New Study on Surgery for Prostate Cancer

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IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/10/2009 11:05 PM (GMT -6)   
Below is a link to a recently completed CaPSURE study with some interesting results for those who have chosen radical prostatectomy for the treatment of localized prostate cancer.
 
 
The study suggests that, in specific situations, surgery may be a very good treatment choice for men seeking only one mode of treatment. 
 
Of course, I am not promoting surgery at all.  I have friends that are doing very well who have chosen a different course of treatment.  There is no single treatment that is best for every situation.
 
I hope this is valuable.
 
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

Post Edited (IdahoSurvivor) : 7/10/2009 11:08:45 PM (GMT-6)


oldflyingfarmer
Regular Member


Date Joined Jun 2009
Total Posts : 32
   Posted 7/11/2009 4:23 AM (GMT -6)   
Thanks for the article Barry. I chose surgery and it was done May 27th. In my case, I felt it was the right thing. It is encouraging to see data that supports this. I realize that it depends on so many factors which option is best. Everyone is different and must be at peace with what treatment they decide to have.
Age 55
Diabetic on insulin pump
PSA started rising in 2007
2 negative biopsiesthru 2008
2009 PSA 31, TURP found Gleason 9 cancer
Started holistic approach while waiting for surgery
RRP on May 27, 2009
Cath out 2 weeks after surgery
Very little drip, some pain
Waiting for post-op doc visit July 16, 09 with fingers crossed


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25371
   Posted 7/11/2009 7:36 AM (GMT -6)   
Good article, thanks, I tend to believe along those lines as a general rule, but again, with PC, too many exceptions and variables to be dogmatic about it
Age 56, 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
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


IdahoSurvivor
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Date Joined Aug 2007
Total Posts : 1015
   Posted 7/11/2009 9:13 AM (GMT -6)   
Another finding of this study, consistent with other studies I've read, is that morbidity directly related to prostate cancer is very low regardless of the method of treatment chosen.
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


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 672
   Posted 7/11/2009 9:54 AM (GMT -6)   
IdahoSurvivor said...
Another finding of this study, consistent with other studies I've read, is that morbidity directly related to prostate cancer is very low regardless of the method of treatment chosen.

We should keep in mind that the morbidity rates are low because so many men are affected.  It is a percentage of the diagnosed PCa cases.  Let's not forget that over 27000 men die each year from prostate cancer in America.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/11/2009 10:19 AM (GMT -6)   
The reminder of those who die each year from this disease is one aspect that motivates this forum and makes others like it very important. Outside of the valued support offered here, we become a voice in our local communities for the need for regular medical exams to continue to reduce that morbidity rate, as has been occurring in the U.S. Every individual lost to any disease is tragic.
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


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 7/11/2009 12:05 PM (GMT -6)   
Good to see a study that is over 7 years old, it will take time but we really need more like 20-25 year studies to figure this thing out. When 270 out of 8000 die with a 7 year avg I would not call the results insignificant.
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.


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 7/11/2009 5:46 PM (GMT -6)   
My surgery was 18 months ago and I must say with all these new studies being released has me second guessing.

Watchful waiting with annual biopsies doesn't sound too good either.
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25371
   Posted 7/11/2009 5:57 PM (GMT -6)   
i agree with you engineer and wd40 both
Age 56, 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
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 7/12/2009 4:54 AM (GMT -6)   
Greetings, Barry.  We all make the choice that we believe is right for us.  I chose surgery and believe that was right for me and am always glad to see a little validation.  Doesn't mean that other choices aren't appropriate for guys in other situations.  Thanks for sharing. David
Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/12/2009 5:27 PM (GMT -6)   
Your welcome, David.

Good "seeing" you again! I'm grateful we have those choices and options that put us in the "driver seat."

Kind regards,

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

Post Edited (IdahoSurvivor) : 7/12/2009 9:00:16 PM (GMT-6)


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 7/12/2009 6:39 PM (GMT -6)   
The choice of treatments is personal for all of us based on all the research you should do to make this decision. I knew at the outset that I wanted the cancer out of by body but I was receptive to other treatments and I investigated the major ones. I chose open surgery with an experienced surgeon and a respected hospital a little over two years ago and I haven't looked back.

Take care all you guys!!!

Mika
age at dx 54 now 56
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
Tossed the pads this spring
ED still a problem
Got a shot last week and it was great
A year an a half of zero's
 


Squirm
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Date Joined Sep 2008
Total Posts : 744
   Posted 7/12/2009 6:50 PM (GMT -6)   
But hasn't radiation treatment advanced more than surgical procedures? Going from 3D external beam (wasn't that the standard back in the 90's?) to IMRT with IGRT seems like a pretty big step. Again, no analysis with proton beam.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4203
   Posted 7/13/2009 3:13 PM (GMT -6)   
Squirm,
Radiation has come a long way, but the major change is in the side affects as the newer IMRT is more precise in not radiating the surrounding tissues. The cure rates are about the same and equivilant to surgery and other local treatments.

75% to 80% of all PC diagnosed is non agressive and can be readily cured by any of the local treatments. The agressive PC is difficult to cure, and all local treatments have a high reoccurrance rate.

It is very important to have your cancer properly staged, preferrably by a noted prostate oncologist, before deciding on any treatment.
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


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 7/13/2009 10:55 PM (GMT -6)   
John, thanks for the reply, have a couple questions.

What is defined as a aggressive prostate cancer? Perhaps a Gleason score of 4+3 and over? In addition, doesn't PSA #'s play a vital role in it? If a PCa can be caught in the early stages, say when PSA is 2.0 or below, should that play a role in the treatment decision? Doesn't PCa start out as non-aggressive and then in time, can turn aggressive?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4203
   Posted 7/13/2009 11:44 PM (GMT -6)   
Squirm,

Some low gleason PCs turn agressive, many do not, you just can't tell. What we do know is that about 75% never progress to the agressive stage in 7 years. I haven't seen any studies of longer duration so we really don't know yet what they will do in 20 years, but we know most men will die with PC than from it.
An agressive PC is anything with a gleason 8 or higher. A Gleason 7 is intermediate with a high probability of gettting aggressive in the future. Anything higher than a G6 needs to be treated. A G7, 4+3 is more agressive than a G7 3+4.
PSA doubling time is a good indicator of agressiveness, anything over 3 years doubling time is probably agressive or will turn agressive.
Total PSA is trickier; High grade Gleasons don't throw off a lot of psa. There are formulas that oncologists use to predict tumor volume using the prostate size, psa and Gleason score. A PSA over 10 with any gleason is a concern because once PC spreads beyond the prostate it starts to generate a lot of PSA.
Hope this answers your questions.
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


Gmike
Regular Member


Date Joined Jan 2009
Total Posts : 48
   Posted 7/14/2009 11:24 AM (GMT -6)   
My urologist told me that over the last 5 years he has seen only minor side effects from radiation patients. The surgery patients he sees have more serious problems. Of course the first priority to cure the cancer.
PSA 2009: 5.2 (21% Free)
Biopsy(s)
August 2008(age 58): 1 core of 12 was "atypical"
May 21, 2009(age 59): 1 core of 12 positive (10%), Gleason 6, Stage T1c, 1 core atypical, prostate 45 grams
Family history: Grandfather had PCa, died at 79 of other causes, Father had PCa still living at 80 cancer free (10 years)

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