Okay, now what does this mean. It is good news for those with lower
Gleason scores. Not so good for those of us with higher results. And I
always wonder if one doctor might assign a 7 where another would assign
an 8 for the same test results.
=======> there's always room for error.  you are correct that sometimes,
but not always, two different persons may give two different gleason
scores.
---------

While I used to consider myself an educated man, I am now having trouble
turning these facts into usable numbers. Taking the 65 deaths for 1,000
man years (don't need to be politically correct and call them person
years since they are clearly MAN years :-) what does this turn into for
me?
======>  it means that you are seeing the end product of what number
crunching is.  when you put the human being into the situation, then the
outcome is not so predictable.  these are general values based on
overall data.   it does not take in other pre-existing conditions.

------------
Second, my cancer was considered aggressive, and was too advanced for
surgery so went right into radiation therapy. There was some evidence it
had just started spreading to my lymph system. The same newsletter
quoted above says those who choose surgery fared better. Does this mean
my odds are worse since I didn't opt for surgery?
========> the newsletter only presented 1/2 the facts.  there is an
order of treatments.  if the prostate cancer is contained inside the
prostate, then surgery would be the logical choice.  if it is starting
to spread, then radiation would be the better choice.  your odds are not
any better, not any worse because of your treatment.  however, if the
pca were to return, then hormone therapy would be the next logical
choice.
------------

Third, are these numbers on some sort of linear curve, or random over
the years. That is, would more deaths occur during the 10th year of
study than the 9th, 8th etc.
Any wise people out there that could give me the simply explanation for
what those quoted numbers mean to me, with a Gleason of 7?
========>  this follows a logical trend but for the wrong reason that
you may be placing on it.  pca is not a young person's disease.  we are
getting near the end of the projected life expectancy tables and the
further the study is expanded the more deaths there would be.  for
example, if the study were to be expanded to 15 years, then even more
deaths would occur.  does this support your non linear theory?  sure.
but it also supports the life that men of that age group have a higher
chance of dying for being in that age group.

i'm sure that leonard can do a lot better job of explaining this as i
did it in as few sentences as possible.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

It was making my brain go buggy, but since I've recently been told my
cognitive skills are not affected by ADT, I decided to sit down and figure
it out.

I decided to start with a arbitrary 10 years (since we keep knocking that
number around).  So, if you, me and 98 others (100*10=1000) have a Gleason
of 7, the study apparently says that only you, me and 33 others will live 10
years.  However, a sampling of 200 of us with a Gleason of 7, you and I
would be two of 135 who will live 5 years.  I just can't see that.  I know
more than 70% of the Gleason 7s are beating this bastard.

The good news is, you and I would be the only ones to live about 175 years.

If I am not mistaken, the quote concerns a study of men treated by
watchful waiting.  And it involves men diagnosed up to 1984 or
thereabouts.   The study author was trying to show that for most Gleason
6 cancers, watchful waiting was a reasonable treatment plan.  The same
issue of the journal, however, contained a critique of the study
pointing out other problems when comparing the men in this study with
current prostate cancer patients.

If I were you,  I would not try to use this information to draw
conclusions about your particular case.   As is usually true with
anything in the research literature,  the results have to be interpreted
carefully.   And that requires an expert.   So you might mention it to
your doctor, but don't be surprised if he doesn't think it is too relevant.

I scored an 8 (at the definitive testing lab, Bostwick) before and after
surgery (post-op path did fnd less 4 than expected), had seminal vesicle
involvement, and my PSA velocity > 2.0. i.e., this thing's gonna kill me
(I'm 61). But the only reason I may cancel a 5-year mag subscription is that
it's supposed to be sport-specific but went way political at election time.
(I HAVE cancelled Newsweek, but only because it's proven itself not to give
a damn about facts or lives. Now THAT'S arrogance!)

I have every intent --- and see no facts to shoot it down definitively -- of
still being active 5 years from now. If I happen to skate around the bell
curve, and recent data just tripled my claimed odds of doing so, I may still
be active 20 years from now. Virtually NObody at your apparent stage of PC
needs to worry about wasting a magazine subscription.

The best I can suggest is to keep reading, if longevity stats interest you
that much. They don't interest me much, as I'm going to live my life until I
die anyway, and have many more useful and fun things to do than chart my
hypothetical demise. (That's meant as a fact and a tip, and in no way as a
putdown.) What I DID spend manmonths studying was the benefits and risks of
my initial and secondary treatment options to try to glean some
facts/statistics to help me make some decisions to ALLEVIATE worrying,
rather than get mired down in stats that may INCREASE worry. IOW, my
objective was to IMPROVE my life, not PLOT it. This disease gives us lots of
time to take care of family business and that trip to China when it's
obvious the bell curve has hit us head on; in the meantime its primary
effect on me-- beyond funny (literally, sometimes) undewear -- is that I'm
increasingly willing to pay someone else to do crappy, time-consuming tasks
like building my shop/garage and installing a new lawn sprinkler system. One
thing I sure as heck want to avoid is dying with more money in the bank than
my wife can spend.

YMMV.

I.P.

...

I'm afraid I don't know the answers to your questions and can't
interpret the statistics for you.  But I have a few ideas about the
general issues you raise about your condition and treatment.

First off, will the radiation treatment cure you?

There's no way to know the answer to that.  You may have
metastases that are outside the range of the radiation, and
you may have tumors within the range that are not killed by
the radiation.  So your chance of a "cure" (no further problem
with prostate cancer forever) is less than 100%.

The statistics show that you are in a group for whom the chance
of such a cure is not as high as it would be for some other
groups.  But there's no way to know what will happen in your
specific case until it actually happens.  You may get a cure
from the radiation.  You may not.

Now that we know that question cannot be answered, the next
question is where to go from there.

I think you have a good chance of fighting the disease.  The
radiation may cure you.  If it does not, it may knock the cancer
back, reducing the total tumor burden in your body and slowing
the initial progression of the disease - adding a useful amount
of time before any symptoms develop.

Your doctors may also recommend androgen deprivation therapy
prior to, during, and/or after radiation.  That may increase your
chances of a cure or, even if no cure obtains, it should suppress
the cancer for some period of time.  How long that will be is
unknown.  For some men it's a short time and for others it's
many years.

If and when that gives out, there are a number of new treatments
in clinical trials that will be ready by the time you are that have
shown considerable promise with hormone refractory prostate
cancer.  One or more of those may do the trick for you.

So you have a decent chance of either killing the cancer, or
holding it at bay long enough to grow old and die of something
else.

Now comes the third and perhaps most vital question, How
should you think about all this?

All of us know that we are going to die eventually.  It is
important that we not allow that knowledge to keep us from
living.  Let's resolve that whatever the future holds, we're
not going to let it destroy the present.

Fight the cancer.  Get the best doctor you can and cooperate
with him to get the best treatment you can.  Then live life as
best you can.  Exercise, eat right, enjoy your family, your work,
your life, as much as possible.  Everything you love is still right
there for you.

   Alan