I respectively disagee with you. Using the defination of 2 pads a day the contintance rate is about
90% at 2 years. If using pad free it is 69% in two years, and using no pads, no leaks it is 28%, (Reynolds, the new Prostate cancer info link nov 16, 2009,)
There is very little improvement after 2 years. Impotence also has different definations, such as the ability to have an errection with meds once every two weeks. The devil is in the details and how they are defined.
Not all prostate cancer grows slowly, some grows fast and others don't grow at all. If PSA doubling time is less than 3 years you have to be treated. 4 to 6 years it's a toss up depending on age, and over 7 years you can most likely go for the rest of your life. Many cancers are stable and don't grow at all for decades. If you show any signs of progression, increasing psa doubling time, tumor growth on a color doppler or gleason change on a biopsy from 6 to 7 you need treatment. If none of these are present you don't need intervention. Getting intervention later is just as effective as getting it immediately if properly monitored.
My views on surgery have been stated many times. It is appropriate for younger men with confirmed contained PC that is not near any any place that would make a positive margin unlikely. It is also appropriate if used as a dubulking procedure for high risk patients. Brachytherapy and IMRT have similar or better cure rates with all grades of PC with much less long term side affects than surgery.
We can disagree, as many experts do; but I feel that AS is a safe and appropriate course of action for men with low risk PC that meet the criteria as long as they are monitored by a doctor experienced with AS. The medical community is rapidly adopting this approach that was considered totally out there 5 years ago. Many noted doctors, such as Scardino, Carrol and Epstien have recently come aboard with this approach. As as data from studies at Hopkins and UCSF become available I think it will become standard practice within 5 or 10 years.
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.