Science Daily article touting new results for surgery as the best approach for long time survival

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Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 5/18/2009 10:05 AM (GMT -6)   
 
Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03
 
PSA August 18th 2008 = .01 or less, test only goes down to .01


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/18/2009 11:53 AM (GMT -6)   
Interesting. I guess this says that surgery increases your chances of survival by 16% points over doing nothing and radiation decreases your chances by 12% points over doing nothing. This makes a good case for doing nothing given the 100% side affects and quality of life issues of all local treatments. If I were the researchers I would definately want to know why.
I've seen a lot of studies that show little difference in survival rates between doing nothing and all local treatments, but have never seen one that says any local treatment decreases survival.
I'm highly suspect of studies that are done by one organization, either Urology, Radiation, or Hormone Therapy as statistics can be manipulated, especially by selection criteria. A controlled study by an independent group not associated with any field of practice would be much better.
JT

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.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/18/2009 1:19 PM (GMT -6)   
John,
Remember this data is based on treatment 16 to twenty years ago. 17 years ago, radiation therapy was not what it is today, and niether were techniques such as WPRT used. Even just recently we discovered that treating the lymph system improved MTBF in certain cases. I believe these numbers are true, but that we need more data on current modalities. Many radiation cases 17 years ago were performed when the cancer was aggressive and determine to be inoperable. Which means very advanced, thus the lower numbers sound like it was less efficient. The facts stating that surgery is the best treatment statistically is in part due to it's long term existance being well charted.

My biggest gripe with studies being touted today about treatments is that PCa is not a ten year disease. My oncologist calls it a 20 year disease, and I have read about cases recurrent at year 25. This is why I remain skeptical of therapies vowing to replace surgery while still their infancy. If in twenty years current methods of radiation delivery, HIFU and TFT still show effectiveness then, and only then, would we have sound historical data. This is one of the worse diseases when it comes to developing treatment protocol simply because of the length of time it takes to get effective results. And by that time there are ten new treatment options being touted.

Also, the no treatment group had a 78% survival rate. The surgery group 94%. Reverse those numbers and 22% died in the NDT group and only 6% in the surgery group. That is almost a 400% statistical improvement. Over 16 years, that is not a good statistic for watchful waiting but even with WW there is a new protocol in place that says WW for a while is ok in well differentiated cases only.

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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

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