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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2006Help me understand this message on WebMD
There is a message on the WebMD prostate cancer group, that I don't understand. This gentleman recently had a RRP. His numbers were a gleason score of 6 (3+3), T1c, and psa of 4.4. Here is a quote from his message that I don't understand (hope he doens't mind) "My urologist did say however that even with my numbers, and my PCa not having showed signs of capsular penetration, that there is still a 1 in 3 chance that it may show it's ugly head again down the road and I will need radiation treatment." I don't understand this. Is the recurrance rate really that high? I thought the survival rate from PCa was around 90%. Help me understand how his urologist got these stats, and is he correct? Here is the link for more info: http://boards.webmd.com/webx?THDX@998.ZMabaQvxhZr.0@.893c7a95!thdchild=.893c7a95 Again, I hope this gentleman doesn't mind this reference to his message. > There is a message on the WebMD prostate cancer group, that I don't > understand. This gentleman recently had a RRP. His numbers were a [quoted text clipped - 6 lines] > 3 chance that it may show it's ugly head again down the road and I will > need radiation treatment." It must be something they teach in uro school. My doc said the same thing for my 7, T1c and 16. The Partin Tables show that there is an 80% chance it is organ confined. If it is and if his surgeon does his job right, he's a lot better off than 66%.  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, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum Here is a quote from his message that I don't understand (hope he doens't mind) "My urologist did say however that even with my numbers, and my PCa not having showed signs of capsular penetration, that there is still a 1 in 3 chance that it may show it's ugly head again down the road and I will need radiation treatment." I don't understand this. Is the recurrence rate really that high? I thought the survival rate from PCa was around 90%. Help me understand how his urologist got these stats, and is he correct? =========== here's the facts and maybe this will explain it. if you have an RP, they can not get every little tiny piece of prostate tissue out of the body. normally, this does not cause a problem. sometimes, they will have to do a resection with some pca tissue involved in the urethra. again, even that doesn't cause major problems. now, for the numbers....... if you have an RP, the usual recurrence happens around the 18 month mark. this is when one may notice the first rise in their psa. and if it continues to rise, then radiation would be used as the next option of treatment. if you are going to have a case of recurrence of prostate cancer in the first 3 years after surgery, there is a 50% chance. now, that doesn't mean that 50% of all men who gets RP's will have recurring pca. that means that of the ones who would get it, 1/2 of the cases show up in the first 3 years. by the 5th year, 80% of the all cases have shown up by the 10th year, 99% of the all cases have shown up for recurrence of pca. that is why -when you survived the 10 year mark, you are about as close to a cure as you're going to get because you only have a 1% to develop pca. at least, that is what the numbers say. ~ 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 Curtis...Where did you find the following information, it differs from my understanding of recurrence rates over time (see my other post in this thread)?..Ron if you have an RP, the usual recurrence happens around the 18 month mark. if you are going to have a case of recurrence of prostate cancer in the first 3 years after surgery, there is a 50% chance. now, that doesn't mean that 50% of all men who gets RP's will have recurring pca. that means that of the ones who would get it, 1/2 of the cases show up in the first 3 years. by the 5th year, 80% of the all cases have shown up by the 10th year, 99% of the all cases have shown up for recurrence of pca > Hi Curtis...Where did you find the following information, it differs > from my understanding of recurrence rates over time (see my other post [quoted text clipped - 11 lines] > of > pca I agree with ron. I would like to see how such estimates were made. From: oitbso@yahoo.com (ron) Hi Curtis...Where did you find the following information, it differs from my understanding of recurrence rates over time (see my other post in this thread)?..Ron if you have an RP, the usual recurrence happens around the 18 month mark. if you are going to have a case of recurrence of prostate cancer in the first 3 years after surgery, there is a 50% chance. now, that doesn't mean that 50% of all men who gets RP's will have recurring pca. that means that of the ones who would get it, 1/2 of the cases show up in the first 3 years. by the 5th year, 80% of the all cases have shown up by the 10th year, 99% of the all cases have shown up for recurrence of pca ======================= ok, i had to go over some of my old notes..... first, the 18 month mark... that is what MY surgeon told me. i had my psa testing done at the 20th month and it had jumped .01. he was concerned. now, let me add that we have a very open relationship and talk shop because he knows of my knowledge in pca and doesn't hide anything. that is when he told me that they can't get ALL prostate cells. that is just impossible to sweep the body of every cell, so some of going to be left behind. but if my psa was to climb, he also believes in a very aggressive treatment program of radiation while it is still in the prostate bed. next, where do the numbers come from. this have been a long time standing on this and there are many references to these numbers. i'm posting the comment from dr. catalona, since he has done the most recorded RP's on record in the world and should be one of the leading authority on this subject with all the stats that he has before him. RECURRENCE OF PROSTATE CANCER Q: What are the statistics on the recurrence of prostate cancer after a radical prostatectomy? A: Patients should have their PSA monitored every 6 months for 15 years. The chances for a recurrence decline the longer PSA levels are undetectable. Overall, about 10% to 30% of patients (depending on the findings in the prostatectomy specimen) who have had a radical prostatectomy have a recurrence in their lifetime. Of these recurrences, about 50% occur during the first three years, about 30% occur during the first five years, and 19% during the first ten years. and since we are on this subject of recurrence and treatment, here is what he says about radiation treatments after recurrence.......... FOLLOW-UP RADIATION AFTER RADICAL PROSTATECTOMY Q: If follow up radiation is needed after a radical prostectomy, how long should I wait before starting the radiation treatment? A: There are two types of followup radiotherapy. One is ADJUVANT RADIOTHERAPY, which is given as a precautionary measure in patients who have adverse prognostic features in their pathology report. This radiotherapy is usually given 3 to 4 months after the operation when urinary continence has returned. It may be delayed further if continence has not yet returned. The other is called SALVAGE RADIOTHERAPY for a rising PSA. This radiotherapy should be given before the PSA level rises above 1 ng/ml. 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 Dick...I couldn't follow your link, so my comments are based only on the information you posted and assume no positive margins or other adverse findings. First of all recurrence rates must always be associated with a specific time. For example, Walsh's data suggests a 5% recurrence rate at 10 years post-RP for a man treated by Walsh with those numbers. Maybe, in this case, the surgeon is simply not one of the better ones and those are the odds for his patients. Recurrence rates following surgery and RT have been shown to be (more or less) linear over time. Eur Urol 2002 Sep;42(3):212-6; Long-term follow-up of radical retropubic prostatectomy for prostate cancer; Swanson GP, Riggs MW, Earle JD, Haddock MG. "recurrences occurred at a steady-state throughout the length of follow-up" "Almost half the recurrences occurred after 10 years" Int J Radiat Oncol Biol Phys. 2004 Jun 1;59(2):406-11; Long-term follow-up of radiotherapy for prostate cancer; Swanson GP, Riggs MW, Earle JD. "The recurrences developed at a steady state throughout the length of follow-up. One half the recurrences occurred after 10 years, and recurrence was still observed >20 years after treatment" Walsh's data also shows a linear recurrence rate over time. For a man with the stats you cited, a 33% recurrence rate would be seen roughly 75 years post-surgery (by Walsh). So again, the possible explanations for this surprising recurrence rate would include: 1. The surgeon is misinformed 2. The patient misheard 3. This particular surgeon is a poorly performing surgeon 4. The patient was in his 20's and expects to live to 100 ...Ron > There is a message on the WebMD prostate cancer group, that I don't > understand. This gentleman recently had a RRP. His numbers were a [quoted text clipped - 16 lines] > Again, I hope this gentleman doesn't mind this reference to his > message. There have been several studies of the likelihood of recurrence based on presurgical diagnosis and post-surgical pathology. And the results aren't always consistent with one another. T1c, Gleason 6, and PSA 4.4 may be only the presurgical diagnosis. After surgery there is more information available such as margin status and revised Gleason. A Gleason 6 after surgery with tumor confined to prostate (as far as they can tell) and clear margins, using up-to-date data and studies, such as used for the Sloan Kettering nomograms, would suggest a biochemical recurrence rate after 10 years of at most one or two percent. But overall studies, combining different pathological results, and, more important, results from before the PSA screening era, may show fairly high recurrence rates. Of course, recurrence may also occur after 10 years, but figuring another couple percent fall off, which probably exaggerates the risk, would still leave the overwhelming large majority of men with such diagnostic criteria still recurrence free. Based purely on pre surgical diagnosis, the recurrence rates are a bit higher, but still very low, for such a case. Some other studies seem to show much higher recurrence rates, and it is not clear to me why that should be the case. It could have something to do with the populations involved, with the skill of the surgeons, or with the methodology used in the study. Unless one knows just what the surgeon was basing his comments on, it is impossible to judge how valid they were. My Uro said the same thing. 1 in 3 > There is a message on the WebMD prostate cancer group, that I don't > understand. This gentleman recently had a RRP. His numbers were a [quoted text clipped - 16 lines] > Again, I hope this gentleman doesn't mind this reference to his > message. Dick, Here is my understanding... Regardless of primary treatment there is also a chance that PCa will return; even if completely gone from the area in and around the prostate. Two main reasons are: A microfiber of cancer could have escaped and is floating around in your body looking for a new home. Microfibers are not detectible. Your genetics. The same gene that caused the cancer is still viable and eventually produces mutated cells again. This is why a lot of stock is being taken in research for cancer vaccines. The vaccines simply destroys the cancer causing gene. The only viable method of tracking a possible return is the PSA test. Time tables with percentages are just that - probabilities. Mike > There is a message on the WebMD prostate cancer group, that I don't > understand. This gentleman recently had a RRP. His numbers were a [quoted text clipped - 16 lines] > Again, I hope this gentleman doesn't mind this reference to his > message. > Dick, > > Here is my understanding... > > Regardless of primary treatment there is also a chance that PCa will return; > even if completely gone from the area in and around the prostate. That is certainly true. > Two main > reasons are: > > A microfiber of cancer could have escaped and is floating around in your > body looking for a new home. Microfibers are not detectible. That is also true, but it should be added that many experts think that cancer cells escape a cancerous prostate all the time and it is only if such cells have the ability to survive outside the prostate---callled metastatic capability---that you have a problem. It is still not clear to me why it may take so long in some cases. My guess is that the immune system keeps a small cancer in check for an extended time, but after long enough it fails and the cancer grows. > Your genetics. The same gene that caused the cancer is still viable and > eventually produces mutated cells again. I'm not sure how that would work. I can envisiion two ways genes could affect whether or not you get prostate cancer. First individual prostate cells may mutate into prostate cancer cells, and the likelihood of this might be dependent on the genes in that cell. Second, your immune system might fail to control beginning cancers. But, if all prostate cells have been removed from your body, then it is hard to see how you could have a recurrence of prostate cancer. > This is why a lot of stock is being > taken in research for cancer vaccines. The vaccines simply destroys the [quoted text clipped - 25 lines] >>Again, I hope this gentleman doesn't mind this reference to his >>message. Leonard Evens wrote...snip...: > > A microfiber of cancer could have escaped and is floating around in your > > body looking for a new home. Microfibers are not detectible. > That is also true, but it should be added that many experts think that > cancer cells escape a cancerous prostate all the time More than think, at the 2006 ASCO meeting the following paper was presented... Circulating tumor cells can be detected using telomerase activity with a high rate in patients with prostate cancer. Results: Blood samples from 107 patients with prostate cancer were studied. CTC were detected in 19/24 (75%) patients with advanced prostate cancer. In contrast, CTC were not detected in blood samples from 22 healthy male volunteers. CTC could be identified even in patients with a very low serum PSA (< 0.1 ng/mL). CTC were detected in 55/70 (79%) when tested in patients with localized prostate cancer before definitive treatment. CTC could also be detected in 3/13 patients (23%) with an undetectable prostate specific antigen (PSA) at least 1 year after radical prostatectomy, which is consistent with the expected relapse rate in this setting. > and it is only if > such cells have the ability to survive outside the prostate---callled > metastatic capability---that you have a problem. It is still not clear > to me why it may take so long in some cases. My guess is that the > immune system keeps a small cancer in check for an extended time, but > after long enough it fails and the cancer grows. We know that as tumors dedifferentiate they become better able to influence surrounding, non-cancerous cells. They can "coax" these cells into producing proteins and other agents that make the local environment less hostile to the tumor cells. A recent example of this (discussed here) involved cancerous cells influencing their local environment when they become "hormone resistant." Since cancerous cells are in the blood from an early stage, some current research suggests that not until these cells are able to get cells at the distant location to secrete "adhesion" factors, can they adhere and survive at this location. > > Your genetics. The same gene that caused the cancer is still viable and > > eventually produces mutated cells again. [quoted text clipped - 7 lines] > prostate cells have been removed from your body, then it is hard to see > how you could have a recurrence of prostate cancer. Two points here. Rarely, if ever, do curative treatments remove ALL cells. so there would typically be some tissue available to permit muation once again. Second, my guess, and it's only a guess, is that stem cells are not completely removed. So prostatic stem cells would be able, over time, to regenerate tissue that could become cancerous once again. This begs the question, are there also cancer stem cells. There is a lot of research in this area. Cancerous stem cells have been found for some organs; there is some interesting data by Bruchovsky to support their existence in prostate cancer (his work suggests an interesting mechanism for androgen independence). Interesting stuff...Ron > More than think, at the 2006 ASCO meeting the following paper was > presented... > > Circulating tumor cells can be detected using telomerase activity with > a high rate in patients with prostate cancer. Ron, Do you have the URL for viewing this paper? I found it fascinating that 79% had circulating CTC prior to treatment, but much less seemed to have it 1 year after treatment (assuming almost all of those were in the category of undetectable PSA). Ed Friedman Ed...Tinyurl seems to be having some problems at the moment, so here's the (big) url...Ron http://www.asco.org/portal/site/ASCO/menuitem.34d60f5624ba07fd506fe310ee37a01d/? vgnextoid=76f8201eb61a7010VgnVCM100000ed730ad1RCRD&vmview=abst_detail_view&confI D=42&index=y&abstractID=20190 > Ed...Tinyurl seems to be having some problems at the moment, so here's > the (big) url...Ron (snip 189-character URL) It's OK now. The Tiny URL is: http://tinyurl.com/pd8gq Regards, Steve J |
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