Sloan Kettering rates

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woodstock97
Regular Member


Date Joined Apr 2008
Total Posts : 44
   Posted 8/1/2010 8:07 AM (GMT -6)   
Why is Sloan Kettering percentages so high for "NO" psa recurrence compared to other nomograms and estimates out there. When I plug in my numbers, I get a 98 % rate for "progression free" at 7 and 10 years. They state progression free is psa undetectable. My numbers are

3.0 pre surgery PSA.
55 years old at time of surgery
3 + 3 gleason Before and after
T2c after surgery
2007 year of surgery
23 months no detectable psa since surgery
positive margin

The positive margin thing is what gets me.... Usually the nomograms and charts really lower your chances of no recurrence for this. While Sloan Kettering chances of recurrence are very low??? Your comments are welcome........... Even without positive margin, their rates are so much better than anything else I ever looked at.

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 8/1/2010 10:17 AM (GMT -6)   
I have no idea how to comment on this statement. I do believe there are many things that go into cancer recurrence outside of the medical community. I think taking care of your physical, mental, and spiritual health plays a huge role in your fight against cancer. I feel as though I have e pretty good knowledge of the treatments available for prostate cancer and even though I do believe Sloan Kettering is world class I do not think there percentages would much different than the national statistics. If they are it is because the pool is much smaller.
Not sure my comments are worthy of anything but hey they are comments.
thanks for posting

peace to you
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
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.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
PSA July 22nd of 2010 is .71
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%

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/1/2010 12:46 PM (GMT -6)   
MSK has been compiling data for many years. The numbers that show up on the nomogram are "like" numbers from case history.

Even with a positive margin, your chances are terrific. Surgery is not a failure if there are positive margins and you can do quite well as in your case. It's just information that tells us how the cancer was acting and might act in the future. Also it is very important to note, many mortalities due to prostate cancer are in a period beyond ten years of initial treatment in the PSA era. MSK has committed to keeping data moving forward. So these nomograms can be useful for many years to come.

Enjoy the low numbers. I think you are doing great... LOL, don't look at my numbers in this table. Good thing it's just a probability nomogram. I too can do very well for many years.

Lord willing...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 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

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 8/1/2010 2:48 PM (GMT -6)   
Statistics can be twisted to prove anything the person who paid for the statistical study wants proven..By cherry-picking the cases that are included in the study, results can be greatly enhanced. To be meaningful, the study must include everyone who walks in the front door and is treated for PC over a number of years...By weeding out "high-risk" patients, (one way or another) the survivability charts suddenly show amazing improvements..

By publishing these tables, S-K knows many people will infer that their chances for survival are much better if they go there for treatment. After all, cancer treatment is a highly profitable and competitive business..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/1/2010 8:53 PM (GMT -6)   
With a gleason 6, low psa, reoccurrance probability is extremely low regardless of margins. and reguardless of 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 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


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 8/2/2010 12:59 PM (GMT -6)   
woodstock97,
 
I'll come out of my self-imposed exile this once to make a point about the MSK post-op nomogram.
 
Look at the difference between the inputs for the MSK nomogram and, say, the Han Table (Johns Hopkins).  The latter asks only for your last pre-op PSA reading, your post-op Gleason score, and whether your PCa was organ confined or not.  That's it.  None of those will change over time after your operation.
 
In sharp contrast, the MSK post-op nomogram asks for your PSA reading, your age, your Gleason score, the year of your prostatectomy, whether you had positive surgical margins, whether you had extra capsular extension, whether you had seminal vesicle involvement, whether you had lymph node involvement, whether you had neoadjuvant hormones, whether you had prior radiation therapy - and, critically important for your situation, the number of months post-op free of biochemical recurrence.
 
Thus, the fact that you (like me) have gone 23 months post-op with undetectable readings is good - not a guarantee of anything by any means, but still everything considered a good thing - and the Johns Hopkins Table does not take that into account.   
 
In my opinion, Scardino has an even better predictive diagram, although the latest version of which I am aware stops with surgeries performed in 2004.  His predictions are very similar to those of the MSK Tables, probably not surprisingly.
 
I would be very interested in what Mel (compiler), our resident mathematician, has to say about the various nomograms.
 
Zen9 
No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1
 July 2010 = <0.1

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 8/2/2010 7:00 PM (GMT -6)   
Zen9 ---- good to hear from you! Always helpful to the rest of us. Thank you.

Woodstock97 --- from what little I know, and compared to most of the guys here it is indeed little, a Gleason 6 is about the only stat you need to know to be assured your future, statistically, is bright. At one time it was thought I was "6" and a prostate oncologist said to me, "you could die of this disease --- but, you're really going to have to work at it!" He also said doctors would be eager to get their hands on me: "You'll make their track record look good." I wish you luck, but I don't think you're going to need it. Being a "6" you're a winner already.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  
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