Good news for today's RP patients

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CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/28/2009 1:07 PM (GMT -6)   
Interesting article published by Stephenson et al out of the Cleveland Clinic, U Mich and Sloan-Kettering. Abstract at jco.ascopubs.org/cgi/content/abstract/JCO.2008.18.2501v1 and discussion at prostatecancerinfolink.net/2009/07/28/15-year-outcomes-after-radical-prostatectomy-a-new-predictive-model/#more-6527.

Conclusions: Fifteen-year PCSM (Prostate Cancer Specific Mortality) and all-cause mortality were 12% and 38%, respectively. The estimated PCSM ranged from 5% to 38% for patients in the lowest and highest quartiles of predicted risk of PSA-defined recurrence, based on a popular nomogram (presumably the MSKCC Kattan Nomogram). Biopsy Gleason grade, PSA, and year of surgery were associated with PCSM....Neither preoperative PSA velocity nor body mass index improved the model's accuracy. Only 4% of contemporary patients had a predicted 15-year PCSM of greater than 5%.

For what it's worth. Alas, they want $22 to read the full article, so I'll have to wait until I get back to the States and can have interlibrary loan get me a copy.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 <0.01

Post Edited (CapnLarry) : 7/28/2009 1:34:32 PM (GMT-6)


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 7/28/2009 2:40 PM (GMT -6)   
Captain Larry,
 
One comment that struck me was:
It may not be appropriate to assume that similar 15-year outcomes can be obtained by “average” community-based urologists. We have long pointed out for newly diagnosed patients that, if surgery (in particular) is your treatment of choice, then having the operation carried out by the most skilled specialist you can get to is a key aspect of optimizing the likelihood of a good outcome.
 
Find the BEST Doctor for your treatment don't settle for average.
 
Yep,
The other Larry
Age at diagnosis 54, PSA 6.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/28/2009 3:22 PM (GMT -6)   
This is good news...BUT....two factors need to be considered. One, the typical robotic or open surgical procedures have improved vastly. Second and foremost, a greater number of men have surgery with very low grade maybe even indolent cancer than previously due to PSA testing and patient awareness. That in itself will skew the percentages and statistics. But still it appears that the trend has been moving upward and that is good news.
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/28/2009 3:45 PM (GMT -6)   
I can live (literally) with the 4 % number. Doesn't sound so bad .
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/28/2009 11:20 PM (GMT -6)   
Thanks, Larry.

I'll always take any good news you can give us! tongue

All the best,

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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/29/2009 12:26 AM (GMT -6)   
Les, just a note...
The study was very clear that high risk patients had better results with RP than even those with low risk disease. Patients with low risk disease are more likely to try alternative therapy to surgery these days and less so in the past. The studues in the coming 5 years ought to be very enlightening...

Tony
 Age 47 (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!


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/29/2009 6:58 AM (GMT -6)   
Tony, you make a valid point.

But I still think that more men are being treated earlier today, than just 10 years ago and those that are having surgery as their choice of treatment will have lower grade tumors. I don't have statistics or anything, just seems like the more you read, the more men are diagnosed earlier with lower grade cancer...which is the good news btw. Early detection is the key to any form of cancer, but that can be used to show favor of one treatment method over another. If you detect the cancer early enough, then every type or treatment method used to treat the cancer would show an increase in survival stats. I am just saying...because I am still not convinced one method is better than another and I become a little cynical. I think that early detection will automatically provide better survival numbers...and the method of treatment only being secondary IMHO.
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

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