The Sweedish study is one of the oldest study on AS and is ofter used to justify that the benefit of PSA screening in saving lives is not cost justified because there is only a 2% benefit of having surgery vs doing nothing. The study also contained a high % of men with a Gleason 7 and other stats that would not be considered candidates for AS in today's world.
A recent study relased by Dr Carrol (UCSF surgeon) showed that at UC Davis, patients on AS that were treated after 2 years on AS had the exact same results of those treated immediately. This supported the studies from Hopkins and Sunnybrook that showed the same thing. Also the Sunnybrook study, which is one of the largest showes that 2/3 of the patients that started AS are still on the program at a medium of 67 months. Which means that over 1/2 have been on for over 6-7 years.
The generally quoted QOL issues are at odds with the above:
Impotance Incontininence stricture Proctitis
Surgery 50% 8 5 -
Seeds 35 - 1 1
IMRT 35 - - 2-4
Martin Sandra, New England Journal of Medicine Mar 2008
John Davis, Journal of Urology April 2005
John Wei, Journal of Clinical Oncology Nov, 2003
David Miller, Journal of clinical Oncology April 2005
The above numbers are taken from the results of the BEST doctors and are on the high scale of what to expect if treated. Incontinence is very rare with seeds or IMRT, and I have never seen anything until now that indicates that it is a problem. I would take the QOL issues quoted by consumer health with a large grain of salt.
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.