What is a "cure" rate?

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An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 6/23/2010 2:23 AM (GMT -6)   
Hello all,
 
My husband was recently diagnosed with PC (see signature) and we are now now looking at treatment options. The urologist has asked for CT and bone scans for staging purposes prior to our visit with him on the 1st of July.
 
Assuming all is good with these scans (please, god!) we are leaning towards surgery, purely because without the prostate cancer diagnosis my husband would have expected another 30 years of life at least - his mum is 87 and very active and most of his aunts and uncles are alive and relatively well. Surgery seems to be the "gold standard" for the younger PC patient and I think suits my husbands rather conservative instincts. Active surveillance would not suit his temprament - and I think he would never forgive himself if that cancer had spread anywhere or gone up a grade whilst he was waiting and watching.
 
Anyway, when looking at surgery as an option and comparing surgeons I have no idea of what to make of their statements on "cure" rate, which seems to mean negative margin rate. As I can see from this site, a negative margin does not mean that the psa will stay undetectable. Many peoples signatures show otherwise. Should I ask about the 5 year survival rate? How can we best judge the ability of a surgeon on their ability to get all the cancer out? How do we compare their "cure rate" results on Da Vinci vs open? I have similar problems judging their stats on urinary incontinance and potency. What do these terms actually mean?
 
An
Husband's age: 52
 
In 2007 my husbands PSA levels were 2.5.
In Feb 2008 they were 1.7
In Oct 2009 they were 3.67 with a free PSA ratio of 27
In Feb 2010 they were 4.03 with a free PSA ratio of 31.
 
Referred to urologist. DRE normal.
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion  "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."
 
Review of biopsy by experienced pathologist, results,
1 out of 12 core diagnosed with 10% of Gleason score 3+3 cancer (left transitional) 
1 out of 12 cores with ASAP (left apex), suspicious but not diagnostic of cancer


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 6/23/2010 4:37 AM (GMT -6)   
Cure rate generallly referres to something like a 93% chance that he is now "prostate" cancer free after surgery.
 
Radation treatment has pretty much the same chance.
Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 6/23/2010 6:06 AM (GMT -6)   
Hi An... not sure I can give you the best answer as there are others here more qualified to get into that, and i'm sure they will respond. I did want to share with you my conversation with two seperate urologists, in seperate meetings just yesterday about my situation. I had Davinci on May 17.. pathology showed matters to be worse than suspected.. Gleason 7 - 4+3, and signs that some cancer still present after removal. They BOTH said they felt confident that radiation could "clean up" the remaining cells and I would be fine. Overly optomistic? Maybe... but they said they were being honest. I ask each, "if I simply didn't trat any further, how long would I survive?".. They both answer "My guess is 10 years". So based on your situation, AT A MINIMUM, I wouldn't be worrying about a 5 year window. ALSO, and most interestingly, they told me had they know my prostate was 75% cancer, with a 4+3 Gleason prior to surgery, they wouldn't have advised on surgery, they would have gone right to radiation (telling me they feel it is that effective).. So I left feeling a little better than when I went in, yet I also left feeling "you mean I had my prostate removed when i didn't need to?".... No simple answers, and no easy ones... But I think have have several and perhaps it's not as bad as you think. I hope it's not.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain!


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 6/23/2010 7:40 AM (GMT -6)   
hi An
 
Thanks for the question. There are so many dynamics involved when speaking of cure rate so not sure I can objectively answer that. I will say that given your husbands age and otherwise good health surgery seems to be the best option. I would encourage you both to get as educated as possible as to the side effects after surgery. Some of the activities you guys may be accustom to will have to take a back seat during the healing. If he is active exercises and remains a positive person then I am sure that this will be breeze for you guys. I look forward to reading the post of others.
 
stay with us and keep us up to date on the journey
 
peace and joy
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


larch
Regular Member


Date Joined Apr 2010
Total Posts : 47
   Posted 6/23/2010 8:02 AM (GMT -6)   
While the instinctive reaction is 'get the cancer out of me', I suggest that the best course for your husband, with a Gleason 6 and very small % involvement, is to get a second opinion about the Gleason score and other factors suggesting how aggressive his cancer is, and then very likely doing 'nothing'.
By nothing I mean no surgery and no radiation, but even WW is probably a poor title, he should be doing Active Surveillance.

If your husband's numbers hold on review, then I suggest that you will find the 10 year mortality for AS, surgery and seeds to be about the same.
You will NOT find the 10 year side effects numbers to be similar, with even good case scenarios being 20-30% side effects for seeds and surgery, and the 20% may be overly optimistic.

The reason you need the second opinion is that about 1/3 of the time the second look by dedicated experts upgrades the Gleason score, and also the second look may find an aggressive form of cancer. If that's what happens, then AS is off the table

Not an easy time, good luck.
Diagnosed 3/10 : Gleason 7 (3+4)
HIFU treatment 6/10


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 6/23/2010 8:12 AM (GMT -6)   
An,

Your husband and I had fairly similar stats (my gleason was changed to 3+3 after surgery). It is bad to have prostate cancer, but if you have it, you can thankful you have a Gleason 3+3 (at least that is what I told myself to feel a little better).

Most likely his 5 year survival rate is 100% even if he did nothing (I am not advising you to do this though). My wife and I went through a period immediately after the diagnosis with a lot of uncertainty (and grief and anxiety) about survival rates, cure rates, the best treatment options, etc. This discussion board helped a lot with understanding the appropriate actions with what my diagnosis was

If you decide on surgery, you are on the right track about finding the best surgeon. From my (I admit limited) research, I couldn't find any significant difference in outcome (getting rid of cancer, incontinence rate, erectile dysfunction rate) between robotic or open surgery on a universal level. Far and away the most important factor is finding an experienced surgeon for your husbands operation whether it be open or robotic. With a robotic surgeon aim for one with 1000 procedures, but definitely more than 250-300. open surgeons are easier to find since the open surgery has been around much longer

I think the best way to decide this is to discount your prospective surgeons own hype and get personal recommendations of previous patients and even other doctors such as your primary physician . This can be tough to do though. Is there a local prostate cancer support group that meets regularly? These guys have been through it already and can be an invaluable resource for options on your local choices.

A lot of us have been where you are and it is tough with all the uncertainty (it was tougher on my wife than on me), so the only thing I can say is to arm your self with all the info you can to make the best choices. There is no reason to not believe that your husband will make a full recovery and live another 30 or 40 years.

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean


Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 6/23/2010 9:01 AM (GMT -6)   
An,
 
One thing that you can be thankful for is that your husband's diagnosis indicates a very early stage, low grade cancer.  I was diagnosed in March with very similar pathology and learned through an extensive research process that it was highly unlikely that PCa was going to kill me (at least not anytime soon) and that any of a number of treatments available today offered close to 100% long term cancer free survival rates.
 
I would disagree that in your case that surgery is the "gold standard" given the rate at which follow-on radiation is required and the potential side effects of urinary and bowel incontinence, sexual disfunction, and penile atrophy (the shrinkage of the penis after the prostate is removed and the urethera is reconnected).  While a good surgeon would likely minimize the potential of urinary difficulties, return of sexual function is more of a hit or miss proposition but surgeons with lots of experience post statistics of "the ability to achieve an erection sufficient for penetration at least once a month" at around the 80% level.  If that fits your idea of sexual function at your husband's young age then I would say go for surgery and best of luck to you.
 
While no option is free of side effects and no option guarantees a "cure" there are other treatments that pose less potential side effects for a man with the stage of cancer you describe in your husband.  Among the courses of treatment I researched included proton therapy, XBRT radiation, IMRT radiation, brachytherapy, HDR brachytherapy, cryosurgery, Cyberknife, HIFU, and AS.   While all of these might not be available in the UK (I'm assuming you're from the UK because of your use of the words 'whilst' and 'mum' they are certainly available throughout the EU and in the US and I know of many patients who travel here from the UK to seek treatment.
 
One thing about AS--I almost chose that because it offered the absolute least amount of near term side effects while keeping open the potential for treatment in the future if things progressed.  I learned through consultations with several doctors and my own research that the best chance of "curing" the cancer was treating it at the earliest possible stage. 
 
For early stage cancer patients such as your husband, statistics show virtually no difference in 10-year survival for surgery, radiation, or surveillance.  All of these options show survival rates into the high 90 percent range.  Given that just about any treatment course offers a high liklihood of defeating the cancer, why not investigate those options that pose less risk of side effects.
 
In my own case, I chose to receive radiation through the Cyberknife procedure and am in treatment now.  There is plenty of available information on the internet about this procedure and I understand a CK center was recently installed in the UK and that the Queen cut the ribbon for on opening day. 
 
I'd recommend that besides just investigating surgeons, that you also look at radiologists and others that have excellent survival statistics.
 
Best of luck to you and your husband as you sort this one out.


============================
Age:  59
Dx:  March 2010
PSA @ Dx:  4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason:  3+3=6 (confirmed by second pathologist)
Biopsy:  1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
DRE: Normal
Stage:  T1c
Bone scan and chest x-rays:  Negative
Prostate Volume: 47 cc
PSA Velocity:  0.19 ng/ml/yr
PSA Density:  0.092 ng/ml/ccm
PSA Doubling Time:  > 10 Years
Treatment Decision:  Will have Cyberknife in June 2010
 
 
 

Post Edited (Kongo) : 6/23/2010 12:37:13 PM (GMT-6)


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 6/23/2010 9:32 AM (GMT -6)   
An:
The urologist for your husband should never have sent him for CAT and bone scan. With those numbers the chance of positive scans is so close to zero as to be zero. Completely unnecessary cost and concern and additional radiation.
First, your husband has the luxury of significant time before treatment. Stop, wait, think, explore, and then consider.
The type of treatment is meaningless before the skill and experience and expertise of the practitioner. Technology is nothing in the hands of the inexperienced and unprepared. Find the very best person for the treatment chosen.
He is imminently curable by any properly applied treatment. This would be true in six months as it is today.
Waiting a few months to be absolutely sure of decisions is not AS. It is just good practice. Seeking another opinion is also best practice.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/23/2010 11:01 AM (GMT -6)   
Instead of a costly bone and Ct scan your doctor should have gotten a 2nd opinion from an expert, Epstien, Bostwich, Oppenheimer, on his biopsy slides. This would be much more informative.
In the case of a true G6 the 10 year survival is about 99% with ANY treatment and 97.5% with out any treatment. So it is imperitive to confirm that this is a G6 and this is done with a 2nd opinion on biopsy slides.
Cure rates are expressed as no indication of growing PC. For surgery this defination is a stable psa of <.2 and for radiation a low and stable psa which could be much higher. Cure rates are much less than survival rates and for a G6 are in the mid 90%.
Cure rates are very important in choosing a treatment, but side affects and quality of life issues are also important. Since all treatments have similar results for low grade cancer you should be concentrating on the side affects and quality of life issues you will be facing.
You have pleanty of time (years) to make a decision, so don't hurry and evaluate all options.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 6/23/2010 3:07 PM (GMT -6)   

I agree with everyone here.  You don't need a bone scan.  There has been study after study about bone scan seeing nothing on people with a PSA below 10 and Gleason 6 cancer.  It is just radiation you shouldn't have unless absolutely necessary.  Even my surgeon at Johns Hopkins said it was not necessary for me.  I was Gleason 6 PSA 2.76

If your husband has surgery and stays Gleason 6 organ confined no tertiary score his chance of cure is 99.6%.  According to Johns Hopkins he has a 0% chance of death or metastatic cancer even up to 20 years after surgery.  I would go to Johns Hopkins for surgery if you can.  These are their stats for patients they treat.

I waited 6 months to have surgery...

Read these...

http://www.medicalnewstoday.com/articles/106167.php

http://prostatecancerinfolink.net/2009/09/22/surgical-outcomes-for-patients-with-organ-confined-gleason-6-prostate-cancer/

 

 



Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Post Edited (ChrisR) : 6/23/2010 2:24:00 PM (GMT-6)


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 6/23/2010 3:30 PM (GMT -6)   
An. I cant say I disagree with anyone here who advises you to take your time, gather information, get other opinions, consider all the options and the ramifications of those options such as potential side effects, etc. It sounds like you may have caught this when it's early, and it does not appear to be overly agressive.. So You Do have time.

That said, I wouldn't classify that available timeframe in "years". My March biopsy showed 3 0f the 12 cores tested proved positive.. 25%. Gleason 7 3+4, all concerned told me they felt it was contained, found early, and removal of the prostate would likely take care of my problem. I had the prostate removed May 17, pathology showed a much more aggressive disease Gleason 4+3 with tituary 5.. and it was in 75% of my prostate, and was found in my bladder neck... ALL to the surprise of my urologist (and me). Ironically, they tell me yesterday that had they know my cancer was as and where it is, they would have advised against surgey, and gone direct to radiation. (I may look back, having paid that price, and look at that as simply a sad irony).

My point is, DONT wait years. Face it, identify what you've dealing with and confront it as you see best. ONE MONTH LOOKING THINGS UP, ASKING QUESTIONS TO YOUR DOCTORS AND ON BOARDS LIKE THESE... YOU WILL HAVE KNOWLEDGE, POWER. 1 MONTH AND YOU'LL HAVE A MUCH BETTER UNDERSTANDING. TRUST ME.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/23/2010 4:25 PM (GMT -6)   
You have been given a plethora of gread advice already. I agree too: research, get a second and even third opinion if possible, don't feel pushed or intimidated by anyone pushing for a particular treatment at this point.

Good luck to you and your husband.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 6/23/2010 4:36 PM (GMT -6)   
I really, really doubt that surgeons know their rates of cancer control in the long run. Aside from surgeons at places like Johns Hopkins who run single institution studies.

For example, I haven't been back to see my surgeon since I was referred for salvage radiation. Is he tracking me statistically, years later? I doubt it. He probably only glances at the reports the radiation oncology sends to him and my primary care doc.

What surgeons are more likely to know is their rate of positive margins. Not a fantastic tool for the patient, since it isn't all that great as a prognosticator all by itself.

I think it's very hard to compare surgeons objectively, because do the surgeons really know their own progression-free survival rates for 5, 10, 15, and 20 years? I would assume not. I'm not singling out urologists here--I bet the same holds true for cardiologists, pulmonologists, etc.

The literature does not usually refer to "cure rates" and for good reason. It's not easily quantifiable. What can be measured are things like progression-free survival, cause-specific survival, overall mortality, etc at specified time periods.

I am very interested in the potential cure offered by salvage radiation. What I study is not a cure rate, but the percentage free of PSA progression as time progresses from the end of radiation. Even if I read that 25% are progression-free at 10 years, I would not assume that those 25% are "cured" the way I define it, because if the percentage is still dropping from 8 to 10 years, why should it stop falling there?

The others who have written about 5 year survival rates not being that useful are right. The vast majority of men diagnosed today would not die from cancer within 5 years no matter what they chose, even nothing at all. With Gleason 6 (assuming it is--the risk is that biopsy path results often differ from surgical path results and perhaps he has another "real" Gleason) he can choose just about anything and should still not be bothered by prostate cancer a decade from now.

I suggest getting the book "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" (2007 ed.), and not rushing into any particular treatment.

Best wishes.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
pcabefore50.blogspot.com


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 6/23/2010 5:48 PM (GMT -6)   

Galileo,

I agree with you about the tracking part.  I bet hardly anyone does a detailed job of it.  That is why I went to Johns Hopkins.  They were the only people that seemed to have such data.  If I stayed G6 organ confined I had a good feeling about what my future holds based on their studies.  Nobody else could tell me anything abouth their personal records of treament.  You can't tell by interviewing a surgeon if he is better then another. So when I went to J.H. I made sure I got a surgeon who had patients in the long term study.  One that has been performing surgery at J.H. for over 25 years.  In fact I choose Dr. Partin of the Partin Tables.  My surgery was over in 58 minutes.  My wife thought he was coming out to give her an update and he was actually telling her it was over.  I had open surgery and did not even have to give blood.  The guy in the bed next to me at J.H. had a different surgeon and had to give blood.  Evidently Partin is very confident he can control bleeding during surgery.  I chalk it up to experience.  The guy trained under Walsh, who is probably the top surgeon in the world for prostate cancer.

Like I said if I stayed G6 then at least from J.H. I know how their patients fair after treatment up to 22 years out.  Nobody died of PCa.  Not one out of 2500 patients.  It is more then any other surgeon could tell me.  In fact the Dr. I saw at Ohio State told me they don't keep statistics like that.  I ran out the door from him.

Watch I'll have reccurence this fall for talking all confident here.....

Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Post Edited (ChrisR) : 6/23/2010 4:53:01 PM (GMT-6)


An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 6/24/2010 12:41 AM (GMT -6)   
Chris R, Galileo, yes, this is exactly what I want from my doctors, stats on their long term survival rates. 5 years doesn't tell me much because as I said earlier my husband is in his early 50s and really what he wants to know is the 20 year survival rate of a particular doctor. If we were in the US we would go and see Dr Partin I think because he does do this (assuming he also has a good rate of success on urinary incontinance and ED). We are in Australia though and our preference is for a surgeon here.

John T, we have had a second opinion with the most experienced pathologist we could find in Australia and the cancer diagnosis was from this experienced pathologist. The hospital pathologist diagnosed my husband with ASAP.

Although we are fully covered for the CT and bone scans from an expense point of view I agree with your opinions on bone scans - on reading since yesterday it seems that they are not necessary and could be dangerous. But we are seeing one of the most experienced surgeons in Australia and he wants us to have them prior to our visit with him. The bone scan is scheduled for Monday and I think I might call up the doctor today to ask him whether it is necessary given the circumstances.

I think we are starting to get more comfortable with the idea of surgery - although our primary focus is on the long term "cure" rate, urinary continance is the other key thing. The ED issue secondary for us and if it takes injections, viagra etc to happen then this is a good outcome. But for now we are trying to find the best possible surgeon. I will encourage my husband to wait on making a decision till he is as comfortable and knowledgeable about options and side effects as he can be.

The surgeon we are looking at now comes recommended and has done over 1500 open surguries and 400 robotic ones. These are his stats (from his website) for the robotic surgery how does this look like to you? His open surgery stats are worse but then I suspect that those are his more complex cases with higher Gleeson scores. I don't think he keeps any long term stats on long term survival rates.

PT2 positive margin rate: 3.5% (all focal).
Operating time: 1.5 - 2.5 hours.
Blood loss: Average 150mls. (no transfusions to date).
Conversion to open operation: Nil.
Hospital stay: 94% of patients leave by day 3 (most on day 2).
Removal of catheter: 95% of patients have catheter removed on day 6 or 7.
Major complications: <1%.
Re-admission rate: 1%.
Urinary stricture rate: Nil.
Urinary continence rate (no requirement for a pad): 75% by 3 months and 90% by six months and 98% by twelve months.
Sexual function rate: With nerve sparing techniques over 85% of patients have achieved sexual recovery within 12 months. Over 90% regain sexual function if under 55 years of age.
 
An


Husband's age: 52
 
In 2007 my husbands PSA levels were 2.5.
In Feb 2008 they were 1.7
In Oct 2009 they were 3.67 with a free PSA ratio of 27
In Feb 2010 they were 4.03 with a free PSA ratio of 31.
 
Referred to urologist. DRE normal.
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion  "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."
 
Review of biopsy by experienced pathologist, results,
1 out of 12 core diagnosed with 10% of Gleason score 3+3 cancer (left transitional) 
1 out of 12 cores with ASAP (left apex), suspicious but not diagnostic of cancer

Post Edited (An38) : 6/24/2010 12:01:52 AM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/24/2010 2:54 AM (GMT -6)   
An,
Stats appear to be too good to be true. Leak free, pad free in 2 years occurs in just 28% of patients, his is 98%. Ed is about 30%, his is 10-15%. The 3.5% positive margin is also way low or he is only choosing low risk patients. I would have a hard time believing these as they are way to optomistic to any stats that I have seen.

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 DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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