The other story form Johns Hopkins about my previous post on 10 year PSA testing.

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ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 2/23/2011 4:15 PM (GMT -6)   
Here is the actual article from Johns Hopkins.
 
It paints a different picture.....
 
 
 
The highlight of this study is that if you can get to 10 years with an undetecable PSA, your chance of death from prostate cancer in the next 10 years is basically 0.  None of their patients died of PCa.

Post Edited (ChrisR) : 2/23/2011 4:04:41 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/23/2011 5:10 PM (GMT -6)   
I think the article makes a good and fair point, and should be encouraging to anyone that has been avoiding BCR long term.
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

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 2/24/2011 8:59 AM (GMT -6)   
Chris: This article makes far more sense than the one written by someone else who used Dr. Loeb's quote in a less understandable way.

I believe the data came from a previous study where a group of Gleason 6 people were evaluated for BCR after surgery. This article may refer to the same data set. Only right at the last line does it point to Gleason 6 patients which makes me remember that an early Hopkins study evaluated around 1,593 people.

While the study focuses on Gleason 6 low PSA category but left room for the early surgical patients who had some positive margin, sem ves, lymph but were initially graded as Gleason 6 patients with some questionable pathology scores. That does give this study some wiggle room for men with some pathology issues.

The final implication gives one greatest room to pause. The study was restricted to high volume academic centers. It that just a disclaimer that the study has natural boundaries because only men who went to academic centers were considered or does it have a larger implication that men who receive surgery outside of major large academic centers do not fare as well in post surgical problems as those who go to high volume academic centers?

Collecting enough data from so many smaller hospitals would be painstaking and expensive. Walsh does imply in his book that results do vary and indicates that lower volume surgeons and those who have lesser opportunities to do RP surgery don't get the same high end results. Can one assume that low experience surgeons do not practice in large high volume academic facilities?

However, we know that from experience and advice here on HW the theme is consistent. The mantra is to pick a surgeon with lots of experience, especially when selecting robotic surgery. Being good at open surgery does not mean the results are the same as robotic until the learning curve is overcome with the equipment.
Dx 56
Biopsy: Gleason 3+3=6, PSA 6.6 One core of 12 with 5% T1c
Surgery: July 2010 J. Hopkins
Pathology Gleason 6, Neg Mar, Neg LN, Neg Sem Vesicles
9/15/10 1st post op PSA >0.1 undetectable
3/11/11 PSA - TBD
Incontinence - very slow recovery
Aug -Sept 2010 - 4-5 pads
Oct 2010 3 pads
Nov 2010 2 pads
Dec - Feb 2011 1 pad all day - 1 pad at night
ED: slow improvements

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 2/24/2011 10:54 AM (GMT -6)   
Perhaps I should rest my case with the following link from the Washington Post.

www.washingtonpost.com/wp-dyn/content/article/2011/02/24/AR2011022402599.html?wprss=rss_metro

So it appears that not all hospitals have the same standards of care, but we all knew that even without being treated for any illness.

Noting specific about prostate surgery in the Washington Post article, but surgical bleeding was listed. It was a notorious issue in prostate surgery before the modern era of urological advances in medicine. It could adversely determine the outcome of an operation both by blood loss and failure to remove the entire prostate during the procedure.

Hoping you all pick good hospitals when considering treatments....

Mike S.
Dx 56
Biopsy: Gleason 3+3=6, PSA 6.6 One core of 12 with 5% T1c
Surgery: July 2010 J. Hopkins
Pathology Gleason 6, Neg Mar, Neg LN, Neg Sem Vesicles
9/15/10 1st post op PSA >0.1 undetectable
3/11/11 PSA - TBD
Incontinence - very slow recovery
Aug -Sept 2010 - 4-5 pads
Oct 2010 3 pads
Nov 2010 2 pads
Dec - Feb 2011 1 pad all day - 1 pad at night
ED: slow improvements
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