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Medical Forum / Diseases and Disorders / Prostate Cancer / June 2005Invisible Return
Waiting and watching for the dreaded signs of cancer's return can for some hold some promise and hope for the future. A two year non return period and doubling rates can be indicators of progression allowing time frames to be prepared. Unfortunately Gleason 9 cases slip under the radar as they do not produce enough PSA to detect it's recurrence until Mets have taken hold. My Uro told me the 2 year period is not applicable to 9's and the cancer may be spreading without any PSA reading. What a bonus, living in a complete vacuum, knowing thay 9's invariably reoccur but having no tieframe yo associate it with. Does anyone know of recurrence statistics for 9's, or alternate indicators. God bless you all Hank B Schokker Age 55 120 Kg & 183cm Good Health PSA 2000 / 2003 3.28 7.8 8.7 9.4 Biopsy Oct 02 inconclusive But poss G7 Jun 03 Gleason 8 Staging estimated at T1 RPP 1 Sep 03 Gleason 4+5=9 Biopsy Extensive adenocarcinoma; Multifaceted; Extensive perennial invasion Catheter out 16 Sep 03 and DRY 2nd opinion that a Gleason 9 is virulent and Radiation & HT in interim is scheduled EBRT Feb 04 04 to Apr 04 HT Lucron 14 Oct 03 and 16 Mar 04 (lasting 4 months ea) PSA Jun/04 <00.1 PSA Sept/04 <00.1 and no Testosterone (reading of 1.1) PSA Dec/04 <00.1 and Testosterone returning (now 12.5 of normal range of 8:- 27) PSA Jun 05 still >0.1 Hank: What about the "PSA Free" test, does it too fail to indicate what is going on? Also, I thought I had read somewhere that there is a new third type of PSA test. Ask about that. Finally, do they do periodic bone scans? Wouldn't that show if metastases were taking hold? I wish you well. David S. > Waiting and watching for the dreaded signs of cancer's return can for some > hold some promise and hope for the future. A two year non return period and [quoted text clipped - 41 lines] > > PSA Jun 05 still >0.1 Hank Schokker wrote...snip... > Does anyone know of recurrence statistics for 9's, or alternate indicators. Hi Hank...You might take a look at Walsh's paper (M. Han, A. W. Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169, 517-523, 2003) where he presents several nomograms that break out recurrence rates as a function of GS, TNM clinical staging, pre-op PSA and number of years since surgery. Your projections would presumably be even better than these since you've had RT in addition to the RP. The paper can be found on-line at http://www.prostate-help.org/download/jhnomo.pdf Best wishes and good health, Ron > Hank Schokker wrote...snip... > [quoted text clipped - 9 lines] > > http://www.prostate-help.org/download/jhnomo.pdf Ron, There seem to be some statistical oddities in the tables in this paper. I looked at my situation. Before surgery, I was T1c, PSA 4.5, Biopsy Gleason 7 = 3+4. After surgery, they found the tumor organ confined, and Surgery Gleason also 7 = 3+4. Yet the after surgery figures were all slighly smaller than the pre-surgery figures. For example, at 10 years, the presugical prediction was 91 percent but the postsurgical prediction was 89 percent. This doesn't make much sense because presumably some cases with a similar presurgical diagnoses would not be found after surgery to be organ confined. Of course, sometimes statistical variation occurs because the samples are different. But if the populations were the same in both cases, it is hard to see how figures like that could arise. Do you have any suggestions? > Best wishes and good health, Ron Hi Leonard...I think the pre-op and post-op populations are different in that the post-op, organ-confined population is a mix of T1c and T2a/b/c. So taking the GS=3+4, PSA=4-10 case, we see that the pre-op 10-year recurrence-free rates are: T1c 0.91 (Table 2) T2a 0.88 (Table 3) T2b/c 0.84 Table 4) The corresponding post-op, organ-confined number is 0.89 (Table 5) as you noted. It seems to fit in that it is less than the T1c number and greater than the T2b/c number...Ron > Hi Leonard...I think the pre-op and post-op populations are different > in that the post-op, organ-confined population is a mix of T1c and [quoted text clipped - 7 lines] > you noted. It seems to fit in that it is less than the T1c number and > greater than the T2b/c number...Ron Thanks. Somehow I misread the legends. Of course, you are right. Also, it seemed paradoxical that my predicted nonrecurrence rate should be higher based on presurgical information than on the more complete post surgical information. The response to that would be that adding a clinical T1c diagnosis to a postsurgical organ confined diagnosis would presumably raise the nonrecurrence rate higher into the 90s. But since they didn't bother calculating that, there is no way to know by how much. It seems implausible to me that it would have much effect. On June 15, Hank Schokker wrote, in pertinent part: > Unfortunately Gleason 9 cases slip under > the radar as they do not produce enough PSA to detect it's (sic) > recurrence until Mets have taken hold. Whaaaat!? What is the evidence to support this? Where is the uro getting his info? Marijuana? > My Uro told me the 2 year period is not applicable to 9's and the cancer > may be spreading without any PSA reading. What two-year period is that? The American Society of Clinical Oncology has established this guideline for judging whether the PCa has recurred: Three consecutive rises in *PSA* There is no differentiation set for those of us with high-Gleason tumors. FYI, my known tumor (there was another) was a Gleason 4+5=9 in mid-2003. The other one, not found by the first biopsy, was a Gleason 4+4=8. Hank should check the Partin Tables. Partin, BTW, was/is a senior medic at the Brady Urological Institute, Johns Hopkins. The table can be found at: http://urology.jhu.edu/prostate/partintables.php For me, the numbers were, though not wonderful, encouraging. Another nomogram is the Memorial Sloan-Kettering. I don't have the URL handy, but it can be found by Hank if he's interested. With my Gleason 9 and other figures entered, MSK's nomogram calculated my *five-year recurrence-free probability at 80%* BTW, my uro did not compute these nomograms, nor even give evidence that he knew of their existence. I found them and did the calculations. I also fired the uro. I have also fired a radiation oncologist who was ignorant of certain basic facts about PCa. I think I see a hint of the cause of Hank's anxiety: he's getting bum advice from a urologist -- one who, it seems, might be a fine surgeon, but not so good an oncologist. I strongly recommend three actions: 1. Check the nomograms 2. Consult the website of the Prostate Cancer Research Institute at: http://prostate-cancer.org/index.html There, he will find unbiased and authoritative information. 3. Fire the uro and consult a medical oncologist -- one who is well-experienced with PCa. Regards, Steve J "'MD' does not mean 'Medical Deity.'" -- Stephen B. Strum, MD I have no stats, Hank, but congrats on the PSA.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > Waiting and watching for the dreaded signs of cancer's return can for some > hold some promise and hope for the future. A two year non return period and [quoted text clipped - 41 lines] > > PSA Jun 05 still >0.1 |
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