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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2005

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Survival Rates

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xyz123abc - 11 Mar 2005 14:48 GMT
I have heard that the 10 year survival rate for RP surgery is about 75%
and for 3-D Ext. Radiation about 50%.

Can anyone tell me if there is a reference for these numbers?
Leonard Evens - 11 Mar 2005 16:04 GMT
> I have heard that the 10 year survival rate for RP surgery is about 75%
> and for 3-D Ext. Radiation about 50%.
>
> Can anyone tell me if there is a reference for these numbers?

Figures like these are meaningless.  Part of the problem is that
prostate cancer is generally discovered at least five years earlier
these days than it was before PSA testing became common.  Also treatment
methods have been improving.  These days, it appears that surgery and
radiation have about the same success rates after ten years, but there
are still arguments about that since there are differing criteria for
what is considered success.

Also, your figures for "survival" are way off, depending on how that is
defined.   Many men diagnosed with prostate cancer are older and might
die within ten years anyway.  It might be more relevant to ask whether
they had died of prostate cancer, although some people argue about that
too.  Death rates after ten years from prostate cancer are much lower
than the figures you give.   The problem is that you may be reporting
"biochemical" recurrence rates, i.e., the likelihood of PSA tests
showing that the cancer has come back.  Even after this happens, there
is often a considerable period of time before there are any clinical
signs of the prostate cancer, and it may take some time after that
before the men die.

In addition, recurrence rates and survival can vary significantly
depending on the specific diagnosis and the age of the patient.

I suggest you read one of the books on prostate cancer.  Many of us like
Walsh's Guide to Surviving Prostate Cancer.  He gives different
statistics with explanations of what they mean.  Another book is a
recent one by Glenn Bubley, a Harvard oncologist.

Also, if you explained just why you wanted to know, we might be able to
help you better.
ron - 11 Mar 2005 16:21 GMT
Survival rates at 10 years must be higher than the numbers you've
posted for both surgery and radiation.  An untreated man has a good
chance of living 10 years past diagnosis.

If you are really asking about biochemical recurrence at 10 years,
surgery and [seeds + RT] use the same definition of failure (DOF,
PSA>0.2 ng/ml) to measure success (biochemical freedom from disease.
All other comparisons between surgery and RT, of which I am aware, use
different DOFs (RT uses ASTRO, RP uses PSA>0.2 ng/ml) to make
comparisons.  Numerous published studies show that the ASTRO DOF adds
an 8-40 point advantage to the RT success rate depending upon the time
after teatment at which success is being measured.  Hence such
comparisons using different DOFs are flawed guesstimates.

Further, treatment success is highly dependent upon staging (PSA, GS, T
stage).  Since small differences in underlying populations can cause
significant differences in recurrence rates between two studies, it is
probably better to discuss success for men in specific risk groups such
as those defined as "low", "medium" and "high".  Analysis of published
data suggests that for the case of SI+RT (RCOG )and RP (JH), were the
same DOF is used and direct apples-to-apples comparison is possible,
results for all 3 risk levels is roughly comparable.  For low-risk men,
freedom from biochemical recurrence rates at 10 years are in the low-90
percent range. ..Best wishes and good health, Ron
 
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