New Study of Active Surveillance and Quality of Life

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geezer99
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Date Joined Apr 2009
Total Posts : 990
   Posted 12/1/2010 9:10 AM (GMT -6)   
Edited at 12:55 to remove non-working links

from the Journal of the American Medical Association
"Active Surveillance Compared With Initial Treatment for Men With Low-Risk Prostate Cancer A Decision Analysis"
JAMA Vol. 304, No. 21, December 1, 2010

To get the free abstract of the original article, go to
jama.ama-assn.org/cgi/content/short/304/21/2373?rss=1

You can also search on the title to find many news stories.

This study looks at quality of life for men with low risk PC (PSA <10 ng/mL,
stage <=T2a disease, and Gleason score <=6) and concludes that active surveillance is often a good choice.

Post Edited (geezer99) : 12/1/2010 10:58:13 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/1/2010 10:24 AM (GMT -6)   
Cant bring up either link without it wanting you to sign up, does it cost any money?
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

Fairwind
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Date Joined Jul 2010
Total Posts : 3887
   Posted 12/1/2010 11:37 AM (GMT -6)   
In my opinion, AS works FINE in many men with PC as long as they know FOR SURE what they are dealing with.. TRUS biopsies can and do miss a spot of higher Gleason grade cancer mixed in with the "indolent" Gleason 6....

A careful investigation of the exact nature of the total prostate should be done before any faith is put in AS.....

Again, in my opinion, having a biopsy every year and a PSA test every 4 or 6 months creates more anxiety then undergoing treatment..Age plays a key factor in making this decision...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 12/1/2010 12:17 PM (GMT -6)   
I agree with Fairwind. I just saw a post where the biopsy showed Gleason 6 and the pathology report came out as an 8. I wouldn't want to be on AS with Gleason 8.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 12/1/2010 12:51 PM (GMT -6)   
MY BAD

The links in the original post don't take you to free access.
To get the free abstract of the original article, go to
jama.ama-assn.org/cgi/content/short/304/21/2373?rss=1

You can also search on the title to find many news stories.
Active Surveillance Compared With Initial Treatment for Men With Low-Risk Prostate Cancer

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 12/1/2010 1:38 PM (GMT -6)   
This editorial comment on the article mentioned above was not freely available, so I wrote my own summary of it (Yes, that is legal under copyright law)
On the Active Surveillance of Prostate Cancer

Based on editorial comment in JAMA on the article
Active Surveillance Compared With Initial Treatment for Men With Low-Risk
Prostate Cancer: A Decision Analysis
JAMA 2010;304(21):2373. JAMA Julia H. Hayes et al.

Before the mid 1980’s, when PSA testing became available most prostate cancer was already metastatic when it was diagnosed. The introduction of PSA testing lead to a doubling of the rate of diagnosis of prostate cancer, but many more of these cancers were at a curable stage. In fact, from 1990 to 2006 deaths from prostate cancer declined 39% in the U.S.

The trend today is to do biopsies at lower PSA scores than in the past. It is also common to take more cores per biopsy. The standard now is 12 compared to 6 in the past. We see more cancers diagnosed after several negative biopsies and we see more low grade cancers being diagnosed. While some have raised concern about overtreatment, over 90% of patients with low grade cancer receive treatment, generally surgery or radiation.

Current studies of active surveillance, where the cancer is not treated unless there is rapid PSA raise, or increase in tumor volume or tumor grade, suggest that AS adds about 3% increase to the risk of cancer death within ten years.

The authors of the study above have used past studies and quality of life estimates to conclude that AS adds, on average, 6 months to quality life expectancy. Because quality of life is subject to many definitions, the authors tested their conclusions with a wide range of assumptions but came to essentially the same conclusion They did, however, note that for some AS patients, anxiety decreases the quality of life enough that immediate treatment may be indicated. There is also concern that biopsy may miss more aggressive cells – 25 to 38% of diagnoses are upgraded when the entire prostate is examined. Finally, repeated biopsy exposes the patient to increased risk of urinary infection.

There are developments in studies of biomarkers specific to indolent tumors. There are also new developments in imaging which allow directed biopsy. Both of these will help physicians and patients to make better decisions about active surveillance.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/1/2010 7:21 PM (GMT -6)   
This is a study that had no patients and attempted to model a hypothetical 65 year old patient with low risk PC. It also assumes QOL effects of having an untreated cancer while all other studies using real patients have found no difference in anxiety levels of those patients on AS and those that were treated. Since it is only a model I see little practicability of it in the real world. It does predict that the QOL for AS patients is better than those that have been treated; that should be a real shocker to the PC community.
JohnT
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.

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 12/1/2010 8:19 PM (GMT -6)   
John is correct -- this was a statistical analysis of existing data not an attempt to study new patients. The interesting part was the attempt to factor in quality of life and combine this with, what seem to me to be very solid probabilities of various outcomes. This was then combined with life expectancy predictions so that living fewer years in good health could be the equivalent of living more years in poor health. Thus, while active surveillance may slightly increase the risk of earlier death, it also increased the overall health before that death

Men were asked to rate quality of life on a scale from 0 (dead) to 1 (excellent health) here are some examples
Quality of life with
ED .88
incontinence .81
bowel problems .63
(lower numbers represent a poorer quality of life)

I think this is the kind of analysis that my grandfather made when his children urged him to change his unhealthy lifestyle: "You can watch to see how long I live, but also watch to see how happy"
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