Surgery a Help for Aggressive Prostate Cancer: Study

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pipedream
Regular Member


Date Joined Aug 2010
Total Posts : 64
   Posted 9/27/2010 9:45 PM (GMT -6)   
Received this Google News alert today - What is not included in the article is what the researchers define as the "most aggressive form of prostate cancer". Is there a way to find out? Also, is it permissible to post the article with attribution as I have done?

Business Week - Researchers report radical prostatectomy can extend survival rates


www.businessweek.com/lifestyle/content/healthday/643622.html

MONDAY, Sept. 27 (HealthDay News) -- Patients battling the most aggressive form of prostate cancer are good candidates for prostate surgery, and it could extend their lives, new research indicates.

A team of researchers from the Mayo Clinic in Rochester, Minn., and the Fox Chase Cancer Center in Philadelphia reported that 92 percent of patients with "high-risk prostate cancer" who underwent a radical prostatectomy procedure had a 10-year cancer-specific survival rate of 92 percent, equal to the survival rate after a combination of radiation and androgen (hormone) deprivation therapy.

But the overall survival rate after a radical prostatectomy, which involves removal of the prostate, was higher (77 percent) than either radiation and androgen therapy (67 percent), or radiation alone (52 percent), the investigators found.

The study findings were to be presented Monday at the American Urological Association meeting in Chicago.

"It's long been believed that patients with aggressive prostate cancer are not candidates for surgery," study author Dr. Stephen Boorjian, a Mayo Clinic urologist, said in a Mayo news release. "We found that surgery does provide excellent long-term cancer control for this type of prostate cancer."

In addition, he said, "by allowing the targeted use of secondary therapies such as androgen deprivation, surgery offers the opportunity to avoid or at least delay the potentially adverse health consequences of these treatments."

Boorjian and his colleagues focused on nearly 1,850 patients diagnosed with aggressive prostate cancer between 1988 and 2004.

Almost 1,240 of these patients underwent surgical treatment, while more than 600 underwent radiation therapy. Among the latter, 344 also were treated with androgen deprivation therapy.

"Patients with radiation and hormone therapy were 50 percent more likely to die than patients who had surgery," Boorjian noted. "This was true even after controlling for patient age, co-morbidities and features of the tumors. These results suggest that use of hormone therapy in patients who received radiation therapy may have had adverse health consequences."

But, he added, "further studies evaluating the differing impacts of treatments on quality of life and non-cancer mortality are necessary before we can determine the best approach for patients with aggressive prostate cancer."
Husband DX @ 64; 7.5 year survivor colon cancer; father had PCa @ age 65
04/09 - PSA 3.06 - retest in 6 mo
10/09 - PSA 1.55 Free PSA 7.74% - retest in 6 mo
04/10 - PSA 4.26

Biopsy 7/10
R base - 3+3=6 10%
R mid & apex - benign
R anterior horn - 3+4=7 20%
L base - 3+4=7 90%
L mid - atypical small acinar prolif
L apex - 3+3=6 < 5%
L anterior horn - 4+3=7 60%

RP Surgery - October 1, 2010

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 9/27/2010 10:44 PM (GMT -6)   
"The most aggressive form of Prostate Cancer"

That would be Gleason 8, 9 and 10 in ascending order..

These magazine articles are so shallow..Other important factors when it comes to survival were not even mentioned..

PSA score at time of diagnosis and the post surgery pathology were not even touched on.

But this is music to my ears! It vindicates somewhat the path I took to reach my treatment decision.
Age 68.
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 age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP performed Sept 3 2010

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 9/27/2010 10:48 PM (GMT -6)   
Amen. I savor my <.01 every day, and whisper thanks to my surgeon.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/27/2010 11:23 PM (GMT -6)   
It is yet again important to note that this an article spun off a level 2 study. There is a lot of data that supports these findings but none are level 1 comparisons.

Also note that this data is not based on gleason sums. But rather stage, gleason. PSA and other factors are being used...

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 : 3887
   Posted 9/28/2010 12:12 AM (GMT -6)   
Could it be....Is it possible.....That a PR outfit hired by the American Federation of Prostate Surgeons put the study together and got the article planted in BizWeek?? nono

No.....Something like that could NEVER happen in America!.

But I liked it anyway... yeah

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 9/28/2010 8:39 AM (GMT -6)   
I'm with you Fairwind. I chose surgery even though my DX showed Gleason 8 and 9. Pathology was Gleason 8.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 9/28/2010 10:54 AM (GMT -6)   
De-bulking large tumors is a common strategy. No mention of this. Knock it down, then attack aggressively what's left with a "phase 2" approach.

Also, some patients with aggressive PC are directing their doctors to operate, even though they see (nomograms) that the chances of organ-contained cancer are not very high (as they are for the most common PC surgeries). Their thought process is "well, there was a chance and I went for it."
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