No win ? With a pole - Which would you rather be right now?

Which would you rather be right now?
9
55 yr old, Gleason 3+3 - 100.0%
0
45 yr old, Gleason 4+4 - 0.0%

 
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BobCape
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Date Joined Jun 2010
Total Posts : 416
   Posted 10/17/2010 7:07 AM (GMT -6)   
We talk alot about age, gleason, psa, stage, treatments, machines, hospitals, specialists, etc... and All of that stuff matters. Absolutely. Bu we dont all have the same stage cancer, or access to the same "best" doctors, or equipment, or health plans.. we dont all have a spouse to help us get through this. EACH case is ABSOLUTELY unique to us. We own it.
 
In a previous post a younger member noted how different all of these assessments can be for a young guy compared to older folks... the ones who Can Afford to find a little comfort in the commenly mentioned fact that "most men will have prostate cancer but die from something else".. problem is, if you are 75 that's great. but not if you are 45.
 
In my previous post I quote a doctor who said "If I had to choose one cancer for myself, it would be prostate cancer
 
My question: Which situation would you CHOOSE to be in?

TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 10/17/2010 8:39 AM (GMT -6)   
I guess if the choice is which cancer, then it would be Pca. If the choice is which situation in Pca, then it would definitely be diagnosis at a later age, i.e. 68 or higher.

Bob, given your clarification of the poll question, I'd definitely choose 3+3 at 45.

TB

Post Edited (TaurusBull) : 10/17/2010 5:05:37 PM (GMT-6)


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 10/17/2010 9:21 AM (GMT -6)   
I didn't pose the question very well.

In fact, I staged it completely wrong. Too much on my mind I guess. Sorry.

I guess I meant 55 with 4+4 or 45 with 3+3.

I was wondering what percentage would be willing to choose age 45 with a 3+3, getting it 10 years earlier, if you knew that waiting 10 years it would be 4+4.

Was trying to measure the collective thinking of that 10 years vs the extra 1+1 on Gleason.

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 10/17/2010 9:49 AM (GMT -6)   
I choose 45 st 3+3.
Dx 42
Gleason 6 (tertiary score 0)

open RP 10/08 Johns Hopkins

pT2 Organ confined Gleason 6

PSA
10/15/2009 <.1
10/15/2010 <0.03
10/15/2011 -

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 10/17/2010 10:01 AM (GMT -6)   
Casey, are you saying that PCA increases in agressiveness over time? That a 3+3 becomes a 4+4 over time? That would make watchful waiting a silly exercise wouldnt it?

ChrisR.. So would be willing to get it 10 years earlier, if he could be assured of a less agreessive case..3+3. Interesting.

If I read this correct, Casey thinks it grows worse over time, so the later you get it the better, period?

(Not trying to put words in you mouths here guys).

We know that if you get it late enough in life, it likely wont have any impact.

I THINK THAT REALLY IS THE QUESTION, WOULD YOU RATHER BE 45 WITH A 3+3 OR 55 WITH A 4+4.

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 10/17/2010 10:04 AM (GMT -6)   
ok, i'm not going to stick my foot any further into my own mouth.

I know NOBODY wants it.. if someone yu loved WAS going to get it, which position would you prefer they be in.

Dont have to answer folks - I cant expect answers when I cont even ask the question correctly.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/17/2010 10:04 AM (GMT -6)   
Its likely that the 55 yr old 4+4 was 3+3 at 45, but didn't know it...

But the 45 yr old at 3+3 also might never get to 4+4; might, in fact, remain 3+3 for the remainder of his life...which is the basis for some doctors recommending a "wait and see" approach for very low risk cases, and the basis for the active surveillence approach. 
 
Not being insulting, but this question is a no-brainer...

I like how MSK surgeon Dr James Eastham says the "wait and see" approach (closely paraphrasing his words, 'before aggressive treatment, let's see what this low risk cancer is going to do') here: http://www.mskcc.org/mskcc/html/95057.cfm

[This link is an excellent series of web seminars with Dr Eastham (surgeon), Dr Michael Zelefsky (radiation oncologist), and Dr Michael Morris (medical oncologist).]

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/17/2010 10:29 AM (GMT -6)   
BobCape said...
Casey, are you saying that PCA increases in agressiveness over time? That a 3+3 becomes a 4+4 over time? That would make watchful waiting a silly exercise wouldnt it?

ChrisR.. So would be willing to get it 10 years earlier, if he could be assured of a less agreessive case..3+3. Interesting.

If I read this correct, Casey thinks it grows worse over time, so the later you get it the better, period?

(Not trying to put words in you mouths here guys).

We know that if you get it late enough in life, it likely wont have any impact.

I THINK THAT REALLY IS THE QUESTION, WOULD YOU RATHER BE 45 WITH A 3+3 OR 55 WITH A 4+4.
 
Bob, sorry, I pulled out my earlier posting (deleted it), added significantly to it with the link to the MSK web seminar, and reposted it a few minutes later...and your post above was apparently sent in between my postings.  As luck would have it, I went back and flipped through this thread and saw your question back to me, which I will address here.  Sorry for any confusion this might have caused.
 
I think I partially answered your question in the re-posted response.  Here's the basic premise:  someone who is 4+4 didn't start out as 4+4.  Rather, their cancer progressed from a lower grade first.  Not everyone's cancer grade progresses indeffinately, and the progression can be stopped or slowed in some people by diet, exercise and/or lifestyle changes, or other factors.
 
I would always want to have a less aggressive cancer that may or may not grow to be more aggressive, because there are levers within my control to help slow or stop the progression, as well as levers outside of my control which may prevent it from further progressing.
 
Bob, does this additional posting help clarify?

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 10/17/2010 10:54 AM (GMT -6)   

Bob -- i really don't like this game cool .

erader


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

John T
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Date Joined Nov 2008
Total Posts : 4226
   Posted 10/17/2010 11:01 AM (GMT -6)   
I would take a 3+3 at any age vs a 4+4. The reasaon is that they are completely different even though they are both PC. A 4+4 is always agressive, without treatment will cause symptoms in a matter of years and has a high probability of death. Even with treatment the chance of a reoccurrance is very high.
A 3+3 has an extremely high cure rate at any age, a 50% probability that it will never cause symptoms in one's lifetime. Death is rare. Even with a reoccurrance death is rare.
Comparing a G6 to a G8 is like comparing two entirely different types of cancers. They act differently, they grow differently and they spread differently. One acts more like a chronic disease and the other like a cancer. Many doctors have recommended that a low risk G6 be given a different name than cancer.
I've never seen any evidence that all cancers start out as PIN and develops to G6 then eventually progress to G8. I think that most G8s start out that way or go through a very short period of mutation (months, not years). PSA doubling time doesn't change over time as it is genitically imprinted on the cell, just as agressiveness and non agressiveness is imprinted on the cell.
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.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 10/17/2010 11:10 AM (GMT -6)   
Married or single?
Given the choice I will pick the less aggressive case and the wellspring of youth.
I figure there will be medical advances 10 years from now that we never thought possible.
Jeff

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 10/17/2010 11:20 AM (GMT -6)   
Casey, it certainly does clarify your personal perspective on my badly premised question.

F8 - I'll assume you dont mean that i'm posting the question just for fun, or because i'm bored.

The collective Pca knowledge & experience of the members of this site is impressive.

I assure you I was not playing games. At 51, having lost my prostate 5 mo ago, a Gleason 4+7 - tertiary 5, positive margins, Ed and ETC.. I dont have alot of room for "play" in my life.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 10/17/2010 11:22 AM (GMT -6)   

okay Bob, then i guess i don't get the point.  would you rather have lung or liver cancer?

erader


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

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 10/17/2010 11:31 AM (GMT -6)   
No F8, you dont get my point. That is my fault for the way I asked the question.

The purpose of my question is best addressed in the way that JohnT answer it above.

He'd rather have a 3+3 at 45 than trade that for a 4+4 and he is cancer free till 55.

It's kinda like - would you feel better getting it late (becasue you have less time to lose) or getting a weaker
case of it younger (because it is weaker, there may be cures, improved treatment, etc..

It is DIFFERENT than asking the question about lung or liver, when ONE OF THE POSSIBLE answers is as JohnT answered, that in HIS 1300+ posts worth of experience, a 3+3 Might Not Even Be Considered Cancer By Some Doctors! Good sir!

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 486
   Posted 10/17/2010 1:42 PM (GMT -6)   
There is a HUGE difference between a 3+3 and a 4+4 no matter the age. For example; A 4+3=7 is three times more aggressive than a 3+4+7.

IF caught early enough, a 3+3 is very survivable no matter the age whereas anything greater than a 3+4 paints an entirely different picture.
Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
6/2010 Bipsy, 7 of 12+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg,Ves neg
tumor in capsule, still 4+5=9
pni extensive
8/5, 2010 cath out
9/3, 2010 PSA - 0.04 whew!
9/3/2010, I'm 99% continent - only stress incontinence
10/14/10, PSA still 0.04, and lupron #1, 99.9% continent
Total ED, 3 caverject failed, pump sux

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 10/17/2010 2:08 PM (GMT -6)   
Kbota - You may like to have a look at the attached link, re your veiw points on Gleason 7.
ie 4+3=7 opposed to 3+4=7.....................Rgds Kev.


http://www.prostate-online.com/gleason7.html
Age 52yrs [Gold Coast Qld, Australia]
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
RP 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - EPE
Dry less than 1 week. ED- okay with Meds.
PSA at 18mths no change remains 0.03
"Everday in Everyway, I get better"

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 310
   Posted 10/17/2010 2:23 PM (GMT -6)   
Also factor in that as of the last few years there are two different Gleason grading systems in use, so one lab's Gleason 6 is another lab's Gleason 7. In other words, a lot of men who would have been a Gleason 6 in the past are now a Gleason 7 - same cancer, just a different score.

Zen9

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 10/17/2010 2:40 PM (GMT -6)   
Hang on guys, lets not concentrate too much on the Gleason Score here, Its all still Cancer.
I think the question should be, whether or not it in or out of the box. Stage plays a major role in recurrence.
Secondly dont let us forget if we are looking at current stats, only one third of guys will experience a recurrence.

Kev.
Age 52yrs [Gold Coast Qld, Australia]
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
RP 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - EPE
Dry less than 1 week. ED- okay with Meds.
PSA at 18mths no change remains 0.03
"Everday in Everyway, I get better"

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 10/17/2010 2:58 PM (GMT -6)   
Too bad I screwed this poll up. I felt it was important, to me at least. Tempted to make it again, or would be against someone else posting it right.

Deal it you have two choices 'TODAY'!!!!! Say you are 20 years old.

You know you will get Pca.

Do you feel better if you get it at 45 with a 3+3, or a 55 with a 4+4. THAT was
what I intended to ask.

*I DO know the difference between 3+4 and 4=3, trust me.

I DO know stage - in or out of box matters, trust me, but you dont have the benefit of that knowledge in my poll.

*The "old" system doesn't apply in my query, which is why I said "right now".

NONE OF YOU GUYS ARE "WRONG".. there is no right, I was just looking for arguments on either side.

Talking about reocurrance "only one third of guys will experience a recurrence".. different story.. Of COURSE you get the benefit of pathology after choosing surgery.

IN the right and now, knowing what we do and do not know.. I personally dont known weather i'd rather be 45 with a 3+3, or have made it to 55, then have a 4+4. I KNOW i've survived a minimum of 10 more years under the 2nd choice,

BUT DO I EXPECT TO HAVE A BETTER RESULT AT 55 HAVING A 4+4, THAN I WOULD IF I GOT IT AT 45 WITH A 3+3. That is what I am trying to understand.
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