It is well known that AS will likely end up in treatment.

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Terry Herbert
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Date Joined Sep 2010
Total Posts : 92
   Posted 10/9/2010 7:02 PM (GMT -6)   
The above statement was made by Tony Crispino on the thread discussing costs - of course being an alien non-resident my costs are nothing like those set out - and i wondered on what basis it was made?

All the studies I have seen to date show the majority of men in the studies do not follow this 'well known' path.

Perhaps those who are better informed, e.g. TC-Las Vegas, can point me to the evicdence supporting this statement.

Many thanks in advance

English Alf
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Date Joined Oct 2009
Total Posts : 2215
   Posted 10/10/2010 4:20 AM (GMT -6)   
To some degree we all do a bit of active surveillance as when we get told we have PCa we don't rush out of the doctor's surgery straight into the operating theatre. You almost start to do AS the moment you have that first PSA test.

My understanding was that with AS the idea that you may/will have to treat the PCa at some future date is always part of the plan, and that AS is simply about trying to select an optimum time to carry out any treatment when the stats change enough to merit it. (So that in the meantime you don;t get your QOL messed up by the side-effects)
And as I posted elsewhere this week: it's one thing to know that only 1 in 7 cases of PCa are the nasty ones, so you may not ahve anything to worry about, but it's something else to know that the docs can't tell if you are the unlucky singleton or one of the other six.

Alf

JohnK11
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Date Joined Jan 2010
Total Posts : 25
   Posted 10/10/2010 8:17 AM (GMT -6)   
AS : 1/2 to 2/3 of patients can expect at least 5 years without need for treatment
from Consumer's Report on Health, October 2010 issue, based on a 2010
study of 6849 Swedish men diagnosed with LOCALIZED prostate cancer.
10 year death rate are about 3% for low risk, and 5% for intermediate risk;
that is about 2% higher than for surgery --note LOCALIZED prostate cancer,
and for treatment in the 1990's.
I know of no studies on the rate for more than 10 years of AS on localized
prostate cancer.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/10/2010 9:26 AM (GMT -6)   
good post alf.

i agree, between my first biopsy and third, which became my PC dx, in a sense I was practicing AS. Lots of monitoring, lots of learning, etc.

Then 3 months after dx, plenty of AS activities went on with me.

i think you made a good point

david in sc
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.

John T
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   Posted 10/10/2010 9:37 AM (GMT -6)   
The largest current study on AS is being conducted be Dr Klotz at Sunnybrook. about 2/3rds are still on the program at 7 years and some that have chose to be treated did not have signs of progression. Although there are no long tem studies past 7 years and treatment may be necessary sometime in the future I think it is a very valid option. Preliminary studies at UCSF indicated that 100% of those in the AS study who where on a controlled diet had no signs of progression. All of this is encouraging data and many recognized surgeons such as Sardino and Peter Carrol are now supporting AS.
With the positive margin rate of surgery running at about 25% and side affects in the 50% range it's hard to justify the risk/benefits of treatment for low risk PC.
The stat for me that is hard to get over is that 50% of all men will have some PC after 50 and 16% will be diagnosed at some time; yet only 4 % ever die from it. This indicates that there are a bunch of 50 year olds that will never even realize they have pc in their lifetime.

JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 10/10/2010 10:23 AM (GMT -6)   
Hey, Terry great to see you over here and by the way, my brother most likely would thank you for talking to him 6-7 yrs. ago about PCa and that with his stats A.S./W.W. would not exactly be a huge risk in his case  (indolent version of PCa).  He has had no psa progression upwards and so far seems very pleased to have great quality of life, while he decides the if and or when and what.
 
Good luck to anyone on PCa whom believes they are worthy of expertise status and have it all figured out, cases vary like crazy and you and I have seen over 8+ years.  I would not attempt to define this question and answer in totality. Might be interesting to watch the dialogue however, if people don't know you here that well....heads up is my suggestion. Even abstracts can be found in error or contradicted by another abstract....nothing is simplistic.

F8
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Date Joined Feb 2010
Total Posts : 3800
   Posted 10/10/2010 10:56 AM (GMT -6)   
>nothing is simplistic<
 
especially when you communicate in greenspeak (alan greenspan) cool .
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Jazzman1
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Date Joined Sep 2010
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   Posted 10/10/2010 11:13 AM (GMT -6)   
The difficulty with these kinds of studies, in my view, is that you have to decide what it may mean in your individual case. It's one thing to say that low risk PC can generally be safely watched over time. It's another to establish decisively that yours is a low-risk PC, and that you are safe in doing so. These studies may have meaning for public health policy-makers who deal with large numbers of patients in the aggregate. They have little value for the individual patient, in my opinion.

As a relatively young man with a Gleason 6 T1C cancer, the Bostwick calculator tells me I have an 88 percent probablility that my cancer is organ confined. As we all know, Gleason scores are often revised upward after surgery. Moeover, many people unfortunately don't think very clearly about probabilities, which explains the success of Las Vegas. Even a 99 percent chance that nothing bad will happen means that sometimes bad things will happen. And with cancer, bad things are often really bad. Public health officials may need to consider those kinds of statistics in their cost/benefit analyses, but individual patients need to consider worst case scenarios. Your treatment decision may not be driven by that one percent or five percent or ten percent chance, but you need to consider it carefully.

There are any number of cautionary tales right here in this forum showing how this disease can turn on you in a very nasty way with very little notice. For me, all my accumulated wisdom of five weeks of research (which admittedly is very limited) tells me that I need to err on the side of caution.

Red Nighthawk
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Date Joined Oct 2009
Total Posts : 289
   Posted 10/10/2010 11:46 AM (GMT -6)   
When we discuss AS, we're talking about more than just 'watching it closely', right? We're talking about lifestyle changes, including changes in our diet if needed. We can choose to either feed the cancer or starve it by what we eat. Alf is right. Many of us ate like Americans and most other first world countries before PCa and only after get religion. I'm one, I admit it. Many of us used to eat lots of fast food, meat, dairy, transfats, pizza, burgers, deli, and pesticide ladden veggies, etc. Now, post op, I imagine cancer cells as similar to weed seeds in the garden. Give them nourishment and wham, they grow. Simplistic? I don't think so.

We can choose to feed cancer, or we can choose to starve it.
Age: 63
Gleason grade: 3+4=7, pT2c NX MX
Robotic RP: Sept. 15th, 2009
No lymphatic/vascular invasion, seminal vesicles, margins tumor free.
Pre surgery PSA: 4.1
Post surgery PSA's: .04, .03, .02, .05, .02
ED: Improvement slow but there are positive signs. No incontinent issues.
Surgery: Dr. Jim Hu. Dana-Farber/Brigham and Women's, Boston

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 10/10/2010 11:50 AM (GMT -6)   
Clearly if you have early PCA--e.g gleason 6, low volume of tumor, PSA< 10, and expect to live 10 years or less, AS is the way to go. There is strong evidence for this. No question. Very like it is also if your life expectancy is 15 years, but there isn't direct evidence for that. The fuzzy area is for healthy people who are less than 65. Because of the lack of long term evidence as to what your risk of dying or needed other treatments like HT or radiation as time passes, 10, 15, 20, 25 years after diagnosis, this is a gray zone that people argue about, and choices vary. If you expect to live 25 years, and knew the odds that the PCa would eventually catch up with you, you'd know what to do. Right now, it is a matter of opinion, and all the different opinions in this thread are all valid and reasonable, albeit contradictory. They are just arguments, faith, hunches, repeating the opinions of a trusted doctor, or quoting studies that don't adequately answer the questions.

If there WAS firm evidence, you'd go to the doctor and he or she would say: This is your situation. This is the best treatment. This is why. This is the evidence that the other treatments are not appropriate. You'd go to another doctor and they would say the exactly the same thing. You'd go to the third doctor, same answer. Just like you would if you go to the doctor with high blood pressure. You wouldn't get different answers from different doctors, or go to the internet to help decide what to do.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/10/2010 12:09 PM (GMT -6)   
post op

your last paragraph was dead on. all the decision process for us PC guys is on us, whether we be educated or non-educated on the subject.
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.

John T
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Date Joined Nov 2008
Total Posts : 4226
   Posted 10/10/2010 12:35 PM (GMT -6)   
Postop is correct in that everything concerning pc is probabilities. When considering the probabilities of AS many assume that the alternative, which is treatment, at 100% cure, but it is nowhere that close. If it is really low risk pc stats you still have only a 90- 95% chance of cure and if it really is a G7 you have about a 70%. The immediate death rate for surgery is .5%. These cure rates remain the same if treated immediatiely compared to being treated in three years. The risk of waiting does not decrease you chances of a cure; this may seem strange, but it has been verified time and time again. (Hopkins, UC Davis). In all probability 30% of the men with low stats will need treatment in 3 to 7 years and 50% in 10 to 15 years, but 50% will not, and avoid all the side affects of current treatments with very little added risk. Patients choosing immediate treatment because they expect a 100% cure rate now or expect that their risk of death will radically drop are not basing their decision on factual, verified information. What is certain is that 50% or more of these patients will have permanent side affects from their treatments.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Red Nighthawk
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Date Joined Oct 2009
Total Posts : 289
   Posted 10/10/2010 2:08 PM (GMT -6)   
This forum is absolutely astounding in the intelligent manner in which we engage topics. I can honestly say I do not disagree with anyone's opinions on this topic.

JohnK11
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Date Joined Jan 2010
Total Posts : 25
   Posted 10/10/2010 3:47 PM (GMT -6)   
Re : 10 year survival rates for AS/SUR/RAD(external)/SEEDS
for diagnosed localized prostate cancer in the 1990's.

Whether you want to believe the study reprized in the CROH
(Consumer's Report on Health)/Oct-10 issue, at least they quote
statistics on 10 year survival rate for diagnosed localized
cancer (2010 study of 6849 Swedish men, so, treatment done in
the 1990's)--that include those incorrectly diagnosed as
localized (maybe the current 2010 diagnosis is more accurate??)
The results are quoted for 4 cases--AS (Active Surveillance),
SUR (mostly open, since it's in the 1990's), RAD (external beam),
and SEED (radiactive)

the results (approximate) for 10 year survival rate (from prostate cancer)
low risk intermediate risk
AS 3% 5%
SUR <1% 3%
RAD 2% 4%
SEED not available; potentially similar to RAD

Assuming that the average age at diagnosis is 65 (my guess),
that would imply a 5-20% increase in death rate, since a
65 year old person have a 20-40% chance of dying in 10 years
anyway from other sources. Thus, AS would increase the death rate by
2% compared to the most "optimal"?? option--SUR--so a 1/20-1/10 increase in
death rate, while being able to avoid all the side effects, at least
for a while.

My guess is the death rates for SUR are those mis-diagnosed
as low/intermediate risk, but with actually metastatized cancer.
RAD (at least around 2000), may not be as effective, but are
likely to be better in 2010.
The additional rate from AS vs. SUR are those localized cancer
that spread before one catches the spread and treatment.

So, if this interpretation is correct, is a 7+-2% increase
in death rate worth avoiding the side effects for years (1/2
to 2/3 of low risk AS do not need further treatment within
5 years). A difficult choice that one must make for localized
Prostate Cancer.

In my case, Gleason 4+3=7 T3b, there is no choice but
treatment !!!

JohnK11
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Date Joined Jan 2010
Total Posts : 25
   Posted 10/10/2010 3:51 PM (GMT -6)   
Clarification :
The last paragraph--by 7+-2%, I mean the 7% of the
(20-40%) normal 10 year death rate for a 65 year old
person--for example, changing 30% to 32%.

John T
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Date Joined Nov 2008
Total Posts : 4226
   Posted 10/10/2010 4:54 PM (GMT -6)   
JohnK,
Most of these studies AS means never treated and no one belives this should be the case. The real defination of AS is getting treated only when it shows signs of progression, which usually occurrs in under 3 years.
If we use this defination then the cure rates are the same.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

JohnK11
Regular Member


Date Joined Jan 2010
Total Posts : 25
   Posted 10/10/2010 8:37 PM (GMT -6)   
JohnT
The section on AS is " 1/2 to 2/3 of patients can expect at least 5 years without need for treatment"
So 1/3 to 1/2 of these ARE TREATED within 5 years, presumably AS noticed that
Cancer is spreading so further treatment is needed. I don't understand your statement.
"Most of these studies AS mean never treated"--Which studies are you referring to ??
Certainly not the one on CROH/Oct10.
Perhaps you meant "successful AS", those 1/2-2/3 that did not need further treatment
in 5 or 10 years.

Terry Herbert
Regular Member


Date Joined Sep 2010
Total Posts : 92
   Posted 10/11/2010 1:20 AM (GMT -6)   
First of all, let me say that I entirely agree with Red Nighthawk when he refers to the polite and civilised way this discussion (and others I have read on this site) are conducted. But having said that, I also have to say, that like so many threads on Forums like this my original point was not really addressed as the discussion meandered along.

A statement was made by Tony: “It is well known that AS will likely end up in treatment.” I think that this statement may not be correct and may be based more on personal perceptions than the reality of whatever data is available. In saying that I am not criticizing Tony in any way: we all interpret data through the spectrum of our personal experiences and outlooks – I’ve even been known to interpret data supporting Active Surveillance in that way, believe it or not!

Perhaps I can just start by referring to English Alf’s post. Although there is no agreed definition of AS, what he sets outas “My understanding was that with AS the idea that you may/will have to treat the PCa at some future date is always part of the plan, and that AS is simply about trying to select an optimum time to carry out any treatment when the stats change enough to merit it. fits the understood definition of Watchful Waiting more than Active Surveillance. Men who choose AS often do so on the basis that their diagnosis may be of one of the variants in the disease that will never present a threat to their life and therefore they may never need therapy. This may seem a fine distinction and my personal view is that it is too fine, but…..it is held by many.

Tony seems to be saying that the aims of the AS men – to avoid unnecessary treatment – are unlikely to be achieved and he says this is ‘well known’. But….as JohnT says with reference to the Klotz study, the majority of men enrolled in the study are still there at a median of seven years after the study started. Now that is a relatively short time, but it is also worth noting in passing that at least two other AS studies are showing a similar pattern and, what is more about 25% of the men in the study have had negative second (and some third) biopsy procedures. That doesn’t necessarily mean that they no longer have prostate cancer of course, given the hit and miss nature of biopsy, but there is no evidence of progress and it is also worth bearing in mind that if their second or third biopsy had been their first, they would not have been diagnosed with prostate cancer and would not be on a formal AS program.

Which brings me to the other point made by JohnT The stat for me that is hard to get over is that 50% of all men will have some PC after 50 and 16% will be diagnosed at some time; yet only 4 % ever die from it. This indicates that there are a bunch of 50 year olds that will never even realize they have pc in their lifetime.

The first oncologist I consulted said that in his opinion and experience and in the light of available studies, the percentage of men who had cells in their glands which would be identified as ‘cancer’ using the then current definitions was roughly the same percentage as their age – in other words about 60% of men aged 60: 70% of men aged 70 and so on. If he is correct and if we don’t change the definition of ‘prostate cancer’ too much again (bearing in mind the significant changes announced earlier this year) then as John T says there are many, many men who are unconsciously practising WW (rather than AS) and for the majority of these men there is no prospect of the disease they are carrying becoming life-threatening, so they are unlikely to end up in treatment.

All in all these are some of the reasons that I think Tony was not correct in what he said, but I’m open to be persuaded by presentation of any reasonable evidence to the contrary.

Just to touch on a couple of other good points from the thread.

Jazzman 1 said The difficulty with these kinds of studies, in my view, is that you have to decide what it may mean in your individual case. It's one thing to say that low risk PC can generally be safely watched over time. It's another to establish decisively that yours is a low-risk PC, and that you are safe in doing so.

And Post op said If there WAS firm evidence, you'd go to the doctor and he or she would say: This is your situation. This is the best treatment. This is why. This is the evidence that the other treatments are not appropriate. You'd go to another doctor and they would say the exactly the same thing. You'd go to the third doctor, same answer. Just like you would if you go to the doctor with high blood pressure. You wouldn't get different answers from different doctors, or go to the internet to help decide what to do.


This uncertainty is certainly a difficult thing to deal with, but is there any more certainty in ANY aspects of our lives? Can anyone say, in full confidence, that they will not die of any of the seven causes of death that outrank prostate cancer and that therefore prostate cancer will get them if they don’t do something. From my point of view it is important to know that statistically there is a 97% chance of my dying of prostate cancer and a 3% chance of my dying of the disease. Just how this population based statistic applies to me can only be guesswork, but there are guidelines that clearly separate the very dangerous from the very indolent – at least in my understanding.
Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony Metastasis: Aug '07: Intermittent ADT: PSA 2.3 Aug '10

It is a tragedy of the world that no one knows what he doesn’t know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey

Postop
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Date Joined Feb 2010
Total Posts : 385
   Posted 10/11/2010 3:11 AM (GMT -6)   
The Pacific coast usually gets the last word in the thread, and is the typical source of eccentric ideas...

Of course there is never certainty. Every health decision in is associated with a probability of different outcomes. Each treatment has a certain chance of certain side effects, and the disease itself a chance of certain consequences. With some conditions these odds are clear cut. If someone has a highly malignant brain tumor--a glioblastoma--they will almost certainly die from it. The treatments will not change this, but they have a certain odds of prolonging life.

The calculus of PCa is a lot murkier. Most men with it will die from something else. Factors that determine the chance of dying from it include the attributes of the tumor, but also your age and health, that is, your life expectancy. If you treat it, the probability of dying from the PCa may go down. To make a rational decision, you need to know, for your situation, these things:

1. your odds of dying from PCa
2. how much these odds are improve by treatment

and

3. the risks of the treatment
4. if chances that you will end up getting treated anyway, and whether the delay in treatment will reduce its effectiveness.

Now you might not believe that making life choices on the basis of some convoluted statistical analysis is the way that you want to live, and you don't have to, but doctors should do this when they recommend a treatment for you.

All of these odds may seem impossible to determine, but they could be. If you buy life insurance, the insurance company is making a bet on your life expectancy, and the actuaries that work for them are very good, and the insurance companies make money by predicting your life span.

The answer to 1 & 2 can come from randomized studies where people are randomized between no treatment and treatment. This has been done for radical prostate surgery for a period of up to 12 years:
Radical Prostatectomy versus Watchful Waiting in Early Prostate Cancer, Bill-Axelson, et al, n engl j med 352;19, 2005

The results are not too impressive. These are people with moderate PCa at diagnosis. For people under 65 there was a modest decrease in death with surgery, (at 10 years 10% PCa death in surgical group, 20% in watchful waiting group). For people over 65, there was no difference in PCa death between the two groups. Maybe with more years of followup, there would be a bigger difference.

It may seem impossible to do the studies that would really allow the kind of analysis that would allow answers to these questions. But, in the US alone, $billions have been spent to take or radiate prostates for uncertain benefit. Why can't 50 or 100 $million be spent for clinical trials to answer some of these questions so our sons have better choices?

Terry Herbert
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Date Joined Sep 2010
Total Posts : 92
   Posted 10/11/2010 4:23 AM (GMT -6)   
Er.....Postop, does that mean you agree or disagree with the subject line?
Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony Metastasis: Aug '07: Intermittent ADT: PSA 2.3 Aug '10

It is a tragedy of the world that no one knows what he doesn’t know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey

cooper360
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Date Joined Jul 2010
Total Posts : 161
   Posted 10/11/2010 6:57 AM (GMT -6)   
Isn't color doppler [in expert hands] a good way to monitor PCa? I believe I have read a well informed poster state it can detect any tumor that could harm you! I also believe some practising AS are using it to keep track of their PCa!

John T
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   Posted 10/11/2010 9:07 AM (GMT -6)   
JohnK,
To clearify: AS in the Sweedish study and in the original Conniticut Study referred to men who went on AS and were never treated. My point is that we know that 30% of the men who start AS will progress within 5 years, many of these are due to underdiagnosis on the original biopsy. What happened to the men on AS that were treated? Are they classified as AS patients or treated patients or just removed from the study? The numbers will be skewed depending on how they were treated for study purposes. My belief is that the AS group in the study reflects men that were never treated and this may not reflect the reality of current AS practices which recommends close monitoring and treatment on signs of progression. Large studies at UC Davis and Hopkins show that men on AS treated within 3 years have the exact same cure rate as those in a controlled group that were treated immediately.
Also if we were to do a real study we should include the men that Terry mentioned, those that have PC and never know it as they too are practicing AS without their knowledge.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

goodlife
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Date Joined May 2009
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   Posted 10/11/2010 9:19 AM (GMT -6)   
I would not argue any of the studies or statistics flying around here.

Odds/statistics are real funny things. All of the men on here statistcially had a 1 in 6 chance of getting PC. So we aleady have "won" a lottery that we had a 16 % chance of winning.

If you tell me, or the majority of men on here that we only have a 20 % (or 10, 0r 5 ) chance of dying of PC by just standing by and watching it, I don't think those odds are great. I am going to eventually have it taken care. From that perspective, I would say most men will eventually have treatment, if their PSA goes up, which is almost a certainty.

In the future, if we can improve on the monitoring and predictive capabilities, it would seem that AS could result in fewer curative treatments. But today, I don't personally feel the odds are with me. I'm already an unlucky guy.
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

Postop
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Date Joined Feb 2010
Total Posts : 385
   Posted 10/11/2010 9:28 AM (GMT -6)   
In answer to Terry,

It's not well known.

Newporter
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Date Joined Sep 2010
Total Posts : 225
   Posted 10/11/2010 10:35 AM (GMT -6)   
Terry,

Based on your signature, if you chose surgery or RT when you were diagnosed, you could be cancer free and not have to deal with ADT, etc.

The decision is really very personal and difficult and everyone of us is different. For me it was so difficult to decide it drove me crazy for two months and I changed my mind every day until I finally decided statistic be darn, certainty of knowing the pathology of the prostate was very important and hopefully provided a peace of mind. Whether it was the right decision only time will tell.

This site help me a lot when I was going through my ordeal and this post should be very helpful for anyone newly diagnosed.

Regards,
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Negative margins; Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason grade 4. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 full continent partial potency. Sept PSA: <.1
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