15 Year Results of Radical Prostectomy. A rather large study.

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ChrisR
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   Posted 1/21/2011 3:11 PM (GMT -6)   

Purgatory
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Total Posts : 25394
   Posted 1/21/2011 3:16 PM (GMT -6)   
interesting read, thanks chris
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

Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2461
   Posted 1/21/2011 3:25 PM (GMT -6)   
Thanks for posting this Chris. I wonder when will the Kattan nomogram will be updated.
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

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 1/21/2011 3:56 PM (GMT -6)   
Great news for the confined G6 patients whose death rate was .0003.
Hopefully this will reduce some stress for the low risk guys.
It confirms that the biology of the cancer has much more to do with the death rate than the treatment option itself.
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.

Radical
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Date Joined Mar 2009
Total Posts : 739
   Posted 1/21/2011 4:30 PM (GMT -6)   
Tks Chris, certainly worth a read, looking forward to the new nomograms.
..............Kev

anxiety out the roof
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Date Joined Aug 2010
Total Posts : 111
   Posted 1/21/2011 4:53 PM (GMT -6)   
Thanks Chris- eases my mind alot.

Tim G
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Date Joined Jul 2006
Total Posts : 2366
   Posted 1/21/2011 4:54 PM (GMT -6)   
Good information, Chris. I've always been at 99% on post-prostatectomy predictive nomograms. Now I'm at 99.9997%!

Post Edited (TimG) : 1/21/2011 8:06:35 PM (GMT-7)


ChrisR
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Date Joined Apr 2008
Total Posts : 832
   Posted 1/21/2011 5:20 PM (GMT -6)   
I have always been living on the G6 stats. from Johns Hopkins that said 99.6% cure and no deaths 15 years out from treatment. What bothered me was I was never able to find anyone else with similar results. This makes me feel a little better at least for the next 13 years anyway. But hey I can't complain compared what others are facing here. Other then I had such a young age at diagnosis.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/21/2011 7:07 PM (GMT -6)   
As "good" as the news is for the G6 guys, the paper (not truly a study) does draw my attention to the 7% mortality rate projected. This does not surprise me but it clearly indicates that there is a significant increase in mortality rate when compared to ten year studies. I know it's improper to draw conclusions between two unconnected studies but there is a "factual" number used by the US Preventative Services Task Force and that is of all men diagnosed in the US about 3% will die from prostate cancer specific mortality. This paper suggests a significant increase in the mortality rate for those who survive long enough. This continues to strengthen my belief that we need longer study periods, preferably with Level 1 evidence.

Just an observation from someone who would like to live a lot longer than 15 years after RP...

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

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 496
   Posted 1/21/2011 9:24 PM (GMT -6)   
With such an infinitesimal death rate from PCa after 15 years for G6 men it is reasonable to ask just how many of them went to surgery prematurely.

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 1/21/2011 9:37 PM (GMT -6)   
Tony,
I think your numbers are a little off. If 3% of all deaths are caused by PC and 1 in 6 men (17%) are dxed with pc then the rate of death of thoses Dxed is 17%. So the rates projected are lower than the current rates. It's really not apples to apples because the study relates to surgically treated men. There are a lot of advanced PC cases that are Dxed that are never treated with a curative intent.
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 1/21/2011 10:52 PM (GMT -6)   
No John,
I may have to introduce you to funny math used by the USPSTF, CDC and the FDA. I have it right. The mortality rate from prostate cancer is about 3% in the US as reported by those agencies. This is the total calculation of men currently living with prostate cancer calculated against the number that dies of prostate cancer specific mortality (PCSM). Mike acknowledges those numbers in the comments section of the above link though he says I should not make the comparison and I know he is probably right, as usual. When I had Mike out to speak for our group in Vegas and he talked about how it is calculated and he left just about everybody confused...

To me the actual mortality rate is closer to 14%. 28,000 will die this year, 230,000 will be diagnosed. But I have had my hand slapped numerous times by my British buddy that we don't calculate rates that way. The fact is that if 28,000 die this year and that means the 202,000 survived and they get added onto the cohort that survived last year and the year before, and before...and so on. So when you look at a group in this 15 year projection and the rate is 7%, it is a higher rate than the USPSTF numbers. That is because they still include the guys that have not lived as yet for 15 years with the disease.

My take on this "predictive" information is that most ten year studies will always be short of predicting actual mortality rates. That is why I don't like them. Biochemical failure is not the true story, prostate cancer specific mortality is. Guys can outlive their relapses easily, in fact they are more likely to. (Remember the statement "you are more likely to die with prostate cancer than because of it")

Tony

Post Edited (TC-LasVegas) : 1/22/2011 12:08:55 AM (GMT-7)


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 496
   Posted 1/22/2011 11:50 AM (GMT -6)   
An important message from this research, noted at the first post in the thread, is that the mortality from prostate cancer is significantly and dramatically different depending on the Gleason score and not the treatment. This is borne out over every research involving our disease. Thus the type of treatment selected is not the major factor in survival. The men who were G8-10 had the same treatment by the same doctors at the same hospital. They died in manifold more numbers. This was not because of the treatment but because of the underlying condition of the disease. Thus, where should the surgeon focus his efforts and where should he caution awareness, AS, monitoring and deliberation before treatment?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/22/2011 12:05 PM (GMT -6)   
Tony,
I always thought that the 3% number referred to the number of total deaths in men caused by prostate cancer to the number of total deaths from all causes annually. Am I mistaken?
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
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/22/2011 12:58 PM (GMT -6)   
John,
The statistic that I am referring to is 3 in 100 men diagnosed with prostate cancer will die of PCSM.

Tony

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 1/22/2011 8:35 PM (GMT -6)   
Tony,
I have to believe the number is far greater than 3%. 14% to 17% is much more likely.
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.

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 832
   Posted 1/23/2011 5:54 AM (GMT -6)   
One thing I have realized is that until the mortality rate is 0 I will constantly live in fear. Since nobody is ever able to tell you which side of the percentages you are on they might as well be 50/50 all the time. You don't know where you will fall. Every PSA test is a crap shoot. Even if the mortality rate was .5% after 15 years, you don't know if you will be one of those .5%  Even at .5% I would still worry about it, because the possibility is still there. We are all at risk of progression and death.

Also, I am not sure why we spend so much time trying to figure out what the exact number is when we don't know which side of the percentages we will be on. Someone said something pretty wise to me once, and that was. What if they could tell you exactly what your risk of mortality was in say 15 years and it was not 0. What would you do about it? Nothing. No matter what the risk is, there is nothing I can do about it. Not a thing. So it doesn't really matter if it's 3% or 7% or 50%.  The fact is there is a chance of death from it.

Again, even though I am a G6 "low risk" person, it doesn't mean that it is impossible that I won't ever have recurrence and die from PCa. Being "low risk" doesn't make having PCa any less stressful for me.

Post Edited (ChrisR) : 1/23/2011 7:33:06 AM (GMT-7)


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 832
   Posted 1/23/2011 9:34 AM (GMT -6)   
questionaboutit,

That is interesting, I have never heard of anyone with G6 dying in such a short time frame. Not that I know everything.

Strange.
Dx @ 42years old on 4/2008
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 -

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 1/23/2011 12:12 PM (GMT -6)   
ChrisR wrote: "One thing I have realized is that until the mortality rate is 0 I will constantly live in fear."

With respect, you can't possibly mean that. It's not as if you were immortal until you got prostate cancer and now you are going to die. We're all going to die, the only unknowns are how and when. And how we live our lives until we die.

Fear of what?

Death - why would death trigger fear? Regret or wistfulness, maybe, but fear? Our cells are programmed to die, it is a perfectly natural process. Were you afraid of being born?

The pain that often precedes death? Pain is also part of life, but in any event experiencing the pain of terminal cancer is voluntary, not required.

Constantly live in wonder, not fear. From wonder to wonder existence opens.

Zen9

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 1/23/2011 12:49 PM (GMT -6)   
Chris,
In Klotz's studies there were 1.7% of G6s that resulted in death within 5 years REGARDLESS of treatment. These are varients and they appear to be G6 but are really not, but are agressive forms PC that are difficult to contain even in the very early stages.
350,000 men die of heart disease and 89,000 of lung cancer compared to 27,000 from PC. Flu causes the same amount of deaths as PC.
Living in fear of something that has an extremely low probability of ever happening will cause stress and increase the probability of dieing from something else like heart disease.
The chances are 99.9% that you will die from something other than PC and 100% that you will die. Your fear of death from PC is understandable, but logically very unreasonable.
Taking resonable steps, stopping smoking and eating healthly, getting flu shots, driving safely and excercising will have much more impact of you living a long life than worring about your low risk PC.
It is a pretty well established fact that those that are Dxed with PC live longer than those that are not DXed. This is becases they are now in the medical system and get regualr screenings that uncover other much more serious condidtions that can be treated. Instead of fearing PC you should be greatful that you actually will live longer because of your DX.
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.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/23/2011 1:32 PM (GMT -6)   
Zen, very good post, well thought out answer, 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

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/23/2011 2:07 PM (GMT -6)   
I know of a few cases of G6 that were just nasty. One guy had RP that verified G6 and contained. 18 months is all he got with it.

But the points being made here are right. We can't be all worried about prostate cancer. I hear many here talking about quality of life when selecting therapies and I think not addressing stress is about the worst thing you can do to QoL. It just isn't worth the worry when you can still get out an enjoy family, friends and life.

Peace to you all...

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

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 832
   Posted 1/23/2011 3:28 PM (GMT -6)   
I think we are all afraid of dying or most of us would not be here. I am sure conversing about PCa is not anyones idea of fun. How many people joined this forum before they were dx. I bet none. Yea, I know I was going to die someday, but thought it was far off. Like most people I always thought that if I was careful and did not do anything really stupid there is no reason I would die young. That is until I met Mr. Cancer. It does not discriminate or care who or what age you are and anyone is capable of being struck down within 6 months in anytime in their life. I guess I fell victum to believing what I read in the press about things like "early dectection saves lives." And once you start reading about cancer and how many people never had a chance in heck no matter when they were dx. you become disillusioned. Especially, when we are constantly reminded that "screening for PCa" has not been proven to reduce mortality. It's not that I believed everything I read in the "paper", but I did think that the medical community was much more controlled about the information that they released to the public. And I believed they practiced a higher standard of professionalism. Yea, I was dupted.

Anyway, once of the things I have often thought about and even considered posting a topic here, was "What if they cured it tomorrow." My problem would not be solved. My life would not go back to the way it was before I was dx. I now worry about all the other cancers I could get and am constantly on high alert for any symptom. I realize that my problem is not PCa, it is dying. There are many coping stratagies developed for people who are dying. Unfortunately, they don't work for me. I lately have tried to turn my focus on dealing with my own death and not PCa, but it is a slow transition.

Like many people here, I have family I don't want my death to affect. Mainly my two young children. I am sort of comfortable that PCa won't get me before they are 18.  They are 5 and 9.
 
JohnT,

I have read the same thing that some studies have suggested that PCa people actually live longer then the general population because they become more health consicious. (sp) My PCa has caused me to clean up a few things in my blood work, that my PCP was not worried about. But, on the other had if you think about it dropping dead of a heart attach is really the way to go. Short amount of pain, no expensive hospital stay and you don't see it coming so you dont fret over it. Now I am taking care of my health so that won't happen so I can live longer and will probably die of another type of cancer instead. Because as we all know all of us are going to die of something.  Ironic isn't it?

Post Edited (ChrisR) : 1/23/2011 1:32:00 PM (GMT-7)


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2366
   Posted 1/23/2011 5:38 PM (GMT -6)   
Stress is definitely a quality of life issue and was part of my decision to treat my prostate cancer rather than use active surveillance.   Also, my family genetics includes a significant number of long-lived relatives.  I didn't want prostate cancer to take me out early.  I have no medical issues at age 62 and take good care of my health.

maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 789
   Posted 1/27/2011 7:34 PM (GMT -6)   
My reasoning, be it right or wrong is, sure I have PCa, and it is going somewhat in the wrong direction, latest 0.7 (up from 0.6) what is the use of worrying myself sick? I am 70, and too much stress and worry could manifest itself on my old body creating other problems for me, I am too busy living life, and have not got the time to waste, so I just enjoy my bowls, bike riding, fishing, family and granchildren, every now and then I go see my doctors, (6 monthly now) I get a bit anxious on the day, then put it out of my mind until next time, what will be will be, I have little or no control, so on with life! yeah

Regards Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept. Totally dry since catheter removed
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA from 30th April 08, until now range- 0.5 to 0.6, I am now 70
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