatment decisions based on their collective advice and my own values, and accepting the reality of where the PSA and imaging results may go thereafter, even if its the biggest roller coaster I could imagine. Imaging results, symptoms (or lack of symptoms), and other things taken in totality can often outweigh the actual number or minor trends on specific PSA test(s). I prefer to spend more of my mental energy on positive things in the current week, rather than ruminating over past things, or fearfully speculating about potentially dire things in the future. Sometimes that's easier to say than to do, of course, but, it has seemed to get easier with the passing months and years.

Charles
Dx Nov 2013 Metastatic Prostate Cancer at Age 65
Numerous Bone Mets and Lymph Nodes, PSA 5,006
ADT Lupron + Zometa, PSA Nadir 1.0
Resistance after two years.
Short rechallenge Casodex.
Oct 2016 Provenge
Dec 2016 Start Xtandi, PSA 95
Sep 2017 PSA 1.4

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4801
   Posted 10/5/2017 5:34 AM (GMT -6)   
@Dave - I might be wrong, but I don't think Effexor is an SSRT, which is the class of drugs that worked for me. You might want to ask about that. Of course everyone is different. And to a large extent, unfortunately, for most people, some level of anxiety comes with the territory with this disease (or any cancer for that matter)

To the original question, nah, I don't think the fear ever goes away. Despite the logical belief that we should live each day to the fullest, and get educated, to reduce the fear, most people just can't do that. Human nature.

I'm guessing though, that after going a number of years with consistent undetectable readings, the fear lessens.
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033
Decipher test, low risk, .37 score

Paxton
Veteran Member


Date Joined Aug 2016
Total Posts : 843
   Posted 10/5/2017 6:17 AM (GMT -6)   
I'm still relatively new to all things PCa, having been diagnosed only a year ago. We were watching my PSA, though, for 5 or 6 years prior to that, but it was lower then. The first 6 months were rough for me, even though I was favorable intermediate risk. Looking back, it was just the monsters in the mind at play.

With my pathology, it is highly doubtful that I would die from PCa. Something else will likely get me first. With my medical history, there are several other candidates. . . I've had my "play dates" with the surgeons and specialists in the past. I have now managed to relegate my concerns about PCa to the same place as those about all of my other chronic medical issues. That area has one rule, which is "There is nothing wrong until there is something wrong." I have learned to tolerate the testing cycles and only worry about what "could" go wrong after it already has gone wrong. There's nothing I can do to stop these things, anyway.
Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23

We can do this
Regular Member


Date Joined Jul 2014
Total Posts : 166
   Posted 10/5/2017 9:21 AM (GMT -6)   
Have been thinking more on this. I love being on this site and get a lot of information and advice from members, but I think it is the "Five years after RALP, PSA rising" type posts that play on my mind. There have been quite a few in the last few days and I guess that is what motivated me to submit the original post. No answer to all this I guess, just focusing on strategies to stop the mind running wild.
Age 49 at DX
Jan-14 - PSA 2.2 (priors 1.5, 0.9, 1.1, 0.7). Biopsy 2 of 12 +ve (3+3). Clear bone scan, MRI, CT scan
May-14 - Nerve sparing RALP. Prostate size 25cc. GS 3+3, <5% involved. -ve margins.
Oct-14 - Post incisional hernia repair (caused by RALP)
PSA Jun14 <0.1, Nov14 <0.1, May15 0.01, Nov15 0.02 Feb16 0.04 May16 0.01 May17 <0.002

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3347
   Posted 10/5/2017 9:34 AM (GMT -6)   
All of the above.

Fear? Or, concern? Fear=bad. Concern=good.

I no longer fear and have less concern, but still healthy concern. My treatment has worked well, thankfully, and if I do have a recurrence, I know there are many effective treatments I can still use, many of which weren't available when I was diagnosed. I am confident that situation will continue to improve.

Looking at your signature, I would put recurrence out of my mind. Still get tested regularly, but don't fear or worry. I'm sure you have bigger fish to fry than a PCa recurrence.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011

George_
Regular Member


Date Joined Apr 2016
Total Posts : 395
   Posted 10/5/2017 10:56 AM (GMT -6)   
You do not have to be afraid. If you get a recurrence now and do nothing about it, e.g. no radiation, the chance to die from prostate cancer is 7.8% within ten years. According to this study. You could probably lower this risk with radiation.

George

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 614
   Posted 10/5/2017 1:10 PM (GMT -6)   
George’s post helps to illustrate—as long as one looks closely—exactly how small your concern should be, "We can do this"…and why “no treatment unless/until needed” is so highly recommended for low risk men. Let's have some fun with numbers in your specific case to understand it more fully...


George’s illustrative post starts out (2nd sentence) with “If you get a recurrence now…” Of course, your years of post-RP PSA tests show absolutely no indication whatsoever that you would have a recurrence (biochemical recurrence, or BCR) now, or in the future…but putting that aside for a second (we will come back to that) one can use the MSKCC nomograms to examine exactly what your statistical likelihood of a BCR, which was George’s opening “If” statement.

I plugged in your case history HERE, and to no surprise your 10-year likelihood of BCR is about 2%. All cases similar to yours, whether they have treatment or not, have the same BCR likelihood. In other words, progression happens in some rare cases of initially low-risk men…and it happens at the same rate whether one has immediate treatment or deferred treatment.

OK, then after determining the 2% likelihood of George’s “If” statement, we can open his link to read and understand the results a little bit more thoroughly…

George’s comment was that if the 2% probability scenario came true and you had BCR now (close to 3.5-years since RP; the study groups men into a 3.1 – 5.9 years category), and you then did nothing to treat it further, your chances of PC-specific mortality in the next 10-years was 7.8%. These probabilities are multiplicative, so the overall probability of someone with your case history having BCR and also dying within 10-years (if you do nothing about it, per George’s paper; more discussion on that in a minute) are:
    2% x 7.8% = 0.15%, or a bit more than 1 in 1,000

But wait. The 7.8% probability (for men who have BCR 3.1 – 5.9 years after RP) includes ALL cases lumped together, from high- to low-risk cases. We know that makes no sense; they are really different diseases. The paper’s abstract points out the obvious by stating: “…increased pathologic Gleason score, advanced tumor stage, and rapid PSA doubling time (DT) predicted systemic progression and death from PCa,” and of course none of these apply to you. So the 7.8% death 10-years after BCR is heavily swayed by those who have completely different (advanced) cases compared to yours. The full-paper probably broke down the results by risk-category, but the abstract only summarized combined results. The 7.8% certainly grossly overstates the situation for low-risk men; for low-risk men a reasonable estimate might be closer to 1%.

But wait, there’s even more. It is absolutely reasonable given your nearly 3.5 years of clinically undetectable PSA scores, and given that your PSA doubling time is, well, zero, it seems more than reasonable to predict that IF you were to have BCR (two consecutive PSA results above 0.2 ng/mL) it wouldn’t happen until at least the paper’s next category grouping of >5.9 years…in which case the 10-year probability of PC-specific death reduces from 7.8% to 4.7%. But, again, this is for all cases. A much more reasonable number for low-risk men (taking a similar % reduction as above) might be closer to 0.5%.

So, now we can use these numbers to calculate a prediction on just how unlucky you’d need to be…and how much you should really worry about BCR and death within 10-years (if you do nothing) in your low-risk case:
    2% x 0.5% = 0.01%, or about 1 in 10,000, if you do nothing post-BCR

Are you that 1 in 10,000? Maybe you should buy a lotto ticket. The risk is not zero, but maybe you should assess your diet, lifestyle & health history and determine your probability of dying of heart attack/disease.



Yes, I thought that while his opening sentence was clear and correct ("You do not have to be afraid."), George’s post, if not more fully explained/understood, had a high likelihood of misleading readers.

As with almost everything having to do with PC, the answer to almost EVERY question is directly dependent upon your specific case characteristics, and it makes NO SENSE to blend responses from polar opposite types of cases. The ONLY thing relevant for you is similar cases. Based on the numbers discussed here, I would think most people with cases similar to "We can do this" have more significant things to worry about than the minuscule risk of PC BCR/death.

Post Edited (NKinney) : 10/6/2017 7:54:46 AM (GMT-6)


FrackMe
Regular Member


Date Joined Jun 2011
Total Posts : 397
   Posted 10/5/2017 1:54 PM (GMT -6)   
My short answer to the original question: Nope.
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