Dana Jennings on Invasion of the Prostate Snatchers

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Galileo
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   Posted 8/31/2010 2:12 PM (GMT -6)   
Not exactly a book review, but Dana's take on the book and his own situation:
well.blogs.nytimes.com/2010/08/30/a-rush-to-operating-rooms-that-alters-mens-lives/

F8
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   Posted 8/31/2010 2:45 PM (GMT -6)   
>>I wish I had had this book back in 2008.<<
 
huh? PSA and surgery saved Dana's life. indecision or complacence may have killed him.  i've read every one of jenning's essays on prostate cancer but he really looked like he forced it here.
 
F8

Galileo
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   Posted 8/31/2010 2:49 PM (GMT -6)   
He also says:

"Despite the impression the authors give, though, judging the velocity or voraciousness of a prostate cancer can still be imprecise. I know this firsthand.

After my biopsy, it appeared that I had a Stage 1 cancer, a doddering old nag that the authors would have designated for active surveillance. As it turned out, I had an especially pure Stage 3 cancer, a real top-fuel eliminator in terms of velocity (and hunger).

I’m a wild card, the 1 man in 48 saved by surgery. Without it, my doctors wouldn’t have learned the cancer was so advanced, and wouldn’t have given me the hormones and radiation that helped keep me alive."

60Michael
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   Posted 8/31/2010 2:55 PM (GMT -6)   
I have enjoyed Dana's articles on PCa and everyone has an opinon. Look at the comment section from 82 yo Charlie who obviously likes to tell it like it is, as he sees it.
Michael

F8
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   Posted 8/31/2010 2:57 PM (GMT -6)   

yeah i read it a couple times yesterday. so did my wife and her impression was the same as mine.  others will come away with a different impression, for sure.

F8


Purgatory
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   Posted 8/31/2010 3:08 PM (GMT -6)   
this article was already posted in another thread today, the one about the book in question
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.

Galileo
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   Posted 8/31/2010 3:36 PM (GMT -6)   
oops...

Fairwind
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   Posted 8/31/2010 3:58 PM (GMT -6)   
"Yet radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that it extended the lives of just 1 patient in 48."

I was unable to find this "study" in the link posted...But even if there is such a study, does anybody here believe this claim??

My own investigations have shown that in first time positive prostate biopsies over 50% of these biopsies reveal aggressive Gleason 7 or higher tumors that require treatment. If we all took Blums and Scholz advice, the annual deaths from PC would over 100,000..
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..

Galileo
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   Posted 8/31/2010 4:38 PM (GMT -6)   
Dana is either directly or indirectly (via Blum and Sholz) referencing the results of one of the studies that caused so much stir recently--the European Randomized Study of Screening for Prostate Cancer, reported in the article "Screening and Prostate-Cancer Mortality in a Randomized European Study", March 26, 2009, NEJM.

"In other words, 48 additional subjects (1410 ÷ 1000 × 34) would need to be treated
to prevent one death from prostate cancer."

The full text is here:
www.nejm.org/doi/pdf/10.1056/NEJMoa0810084

April6th
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Total Posts : 264
   Posted 8/31/2010 5:26 PM (GMT -6)   
Somebody said...
“Out of 50,000 radical prostatectomies performed every year in the United States alone,” Dr. Scholz writes, “more than 40,000 are unnecessary.


Even assuming this is correct, I still would have the surgery.

How would I be certain before the surgery if I am one of the 80% where the surgery was unneccesary or I am one of the 20% who would eventually get an advanced if it wasn't treated soon after diagnosis.

I have read too many times patients going into surgery a 3+4 and finding out after the prostate is sliced and diced that that were a 4+3 with more tissue involvement than expected.

Yes, overtreatment is a problem, but the big problem is not yet being able to accurately diagnosis the severity of the PCa prior to treatment

Dan

Purgatory
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   Posted 8/31/2010 5:49 PM (GMT -6)   
fairwind, i for one, dont believe a word of the 1 in 48 study, i think its b.s. and misleading

april6th - i also do not believe dr. scholz's opinion about 4 out of 5 operations being unecessary. I get real scared when one doctor thinks he's the only one that is right, and all the other doctors are wrong. That sends up a big warning flag to me.

none of those stats mean a thing, when its you, you are talking about, or your loved one.
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.

NEIrish
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Date Joined Aug 2010
Total Posts : 245
   Posted 8/31/2010 6:10 PM (GMT -6)   
At a 3 physician Boston consult this past spring one oncologist gave us the same Blum etc. study; "1 in 48 with stats like yours will never die of the disease" he said to my husband. We'd decided on AS til we read the May 11th AUA article entitled "Delayed Surgery Boosts Prostate Cancer Risk" which suggests patients delaying surgery for low risk prostate cancer for six months or more increases the risk of adverse outcomes. Gray is gray with this disease and thank God that although I've been second guessing as a result of his post surg loooong recovery, my husband says it's a done deal, don't look back and refuses to hear it. That's as black and white as we have right now. It's also why no one else but those who've walked through the Gray Valley knows what it's like. Has anyone done a Rex Morgan style thread on the comments, well meant but exasperating, from fam and friends when you tell them about the PCa? Sheesh.
Husband 60yrs., no symptms: PSA 10/04 2.73, 12/06 3.64, 5/09 3.9, 10/09 4.6, 1/10 5.0w/ free PSA 24
6 core biop 4/1/10 path rept: rt mid: adnocarc. G=3+3, 5% of core; R apx v. susp. minute ca, R base bnign w/ mod. atrophy, L side atrphy only; 2nd opnion JH confrmd
MRI - 15mm nodule
BiLatRP surg 7/6/10, path: T2c, nodes, sem.ves, extra caps. neg., adenoc both sides G=3+3 cntinent, Viagr-8/27 ED

142
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Total Posts : 7084
   Posted 8/31/2010 6:21 PM (GMT -6)   
I read the column, and I'd be hard pressed to say what I think he meant. I would suspect that if he had read the book, he might have reconsidered surgery, which in his case, would not have been a good choice?
 
Like a lot of us try to remember, what's done is done. I would have looked at the book as something for the next guy, not something I wish I had seen earlier. No do-overs.

Galileo
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   Posted 8/31/2010 6:22 PM (GMT -6)   
Blum etc. didn't do a study.

NEIrish
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Date Joined Aug 2010
Total Posts : 245
   Posted 8/31/2010 7:09 PM (GMT -6)   
We were told it was a British (could it have been a Swedish) study. I used the Blum name from a poster above since I couldn't remember names. My bad.
Husband 60yrs., no symptms: PSA 10/04 2.73, 12/06 3.64, 5/09 3.9, 10/09 4.6, 1/10 5.0w/ free PSA 24
6 core biop 4/1/10 path rept: rt mid: adnocarc. G=3+3, 5% of core; R apx v. susp. minute ca, R base bnign w/ mod. atrophy, L side atrphy only; 2nd opnion JH confrmd
MRI - 15mm nodule
BiLatRP surg 7/6/10, path: T2c, nodes, sem.ves, extra caps. neg., adenoc both sides G=3+3 cntinent, Viagr-8/27 ED

Galileo
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Date Joined Nov 2008
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   Posted 8/31/2010 7:57 PM (GMT -6)   
If you go here you see the study and all the names.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa0810084

Dr. Walsh said the European study conclusively proved that screening saved lives. That is not in question.

The question raised by the study, and apparently by Blum and Scholz-- and by Dana Jennings in his blog-- has to do with over-diagnosis. To this point Walsh wrote:

"In the European study it is estimated that to prevent one prostate cancer death at ten years, 1,400 men would need to be screened and an additional 48 men would need to be treated. Ten years is the earliest time at which one would expect any benefit and if one looks at a 50 year old man who is going to be alive for another 35 years, those odds would be entirely different. Also, with longer follow up in the European trial these odds will improve. However, if screening for prostate cancer is ever going to receive popular support, it will be necessary to avoid over-diagnosis in men who are unlikely to have a survival benefit (men who are too old or too ill to live longer than ten years) and to avoid over-treatment in men over age 65 who have low volume disease. Most of all, it is imperative for us as physicians to continue to improve the quality of treatments to reduce their morbidity. If one day it were possible to reduce these side effects to a minimum, the debate would end."

(Source: Brady Urological Institute: http://urology.jhu.edu/prostate/PSA_controversy2.php)

Postop
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Date Joined Feb 2010
Total Posts : 385
   Posted 8/31/2010 8:32 PM (GMT -6)   
The European prostate cancer screen study was well conducted--it's a randomized study, level 1 evidence (a thread last week discussed different levels of evidence. It makes sense that few men in the control group died, showing only the 1/48 chance that screening will save lives. This study had a median followup of 9 years; PSA screening picks up PCa early; PSA often grows slowly. However, what if they had followed these patients for 10 more years instead of ending it in 2006? You might find a higher benefit in terms of lives saved. Figure 2 showed that the difference between the two groups was starting to diverge over time. So Dana should discuss this study as the last word on PSA screening. Unfortunately, he also might be mistaken to count himself as the 1 out of 48 life saved. With his stats, he's not out of the woods yet, even with surgery and radiation.

Galileo
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Date Joined Nov 2008
Total Posts : 697
   Posted 8/31/2010 10:11 PM (GMT -6)   
Walsh also wrote that in the ESRPC study only 85% of the men in the screening group actually got screened, and if you adjust for that, then the reduction in PCa deaths jumps up to 27%, even with such a relatively short followup.
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) Jan-Mar 2007
PSA 9/2007 and thereafter <0.1
pcabefore50.blogspot.com
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