PSA Testing Saves Lives...Incredible!

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ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 5/19/2011 11:51 AM (GMT -6)   
Finally some common sense...watch this interesting webcast:
Ramon Guiteras Lecture: Early Diagnosis of Prostate Cancer through PSA Testing Saves Lives
William J. Catalona, MD


tinyurl.com/3cagmep

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/19/2011 11:55 AM (GMT -6)   
I sure didn't need convincing, thanks for posting it
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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/19/2011 12:18 PM (GMT -6)   
Ralph,
It's important to note that PSA research was largely conducted by Catalona in the 80's. Some consider his findings biased.

But not me. I consider him an elder statesman with strong insight on PSA screening.

This presentation is consistent with even the ERSPC findings that showed extending the timeline of the trial from 9 year to 12 years, announced earlier this year, showed the number dropping drastically for the number needed to be treated from 1 in 48 to 1 in 24 NNT to save a single life. The suggestion is to extend the trial to 15 or 20 years and the number should drop below 1 in as low as FOUR will reap benefit of screening and treatment.

Ralph this also challenges studies comparing active surveillance to treated arms in studies. The longer you extend the trials the more treatment appears to be beneficial. Trials on AS that show little difference at year ten are going to not be as positive for year 15 and 20. There will be continued debate until we have that data as to whether deciding to go with AS for say 7 years does no harm at year 15. We don't know we do not have that data.

The fact is if life expectancy is less than 10 years ~ the above findings means it can be quite safe to skip further screening or to go with AS if low risk prostate cancer is found in screening but doesn't apply unilaterally. What's more these numbers as posted in the USA and European studies on screening as released in the NEJM in 2009 would never apply to someone under the median age of diagnosis (67 years old) and has no other morbidities. And someone under 60 needs to understand that the data to get him to 80 does not exist in screening or in AS studies...

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

Post Edited (TC-LasVegas) : 5/19/2011 12:31:10 PM (GMT-6)


ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 5/19/2011 12:48 PM (GMT -6)   
Tony,
I think that Dr. Catalona’s presentation provides a strong viewpoint to address the current opposition to PSA testing that has eventually resulted in less men here being tested with PSA. If this trend continues rather than a wise application of the test, more men will die unnecessarily. His presentation supported the use of AS by pointing to the results of the Goteborg screening trial. The 44% reduction in PCa mortality was achieved when 28% of the screened men were undergoing AS. This is an indication that AS is a great option for men who are diagnosed early with minimal disease.

In the absence of PSA testing in the USA, the mortality rate in the early 90s would have prevailed and many more men would be dying of PCa presently. In spite of the lack of specificity, PSA used wisely can avoid overtreatment and save lives. I think that Dr. Catalona’s view is correct and wish more practitioners would support his views and save lives...

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 5/19/2011 3:27 PM (GMT -6)   
Tony,
I have no problem believing that the longer you go the greater chance of having PC grow, But if the Hopkins studies are correct in that patients treated after being on AS for a number of years have similar results to being treated immediiately this means that a very high proportion of patients can safely avoid all side affect for a good number of years and perhaps for their entire lives with little or no added risk. If monitored properly a good doctor can pick up changes in growth. AS doesn't necessarly mean going foverever without treatment or eliminating all risks. As the study pointed out there were still risks for those opting for surgery. No option contains a garantee of success. I have never had an issue with screeing and it makes a lot of sense.
There are a lot of models that predict future reoccurrance based on 7-10 year data. They all show that the longer you go the less chance of reoccurrance and in no case doe the roccurrance rates rise after 5 years (except HIFU). There will always be some long term reoccurrances after any treatment, but there is no data to suggest that at year 15 or year 20 your risks of reoccurrance go up, they continue to decrease with the passage of time, but never go to zero. I also believe that with AS the pasage of time will increase risks, but most of the progressions are found within the 1st three years. The problem is not screening, but giving low risk patients all the information they need to make good choices.

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.

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/19/2011 5:10 PM (GMT -6)   
The Scandinavian study www.ncbi.nlm.nih.gov/pubmed/21542742 shows a steady rate of recurrence over 15 years, in both the surgical and watchful waiting group. The rate of recurrence doesn't increase or decrease over time. Because the slopes of the curves (the rate of recurrence) are different for the surgical and watchful waiting group, the benefit of treatment increases slowly the longer the followup. The number to treat to prevent one death with 15 years of followup is 1 in 15 for the whole study, but 1 in 7 for patients younger than 65 at the time of the treatment decision. There is no reduction in mortality in patients treated when they were 65 or older at the time of surgery. The majority of these men, about 80%, had their prostate cancer investigated and detected because of symptoms (like difficulty urinating) or a positive digital rectal examination. The benefits of surgery in reducing the risk of death was similar in low risk patients (PSA <10, Gleason 6 or lower at biopsy) to the whole group, but even the majority of these patients were not detected by PSA screening alone.

You'd guess that patients detected by screening alone, since they are, on average, earlier in their condition, would have less benefit from surgery at 15 years than these men--it would take longer to save lives.

Post Edited (Postop) : 5/20/2011 12:36:18 AM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/19/2011 10:36 PM (GMT -6)   
Ralph,
I had my UsTOO meeting tonight and Lew Musgrove said to say Hi.

Great post, Postop. Consistent with a couple other folks professional analysis'

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
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