14 year prostate cancer screening study ~ 50% improvement in mortality

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/1/2010 5:18 PM (GMT -6)   
First my apology to Tatt2man. He posted this study before me, but I am posting it again because of its significance and to add my commentary.

A Swedish study of 20,000 men over a 14 year period found that screening dropped prostate cancer specific mortality by 50% at year 14. So much for that silly 1 in 48 number at year nine posted in the New England Journal of Medicine last year.

Missed the mark by a mile as I like to say...

Being a person who was diagnosed with advanced disease at age 44, I found it amazing that no long term studies were available for prostate cancer. The typical study is considered "mature" at ten years and you'll see lot's of studies showing results at even less intervals. My suggestion ~ throw them out. Prostate cancer is a 20 year or longer disease. When you start extending study terms as this one does, you get totally different results.

Here is the Infolink article:
prostatecancerinfolink.net/2010/07/01/new-swedish-data-suggest-that-screening-does-lower-mortality/

Screening saves lives!

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 7/1/2010 4:42:43 PM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 7/1/2010 6:41 PM (GMT -6)   
Tony,
I'm confused. An article posted a few days ago on the NEw Prostate Cancer InfoLink shows the opposite.
new epidemiological analysis of data from Denmark, Finland, Norway, and Sweden suggests that despite a significant increase in the incidence of prostate cancer (the number of men diagnosed each year), prostate cancer-specific mortality rates have been minimally affected over the past 40 years in these four countries.
Maybe I'm missing something.
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


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 7/1/2010 7:10 PM (GMT -6)   
Tony - no worries - there are more fluent that me in the various studies and such - just wanted to post the link as described - it appears to be the same link john t is talking about - but he has reversed what I read as "decrease in mortality" - to increase... here is a copy of the email sent...
............
The "New" Prostate Cancer InfoLink Social Network
A Service of Prostate Cancer International
A message to all members of The "New" Prostate Cancer InfoLink Social Network

There's a new report from a Swedish study involving 20,000 men followed for 14 years suggesting that biannual PSA testing can lead to a 50% reduction in prostate cancer-specific mortality.
................................
BRONSON
.................
Age: 54 - gay - with common-law spouse of 13 years, Steve - 60
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: Feb 2010- 3-5 pads/1-2 clothes changes/day- March 3, 2010 - week 14 after surgery -finally seeing improvement - March 29- incontinence better - 1-2 pads a day - one pad at night - May 25 - 1 pad during day - 1 pad at night for security (barely needed at all) - stress incontinence at work - lifting trees and shrubs...
location: Peteborough, Ontario, Canada
Post Surgery-PSA: - April 8, 2010 - 0.05 - I am in the ZERO CLUB - hooorah!
Next PSA - October 8, 2010 - TBA -
............

Post Edited (tatt2man) : 7/1/2010 6:18:36 PM (GMT-6)


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 7/1/2010 7:17 PM (GMT -6)   
here is the link from lancet - this should clear up any confusion

www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2810%2970146-7/fulltext
.................
Age: 54 - gay - with common-law spouse of 13 years, Steve - 60
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: Feb 2010- 3-5 pads/1-2 clothes changes/day- March 3, 2010 - week 14 after surgery -finally seeing improvement - March 29- incontinence better - 1-2 pads a day - one pad at night - May 25 - 1 pad during day - 1 pad at night for security (barely needed at all) - stress incontinence at work - lifting trees and shrubs...
location: Peteborough, Ontario, Canada
Post Surgery-PSA: - April 8, 2010 - 0.05 - I am in the ZERO CLUB - hooorah!
Next PSA - October 8, 2010 - TBA -
............


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/1/2010 8:18 PM (GMT -6)   
Well, I don't know a lot about this stuff, but it just stands to reason, or logic, that regular screenings have to have some statistical improvement. It just makes no sense that the men on this site who have had treatment for their PC, are no better off than if they had not been treated at all.

It is kind of hard also to compare men who had screenings with men who could have been diagnosed and treated who didin't get screened and died. Once they are dead, kind of hard to follow up on them.

Maybe I'm just thinking too much about this stuff !
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/1/2010 9:14 PM (GMT -6)   
No good life, I think the simplicity of your logic is much more sensible then all the academia with some of these studies. If you get tested, you get dx, you get treated, you have a better chance of survival from PC. Doesn't need to be any harder than that.

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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 7/1/2010 9:25 PM (GMT -6)   
Bronson,
I'm referring to a study posted 4 days ago.
http://prostatecancerinfolink.net/2010/06/28/prostate-cancer-mortality-in-scandinavia-1965-to-2006/

This study shows no difference in mortatlity over the last 40 years.
So which study are we to believe?
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


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 7/2/2010 3:54 AM (GMT -6)   
Seems like these two studies are looking at different things. The study JohnT mentions says that the death rate from prostate cancer hasn't gone down in those countries. It has gone down in the US over the last 20 years. Maybe there is a difference in how often men get treated in these different countries.

The study that this thread is about put a group of men in two different groups. One group got a PSA every two years, the other group wasn't offered screening. The group that got screen had about 1/2 the death rate from prostate cancer as the nonscreen group after 14 years. 12 men had to have prostate cancer detected by screen to save 1 life (at 14 years of followup). So, the other 11 would still be alive at 14 years. Some of them might have advanced disease, who knows. If you go out for 20 years (the study hasn't been going that long yet, more lives would be saved. Seems like if you only expect to live for 10 years (a reasonable guess if you're in your 70's), getting screened for prostate cancer is unlikely to save your life. If you are expecting to live 20 or 25 years, there must be a much higher chance of saving your life, but no one has done one of these randomized studies long enough to measure by how much. Maybe in 6 years they will publish their 20 year results. At 14 years, the life saving by screening is sort of borderline.

The conclusion I'd draw from this, if you are over 70, don't get screened. Younger than that, the studies don't really prove that much benefit, but it seems reasonable if you're in your 50s in good health, there is likely a significant benefit. But early prostate cancer is slow growing, so, if you've got it, you may well not die from it, and if you radiate it or have surgery, there is some possibility that you may not be saving your life.

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 7/2/2010 8:32 AM (GMT -6)   
Everytime I wrap my mind around a conclusion it seems that the target has been moved. I'm 51, had my RP 6 weeks ago. My 3+4 went to 4+5 with titiary 5, pos margins. Seems logical to have RT.. and will be talking with Rad Onc in a week+-. I REALLY am concerned about the effects of that radiation on my quality of life - the 3-5 years down the road when the damage from that radiation starts taking effect. I've spoken to doctors/oncologists who have no personal interest in my specific case, and they speak of it as "they got your cancer, now radiation is just going in and cleaning up the leftover cells... we find radiation VERY effective at doing this, and you should be fine". One said in retrospect (pathology), they wouldn't have removed the prostate, they would have gone radiation???? But then I hear how there is really no conclusive evidence that X works better than Y.... NOW better than LATER... I also got the same "Ballpark" answer when I asked 2 different urologist "what if I dont treat at all, how long would I survive from the disease?"... Both said "Probably 10 years". And I say to myself (and my wife) HECK, if I can hope for 10 years, and nobody can show me that the radiation can extend that window, why the help put myself through that radiation, further diminishing my quality of life?

And thoughts? I Dont mean to steal this thread if thst's where this ended up, but I am concerned and have to make some decisions.. and it DOES ultimately lead back to the screening issue - AS IN Did it / Does it - really matter if you knew you had Prostate cancer if the only thing proven about the treatments is they complicate the quality of your life?
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!


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 7/2/2010 8:33 AM (GMT -6)   
Correction - My 3-4 went to 4+3... went from 3 of 12 in biopsy in March to 75% upon post RP pathology.
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 : 25380
   Posted 7/2/2010 8:37 AM (GMT -6)   
postop ended his post with these words:

"The conclusion I'd draw from this, if you are over 70, don't get screened. Younger than that, the studies don't really prove that much benefit, but it seems reasonable if you're in your 50s in good health, there is likely a significant benefit. But early prostate cancer is slow growing, so, if you've got it, you may well not die from it, and if you radiate it or have surgery, there is some possibility that you may not be saving your life".

I don't think I could disagree with your conclusion any more than I do. If a man is 70, comes from a non-PC family, and has/had family members living into their upper 80s or even 90s, then if they were dx with PC, there are still treatments for dealing with it appropriate for their age, and might assure them they could live out their normal life time.

"Younger than that, the studies don't really prove that much benefit" - how could you draw that conclusion. For most men, detection is what leads to treatment which leads to saving their lives. If they weren't screened, they wouldn't know and wouldn't be treated, and pc cases would advance, and men would die.

Then other myth is that PC is slow-growing. That is not always true. We have a large segment here just in our small world at HW that are Gleason 7 and above, including a fair number of Gleason 8 higher cases. Left untreated, these men would very well die of PC.

Then you end by saying, paraphrase, that even if you have surgery or radiation, you may still die. So which way is it?

You didnt post your stats this time, so I can't remember your particulars, to see if screening, dx, and treatments have helped you with ayour PC journey and what your own prognosis is like.

This is why I don't like all the analysis of well meaning studies, that the average person can't prove or dis-prove the numbers. Its easy to talk about the meaning and value when its just numbers on a piece of paper. I put PC not at the report level, or nanograms, but at the person level, the human level, one patient at the time, and the value of his life as an individual trying to survive this thing called PC.

No disrepect to your post in any personal way.

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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17

Post Edited (Purgatory) : 7/2/2010 7:41:59 AM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/6/2010 11:57 AM (GMT -6)   
Hi guys,
I have been out of town since posting this and I had a terrible time reading the responses.

First, screening saves lives. This is an indisputable fact. This is the reason I advocate screening and better education for men who may have discovered their cancers. The study that John T mentions is not an apples to apples comparison establishing anything about screening. The fact is that the death rate in the US has declined, the total number of deaths attributed to prostate cancer has declined, and people are living longer with prostate cancer because of early detection.

If you don't like screening then so be it. I find it hard to believe that those who are at this website would agree with that position. Just be happy you were screened.

David, I agree with that sentence by postop. But back to what I just said. You might not be "saved" by treating your prostate cancer. But you might be killed sooner by not treating it.

I applaud the Swedes in this study, and you will see more data to suggest this is accurate information. And in my opinion, it is an ignorant position to suggest that screening does not impact the number of deaths attributed to prostate cancer. And it is also an ignorant position to suggest that treatment for prostate cancer isn't absolute necessary to most men diagnosed with the disease...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

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