Swedish study on surgery/AS

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davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 5/5/2011 5:37 PM (GMT -6)   

Sleepless09
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Date Joined Jul 2009
Total Posts : 1267
   Posted 5/5/2011 5:42 PM (GMT -6)   
Hi David, this looks to have much more perspective to the report than the link posted a couple of days ago --- best I can tell from a quick look.

Thanks !

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 5/5/2011 5:43 PM (GMT -6)   
haven't been around for a while. Sorry if it was already discussed.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Sleepless09
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Date Joined Jul 2009
Total Posts : 1267
   Posted 5/5/2011 5:53 PM (GMT -6)   
Don't be sorry. A) there are days when I don't get here and posts with great information are three pages back and I never get to see them --- so I'm always glad to see a topic come back up. If I don't want to read, I don't have to. B) There are cases like this where a different link puts a different perspective on news and that's welcome too.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 5/5/2011 8:45 PM (GMT -6)   
Davidg,
You are confusing Watchful Waiting with Active Survelience. They are totally different and the Swedish study is on Watchful Waiting.
AS is the process of closely monitoring the progresson of one's low grade cancer for signs of progression. It is well established that 30% will progress and 70% will not. On any sign of progression the patient is treated. Delayed treatment of these patients has the same result as immediate treatment.
In watchful waiting there is no plan to treat with a curative intent on signs of progression. It should be expected that any treatment would result in 30% improvement, because we know that 30% will eventually progress.
AS's intent is to identify these 30% so they can be treated leaving the 70% who need no treatment free of all the side effects that any treatment entails.
These two terms are often used interchangably but they are totally different protocols with completely different results.
JT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/5/2011 9:24 PM (GMT -6)   
I think that the difference between WW and AS are the interpretation of the reader and the doctor. There are varying ways to do AS and WW and even doctors don't necessarily differentiate the two terms.

That stated, this study was a do nothing until symptoms study and it is called WW in the study. Regardless of the terminology or interpretation, what we see here is if we do not screen, then we are in the WW category involuntarily and just by applying treatment, even when the stage advances, there is an undeniable survival benefit to therapy for "early" stage low risk, intermediate risk, and high risk prostate cancer.

I think with more time we will verify that we are missing very important information about WW and AS...

Stay tuned...for fifteen or so years.

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/6/2011 12:22 AM (GMT -6)   
This is a followup report of the Scandinavian trial that has been discussed before. The difference is extending the results out to 15 years of followup:

www.nejm.org/doi/full/10.1056/NEJMoa1011967?query=featured_home

The full article isn't yet available on line for free. The last previous report is

www.nejm.org.offcampus.lib.washington.edu/doi/full/10.1056/NEJMoa043739.

These are men with prostate cancer detected mostly based on symptoms or digital exam; at the time the study was done, there wasn't much PSA screening going on in Scandinavia. They were randomized between surgery and watchfull waiting. "Watchful waiting" means no surgery initially, but the men could have surgery or other treatments later. This wasn't intended to be a study of watchful waiting or AS, because many of these men wouldn't qualify for AS. It really was intended to be a randomized controlled study to see if surgery works, that is, keeps people from dying. The answer is, yes, somewhat, if you are less than 65 at the time of treatment.
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