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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2005Had RRP BUT did I need it ?
hi, Read how many people have non aggressive prostate cancer. I had RRP but now wonder if I should have done watchful waiting. Guess I will never know still this might be useful for people about to decide on treatment. Was diagnosed at age 56. PSA 4.7 2003 PSA 5.6 2003 PSA 8.7 2003 PSA 6.4 2003 PSA 5.6 2003 RRP jan 2004 biopsy 1 core out of 12 gleason 3+3 from urocor gleason 3+4 from Hopkins After RRP gleason was 3+3 organ confined, microscopic foci in other words I think not much cancer So I am thinking MAYBE i could have done watchful waiting. The gleason 7 was what threw me otherwise I would have done watchful waiting. It's the side effects that bother me. Lucky am continent but erections are still not as good as before RRP but hope they will come back. I can get erections unaided but need lots of manual stimulation and it is not as hard as before and does not stay as long. Am not complaining just wondering if maybe I could have done watchful waiting. I do not think my cancer was aggressive. What do people think ? Hi, I was 65 PSA 4.56 Gleason 3+3 and decided for immediate RP. There is no negotiation with cancer, while one waits the cancer grows. There is a clear advantage and by far better chances to tackle the cancer when it is still "small" Therefore I feel you made the right decision under the circumstance. >hi, > [quoted text clipped - 36 lines] > >What do people think ? There is one truism about watchful waiting. Watch and wait long enough, and we will all die, whether from PCa, accidents, or something else. Four years aog, my brother-in-law's older brother was dxed with PCa about the same time as I was. I chose RRP. He chose WW. My PSA to date remains undetectable. He has bone mets and is now waiting, but not as watchfully. Ray Walsh Perth, Australia WW, at 56, with Gleason 7? Not on MY life! Doesn't matter if your post-op pathology determined that it was a just a cold; you had to make your decision BEFORE treatment, not afterwards. "Not much cancer" is like "not much pregnant"; the game is Hand Grenade, not Darts. You'll remember being alive long after you've forgotten what else your wanger used to do besides pass urine. Better yet, you might be in the saddle again before your scar fades. I.P. > hi, > [quoted text clipped - 36 lines] > > What do people think ? Answering this does break my rule of "Make a decision, and don't look back," but with numbers almost identical to yours, I did ask myself the same question. There is a way to calculate the odds that you (we) could have gotten away without treatment. I've forgotten how to do that, but I once worked out the figure of around 12 to 15%. So the chances my case would get worse or kill me were about 85%. I decided on treatment. jimhoney Gleason 6, PSA 5.7, standard RRP age 52, cured, no significant aftereffects P.S. I'm adding this keyword: " newly diagnosed " so that newbies will pull xten's post and read it. Every once in a while we see someone on this newsgroup (I don't mean xten) who is so miserable after treatment that maybe he should have declined it and taken his chances, or just let the disease take its course. > hi, > [quoted text clipped - 36 lines] > > What do people think ? > I do not think my cancer was aggressive. > > What do people think ? Hi, You absolutely did the right think. A Gleason 7 at age 56, demands intervention, I don't think Watchful Waiting is, imho, a remote option. I had an RRP in May with a Gleason 7. The post op pathology report confirmed this, but also found 5% of the tumor volume to be Gleason 5 which is not good. The tumor was confined and there was no capsular penetration but according to my surgeon the cancer was right to the edge. If I had delayed, even the slightest, I am sure my outcome and prognosis would be far different. Because of these circumstances I will, in this group, and in life, always advocate prompt intervention by surgery for anyone with a Gleason 6 or greater under the age of 60. Surgery vs radiation because you get the path report so you know what you are dealing with, and you get a second chance at radiation in case of a rising post-op PSA. chris m I would do...and DID the same thing as you, xten, under similar conditions. Some of us handle things better than others but I could not have watched NOR waited knowing what I had inside at my age. (also 56) Best wishes, Ron B. Chicago >You absolutely did the right think. Great Freudian slip, regardless of whether it occurred in the mind or at the fingertips. I.P. Rule Number One, after you read, study, and make a decision, never look back. We know going in that there is not one "right" answer. That is why we research all we can and make the most informed decision that we can with the information available. Make the decision and move on. There is nothing to be gained by second guessing the decision. BTW, there are certain known facts in life: 1) Weight loss is achieved by taking pills, 2) No good married Christian man ever thinks about other women, 3) prostate cancer is slow growing. > hi, > [quoted text clipped - 36 lines] > > What do people think ? Your cancer WAS (mildly aggressive) according to the experts. Also Gleason 6 is the most common stage found in most men by far. Watchful waiting would only apply to older men of maybe 75 or so with your numbers. You could have waited a few more years until your cancer was a 7 or 8, then you might have felt better after the fact but the probability of the cancer escaping the capsule increases and you might not get it all by removeing the prostate. Your chances now are excellent that you probably got it all out. A young man with a gleason 4 might consider watchful waiting with regular monitoring of PSA. Ron S. > hi, > [quoted text clipped - 11 lines] > PSA 5.6 2003 > RRP jan 2004 Were the above readings taken a couple months apart? Are they in chronological order? When was the biopsy taken? Any explanation from the docs on the 8.7 dropping to 5.6? The rise from 4.7 to 8.7 is an alarm bell. > biopsy 1 core out of 12 > gleason 3+3 from urocor [quoted text clipped - 16 lines] > stay as long. Am not complaining just wondering if > maybe I could have done watchful waiting. You can get erections unaided? In this neighborhood, that's called a perfect outcome. An acceptable result is getting a "good one" on 100 mg of Vitamin-V. Somehow, needing 5, 10 minutes of gentle stroking to get going doesn't seem like a disability. > I do not think my cancer was aggressive. You were 56 with an 8.7 and gleason 7, maybe gleason 6, one core out of 12. I was 57, PSA 10+, gleason 7, 5% of one core out of 12. Or was it one core out of 18 as the first biopsy with 6 cores missed it. My docs called mine "mildly aggressive" and had a "we gotta do something" tone in their voice. The Uro wanted to yank that dude out-a there. The Rad-doc said to hit it with Lupron, then 25 sessions of IMRT from his 5 million dollar machine, then palladium-103 seeds, hit it hard and keep hitting it. Because, the Uro said, "this'll kill you in 10-12 years". The Rad-doc, after running his electronic scanning magic, said, "Not 10-12, more like 8, maaaaybe 10 years." > What do people think ? You have nothing to complain about. You're in the top group for minimal side effects, from what I've read. You are only 56 and you have cancer. Watchful waiting isn't an option for you unless you want to die an early and painful death. Get rid of that demon. You did the right thing! This recent update to the well-known large-scale Swedish study shows a definite advantage to RP over Watchful Waiting: Radical prostatectomy versus watchful waiting in early prostate cancer. Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S, Spangberg A, Busch C, Nordling S, Garmo H, Palmgren J, Adami HO, Norlen BJ, Johansson JE; Scandinavian Prostate Cancer Group Study No. 4. Department of Urology, University Hospital, Uppsala, Sweden. anna.bill.axelson@akademiska.se BACKGROUND: In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results. METHODS: From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer; the secondary end points were death from any cause, metastasis, and local progression. RESULTS: During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88; P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86; P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44; P<0.001 by Gray's test). CONCLUSIONS: Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial. Copyright 2005 Massachusetts Medical Society. Publication Types: Clinical Trial Randomized Controlled Trial PMID: 15888698 [PubMed - indexed for MEDLINE] From: xtensory1@sbcglobal.net (xten) hi, Read how many people have non aggressive prostate cancer. I had RRP but now wonder if I should have done watchful waiting. Guess I will never know still this might be useful for people about to decide on treatment. Was diagnosed at age 56. PSA 4.7 2003 PSA 5.6 2003 PSA 8.7 2003 PSA 6.4 2003 PSA 5.6 2003 RRP jan 2004 biopsy 1 core out of 12 gleason 3+3 from urocor gleason 3+4 from Hopkins After RRP gleason was 3+3 organ confined, microscopic foci in other words I think not much cancer So I am thinking MAYBE i could have done watchful waiting. The gleason 7 was what threw me otherwise I would have done watchful waiting. It's the side effects that bother me. Lucky am continent but erections are still not as good as before RRP but hope they will come back. I can get erections unaided but need lots of manual stimulation and it is not as hard as before and does not stay as long. Am not complaining just wondering if maybe I could have done watchful waiting. I do not think my cancer was aggressive. What do people think ? ======= since you ask what we think and you feel i take it that your opinion is....... "I do not think my cancer was aggressive." here's the facts. it takes 13 years on average to go from pca to death doing watchful waiting. even if you to assume that you were just starting near the beginning of the path, you would live to the age of approx. 67 to 69, but you not see your 70th birthday. and given the fact that your cancer was a gleason 7, that tends to shorten up the time line even more. then let's not forget that the last three years of your life would be in pain. that is what you missed by having the RP. plain and simple. no sugar on this one. but you still have a chance at having a recurrence of pca, so if you want to do watchful waiting to find out which way you should have gone, you might get your chance.............. since you didn't post your post op psa's, i can't give you any advice on that part. but a 1.3 psa is consider the cutoff point for recurrence of pca after the RP, not 4.0 ~ 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 >hi, > [quoted text clipped - 3 lines] >will never know still this >might be useful for people about to decide on treatment. I have not visited this group for several years but was a daily regular back when I was first diagnosed in ... 1998? In those days there were huge and sometimes very heated, even vitriolic, arguments raging about the best course of treatment after diagnosis. In some cases, it seemed that people had made their choices, instinctively knew that they had made a bad choice but then felt obliged to defend their choice no matter what. I don't see those flame wars here today. What I do see, even as papers and opinions from the medical crowd emerge hinting that maybe PSA is overdone and surgery isn't always necessary and that watch and wait might be a viable option, is overwhelming opinion among the people for whom it matters most -- us -- that the very best response is surgery as soon as possible before the cancer has a chance to spread. I was excoriated here for holding that position six years ago. Not today. Looks to me like most have now decided if they got it at all, get rid of it all, now, and any other treatment is fall back. So, yes, you did the right thing and don't look back no matter what the future consequences. Still, there are men who fear impotence more than they fear death. Well, that's their choice. Let me again pose an analogy. Think of your prostate as an isolated island in the middle of a sea surrounded by other lands and continents. There is a barrier between the island that is your prostate and the other regions. It's not a very strong barrier any more than a narrow body of water is to a good swimmer or a small boat. The cancer cells are a growing population on your island that will want to migrate to other regions across that barrier. As with any populated city or country, you can attack that island with any and all weapons you choose -- radiation, Lupron, whatever. You may get 99.9% of the population. You won't get them all anymore than you can kill all the people in a city with a nuclear bomn. Enough will survive to repopulate and migrate. You must physically remove that island with its entire population before any of them can migrate. Only surgery can do that. You made the right decision. Unlike many of the others, I do not think that RRP should be an automatic, knee-jerk decision. I think too many patients and even their doctors freak out over the "C" word and don't make rational choices. The ultimate yardstick for any treatment is survival benefit - if your treatment did not prolong you life, perhaps you should not have had it. We are still relatively recently into the PSA era and it still remains to be seen which treatments actually prolong life as opposed to keeping PSA down. Decisions should be based on life expectancy, extent of disease, importance of QOL, etc. - not "Oh my Lord, I've got cancer, let's cut it out NOW!" At 56 w/ a G.S. 7 it sure sounds like xten made the right choice. On the other hand, Reuben, a 65 y.o. sexually active man w/ a G.S. 6 might indeed want to withold treatment if he has other health problems like heart disease and may not live another 10 years anyway. Bill Denton RP 2/12/02 PSA .6 Memphis <snip> > I have not visited this group for several years but was a daily regular > back when I was first diagnosed in ... 1998? In those days there were huge [quoted text clipped - 3 lines] > but then felt obliged to defend their choice no matter what. I don't see > those flame wars here today. The burns on my virtual body tell me that there are still some flames to be found here. I think we have kind of arrived at an informal agreement to not discuss the following subjects: Religion Politics Diet Programs Oral Sex. You are pretty safe with anything else. "Catholics and Masturbation" was a big hit for example. Anyway, welcome back! ><snip> >> > [quoted text clipped - 19 lines] > > Anyway, welcome back! Thanks. The conversation is generally intelligent and relevant. The flame wars I recall were not those subjects, which seem quite off-topic in this group anyway, but surgery vs. watch-and-wait vs. radiation vs. hormones, etc. More than one good contributor, including some physicians, were driven away by the vituperation. The battles transcended religious wars. "David S." <buttercupsdad@dog.net> wrote >> > The burns on my virtual body tell me that there are still some flames > to [quoted text clipped - 6 lines] > Diet Programs > Oral Sex. I wasn't aware of, and do not support, those agreements when specific references to them are relevant to our physical or psychological care, status, or decisions. Religion is definitely vital to the well-being of those who have it, politics matter a great deal when they affect present or future medical choices, diet is vital to many PC pts as it affects treatment options and the Type II diabetes several of us face, and oral sex is an important option to MANY of us temporarily or pemanently. IMO, anyone who can't handle frank, RELEVANT discussions of those topics can just look the other way rather than trying to prohibit others' discussion of any relevant topics. Sensitive people have every right to suppress certain tough topics in open, unavoidable, public speech, but not in a filterable, written CANCER forum. I've still not forgiven that cowardly President Whozit that fired Surgeon General Whatshername (how quickly we forget details) because she suggested masturbation as a valid alternative to teen sex, considering that probably every man, woman, monkey, and dog on the planet practices it . . . even AFTER s/he gets it right. I.P. Calm down I.P. That was supposed to be a joke, but as you can see just the mere mention of those subjects caused blood pressures to rise. > "David S." <buttercupsdad@dog.net> wrote >> > > The burns on my virtual body tell me that there are still some flames [quoted text clipped - 26 lines] > > I.P. Don't equate long responses with elevated BP. As others can verify, it doesn't take stress to send me off on a lengthy riff. My concern was that a newbie (or long-absent "oldie") may BELIEVE we have a ban on some topics. I doubt anyone recognized the humor in the quote below, especially since we've lost some angry participants who couldn't divert their eyes when tender topics arose. I.P. > Calm down I.P. That was supposed to be a joke, but as you can see just > the [quoted text clipped - 14 lines] >> > Diet Programs >> > Oral Sex. Sorry I.P. I get the point about newbies and long-absent members. I guess I take it too much for granted when I try to say something that I think is humorous that others will be in tune. We definitely do not want to lose anymore participants due to unnecessary rifts over the topics discussed here. > Don't equate long responses with elevated BP. As others can verify, it > doesn't take stress to send me off on a lengthy riff. My concern was that a [quoted text clipped - 23 lines] > >> > Diet Programs > >> > Oral Sex. "Gogarty" <Gogarty@Clongowes.edu> wrote > > there are men who fear impotence more than they fear death. There's an easy way around that fear. It's called ADT, and its mechanism is that it makes us no longer CARE that we're impotent. I.P. Quoting "Gogarty:" >> there are men who fear impotence more than they fear death. IP responded: > There's an easy way around that fear. It's called ADT, and its mechanism > is that it makes us no longer CARE that we're impotent. Speaking for myself, I disagree. I care a lot, but know that there's not a thing to be done about it so I don't obsess over it. I'm still able to enjoy beauty. Reminder from previous posts: I'm impotentx3: 1. the failed cryosurgery in November, 2003, that didn't cure the PCa but certainly did destroy the erectile nerves, 2. IMRT ending in November, 2004, and 3. ADT since September, 2004. The primary destruction was done by the cryo, though. Numbers two and three at most added the coup de gråce. Regards, Steve J "The world breaks everyone and afterward many are strong in the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry." --Ernest Hemingway, author and broken man.... "Stephen Jordan" <wrote > Quoting "Gogarty:" > [quoted text clipped - 6 lines] > > Speaking for myself, I disagree. I care a lot By "care" I meant "physically want to but can't" as in libidinous but impotent. I.P. >"Stephen Jordan" <wrote >> [quoted text clipped - 11 lines] >By "care" I meant "physically want to but can't" as in libidinous but >impotent. Pardon my ignorance, but what is "ADT?" On August 4, Gogarty inquired: (su-nip) > Pardon my ignorance, but what is "ADT?" Androgen Deprivation Therapy, typically Zoladex, Lupron or Trelstar. They suppress the testicular production of testosterone (T). The reason that that is done is because the proliferation of PCa cells is encouraged by T. See the website of the Prostate Cancer Research Institute: http://prostate-cancer.org/index.html Regards, Steve J > hi, > [quoted text clipped - 15 lines] > gleason 3+3 from urocor > gleason 3+4 from Hopkins Except for the Gleason 7 and your age, you might have been a candidate for watchful waiting. Some Gleason 6 cases in men in their late 60s or older with characteristics like yours are treated that way. Walsh in his Guide to Surviving Prostate Cancer discusses such cases. His group at Hopkins is, I believe, currently doing a study about the matter. You could look at his web site for details. As it turned out, the Gleason 7 was downgraded to Gleason 6 in the complete pathology after surgery, but there was no way you could have known about that beforehand. In addition, I think most urologists would have recommended against watchful waiting for a man your age. In 20 years, you will be only 76, so there would be plenty of time for a cancer to metastasize. With watchful waiting, it is hard to be sure any advance would be detected in time. Also, you would probably need many repeat biopsies. On the other hand, it seems clear that some cancers like yours would never bother the patient if left untreated. Unfortunately, there is no sure way to distinguish those that will from those that won't. > After RRP gleason was 3+3 > organ confined, microscopic foci [quoted text clipped - 11 lines] > stimulation and it is not as hard as before and does not > stay as long. If you can get erections sufficient for sexual intercourse without aids, you are doing pretty well. Also, some of what you experience may be due to anxiety about the matter. Before surgery, you probably never thought about whether or not you could maintain an erection, but now you do. Also, keep in mind that it is normal for erections to decline somewhat as men age, and you appear to be better off in that respect than many men your age who have not been treated for prostate cancer. If the nature of the erections is a problem in some way, you could try one of the Viagra like drugs. > Am not complaining just wondering if > maybe I could have done watchful waiting. > > I do not think my cancer was aggressive. That is something you will never know. You made your choice on the basis of what you knew at the time. If you had chosen not to be treated, you might have lived out your life without every being bothered by the cancer. On the other hand, it might have metastatized before it could be caught in time. It is fruitless to have second thoughts at this point since there isn't anything you can do about it. Consider another possibility. Ten years from now, there may be simple definitive tests which allow doctors to clearly distinguish aggresive cancers from innocuous ones with sufficient time for treatment. Treatment may also have advanced to the stage where few men experience any side effects at all. If so, all of us who were treated in what will be viewed as the Stone Age of prostate cancer treatment, will wish all this can come to pass much sooner. But that doesn't change the fact that we had to make our decisions based on what we knew at the time. > What do people think ? . Also, keep in mind that it is normal for erections to decline >somewhat as men age, To be frivolous: "The angle of the dangle decreases with age." > ... > Consider another possibility. Ten years from now, there may be simple [quoted text clipped - 6 lines] > that we had to make our decisions based on what we knew at the time. > ... That's a fascinating thought. It leads me to more speculation. It seems to me that the event horizon for "fast track" new treatments is around 10 years. If the treatment has just been developed, it will take 10 years to prove it, refine it, and make it available. If you need a treatment in five years, you better hope it's one that is in trials now. (Several promising PCa treatments are in trials now, but we still don't know if they'll pan out.) This is frustrating to everyone with a terminal illness. But developing new medical treatments is a bit like making babies. You can hurry and fuss all you want, but the gestation period still takes a long time. Alan Another option, between WW and RP, would be to look at seeding. I had such bad results from RP that if I had to do it over again I would have sought out someone who was good at seeding and given it a whirl. Does seeding foreclose a future RP? > Another option, between WW and RP, would be to look at seeding. I had > such bad results from RP that if I had to do it over again I would have > sought out someone who was good at seeding and given it a whirl. Does > seeding foreclose a future RP? Seeding is easy to take and is thought to be highly effective in low risk cases. After effects are generally light, but by no means guaranteed. Bad things can happen with any complicated medical procedure. This may indeed be a good alternative to WW vs. RP. Seeding is generally thought to foreclose future RP. The theory is that the radiation damages tissue enough that surgery presents many difficulties and complications that are dangerous for the patient. RP can be done, but it's high risk, has a lower probability of success, and most surgeons won't do it. Alan You were 56 and had prostate cancer. Watchful Waiting was not an option.  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 > hi, > [quoted text clipped - 36 lines] > > What do people think ? |
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