More AS controversy.

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/26/2011 10:42 AM (GMT -6)   
A retrospective look at the patient database of Bill Catalona (he has done over 5000 surgeries over 30 years) at patients meeting the D'Amico criteria for active surveillance (AS) shows a noticeable risk, al biet small, that delaying therapy does in fact show increased of disease progression. Catalona, one of the most respected surgeons in the world, has long been in disagreement with the guidelines for AS. he spoke at the AUA conference last year stating that AS is an option but does not come without risk. On one side of this argument are well established oncologists who argue against over treatment and PSA testing, and on the other side are the other are also well established oncologists that are proponents of screening and concerns about under treatment and a revert back to 1990 prostate cancer mortality rates which were quite higher than they are today.

www.physiciansbriefing.com/Article.asp?Aid=653127

It has been my opinion as an PCa advocate that AS is quite safe for men that are at the median age (67 years old) or older that meet the NCCN guidelines for AS. But we are in fact seeing doctors going outside those guidelines and recommending AS for all patients that have a G6 and PSA under 10. I believe that age is a major factor when considering AS. The NCCN guidelines are quite clear that AS is an option when life expectancy is under ten years for low risk patients (or 20 years when the risk is very low). But when I see men that are in their 50's and 40's on this protocol I hope that they understand that the mortality statistics are completely unknown when they live to their 70's and 80's and we need more data. Until we have that data, the risk of going outside the NCCN guidelines isn't the patients doctors making these recommendations ~ it's their own...

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

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 5/26/2011 10:55 AM (GMT -6)   
Tony, that is exactly how I feel.

When my grandfather got PCa it made sense to him, his urologist and all of his children and grandchildren that he not treat it with surgery or radiation. He went on to live another ten years and did not die of PCa.

But in a case like mine, at 40? Every single instinct in my body told me AS was the wrong thing for me. Also, every expert I spoke with, and they were not all surgeons, reinforced the same.

Every family that goes through this will make up their own mind. In my personal opinion, recommending AS to someone who is in my age group with similar stats is like underplaying the risks associated with smoking cigarettes. Far too dangerous.

I'm about to leave for the airport so won't be seeing the responses from the AS proponents here who usually jump on posts liek these.

Hope to be able to log on at least once or twice while apt shopping in Rome. Going for my own personal version of house hunters international.
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

HD_Rider
Regular Member


Date Joined Apr 2011
Total Posts : 414
   Posted 5/26/2011 11:33 AM (GMT -6)   
I completely agree. As much as I would love AS to be an option for me, I know that age is a very significant factor in the treatment of this disease. The younger you are, the more important immediate treatment is warranted. AS is not a treatment.
John (HD_Rider)
Age: 49
PSA: 3.5, 6/07
PSA: 4.5, 3/11
Biopsy, 12 cores: 04/13/11
Dx: 04/19/11
Gleason: 3 cores at 3+3=6 and one core at 3+4=7 (primarily on right side with <5% on left side)
DaVinci: scheduled for 06/09/11, hoping and praying for the best

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 5/26/2011 11:52 AM (GMT -6)   
Age has to be taken into consideration for ALL treatments. thus surgery is probably inappropriate for most men aged 80 and AS is probably inappropriate for men in their forties, quite simply becasue they (we) simply have so many years ahead of us for things to get worse, and there is a risk that the optimum moment to take action might be missed.

Alf

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 5/26/2011 1:14 PM (GMT -6)   
Tony,
It all makes sense. I didn't have the option of AS because of my Gleason 8 but even if I had a Gleason 6 I would have opted for surgery.
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, 21, 2 years <.008? ) undetectable
27 months: .005

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2299
   Posted 5/26/2011 3:14 PM (GMT -6)   
Tony,
 
I am in agreement with this.  I think, however, that low-number (PSA and Gleason) men should know that they have time to consider their options and to research in order to make a reasonable decision. 
 
My urologist's first statement after telling my wife and me that I had prostate cancer was to assure me that I did not have to make an immediate decision about the treatment.  He did not push surgery, brachytherapy or other treatment on me, but suggested that I give my emotions a chance to settle, do a lot of reading on prostate cancer (Walsh's and Scardino's books were suggested). 
 
 
Age 62 PSA quadrupled in one year (0.6 to 2.6)
DRE negative Retested at 3 months
1 of 12 biopsies positive (< 5%) G6
RP open surgery June 2006 at age 57
Bilateral nerve-sparing
Organ-confined to small area, downgraded to G5
Prostate weight 34 grams
PSAs < 0.1

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/26/2011 3:20 PM (GMT -6)   
I fully agree, Tony
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

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 5/26/2011 3:43 PM (GMT -6)   
 
This study contridicts the Hopkins study that says delayed treatment has no signifiant impact on results. So who are we to believe? AS is just not about eliminating treatments; which the vast majority of patients on AS have done, but also delaying the side effects of treatments for years and improving ones quality of life years if treatment is ever needed. A younger patient who has the most to lose on AS also has the most to lose by getting treatment as he will live many more years with the treatment's effect on QOL. It's a very personal decision and the choice will be different for different personalities. I for one would have gladly done AS if my stats were low risk. As I have said many times I would not go on an AS program without 1st getting a color doppler or MRIS to better evaluate my risks and to establish a baseline for monitoring purposes. I think this cuts any risks significantly.
JohnT

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 5/26/2011 7:06 PM (GMT -6)   
In the ideal world the biopsy sample would provide an accurate snapshot of the amount of and grade of cancer in the prostate.

But in 30-40% of cases (depends whose stats you look at) the cancer gets upgraded to a Gleason 7 from a Gleason 6. People with anterior dominant prostate cancer are even less likely to have their trans-rectal biopsy sample match up to the reality of the cancer. Color dopplers and other scanning techniques picked up large cancers quite well but don't really pick up smaller regions of high grade cancer. If you wait for small regions of high grade cancer to become larger regions of high grade cancer the benefit of finding the cancer early is diluted for the younger patient.

A person diagnosed young (40s, 50s) needs to consider these factors. The side effects of the operation (if this is where they want to go) are much better if the patient is younger.

AS is a relatively easy option to recommend to someone who is 70+. The small risks of AS are magnified for someone in their 40s or 50s. There is a gray area in the 60s in my opinion where people have to consider their expected life span.

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. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03|Feb11 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01|Feb11 – 0.01|Apr11 – 0.01

mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 5/26/2011 10:04 PM (GMT -6)   

Yes, the issue of AS will continue on this website to give men diagnosed with prostate cancer pause to think about how what they are about to do will effect the rest of their life with potential incontinence and ED. We are talking about gleason 6 guys here. The 7 or higher guys have to do something based upon the literature, not a whole lot of real choice there. For the gleason 6 guys we have AS, surgery, radiation as the primary options. Roll the dice and see how lucky you are.........


My age= 52 when this all happened.
DRE=negative,
PSA went from 1.9 to 2.85 in one year, biopsy ordered,
Second biopsy on 08/14/08 found 2/12 cores positive for CA on R side, 1 core=5%CA, other core=25% CA, Gleason score= 6 both cores,
Bilateral nerve sparing robotic surgery on 09/11/08, pathological stage T2A,
No signs of spread, organ confined,
6 0's in a row, still use trimix for ED

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/26/2011 10:32 PM (GMT -6)   
JohnT,
I am no longer surprised that conflicting data can tear studies into shreds? The fact is that both sides are not using the same criteria when selecting which retrospective data that they want to display and both are biased. Bruce Trock is a statistician at JHU. He is a specialist at applying formulas to the database they have already accumulated. Nothing wrong with this and in fact I find it fascinating. But these studies that JHU and Northwestern (and their Trock equivalent) assembled are inappropriate to use as law. I look at it like I look at CNN.com and Foxnews.com. These are both the idiots and in the middle of these partisan news agencies somewhere is truth. We do not have survival statistics on AS as presented by both sources and that's truly what we need. The only way is a registry that will take years to accumulate. What we need even more are direct head to head level 1 studies...

An,
Very thoughtful post. I don't disagree with anything you stated with one exceptionI might adjust. The 30-40% of cases where the Gleason changed after prostatectomy can go in many ways. I have seen G6 go to G9. I have also seen G9 drop to G8 or G7. But you are correct that 30-40% change in Gleason grade after a full evaluation of the complete prostate is done.

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

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 5/26/2011 10:42 PM (GMT -6)   
Once again I can't understand how these folks can expect the disease to not progress if it is not treated. Oh yeah, "the statistics show....".

Got cancer? Get rid of it!!!
 
Dead men have no use for boners and dry shorts.

Jim
Age 76. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06. Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + .05 cc Trimix = Excellent Results
PSAs from 1/3/07 - 8/02/2010 zero.
Next PSA - July/2011
Lung cancer dxed 6/08. Surgery followed by chemo. In remission since.

Post Edited (biker90) : 5/27/2011 7:12:49 PM (GMT-6)


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 5/27/2011 12:39 AM (GMT -6)   
AS has to be both Active and involve Surveillance.
It is not a case of the uro saying that your problem is not that serious and that you should come back in a couple of years.
Thus you have to have a plan for regular, perhaps even frequent PSA tests DREs etc to help establish the speed of any changes (PSA velocity or PSA doubling time).
Yes PCa is bound to get worse over time, the question to be answered during AS is "how fast is it happening": a PSA that goes up from say 4.5 to 5.2 over three months will ring alarm bells whereas one that goes from 4.5 to 4.6 over a year may not. (My father-in-law has been on AS for nearly 15 years as his PSA has stayed very stable, this is good news for him as his general health is such that he is not well enough to undergo surgery etc.)

A doc's view about how and when to react to having Prostate Cancer has to be seen in the context of how they/you have to react to other cancers. Other cancers can get nasty very quickly, so you don't often get much time to think about what you want to do let alone decide to do nothing besdies monitor it.
With me, after telling me I had PCa my uro told me to go home and have a think about what I might want to do and then come back and see him in two weeks, and he said it wouldn't matter if I needed twice as long. But for other cancers it just isn't like that - a couple of examples:
A few years ago my Mum's neighbour had a bad back, she went to the doc and was diagnosed with lung cancer and was dead within two weeks.
A young friend of a friend was diagnosed with melanoma and the mets had killed her within 9 weeks of the diagnosis.

Yes PCa is cancer, but it comes with a different time line. And AS is only an option because of this. And remember that opting for AS has to involve the realisation that at some point the monitoring will detect a change that will call for decisions to be made about treating the cancer.

Edited (I forgot to sign!)
Alf

Post Edited (English Alf) : 5/27/2011 8:37:52 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/27/2011 6:15 AM (GMT -6)   
very good answer, alf, i fully agree
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

adderboy
Regular Member


Date Joined May 2011
Total Posts : 33
   Posted 5/27/2011 8:32 AM (GMT -6)   
I told my local Uro I had decided to have surgery and not AS because of my relatively young age. His response was "A reasonable man would not make this decision". My decision was based on reading as much as I could on the subject as well as information from forums such as this one. I spoke to as many people as possible who had gone through various forms of treatment. As well, in my case a lump appeared where there was none the year before. Was that a slow growing cancer? My goal is to to live as long as I can with as few side effect as possible. A reasonable decision for me was remove the cancer.

When I asked for a referral to another city his response was "Ok, at least won't need to deal with any of the complications you will have". Among many other thoughts racing through my mind at the time, the most passive thing I could think of was to run as fast as I could out of his office!

I think AS is fine if you are able to live with the knowledge you have cancer in you and you feel confident that it will be dealt with appropriately in the future. Some people do not. I was one them.

A decision on treatment is not taken lightly and is very personal. Once a person has decided on a course of treatment, it is the right decision for him. Some doctors do not seem to get that!
Age: 55 Ontario, Canada
PSA: 1.2
Dec 2010: Family Dr. found lump on routine physical (not there 1 year prior)
Feb. 6 2011 biopsy: 3 of 11 cores, T2a, Gleason 6 (3,3)
Urologist recommended "watchful waiting" ...back to my family doctor he recommended surgery.
Back to Urologist asked him to refer for third opinion (he did so reluctantly)
3rd opinion: Urologist recommends surgery
April 15: open radical prostatectomy
April 27: catheter removed...absolutely no ED issues and a little incontinence.
May 6 2011: Pathology report excellent, cancer confined to prostate, Gleason score remained at 6!

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 5/27/2011 9:21 AM (GMT -6)   
Sorry again. I also also forgot my point in relation to this thread ie that if you do AS and thus wait/delay then you obviosuly run the risk of waiting too long before opting for treatment, but this is the other side of the coin that has seen some guys getting too much treatment too soon and suffering with the SE and reduced QOL.

Alf

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 5/27/2011 12:35 PM (GMT -6)   
Active surveillance should be the preferred option for men diagnosed with low-grade prostate cancer who currently qualify for this protocol. Avoiding early treatment will prevent unnecessary treatments and their side effects. This said, it is important to recognize that even early stages of prostate cancer, if given enough time, could progress to more aggressive forms and become more difficult to treat.

Conservative treatment of prostate cancer has a long natural history. This history was written years before the advent of the PSA era, and the best-documented details of that history exist in the data compiled by the Scandinavian cancer registries and the studies of those data.

What do we mean by conservative treatment? To all intents and purposes, conservative treatment of prostate cancer meant that nothing was done until a man showed clear symptoms of prostate cancer. If a man had no symptoms, nothing was done. When a man showed symptoms (urinary retention, bone pain, etc.), these symptoms would be treated (“palliated”) so that the patient would have the best possible quality of life, but treatment was not carried out with curative intent.

For the most part, between 1970 and 1990, this is how prostate cancer was treated in Scandinavia, where excellent long-term health records are available going back decades. By looking at what happened to these men with conservatively treated prostate cancer, we can understand how the disease progresses when it is effectively undisturbed (untreated) until late in its course.

So let’s look at the available data, complied over the years in seven major Scandinavian analyses:

In 1994, Grönberg et al. reported that patient age alone could be a significant prognostic factor in prostate cancer. They analyzed data from a large and unselected cohort of 6,890 prostate cancer patients diagnosed between 1971 and 1987 in northern Sweden. Tumor grade information showed that 26.4 percent of the patients had well-differentiated tumors (grade 1), 40.0 percent had moderately differentiated tumors (grade 2), and 17.7 percent had poorly differentiated tumors (grade 3). There were no data to suggest that tumors in younger patients are more aggressive per se. However, loss of life expectancy differed significantly among all age classes and in all three grades. In patients with grade 1 tumors the time lost due to prostate cancer ranged from 11.0 years in the youngest age group to 1.2 years in oldest age stratum, even though the relative survival was approximately 0.70 in all age classes.

In 1996, Adolfsson published data on 172 Swedish patients diagnosed with T1-3NxM0 prostate cancer. These patients were all diagnosed between 1978 and 1982 and followed for at least 10 years using a surveillance protocol with deferred treatment on symptomatic progression. The median age at diagnosis was 68 years. The disease-specific survival at 10 years was 80 percent for the total series, 84 percent for the subgroup with T1-2 tumors, and 92 percent for patients with T1-2 tumors diagnosed when the patients were less than 70 years of age. For the subgroup with T3 tumors, the disease-specific survival at 9 years was 70 percent. In all subgroups the competing mortality was higher than the prostate cancer mortality.

In 1997, Johansson et al. published the results of a population-based study of 642 patients in Orebro, Sweden, with prostate cancer of any stage. The patients were consecutively diagnosed between 1977 and 1984, had an average age of 72 years, and were followed until 1994. Prostate cancer accounted for 201 of all 541 deaths (37 percent). Among 300 patients initially diagnosed with localized disease (T0-2), 33 (11 percent) died of prostate cancer. The corrected 15-year survival rate of 81 percent among these 300 patients was similar in 223 patients who had deferred treatment and in 77 who received initial treatment. The corrected 15-year survival was 57 percent in 183 patients initially diagnosed with locally advanced cancer (T3-4) and 6 percent in the 159 patients who had distant metastases at the time of diagnosis.

Also in 1997, Grönberg et al. published data from a study population of 6,514 patients diagnosed with prostate cancer between 1971 and 1987 in northern Sweden. about 85 percent of these patients died during the follow-up period, and the prostate cancer-specific mortality was estimated to be 55 percent. Age at diagnosis was found to be a strong predictor of prostate cancer death. Patients diagnosed before the age of 60 had an 80 percent risk of dying of prostate cancer, whereas those over 80 years of age at diagnosis had less than a 50 percent risk of prostate cancer-related death.

In 1999, Adolfsson et al. published a report on a prospective study of long-term survival in 50 selected men with locally advanced, non-metastatic prostate cancer managed with deferred treatment. The men were treated if and when symptoms occurred or upon their request. All patients were followed until December 1994, and no patient was lost to follow-up. The median patient age at diagnosis was 71 years. All patients were followed for at least 144 months or died before then. Actual overall survival rates at 5, 10, and 12 years were 68, 34, and 26 percent; disease-specific survival rates were 90, 74, and 70 percent, respectively. A third of the patients had received no cancer-specific treatment at follow-up or before death.

In 2004, Johansson et al. published additional data on the 223 men from the original Orebro study (see above) who had received deferred treatment. By this time, this patient cohort had then been followed for an average observation period of 21 years. The patients who had had tumor progression were treated hormonally (either by orchiectomy or with estrogens) if they had symptoms. After complete follow-up, 39/223 patients (17 percent) experienced generalized disease. Most cancers had an indolent course during the first 10 to 15 years. However, further follow-up from 15 years (when 49 patients were still alive) to 20 years revealed a substantial decrease in cumulative progression-free survival (from 45.0 to 36.0 percent), survival without metastases (from 76.9 to 51.2 percent), and prostate cancer-specific survival (from 78.7 to 54.4 percent). The prostate cancer mortality rate increased from 15 per 1,000 person-years during the first 15 years to 44 per 1,000 person-years beyond 15 years of follow-up.

While there is considerable variation in the results of these seven studies, several things seem to be very clear:
· Early stage, low and intermediate grade disease can be treated successfully with conservative therapy in older men with at least 10 and perhaps 15 years of life expectancy.
· More aggressive prostate cancer results in a high rate of mortality when left untreated.
· Age is an important factor in decision-making.
· If early disease is diagnosed at a young age, there is a high risk of the patient dying from prostate cancer if treated conservatively.

There has been resistance to accept active surveillance in the urology practice, but the door has been opened for men to learn and recognize this possibility if their cases qualify. As survivors with knowledge we need to advocate and support this modality for the benefit of those that follow our footsteps.

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

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/27/2011 12:50 PM (GMT -6)   
As always ~ great post, Ralph.
My 76 year old father is on AS and I am fine with it. You are so right that we ~ the survivors ~ need to understand AS so that we can know when it's good and when it's not and pass the information along. However, I know many on the "AS bandwagon" that misinterpret it's value and safety. And age is a critical piece when deciding when to do it. This interpretation problem is also found in the medical profession. Many doctors don't understand the value of it either. But the option is a good one for many men.

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

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6946
   Posted 5/27/2011 6:13 PM (GMT -6)   
Yet again something to sign up for - will have to pass on that.
 
I wonder if more men die of PCa in Scandanavia because they don't die of something else first? Here in the states there seem to be things lining up to kill us, like trying to drive to the store.

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 5/27/2011 8:05 PM (GMT -6)   
142,
No need to sign up. Do look at the figures. While the "widespread" use of PSA testing in the US amounts to a bit more than 50% of men over the age of 50, the PCa mortality rate here has been reduced by 40%+ in the past 15 years (1992-2007) of available data.

In the Scandinavian countries the use of PSA is 10% or less. The PCa mortality rate in those countries has increased as much as 10% in the past 15 years. That in my view is information that supports the value of early detection and effective treatment.

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/ml
Laughter is still the best medicine!
www.pcainaz.org/phpBB304

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/27/2011 8:10 PM (GMT -6)   
i fully agree with you, Ralph
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

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6946
   Posted 5/29/2011 9:43 AM (GMT -6)   
Ralph,
 
The link sent me to a page that required me to register - seems like every time I do that I add a dozen or so emails to the daily crop I already get.
 
I was just making the point that living in Europe in general seems safer in so many respects that you are more likely to die of a cancer, because the things that thin us out, like being murdered or killed in a traffic accident, happen less over there. Just my observation after having lived there a good number of years.
 
My company required extensive annual physical exams, and it was "on the clock" work time. I don't know if a PSA was done (the employee did not get the results unless there was an evident problem), but I doubt it, as it was in its infancy as a test, and I was much younger.

GOP
Veteran Member


Date Joined Dec 2010
Total Posts : 657
   Posted 5/29/2011 9:47 AM (GMT -6)   
...but also delaying the side effects of treatments for years and improving ones quality of life...
 
I agree, and it seems to me like this would be even more important to the younger among us. It was for me.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 5/29/2011 10:45 AM (GMT -6)   
The men in these studies were treated only when symptoms appeared if they were treated at all. I don't think that anyone in the US is advocating this for anyone under 70. The essence of AS is to treat those that show progression while the cancer is far from symptomatic. Basically to treat those that need treatment and delay or not treat those that don't need it.
It is interesting that the incidence of positive margins was similar in the Cantolona study and progression seemed to come from Gleason upgrades from 6 to 7. I think that this suports the arguement that most of the progressions are due to undersampling on the initial biopsy and not the growth of G6 cancers. The fact that most progressions of those on AS are discovered in 3 years also supports this arguement. So the real question is progression on low risk men due to under sampling of the biopsy or actual growth of the PC? Data would suggest the former.
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.

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 5/29/2011 11:47 AM (GMT -6)   
GOP,
The point I was trying to make is that progression of untreated prostate cancer can affect the QOL of that patient. Progression can cause excessive blood clotting, bone pain, obstructive urination etc. To ignore that possibility because PCa is indolent and will seldom kill, is illusory...

JohnT,
I was not comparing patients from the PSA era to current patients. I was pointing to the potential progression of untreated PCa. The current view is that PCa is indolent and always progresses slowly. The data shows that in the absence of early detection, there is excessive death and loss of QOL with disease progression. I am not trying to undermine active surveillance. On the contrary it is a very viable option for those that have their disease early on. To ignore the potential of PCa to progress while untreated because it is believed to be indolent can be dangerous and it is definitely not representative of the natural history of the disease.

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/ml
Laughter is still the best medicine!
www.pcainaz.org/phpBB304
New Topic Post Reply Printable Version
Forum Information
Currently it is Monday, June 18, 2018 1:37 PM (GMT -6)
There are a total of 2,972,865 posts in 326,024 threads.
View Active Threads


Who's Online
This forum has 160864 registered members. Please welcome our newest member, Peter Clint.
424 Guest(s), 8 Registered Member(s) are currently online.  Details
DBwithUC, Balladeer, skeener, Broken0ne, redskinsfan, Jim48, njfillet, limey