Even when prostate cancer returns, most survive

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BillSD
Regular Member


Date Joined Sep 2008
Total Posts : 143
   Posted 8/25/2010 5:33 PM (GMT -6)   
Interesting article from Reuters Health:
 
 
Bill in San Diego

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 8/25/2010 5:54 PM (GMT -6)   
Interesting, but not a surprse. Most men are diagonosed with a Gleason 6 and those rarely die whether treated or not. We need to know the risk factors of those who did die. I would assume that they were all G8 or above.
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


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 8/25/2010 5:56 PM (GMT -6)   
that is an interesting article. I do agree that just because PSA is rising that most men should not jump into treatment. I, for one have a rising PSA that has doubled quick however I have opted to wait for another test to see the pattern before considering what to do. I also agree with the report that the persons overall health should be considered too. I run, swim, bike, and work out five days per week and feel better than ever so for me I am in no hurry to go back to ADT3.
Thanks for sharing the article

peace to you
Dale

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/25/2010 6:38 PM (GMT -6)   
Unless I misread, it doesn't make the case that radiation as a primary treatment is as effective as surgery at 10 and 15 years, based on the stats in the article, radiation was only about 50% as effective.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 202
   Posted 8/25/2010 7:02 PM (GMT -6)   
I agree that the statistics in the article make it appear the surgery patients had a lower probability of recurrance. But, we don't know the pathology of the biopsies. It's possible back in the early 90's that surgery was favored for the less aggressive cancers and radiation for the more aggressive.

Regardless, it's an encouraging article. Thanks.

Dave
Age:54
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3743
   Posted 8/25/2010 9:06 PM (GMT -6)   
I'm beginning to distrust many of these "studies" because they almost never give any details how they selected the men they studied...This article treats all PC the same and uses clever phraseology to paint a rosy picture. "Most men" = as long as 51% survive, you can say "most men"...

Another cause of death that almost certainly lowers the death rate from cancer, all cancers, is suicide. Suicide killed 34,000 last year and is the 7th leading cause of death among men...

"Doctors have discovered the most effective treatment for many forms of advanced cancer is a .38 Special, which uniformly produced a 100% cure rate." No person treated by Smith & Wesson has EVER died of cancer! Hallelujah!

You will NEVER read that in The New England Journal Of Medicine but Smith & Wesson cures MANY people...

230,000 men are diagnosed every year in the U.S. and 32,000 die from PC, 14%.

But the mortality risk is NOT evenly spread over the entire group. The Gleason 6, PSA under 10 group have a MUCH better chance at long-term survival than the Gleason 9, PSA over 20 group..The Reuters article reflects the battle now going on over the proper diagnosis and treatment of PC....Who gets treated and who does not....
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 12 core 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..

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 8/26/2010 5:06 AM (GMT -6)   
I think all this study projects is the typical long course of prostate cancer. Not long for everyone, but most. I think it is a 15-25 year cancer, which means that when you are dx at 65 or older you most likely will die with it and not from it. But if you live long enough it will probably get you. That is why I am skeptical when I hear things like a 99.6% cure rate for people like me who still have potentially 40 years of life left. The studies don't go out 40 years. If you look at yananow.net and sort by year dx. practically all of the the people dx. almost 20 years ago have had second line therapy. Although still alive, they seem to have advancing desease after 20 years. Hopefully there are a bunch of people dx. 20 years ago that aren't advancing, but have just put it behind them and we never hear from them....Who knows.... 

I am sure next month another study will come out contridicting this one....

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 487
   Posted 8/26/2010 8:12 AM (GMT -6)   
This story is missing large sections of important information. However, since the patients were Veterans treated from the early 1990's we can assume many were diagnosed as T2 or greater. Also, the men would have been older than those diagnosed today with psa (T1) and these two issues together indicate that the VA men would be older and sicker than those dx today. Relevance for a 68 year old man, treated at the VA, with conditions normal for the treatment site, time period, and patient background is different than that for a 56 y.o. today. Those VA doctors could feel "good" if their patients died of some other condition.
Those 12 years make all the difference in the world.

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 8/26/2010 9:05 AM (GMT -6)   
To further complicate it back then psa was normal up until 4.0. I wonder how long many of us could have gone waiting to hit the 4.0 mark. Maybe some of us would have taken 10 or 15 years. Then we would be in the 68 year old dx. Time frame.
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
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