PC "staging" does not work says new study

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geezer99
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Date Joined Apr 2009
Total Posts : 990
   Posted 11/22/2010 9:52 AM (GMT -6)   
There are a number of reports on this study (published in Cancer) in today's news. Here is one from NPR.

www.npr.org/blogs/health/2010/11/22/131506788/researchers-say-common-test-for-prostate-cancer-may-not-work

I could not find the original article. I suspect it will appear in the Nov. 30 issue.

Fairwind
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Date Joined Jul 2010
Total Posts : 3745
   Posted 11/22/2010 11:06 AM (GMT -6)   
I think most of us here on this board know more about "clinical staging" than the author of the article does...

I like the paragraph where they mention that in 35% of the cases, the clinical stage turns out to be worse than originally thought.. This makes the claim that "40% of all prostate cancer is indolent even more hard to swallow....

The medical profession, the researchers, the study writers, the magazine content providers need to get their collective act together and sift through all these conflicting statistics and separate the wheat from the chaff...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/22/2010 11:19 AM (GMT -6)   
Fairwind, I don't think the facts are important enough in their mind to take the efforts, its just whatever it takes to get it in print to snag some readers.
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 11/22/2010 11:59 AM (GMT -6)   
i don't even bother reading this type of stuff, which will make you crazy.  i know i've done everything i can.
 
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

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 11/23/2010 1:38 PM (GMT -6)   
What the article basically says is:

1.) The clinical stage (T2C, T3A) etc. does not have as much value in predicting the course of your cancer as does other information, most importantly the pre-treatment PSA, the Gleason Score, and the tumor volume.

This is not new news. Most of the modern nomograms and predictive tools reflect this already. Most people on this board know this.

Please note that the clinical stage is different from the pathological change, even though both use the same terminology. The clinical stage is what the doc *guesses* is going on based on the digital rectal exam. The pathological stage is what they *KNOW* is going on if you have a prostatectomy and they can then examine the gland in detail and determine the size and location of the cancer. Except for the use of color doppler, everyone pretty much knows that clinical staging information is just a vague and not very useful estimate.

2.) The other point is about upgrading and downgrading. Between the initial tests (biopsy and DRE) and the pathology report done after surgery, a lot more is learned. The Gleason and staging is often revised up or down when surgery is done and the docs can actually examine the prostate in its entirety. Again, this is not new news.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/23/2010 1:56 PM (GMT -6)   
It's important to note a couple things about this article:

The reporter is severely misinformed. There is no test to staging, it is done by guidelines provided to the medical industry by the American Joint Committee on Cancer. Second, the study done by UCSF is based on clinical staging only. The findings are somewhat inconclusive and do not provide us any better information that the clinical staging based on a biopsy pathology report.

This has been on the InfoLink news stream for a couple days now, which prompted me to repost the AJCC2007 staging guidelines for prostate cancer.

prostatecancerinfolink.net/2010/11/22/accuracy-and-relevance-of-clinical-stage-in-diagnosis-and-prognosis-of-localized-prostate-cancer/

Mikes write up covers these things.


My commentary is that clinical staging is only one piece of the prognostic indicators. We also have Pathologic Staging, Anatomic Staging, Gleason sum and grade, PSA and other things in the equation. To think that we can look at staging alone in prostate cancer is blindly putting faith into one aspect and excluding the others. Even with all of the others, there is no doctor that can accurately predict how someone will do after being treated. Even a stage IV, Gleason 10, PSA 100 can still do well for long periods of time. What we have after a biopsy is only partial information.

NPR's reporting did not take any of these things into account, and they misinterpreted the study at UCSF.

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

Post Edited (TC-LasVegas) : 11/23/2010 1:04:08 PM (GMT-7)


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 11/24/2010 1:35 AM (GMT -6)   
Very poor journalism/reporting IMO, well not poor so much as sensationalist and inaccurate.

and anyway it conceals the full opicture within it as a key sentence of the article is:

"...doctors should use these types of clinical staging tests to help decide how to treat cancers."


It thus actually says that staging is merely one of the things that should be used to help, so it thus says that it is not the be all and end all item on which to base treatment.

Also another key bit of data for helping work out treatment and outcome is the PSA velocity or doubling time as this is almost certainly directly proportional to the rate of growth of the tumor.

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK
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