Delayed Treatment After Active Survelience

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 12/13/2010 11:16 AM (GMT -6)   
A study posted on the New Prostate Cancer Info Link on the UCSF program on AS for intermediate and low risk PC confirms the same results that Hopkins and other institutions have found that delayed therapy after 3 years of Active Surveilence produces the same results as immediate treatment.
  • 113/376 low-risk patients (30 percent) and 32/90 of the intermediate-risk patients (35 percent) had opted to initiate treatment after some time on active surveillance.
  • Of the patients who had opted to initiate treatment by surgery (which was the most common form of therapy)
    • None were found to have lymph node positive disease.
    • None had had a post-surgical rise in their PSA level within 3 years of surgery.
  • The data has been pretty consistant in that about 1/3 of the patients on AS will at some point opt for treatment within three years (this is when most of the progressions are discovered) and there is no or very little added risk for the group of carefully selected patients who delay treatment. This is true for not only low risk patients, but also intermediate risk patients. I'm not recommending AS for intermediate risk patients unless they are older, but the data is becoming overwhelming that patients on a carefully monitored AS program when treated for any sign of progression fair just as well as those who were treated immediately.

    I know that many will find this hard to believe and think that AS is way to risky to even contemplate, but the data is consistant. Delayed treatment for the ones that progress is similar to immediate treatment, and 50% to 70% of those on AS show no sign of progression in up to 7 years, which are as far as current studies go.

    JohnT

     


    April6th
    Regular Member


    Date Joined May 2010
    Total Posts : 264
       Posted 12/13/2010 11:19 AM (GMT -6)   
    It would be interesting to see if the same results hold true 10 or 15 years post surgery. I hope they do.

    Dan
    Here are some of my stats:
    Age:54
    Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
    My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
    DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
    PCa diagnosed 4/6/10 after biopsy on 4/1/10
    1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
    Gleason 3+4
    Da Vinci surgery on 6/1/10
    Pathology report shows cancer confined to prostate and all other tissue clean
    PSA tested on 7/15/10: Zero Club membership card issued (trial membership with 90 day renewal)

    goodlife
    Veteran Member


    Date Joined May 2009
    Total Posts : 2691
       Posted 12/13/2010 12:24 PM (GMT -6)   
    John,

    I am wondering if this would also apply to adjuvant vs salvage radiation. I have seen some numbers that imply that adjuvant has a better odds of no BCR vs. salvage.

    I consider myself in an AS mode, waiting for an uptick in PSA before initiating phase II. Frankly with a G9, it may be a futile attempt anyway, so I am playing the QOL game as well.

    This study just kind of caught my eye.
    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

    John T
    Veteran Member


    Date Joined Nov 2008
    Total Posts : 4227
       Posted 12/13/2010 1:39 PM (GMT -6)   
    Goodlife, There are a lot of experts that believe that adjuvant or any type of combination treatment for high risk patients has the best results. Personnally if I were DXed with agressive PC, I would hit it with everything they have as early as possible, and that would include HT.
    Questions about it, most patients on AS do not have treatments, the number is somewhere between 30% and 50% with about 12% choosing treatments without any sign of progression. Most progressions are identified within three years, so most of the men stay on AS for the duration and are never treated. (Up to 8 years so far).
    "Why run the risk?" Because 50% to 70% never get treated and therefore have no side affects. If the side affects of treatments were benign like having your appendix out we wouldn't be having this discussion, but in most cases, low risk cancer, the treatment is worse than the cure. A better question would be "why run the risk of ED and incontinence" which is far, far greater than the risk of cancer spreading. The data shows that there is no risk in waiting and is pretty clear and confirmed by many institutions. Exactly what evidence do you need to prove there is little to no risk or is the mention of cancer so frightening that you have to treat it regardless of any evidence to the contrary? Many men feel the way you do about the unfounded risks of AS, because it goes agains everything we have ever heard about cancer.
    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.

    Tony Crispino
    Veteran Member


    Date Joined Dec 2006
    Total Posts : 8128
       Posted 12/13/2010 1:45 PM (GMT -6)   
    Here is the link to the article John posted about:

    prostatecancerinfolink.net/2010/12/11/11216/

    I posted two pennies worth myself. I think it's reasonable to not treat G7 prostate cancer if the patients health is poor and life expectancy is short. But as I posted in the thread at the InfoLink, I am glad I am not the test subject. It certainly is OK to not rush into any treatment and allow time for the patient to investigate all of his options.

    But I am getting concerned that doctors may in fact be pushing the envelope in trying to decipher who is a good candidate. Balancing "QoL" with a gray area seems like a risk I would never partake in. Increasing the risks with AS has to have at least some negative affect on QoL.

    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

    Ziggy9
    Veteran Member


    Date Joined Jul 2008
    Total Posts : 981
       Posted 12/13/2010 6:48 PM (GMT -6)   
    questionsaboutit said...
    Maybe, I really hope that those that choose AS don't find out, in 15 years or so , that the side effect of doing nothing is death. It will be a while before we know.

    It was not an option for me as I would have had a stroke worrying about it. Also, I had a palpable tumor which seems to have limited my choices.


    What is it about AS that you don't understand? It stands for Active Surveillance. Thus you are not going to go 15 years monitoring your PCA to all of a sudden have it kill you on the spot. Hell if you can go 15 years without treatment and thus no change in quality of life justifies it alone.

    It's normal for many here to justify their treatment by condemning others or especially AS. Those most vocal about it for some reason are many who have not been at this site long and soon are mass posting after treatment. I do hope your side effects get better but you shouldn't condemn those who aren't in a rush to experience and can live with PCa. You may think the surgery is still the gold standard and of course you know for sure after pathology blah blah blah. I know all the reasons men opt for it. But it's true that by not having radiation leaves it as a secondary treatment if necessary but most gloss over the fact it only has a 30% success rate. Many here who have had surgery find themselves soon after with systemic PCa, or lifelong effects. For those with low risk PCa many rather just worry about possiblities than have to wonder about incontinence that worse case scenario may never get better and likely long lasting ED and it's effect on relationships. All of a sudden 15 years of AS looks like a pretty good option IMHO over those.
    Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
    Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

    2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

    4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

    7/30/08 - Psa: .32
    11/10/08 - Psa.62 -
    April 2009 12 of 12 Negative Biopsy

    2/16/10 12 of 12 Negative Biopsy

    Tudpock18
    Forum Moderator


    Date Joined Sep 2008
    Total Posts : 4156
       Posted 12/13/2010 7:05 PM (GMT -6)   

    John, thanks for posting this.  This should be encouraging for those involved in or considering AS. This obviously confirms the existing research on low risk patients but this is the first data I have seen on intermediate risk patients.  As an intermediate risk patient myself (and a young 62 and healthy) I did not choose AS but it is VERY interesting to see data that indicates what might have happened if I had done so.  It will be interesting to see if other studies bear this out.

    Questions, AS is not "doing nothing"...in fact it is much different than that.  I understand that you would not meet the eligibility requirements anyway with a postive DRE and an admitted "get it out" attitude but we are all different.  I suggest you go back and read some of the other posts on HW on this subject and I think you may understand some of the thinking of men who have chosen that path.  Again, that doesn't mean it is for you but hopefully you will gain some perspective why it is a legitimate approach...

    Tudpock (Jim)


    Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
    http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

    Purgatory
    Elite Member


    Date Joined Oct 2008
    Total Posts : 25380
       Posted 12/13/2010 8:10 PM (GMT -6)   
    ziggy, that was a good answer to Questions, you got my thumbs up on that one.
    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

    John T
    Veteran Member


    Date Joined Nov 2008
    Total Posts : 4227
       Posted 12/13/2010 9:03 PM (GMT -6)   
    Tud,
    I was on AS unintentionally for at least 10 years and most likely 12 years with a G4+3. It may have started as a G6, but who knows. It looks like even after a delay of 10 years, treatment is having the same results as if I were treated 10 years ago, but 10 years ago radiation and robotics were not where they are today, and I would have most certaintly suffered some side affects that would have had an impact on my QOL for that 10 year period. The anxiety I felt during those 10 years with quarterly checkups is exactly the same as I have today after treatment whenever I get my psa tested. I asked my onco what would happen if I did nothing. He said I would most likely be symptom free for 10 more years.
    I wouldn't recommend AS for anyone who has intermediate risk PC unless they are in their 70's or in poor health, but the data is pretty interesting. I think the most important thing to take away is that PC is really not just one type of cancer, but a spectrum that goes from harmless to agressive and you have to fit the treatment to what you have and not treat all PC the same. For agressive, high risk PC I don't think that most patients are agressive enough in their primary treatment opting for a mono treatment rather than a combination and too agressive in their treatment of low risk PC.
    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.

    Ziggy9
    Veteran Member


    Date Joined Jul 2008
    Total Posts : 981
       Posted 12/14/2010 12:12 PM (GMT -6)   
    2senstivehere said...
    Ziggy,

    I think you are seeing insult where there is none. I could care less what option anyone chooses, I hope they all work for all of us. You are so sensitive about it, perhaps you have some doubts.



    I'm sensitive?? You're the one who has now changed his name and deleted his post in this thread. What do I have doubts about? I didn't do AS instead I was treated by TFT a far less invasive clinical study. Which many here thought I was crazy to risk. For me a less invasive treatment in an age of massive over treatment was a no brainer. That said as time has passed by and more information has come out I may have well chosen AS now with what I know. But the decision for me wasn't AS vs Radical treatments but what has been going on 3 years a very successful treatment whose only effect is maybe a 60% loss of ejaculate.

    What will you change your name to now in order to comment on your view of this forum?

    Oh and I almost forgot, thanks Dave.
    Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
    Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

    2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

    4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

    7/30/08 - Psa: .32
    11/10/08 - Psa.62 -
    April 2009 12 of 12 Negative Biopsy

    2/16/10 12 of 12 Negative Biopsy

    Post Edited (Ziggy9) : 12/14/2010 12:07:33 PM (GMT-7)


    Tim G
    Veteran Member


    Date Joined Jul 2006
    Total Posts : 2301
       Posted 12/14/2010 2:10 PM (GMT -6)   
    Ziggy9 said...
    I didn't do AS instead I was treated by TFT a far less invasive clinical study. Which many here thought I was crazy to risk. For me a less invasive treatment in an age of massive over treatment was a no brainer. That said as time has passed by and more information has come out I may have well chosen AS now with what I know. But the decision for me wasn't AS vs Radical treatments but what has been going on 3 years a very successful treatment whose only effect is maybe a 60% loss of ejaculate.


    As you point out, your treatment was part of a clinical study, which involves the risks of unproven over standardized treatments. Hindsight tends to be 20/20 if the experiment worked, but if not? Treatment is a very individual decision. All the best on your continued success!

    Post Edited (TimG) : 12/14/2010 1:13:17 PM (GMT-7)


    An38
    Veteran Member


    Date Joined Mar 2010
    Total Posts : 1148
       Posted 12/14/2010 2:23 PM (GMT -6)   
    John T said...
  • 113/376 low-risk patients (30 percent) and 32/90 of the intermediate-risk patients (35 percent) had opted to initiate treatment after some time on active surveillance.
  • Of the patients who had opted to initiate treatment by surgery (which was the most common form of therapy)
    • None were found to have lymph node positive disease.
    • None had had a post-surgical rise in their PSA level within 3 years of surgery.

    -----------------------------------------------------------------------

    Hi John,

    Your quote above is very encouraging for a case like ours. My husband Paul was a candidate for AS, apart from his age. Only 1/12 cores were positive with Gleason 3+3. Post surgery we are concerned that the ultrasensitive PSAs may be on their way up, best case scenario is that they are hovering around the 0.02/0.03 mark due to prostatic tissue left behind.

    So according to this study none of the people who were candidates for AS had post-surgical rises in their PSA levels for 3 years. I hope and pray that this will be the case for Paul.

    An

     

     


    Husband's age: 52. Sydney Australia.
    Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
    PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
    Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
    Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone.
    Post RP PSA,
    Lab 1: Sep10 – 0.02|Nov10 – 0.03
    Lab 2: Nov 10 - 0.01

    Post Edited (An38) : 12/14/2010 1:44:17 PM (GMT-7)


    Tudpock18
    Forum Moderator


    Date Joined Sep 2008
    Total Posts : 4156
       Posted 12/14/2010 2:37 PM (GMT -6)   
    An, I really had not thought about this study in the light you presented but I think you made a very good point.  That should definitely be encouraging to you and Paul.  Best wishes and prayers for continued success.
     
    Tudpock (Jim)

    Ziggy9
    Veteran Member


    Date Joined Jul 2008
    Total Posts : 981
       Posted 12/14/2010 11:32 PM (GMT -6)   
    TimG said...
    Ziggy9 said...
    I didn't do AS instead I was treated by TFT a far less invasive clinical study. Which many here thought I was crazy to risk. For me a less invasive treatment in an age of massive over treatment was a no brainer. That said as time has passed by and more information has come out I may have well chosen AS now with what I know. But the decision for me wasn't AS vs Radical treatments but what has been going on 3 years a very successful treatment whose only effect is maybe a 60% loss of ejaculate.


    As you point out, your treatment was part of a clinical study, which involves the risks of unproven over standardized treatments. Hindsight tends to be 20/20 if the experiment worked, but if not? Treatment is a very individual decision. All the best on your continued success!


    If not I still have all options available to me. We are all monitored from the study. In fact after my next semi annual checkup I'll likely just have an annual appointment. Like I said a no brainer as far as I was concerned compared to radical surgery, which I still have as an option if ever needed. I never saw it as a huge risk and still don't. As lumpectomies took over radical breast cancer surgery for many expect TFT to have a similar outcome soon. They are now also doing it with a laser. Time moves on and so do treatments. That alone is a probable better outcome to those doing AS, that if treatment is needed later it will be more advanced than what is now available to most men.
    Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
    Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

    2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

    4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

    7/30/08 - Psa: .32
    11/10/08 - Psa.62 -
    April 2009 12 of 12 Negative Biopsy

    2/16/10 12 of 12 Negative Biopsy

    Tim G
    Veteran Member


    Date Joined Jul 2006
    Total Posts : 2301
       Posted 12/15/2010 7:35 PM (GMT -6)   
    Ziggy,
     
    This new therapy (TFT) sounds very promising, especially with your good results.  Do you know if it is expected to be made more widely available, or is it still in the study phase? 
     
    Tim

    Jazzman1
    Veteran Member


    Date Joined Sep 2010
    Total Posts : 1160
       Posted 12/15/2010 7:59 PM (GMT -6)   
    John T's just about got me convinced with his usual impeccable logic. I'm about ready to go with AS if I can just find out where to apply to get my old prostate back, but there's one question I simply can't get past.

    John T advocates AS for low risk PCa patients, but wouldn't recommend it for intermediate risk patients unless their in their '70s or in poor health. Fair enough, but my biopsy indicated that I had a G6 cancer while the post surgical pathology indicated G7.

    Was I low risk or medium risk, and how was I to know for sure?
    Age 55
    PSA: 8/09 2.69 -- 7/10 4.00 -- 8/10 4.11
    --------------------------------------------------
    Biopsy 8/10
    Three of 14 cores positive: 10%, 60% & 80%
    Stage T1C; Gleason 6
    ---------------------------------------------------------------
    open radical prostatectomy at Cleveland Clinic 11/2/10
    Post-surgical pathology: Gleason 7 (3+4)
    Three positive margins; Stage T2c(+)
    12/7/10 PSA: <.03

    Purgatory
    Elite Member


    Date Joined Oct 2008
    Total Posts : 25380
       Posted 12/15/2010 8:12 PM (GMT -6)   
    Jazz, that is one of the risks of doing AS that not even your doctor could answer, its not uncommon to have an upgraded Gleason post surgery.
    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

    John T
    Veteran Member


    Date Joined Nov 2008
    Total Posts : 4227
       Posted 12/15/2010 8:34 PM (GMT -6)   
    Jazzman,
    A follow up biopsy or a continuning rise in PSA would have triggered a treatment. Most of these occur within 3 years. You were borderline AS with a 60% and 80% involvement. Your psa was rising faster than .75 ng per year. Your psa doubling time also was lower than 3 years which would have also kicked off treatment. The way your stats were trending, treatment would have been triggered shortly.
    Clincicaly you were low risk, pathologically intermediate or high risk because of the positive margins. Personnally I would never go on AS without first getting a color doppler or an MRIS. In fact I would never consider any treatment without them. In all probability either scan would have indicated the possibility of a positive margin and you could have chosen a treatment based on that information. It is very doubtful that after having either scan you would have been a candidate for AS.
    I don't know how large your prostate was, but if it were smaller than 27cc then you would also not have been a candidate as psa would have exceeded 1.5 X prostate size.
    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.

    BuiDoi
    Regular Member


    Date Joined Aug 2010
    Total Posts : 234
       Posted 12/15/2010 11:29 PM (GMT -6)   
    Ziggy9 said...
    But it's true that by not having radiation leaves it as a secondary treatment if necessary but most gloss over the fact it only has a 30% success rate.


    As a relative newbie, do I assume that you are saying that RADIATION only has a 30% Success rate.. A very good reason for NOT considering it as a first step, if it means that surgery is pretty much OUT after Radiation, and Radiation only starts the problems of Incontinence and ED, which I understand, creep up over the next few years..

    [Quote]Many here who have had surgery, find themselves soon after with systemic PCa, or lifelong effects.
    Could I suggest that there should be a special qualification to that comment.. Most Folk hanging out here have a problem. By far the greater number of those who have surgery, never come back here.. The general statistics suggest that 95% can be guaranteed a normal life after an RP. That may be questioned by the percentage, for whom Incontinence and ED are an issue, but they still know that there is only a 5% chance of Systemic PCa.


    [quote]For those with low risk PCa, many rather just worry about possiblities than have to wonder about incontinence that worse case scenario may never get better and likely long lasting ED and it's effect on relationships. All of a sudden 15 years of AS looks like a pretty good option IMHO over those.
    Yes - that is the whole problem.. How does one define QOL... Sleeping well in the belief that I have a 5% chance of failure, or stressing the heart with the fear that the PSA will JUMP just after my next PSA test and that it might have escaped, by the time I have another.

    Still - JohnT's observations are reassuring that given the RIGHT circumstances, AS can be a positive thing, if the patient has a positive attitude..

    It's normal for many here to justify their treatment by condemning others or especially AS. Those most vocal about it for some reason are many who have not been at this site long and soon are mass posting after treatment. I do hope your side effects get better but you shouldn't condemn those who aren't in a rush to experience and can live with PCa.
    I suppose that many could be hurt by being criticised for their treatment decision (or lack of it ), by those who are convinced that statistically, the risk is NOT there in the first place, and that AS is the way to go. It's a two way street !

    I would have thought that each is likely trying to justify their choice, and that NEITHER is critical of the other... Just trying to ensure that a third-part, sitting back and observing, is aware of ALL the issues..

    Like folk talking about Radiation, and how minimal invasive it is and how few the side effects are, but omit to mention that once irradiated, the goose is cooked and it's pretty much down hill from there until after three years, you are pretty much where the RP chap starts with lots of hope.. ( or that's at least as I have been told by Professors of Radiation - DON'T have radiation ! except ...... )

    I would have been OK with AS, but ED would have been an absolute certainty, after castration by the bride, if I did not get cut and, after the Onc. told us of the prognosis.. Now, ED is a 50/50 thing, and I still have the family jewels !
    Where there are Jewels - there's hope !

    NO - I would hate to think that ANYONE reads discussion as criticism of personal choice.
    Many of us Newbies might be just trying to convince ourselves that WE made the best choice for our situation.. Just as the Oldbies are convinced that they are right, whilst they await that NEXT PSA...

    .
    .
    Nov 2009 = First-PSA 5.3 @ 60yo - Asymptomatic - DRE-Non-Palpable
    Jan-'10 = TRUS Bx DX - AC T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
    May-'10 = RRP-Nrv-Spare
    Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
    MI(xtensive) Post, Grade3 x 8mm
    +8week PSA<0.01, ED-85%, Incont-30%
    +16W PSA<0.01, ED -85%, Cont -5%
    +17W First 'DRY' day. ED -90%
    +26W ED -60%

    Alegar
    Regular Member


    Date Joined Oct 2010
    Total Posts : 91
       Posted 12/16/2010 9:14 AM (GMT -6)   
    Well said, BuiDoi!
    Diagnosis:
    July 1, '10
    PSA 3.88
    Gleason 3+3=6
    2 out of 12 samples positive

    Solution:
    DaVinci Oct 1 '10, UNC Chapel Hill
    Cath/JP Drain out Oct.16, '10

    Personal Statistics:
    Age: 54
    Weight: 184 lbs.
    Height: 6 feet

    AIRBORNE ALL THE WAY!

    Julietinthewoods
    Regular Member


    Date Joined Sep 2010
    Total Posts : 309
       Posted 12/16/2010 9:31 AM (GMT -6)   
    Actually, I think Ziggy might have meant that the success rate of radiation following surgery is not that high. We were told that by both our urologist and the radiation oncologist during our consultations. Neither doctor (one of whom is a surgeon) pushed us in any direction, but were trying to point out that the 'radiation as a backup for failed surgery' wasn't the best reason to choose surgery. I also read this in a book I picked up.

    Success rates for radiation as a first choice therapy (for those carefully chosen candidates) are certainly better than 30%. And the 'goose is cooked....pretty much downhill from there' comment is, in my opinion, unfounded.

    As to the original question regarding AS, I KNOW my husband would have chosen it if he had been able.

    Juliet

    Ziggy9
    Veteran Member


    Date Joined Jul 2008
    Total Posts : 981
       Posted 12/16/2010 9:51 AM (GMT -6)   
    Julietinthewoods said...
    Actually, I think Ziggy might have meant that the success rate of radiation following surgery is not that high. We were told that by both our urologist and the radiation oncologist during our consultations. Neither doctor (one of whom is a surgeon) pushed us in any direction, but were trying to point out that the 'radiation as a backup for failed surgery' wasn't the best reason to choose surgery. I also read this in a book I picked up.



    Juliet


    Yes that's exactly what I am saying. I mentioned that because many men here in the past have used radiation as a second treatment post failed surgery as a prime reason to chose radical surgery. Only to gloss over and/or ignore the 70% failure rate of it then. As a first treatment for those with low risk numbers have shown it to be about identical with those who opt for surgery less although sometimes with delayed ED effects.

    Post Edited (Ziggy9) : 12/16/2010 9:09:39 AM (GMT-7)


    Ziggy9
    Veteran Member


    Date Joined Jul 2008
    Total Posts : 981
       Posted 12/16/2010 10:08 AM (GMT -6)   
    TimG said...
    Ziggy,


    This new therapy (TFT) sounds very promising, especially with your good results. Do you know if it is expected to be made more widely available, or is it still in the study phase?



    Tim


    I expect it to be more widely available. I'll ask my doctor next time I see him. It's received more and more press as time goes by. There is of course much push back from those paying off DaVinci machines. The current stage of PCa is a cash cow where many will resist less costly and invasive treatments for sake of the bottom line. In fact my insurance paid for the procedure and only balked at the 3D saturation mapping biopsy until its purpose relevant to TFT was explained to them on appeal and then approved. The targeted cryosurgery was never a problem nor would I believe it also being done by laser now.
    Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
    Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

    2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

    4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

    7/30/08 - Psa: .32
    11/10/08 - Psa.62 -
    April 2009 12 of 12 Negative Biopsy

    2/16/10 12 of 12 Negative Biopsy

    Post Edited (Ziggy9) : 12/16/2010 9:11:46 AM (GMT-7)


    brb0923
    Regular Member


    Date Joined Jan 2009
    Total Posts : 32
       Posted 12/16/2010 11:57 AM (GMT -6)   
    I have been doing AS for a couple of years with no change.
    Here is another good reason to wait if possible.
    Research is always ongoing. check out this link.

    http://www.freep.com/article/20101216/FEATURES08/101216047/1320/Prostate-cancer-treatment-hailed-as-new-era

    John T
    Veteran Member


    Date Joined Nov 2008
    Total Posts : 4227
       Posted 12/16/2010 12:12 PM (GMT -6)   
    Buidoi,
    You seem to have picked up some misconceptions about radiation. First of all the cure rates are similar to surgery and in many cases better among all risk catagories and the side affects are generally better, absolutely in the short term and most likely in the long term.
    The prime reason surgery fails for non systemic cases are that every surgery leaves a small amount of prostate tissue around the nerves and in the APEX, or there is a small margin of PC cells in the prostate bed. This can be cured by salvage radiation, but would have been easily taken care of with radiation as a primary treatment.
    There are also many alternatives to failed radiation for localized PC, seeding, HDR Brachytherapy, cryosurgery that all have the exact same cure rates as salvage radiation after surgery.
    The incidence of incontinence is very rare with radiation as opposed to surgery and ED rates are slightly better at the 3 years mark and are more responsive to medications than ED from surgery. There is a slightly higher risk of bowel issues from radiation. With seeding, incontinence and bowel issues are rare, because the radiation only effects 1mm from any seed.
    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.
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