Posted 3/31/2009 10:07 AM (GMT -6)
You can always find exceptions to anything. On the whole more watchful waiting will cut way down on the over treatments and subsequent side effects inherent in such. As I keep predicting these days of over treatment of radical procedures will be looked back on with much regret in future years.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 

Posted 3/31/2009 12:18 PM (GMT -6)

Terry is a success story for Watchful Waiting, not an exception.  He was able to get nearly ten years before intervention, which is great.  It is old news that watchful waitings MTBF is average 6.2 year and declines rapidly soon after.  The following study is from the National Cancer Institute:

http://www.cancer.gov/clinicaltrials/results/surgery-vs-watchful-waiting0902

This is why people should not confuse the recent contraversial screening studies on mortality with actual confirmed cancer cases and life extention treatments...There was a 44% improvement in MTBF in surgery (and other forms of intervention) over watchful waiting at year 8 for distant spread, and over 60% improvement for local spread. 

There was a 40% improvement in mortality in treated cases vs. WW. 

That's pretty significant!

Tony

Posted 3/31/2009 4:10 PM (GMT -6)

Selmer it's who do you believe?  Europe or the US?

Still, here is what Johns Hopkins says about WW and who qualifies:

http://www.johnshopkinshealthalerts.com/alerts/prostate_disorders/JohnsHopkinsHealthalertsProstate_526-1.html

When you read the "When to stop Waiting" part you see it falls into the criteria outlined in the NCI study.  In US studies, WW is not expected to last more the 7 to 10 years.  And when you read the links I provided at YANA, you see why that is.  Again I am not against WW, but I do prefer Active Surveillence as a term because you have to keep watching it and eventually move before it spreads.  That is not an easy thing to predict.  PSA is unreliable and Velocity can happen when it's too late to get a handle on the progression.

In Terry's case, he was a typical case that would qualify today for WW in the JH website.  He was 54, Gleason 6, PSA was 7.2, and only a couple cores positive.  He now has incurable stage IV mets and is only 67 and he has all the ADT SE's.  He is still hopeful for 6 more years.  Many of us won't settle for that.  And at 54 it was possible to be cured.  I don't like using Terry in this example, I love the guy and he is my friend.  But he understands where he sits with this as well.  And there are more stories at YANA and the PPML that show the same results or worse ~ some deaths.

The reason I posted this thread is because there may be a misconception that doing nothing is going to be the norm.  People just need to know the ramifications and that WW is not without possible severe SE's.  This is a very tough decision mentally, and if more information is provided, people may make more informed decisions.  We need WW.  It is needed at various points in fighting this disease.  If one makes it the first choice, they have to know it's likely only for a while not forever.  And then what? 

Tony

Posted 3/31/2009 4:24 PM (GMT -6)

David,

I believe that radiation, not surgery is the most prevelant treatment for prostate cancer in the US. In 2001, 50,000 brachytherapy procedures were done compared to 30,000 radical prostatectomies. This does not include external beam radiation (National Medicare Data) published in Dr Dattoli's book. I think a lot of people believe that surgery is the most prevelent treatment if you olny read this forum.

This forum has a bias towards surgery, but that's OK. Yana has a bias towards WW and other sites have a bias towards radiation. You can learn alot by visiting all of the sites and doing your own research.

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

Posted 3/31/2009 4:40 PM (GMT -6)
Thanks Tony and Selmer for the debate...very interesting the various posts and positions that were taken on both sides. There probably will never be an answer that will satisfy everyone, but just the same if you are just recently diagnosed...it is information that needs to be read before moving forward with treatment or without treatment.
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

Posted 3/31/2009 5:33 PM (GMT -6)

Les you are very welcome...

JohnT,

50% of 218,000 men diagnosed in 2008 were treated with RP making it the most common cancer treatment in the US (save skin cancers).  This accorging to NCI.

Next is radiation, then watchful waiting. 

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!

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