Stats on treatment options

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4250
   Posted 3/10/2009 2:10 PM (GMT -6)   
I found the following stats on BRFS (Bioehemical Relapse Free Survival) in "The Prostate Treatment Book" published by Seattle Prostate Institute/Swedish Cancer institute.
As in all studies the data may not be perfect, and combines data from various studies and hospitals. but it's the 1st head to head comparison that I have run across.
 
Risk Group      5 year BRFS                                 10 year BRSF
                  Surgery       3D CRT    Seeds    Seeds     Seeds/ERBT
 
Low              83-85%       90%         87-94%   87%          84-85%
 
Intermediate  50-65%        70%        82%         76%         77-90%
 
High              28-32%       47%         65%        --            46-57%
 
The low risk group survival rate is pretty much equal for all treatment options and matches everything else I have read. So in treating low risk PC, the side affects are more important than the treatment option when it comes to making a decision.
 
In the high and intermediate risk groups there is a difference in the BRFS. This makes sense to me as these groups are at higher risk for extra capsular extension, seminal vessel invasion and tumors close to the urethea which are all more difficult to get a clear surgical margin.
 
If your surgeon or radiologist is quoting higher cure rates than these then he should be able to clearly explain why.
 
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

JohnT


Smokie
Regular Member


Date Joined Oct 2008
Total Posts : 46
   Posted 3/10/2009 2:27 PM (GMT -6)   

JohnT,

Thank you for posting this info. I have a couple of questions.

1. What criteria establishes risk category?  2. Are percentages shown survival rates, or cancer-free rates?

Thanks,

Smokie


Age: 43
Diagnosed at 41 by routine blood test
PSA at diagnosis: 5.1
Pre-op Gleason: 3+4=7
Post-op Gleason: 6 (different labs?)
No luck finding local experience with DaVinci
Scheduled RP at Vanderbilt: 8/06
Insurance trouble, rescheduled at Centennial Hospital, Nashville
Prostate removed 9/06
Robotic, nerves spared, no positive margins
PSA since RP: good (less than .05)
Currently suffer ED
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 3/10/2009 2:50 PM (GMT -6)   
John...the numbers are a little lower than the Partin tables...do you have the publication date on your source? What about surgery at the 10 year BRFS...the columns didn't show that one or I am misreading the table. And I would also be interested in how they classified the risk category as well...i.e. Gleason Scores, PSA, staging etc.

Smokie.. I believe the percentage is the amount of people that do not have a recurrence of cancer as measured by the rise in PSA over a specific time, I think around three consecutive increases at three months apart...although John can correct me if I am wrong.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/10/2009 5:00 PM (GMT -6)   
If anyone is claiming better mortality rates they are not dealing with anything more than bias. Still today many top hematologists feel that surgery is the best starting point for stage II, III and even some IV. Not because they feel it is better but because there is real data over longer periods of time. Over longer periods radiation therapy have bigger risks time includind collateral cancers like bladder and rectal to name a couple.

Unfortunately, these numbers appear good for conformal radiation for localized cancer at the ten year mark, but they do not have any reinforcement concerning mortality. When I went into this game I still had 39 years of life expectancy left. Surgery was an obvious call. Men enduring xRT and holding up for 39 years is a quite a different story. I do understand that real data for 25+ years survivals are for those who has EBRT and burned everything in the area, but you get the point. Newer technologies like 3D conformal, IMRT, IGRT, PBT, and brachytherapy and helped deliver radiation with less SE's but still the mortality rates in the end are unmoved. Systemic treatments are, in the long term, appearing like they are going to have the solution.

The news on Finasteride as a preventive drug isn't great but promising for many. But we still need that knock out punch...and for me it was not local therapy.

I know I would feel better with it.

Tony


Age 46 (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 (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 3/10/2009 4:36:28 PM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4250
   Posted 3/10/2009 5:30 PM (GMT -6)   
Smokie and Les,
The book was published in 2003 and may be a little behind. The number reflect PSA low and stable, survival rates are much higher. As in any study there ae always diffferences in staging that's why they are hard to compare apples to apples because different institutions have their own criteria in staging, but in general low risk is Gleason 6 or less and PSA under 10. High Risk is Gleason 9 and 10 with PSA over 20. There are a lot of disagreements on intermediate risks. There was no data on surgery at the 10 year period, I don't know why.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

JohnT


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 3/12/2009 4:26 PM (GMT -6)   
Thanks John
The information maybe dated a little, but still very relevent. I think most of these studies show the mean age above sixty and with more and more younger men being diagnosed the stats will change. I often wonder if the bodies immune system plays a big factor in the recurrence issue than is mentioned. Meaning that the older we get our immune system isn't as healthy and therefore cannot fight off the residual cancer cells as effectively. This would mean that a young man with residual disease would have a better chance of not incurring a chemical failure and would skew the stats upward, while the older men with less immune resistance would more likely to see a chemical failure and skew the stats downward. So you are correct in that it is nearly impossible to compare apples to apples between any two studies, but still very important for the decision factors one must make regarding initial treatment.

Thanks for the info...very informative
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06

New Topic Post Reply Printable Version
Forum Information
Currently it is Sunday, August 19, 2018 4:18 AM (GMT -6)
There are a total of 2,994,288 posts in 328,118 threads.
View Active Threads


Who's Online
This forum has 161267 registered members. Please welcome our newest member, Kweenkie.
101 Guest(s), 2 Registered Member(s) are currently online.  Details
Zimica, F8