 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / August 2006What are the odds of PCa returning after 10 years?
What I really do not understand is why the odds seems to increase substantially that PCa returns after 10 or 15 years. If a man was monitoring his PSA and PCa was found in the early stages and subsequently had a RRP performed what are his odds of having PCa return after 15 years? and Why? What I don't understand is from some general reading I've done. They say that (roughly) 1 in 10 men who get PCa will die from it. Yet that seems counter to the notion that roughly 1/3 of men with PCa after 15 years will die from it. Are there cancer cells that were missed? If so, why not do EBR after surgery? > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. [quoted text clipped - 10 lines] > Are there cancer cells that were missed? If so, why not do EBR after > surgery? Can you say more about those statistics? Are we talking only about men who have had primary treatment (surgery or radiation)? Or are we including men who have never had primary treatment? Do you have a specific source? I seem to remember reading that, after surgery or radiation, the chance of a recurrence drops every year that goes by. More men will have a rise in PSA the first year after treatment than the second year. More will have a rise in the second year than in the third. And so on. However, I might have that wrong. Someone jump in and correct me if that is so. As for why a recurrence should happen 10 or 15 years after treatment, that's a tough one. I would think it could mean that one or more cancer cells were not killed by the treatment and continued to live and grow. Perhaps the death rate among those cells was almost as high as the reproductive rate, so that it took many years before they built up to a detectable level. A rad onc told me that surgeons _think_ they got all the prostate tissue out, but they can't know for sure. A surgeon once told me that rad oncs _think_ their radiation kills all the cancer, but they can't know that for sure either. Alan > A rad onc told me that surgeons _think_ they got all the prostate > tissue out, but they can't know for sure. A surgeon once told me > that rad oncs _think_ their radiation kills all the cancer, but they > can't know that for sure either. Neither promised me anything; the best reassurance I got was one simple "fact": negative margins. Whoopie; even if true and even at a cellular level, there are still cancer cells in my blood stream and no doubt others lodged in distant spots, all looking hard for a spot with favorable conditions to flourish. The higher our Gleason score, the greater their odds of success. Given that and my G8, all my negative margins do for me is shift my cancer's return odds towards distant --- i.e., incurable -- mets. With any luck I'll die of a heart attack instead. That would be a HUGE victory, given that my heart is apparently very healthy. I.P. > Can you say more about those statistics? Are we talking only about > men who have had primary treatment (surgery or radiation)? Or are [quoted text clipped - 22 lines] > > Alan Alan, I'm sorry, here is one of the references. http://www.casodex.net/9898_15535_5_6_0.aspx?mid=4#3 It's all very confusing IMO. I'm under the impression just like you, that as time goes on, the risk of recurrence is lower. http://www.casodex.net/9898_15535_5_6_0.aspx >>Can you say more about those statistics? Are we talking only about >>men who have had primary treatment (surgery or radiation)? Or are [quoted text clipped - 25 lines] > Alan, I'm sorry, here is one of the references. > http://www.casodex.net/9898_15535_5_6_0.aspx?mid=4#3 The data there refers to men who have shown evidence of biochemical recurrence through a rise in PSA. That is very different from the question you asked originally. > It's all very confusing IMO. I'm under the impression just like you, > that as time goes on, the risk of recurrence is lower. As I said in response to someone else, that may not be true. at least for moderate Gleason and PSA less than 10. The trouble is that the likelihood of recurrence in the next year for such a case is pretty small to start with, less than 1/2 percent. So it is not necessarily easy to detect a lessening of the recurrence rate over time. The data will always have some statistical noise, and that may overwhelm any small changes in the yearly recurrence rate. But look at it this way. At the very beginning, the risk of recurrence in one year is extremely small. The risk of recurrence within the next ten years is still not large, at most a few percent. If you get through that ten years, at worst you have the same risk for the next ten years. As time goes on, you face other risks, and the risk of something else happening will surely be larger than the risk of prostate cancer recurrence. At a certain point, it doesn't make sense to worry about it. Finally, since you won't live forever, as time goes on, the risk of recurrence during your expected lifetime does decrease. >>What I really do not understand is why the odds seems to increase >>substantially that PCa returns after 10 or 15 years. [quoted text clipped - 23 lines] > However, I might have that wrong. Someone jump in and correct me > if that is so. I have seen that asserted also. My urologist even told me that. But I haven't seen any specific research establishing that. My eyeballing of various graphs suggested to me that the probability of recurrence, as shown by a PSA rise, stays about the same for five or more years. After that, up to 10 years, it decreases, but very slightly. But I don't think the data is precise enough to draw really firm firm conclusions of this sort. > As for why a recurrence should happen 10 or 15 years after treatment, > that's a tough one. I would think it could mean that one or more [quoted text clipped - 9 lines] > > Alan > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. Maybe it just often takes that long for G6 micromets to defeat our immune system. > Are there cancer cells that were missed? If so, why not do EBR after > surgery? What would you irradiate? How would that stop micromets elsewhere? I.P. >What I really do not understand is why the odds seems to increase >substantially that PCa returns after 10 or 15 years. > >If a man was monitoring his PSA and PCa was found in the early stages >and subsequently had a RRP performed what are his odds of having PCa >return after 15 years? and Why? AFAIK, no matter which mode of Initial & Supplementary Treatments you have, you can never be sure you don't have Cancer cells still residing in your bloodstream. These can emerge, form clusters and redevelop Tumours at any time in the future after the effects of any prior Treatments have disappeared from your body. However, this is apparently minimised by keeping your Immune System healthy. Disclaimer: It's NOT a "given" and I'm not a Doctor, and even they cannot predict specific outcomes. -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC > this is apparently minimised by keeping your Immune System healthy. Which ALSO requires walking a tightrope . . . between sufficient exercise and too much exercise. I.P. I was under the impression that there will be cancer cells that remain free, however they are basically remain "dormant". And sometimes these dormant cancer cells "awaken" and can form new tumors. I'm confused. > I was under the impression that there will be cancer cells that remain > free, however they are basically remain "dormant". And sometimes these > dormant cancer cells "awaken" and can form new tumors. > > I'm confused. No confusion there. Sounds right to me. The HOPE is that all of those cells are subject to Death By ADT and will die at its hands. The REALITY is otherwise. I.P. > I was under the impression that there will be cancer cells that remain > free, however they are basically remain "dormant". And sometimes these > dormant cancer cells "awaken" and can form new tumors. I don't think I know any more than you do, but it was my impression that cancer cells without metastatic capability would be destroyed by your immune system if they took up residence elsewhere in your body. Those with metastatic capability would grow exponentially. so my guess is that it is only in the latter case that you can have recurrence. Just why it can take a long time for such a recurrence to reach the level of detectability is something I can only guess about. As I noted previously, my guess is that the immune system keeps such cells under control but doesn't elliminate them. > I'm confused. I am not sure where you come up with re- accurance...After 10 to 15 years, and please give me your details.. If you have a Dr. and do a biopsy, and decide your route, You will either be having RP, and or having Rp, and Radiation. You may have hormone, and such. Ablaition... I am confused with your statement and 15 year return...if not 10. Where are you getting this info from? You must be afraid to proceed... Anyway, keep in touch, make sure you are not just waiting ... Get your Diagnosis, and get that cancer out, before it spreads.. > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. [quoted text clipped - 10 lines] > Are there cancer cells that were missed? If so, why not do EBR after > surgery? > I am not sure where you come up with re- accurance...After 10 to 15 years, > and please give me your details.. [quoted text clipped - 3 lines] > I am confused with your statement and 15 year return...if not 10. > Where are you getting this info from? It's commonly known, and studies support, that PC often takes a turn for the worse around the 15-year point. I.P. Is this with treatment or without treatment? When I was diagnosed I read that if left untreated, a typical G6 patient had a 20% chance of being dead from PCa at 15 years with a sharp increase after that. With treatment, there is a steady decline in recurrence rates. I also read that any recurrence after 10 years is likely to be a new cancer in some left over prostate tissue, not a recurrence. I'm pretty sure that is some doctor's guess, not data from a study. Dave Perry > > I am not sure where you come up with re- accurance...After 10 to 15 years, > > and please give me your details.. [quoted text clipped - 8 lines] > > I.P. > Is this with treatment or without treatment? When I was diagnosed I > read that if left untreated, a typical G6 patient had a 20% chance of [quoted text clipped - 4 lines] > some doctor's guess, not data from a study. > Dave Perry I seem to recall that it's without tx, but I'm not certain, nor do I worry (i.e., care) about the distinction. 15 years is a lifetime away at this point in most of our lives, and it's not important whether anyone calls it a recurrence or a new cancer; it's still cancer, and we'll handle it if and when it happens. And even if PC doesn't recur or start anew, something else probably will try to kill most of us by that age. If we eat well, play hard, and get plenty of sleep, everything else will just have to depend on our genes, we already suspect they're faulty, and at present we can't do anything about that. And whether some doctor "pronounces" us cured of PC at some magical PSA/elapsed-time point has absolutely no bearing on the behavior of any PC cells that may remain; all it means is that the average pt who reaches that point ultimately dies of something else. That statistical factoid is of no practical use to most of us, nor do I find it particularly comforting. I.P. But, in 15 years a lot can happen. We can die of something totally unrelated to the cancer and/or a better treatment/cure may be found. By the way, my doc said the longer you go undetectable, the better your chances are that you will die of something other than Pca. Meaning you will be dead with undetectable psa levels. Kinda comforting to know, I think. (And some/most of us may even be cured now, period). I have a good friend that has been treated 10 years ago and is doing great both sexually and health wise. In the mean time, try not to loose any sleep dwelling over it. It could kill you sooner. I guess the only thing left for us to do is to wait and see. B.A. > But, in 15 years a lot can happen. We can die of something totally > unrelated to the cancer and/or a better treatment/cure may be found. By > the way, my doc said the longer you go undetectable, the better your > chances are that you will die of something other than Pca. Yes, so do these statistics adjust for that? > Yes, so do these statistics adjust for that? I'm not sure. There seems to be a lot of confusion with interpreting statistics. Sometimes there more that I read, the more confused I actually become. Numbers can be massaged to mean just about anything. Who really knows with complete certainty? (If so, please come forward and reply). I hope that my doc is right. All he treats is Pca and he's been doing so for a long time. B.A. I'm going to take a purely statistical stab at this. Many of the retrospective studies used Pt populations from the pre-PSA era and were, thus, comprised of older men diagnosed later in the progression of their disease. A lot of them probably died early of PCa or other conditions associated w/ their advanced ages. That left the ones who were unusually healthy otherwise and/or caught at a relatively younger age. 15 years out, many of these men had gotten pretty old but the ones still alive by then were the more generally healthy ones. However, these studies do not say that many of them did not have detectable PSA up to that point. I.e. they had PCa all along. Since they are the generally healthy remaining subjects, they are statistically more likely to die of the one serious condition they have - PCa. Just a hypothesis. Another thought is that some benign prostate tissue was left behind and continued to suffer the same mutations that started the PCa in the first place. After 15 years you get an independent, second case of PCa. Not a recurrence but a new case. Bill Denton RP 2/12/02 PSA ? Memphis >>But, in 15 years a lot can happen. We can die of something totally >>unrelated to the cancer and/or a better treatment/cure may be found. By >>the way, my doc said the longer you go undetectable, the better your >>chances are that you will die of something other than Pca. > > Yes, so do these statistics adjust for that? It depends on what is being estimated. But I think ordinarily they try to isolate factors related to the condition being studied. So unless they say otherwise, it would be reasonable to assume that when they talk about a recurrence rate after a certain period of time, they are giving estimates assuming that no one in the study population dies of something else. B.A. wrote: > But, in 15 years a lot can happen. We can die of something totally > unrelated to the cancer and/or a better treatment/cure may be found. > By the way, my doc said the longer you go undetectable, the better > your chances are that you will die of something other than Pca. Leonard Evers wrote: > It depends on what is being estimated. But I think ordinarily they > try to isolate factors related to the condition being studied. So > unless they say otherwise, it would be reasonable to assume that when > they talk about a recurrence rate after a certain period of time, > they are giving estimates assuming that no one in the study > population dies of something else. Leonard: I do hope that the recurrence estimates are based on this "reasonable assumption". (I hate to assume anything as of late). None the less, what one will eventually die from may be, in the end, moot to this subject. But I do see your point though. B.A. >> I am not sure where you come up with re- accurance...After 10 to 15 >> years, and please give me your details.. [quoted text clipped - 8 lines] > > I.P. Can give some references to the medical literature? >>> I am not sure where you come up with re- accurance...After 10 to 15 >>> years, and please give me your details.. [quoted text clipped - 10 lines] > > Can give some references to the medical literature? Not specifically. It has been discussed here before, and I read it several months ago in one of my newsletters from J-H, Mayo, or Harvard. It's not important enough to warrant my time to research it again. I.P. > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. [quoted text clipped - 10 lines] > Are there cancer cells that were missed? If so, why not do EBR after > surgery? I think the figures are very much a function of your pathology etc. I was told that early detection, normal Gleason, contained, etc is basically a cure after 3 years of undetectable PSA. I'll wait for Leonards response... as always.  SignatureJK Sinrod www.SinrodStudios.com www.MyConeyIslandMemories.com Dick Smith wrote...snip... > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. I don't think the odds increase out beyond 10-15 years. Several papers have described recurrance rates versus time for both RP and RT; to a first approximation, the rates appear to be linear with time. Specifically for RP, the Hopkins' nomograms (which can be found at http://www.prostate-help.org/download/jhnomo.pdf) show the projected biochemical recurrance-free rates at 3, 5, 7 and 10 years post-treatment for men with various combinations of PSA, GS and TNM stage prior to treatment. I don't know what your initial staging was, but for a T1c man with PSA = 4-10 ng/ml, and GS=6 the recurrance rates at theses times were found to be 2, 3, 4 and 5% respectively (note: this data is based on a large series of men treated at Hopkins over a long period of time and then temporally adjusted to what a man receiving treatment today could expect). If you plot this data you will see a roughly linear trend with time. In other words, about 2.5% of these T1c, PSA=4-10, GS=6 men will suffer biochemical failure at 5 years, 5% at 10 years and 7.5% at 15 years; an additional 2.5% of the population will fail every 5 years as time goes on...roughly speaking. The odds for failure do not increase substantially over time. There was a study that once claimed a failure spike out at the 15 year post-treatment time frame, but further analysis showed this claim to be in error (see 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer; Peter C. Albertsen, MD, MS; James A. Hanley, PhD; Judith Fine, BA; JAMA. 2005;293:2095-2101). > If a man was monitoring his PSA and PCa was found in the early stages > and subsequently had a RRP performed what are his odds of having PCa > return after 15 years? and Why? The "odds" part of your question is addressed above. As to why reocurrances occur, either the primary treatment missed some of the cancer, it was already systemic, or the same genetic and environmental factors that produced PCa in the first place combined to produce a new cancer on some remaining tissue...Best wishes and good health, ron > Dick Smith wrote...snip... >> What I really do not understand is why the odds seems to increase [quoted text clipped - 3 lines] > have described recurrance rates versus time for both RP and RT; to a > first approximation, the rates appear to be linear with time. ... < Good analysis elided > ... I'll add to Ron's analysis that, if I understand the article that Dick cited, the longer it takes for a recurrence, the less likely it is for the recurrence to kill you - not just because you're older than if it recurred earlier, but also because the rate of cancer growth is lower for the men whose PSA begins to rise in later years. Alan > Dick Smith wrote...snip... > [quoted text clipped - 19 lines] > population will fail every 5 years as time goes on...roughly speaking. > The odds for failure do not increase substantially over time. I hate to disagree with ron because he is much better on the literature and he is almost always right. But he and I have had this discussion previously, so I will remind him again, that if the number who are still recurrence free is a decreasing linear function of time, then the probability of recurrence in any given year must be going up. That is because in any given year, the number of men left in the non-recurring population is smaller. If you divide a fixed change---consequence of linearity---by a smaller denominator, you get a bigger ratio. It is that ratio which gives you the recurrence rate. But as I said previously, there is too much noise in the data to come to such a conclusion. I don't believe the recurrence rate actually increases with time, although it is possible it is constant. My conceptual model of what is happening is something like this. Take 100 men with the same diagnostic criteria who are treated the same way with the same results. A certain number of them will be cured entirely with no prostate cells left in their bodies. The remainder will start exhibiting recurrence and over time that population will decline to zero. But for moderate cases treated early, that will take so long that all 100 men will have died of something else anyway. Not knowing anything else, it is plausible that the men in the cancer subpopulation will decline exponentially with a certain half life. That means there will be a period of time after which the number left will be half, after another such period, the number left will be one quarter, etc. But this half life is probably many decades or perhaps even longer. So in fact within any reasonable period of time the great bulk of these men won't have shown evidence of recurrence. Of course, I don't have any evidence that this is a useful model and even if it is, I have no idea what the relevant parameters are, i.e., size of cancer free subpopulation and half life for the cancer subpopulation. > There was a study that once claimed a failure spike out at the 15 year > post-treatment time frame, but further analysis showed this claim to be [quoted text clipped - 11 lines] > factors that produced PCa in the first place combined to produce a new > cancer on some remaining tissue...Best wishes and good health, ron Leonard Evens wrote...snip... > > ron wrote: > > I don't think the odds increase out beyond 10-15 years. Several papers > > have described recurrance rates versus time for both RP and RT; to a > > first approximation, the rates appear to be linear with time. > I hate to disagree with ron because he is much better on the literature > and he is almost always right. But he and I have had this discussion [quoted text clipped - 5 lines] > linearity---by a smaller denominator, you get a bigger ratio. It is > that ratio which gives you the recurrence rate. Leonard...That is a very important point that you make. Thank you for the kind reminder. So let's see if I have it right. When the cumulative rate appears linear over time, the actual rate for a given interval is increasing with time. I can see why I do not want to remember that! Nonetheless, if the recurrence rate for a [T1c, GS6, PSA-4-10] man treated with RP is 5% per 10 years, then it would require 200 years for all of those men to succumb. I guess I can still sleep soundly knowing that! And as you allude to, that is probably a "worse case" scenario. The curves for higher risk men do appear to show a flattening over time. Presumably, at longer times, such flattening would appear above the noise in the curves for the lower-risk men as well, further elongating their survival time. Thanks again for making your point...Best wishes and good health, ron > Leonard Evens wrote...snip... > > > ron wrote: [quoted text clipped - 25 lines] > well, further elongating their survival time. Thanks again for making > your point...Best wishes and good health, ron I recently was diagnosed (Jan 2006) and had my Laproscopic RP on June 21st. I was T1C, Gleason 6 and had excellent pathology results. I will have my first post surgery PSA results on August 14th. I have been monitoring some of the traffic on the support group, and find a lot of conflicting opinions. One basic statistic that I find reassuring is that one in 6 men will develop prostate cancer in their lifetime, mostly after age 60, but only one in 34 will die of it. Earlier detection reduces the probability of PCa taking your life..perhaps we should focus on improving our life styles to eliminate the other causes of death. That's my spin. Cliff <perhaps we should focus on improving our life styles to eliminate the other causes of death.> My wife and I had that same conversation, particularly with, at the time, 5 and 10 year old kids. But after deliberation, and with a $2M life insurance policy to back me, I bought a Harley. One of the Harley mottos is "Ride to Live, Live to Ride". Works for me. Tom >perhaps we should focus on improving our life styles to eliminate >the other causes of death. But that would leave PCa as the cause of death - I thought that was what we wanted to avoid - at all costs....(my head's spinning)... "But that would leave PCa as the cause of death - " And that brings us back to my little statistical hypothesis from earlier in the thread: "15 years out, many of these men had gotten pretty old but the ones still alive by then were the more generally healthy ones. However, these studies do not say that many of them did not have detectable PSA up to that point. I.e. they had PCa all along. Since they are the generally healthy remaining subjects, they are statistically more likely to die of the one serious condition they have - PCa." As to dormant PCa waking up, perhaps there are almost always PCa cells remaining after whatever Tx you have had, and at some point in your life, for whatever reason, there is some insult to your immune system and it no longer can "keep up." Bill Denton RP 2/12/02 PSA ? Memphis >>perhaps we should focus on improving our life styles to eliminate >>the other causes of death. > > But that would leave PCa as the cause of death - I thought that was > what we wanted to avoid - at all costs....(my head's spinning)... Even those of us who have accepted the inevitable, death is very strongly avoided. However, not at all costs. Many here have voiced their opinion that they would accept death in lieu of some treatments. One has to believe that some, when the decision time actually arrives, will do just that. Howard Martin chose death rather than take meds that were tested on animals. We all have our own order of priorities. Personally, I've accepted death. I'm hoping a heart attack or bus intervenes. 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, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum > Personally, I've accepted death. I'm hoping a heart attack or bus > intervenes. I researched my life insurance policy to determine whether I would have to make my death look accidental if my PC gets out of hand. Nope; suicide is excluded only for a policy's first few years, so you don't have to be a good actor to end up under those bus wheels and still provide for your survivors. My problem is that if I have the mental and physical capacity to get to the bus, it's not time yet. I.P. >> perhaps we should focus on improving our life styles to eliminate >> the other causes of death. If mankind knew how to ELIMINATE the other causes, most of us would live way past a hundred. I suspect Jack LaLanne also has great genes, unlike Jim Fixx or my anti-smoking aunt who died a horrible death of throat cancer, and we can't choose or alter our genes . . . yet. > But that would leave PCa as the cause of death - I thought that was > what we wanted to avoid - at all costs....(my head's spinning)... THAT'S (mechanically) easy to achieve, but few people are willing to commit suicide. Thus the bigger issue becomes timing: how do we guarantee that our self-induced cardiovascular event will come at juuuuust the right time and will be quick and fatal? If we all subscribed to the "at all costs" clause, we'd hit it with RP, RT, ADT, chemo, and supplements the minute we recovered from our biopsies. Many/most of us wait for a reason to seek adjuvant tx BECAUSE of the costs, even if our insurance covers every dime. I.P. >> But that would leave PCa as the cause of death - I thought that was >> what we wanted to avoid - at all costs....(my head's spinning)... [quoted text clipped - 3 lines] >guarantee that our self-induced cardiovascular event will come at >juuuuust the right time and will be quick and fatal? In Marco Ferreri's film La grande bouffe, 4 disenchanted late-middle-aged friends fornicate and eat themselves to death - I think it took them about 4 days. (Eating food, by the way, not each other!). But this was a rich man's suicide, the truffle costs alone would have been prohibitive. >If we all subscribed to the "at all costs" clause, we'd hit it with RP, >RT, ADT, chemo, and supplements the minute we recovered from our >biopsies. Many/most of us wait for a reason to seek adjuvant tx BECAUSE >of the costs, even if our insurance covers every dime. > >I.P. >>Leonard Evens wrote...snip... >> [quoted text clipped - 41 lines] > That's my spin. > Cliff With your pre-surgical diagnosis and excellent pathology results, if you were coldly logical, you would not worry at all about prostate cancer in the future. But, like the rest of us, you probably will. Given that someone is diagnosed with prostate cancer, the chances are between 1 in 5 and 1 in 6 that he will die of it. But, as a rough guess, I think the chances that someone like you will die of prostate cancer are at least five times better than that. > With your pre-surgical diagnosis and excellent pathology results, if you > were coldly logical, you would not worry at all about prostate cancer in [quoted text clipped - 3 lines] > the chances that someone like you will die of prostate cancer are at > least five times better than that. Viewing a slide show at http://www.cdc.gov this morning. SLIDE 20 Risk of Mortaqlity From Prostate Cancer Among Men in a Randomized Trial Average age 65 years at entry: 8 years followup PROSTATE REMOVED vs. WATCHFUL WAITING 7.1% died of PCa 13.6% died of PCa 14.9% died of other causes 14.7% died of other causes >> With your pre-surgical diagnosis and excellent pathology results, if you >> were coldly logical, you would not worry at all about prostate cancer in [quoted text clipped - 17 lines] > 7.1% died of PCa 13.6% died of PCa > 14.9% died of other causes 14.7% died of other causes The slide NICK cites is at http://www.cdc.gov/cancer/prostate/screening/slides/slide19.htm. It is based on one study of 800 men who elected watchful waiting. The explanatory text that accompanies the slide doesn't say who did this study or when it was done; it references more than a dozen studies, only two of which were published in 2000 or later; the rest go back as early as 1994, which is means they studied men who may have been treated in the 1980s. I don't believe, therefore, that the slide represents survival rates for either state-of-the-art active treatment available today (surgery, radiation, etc.), or state-of-the-art active surveillance as practiced today (frequent PSA studies, with options for supplements and dietary changes, etc.) Alex > The slide NICK cites is at > http://www.cdc.gov/cancer/prostate/screening/slides/slide19.htm. [quoted text clipped - 4 lines] > which were published in 2000 or later; the rest go back as early as 1994, > which is means they studied men who may have been treated in the 1980s. You are correct for the daes with slide 19. However, the slide I mentions was #20, and the single date mentioned is Source: Holmbert et al., 2002 http://www.cdc.gov/cancer/prostate/screeing/slides/slide20.htm >> The slide NICK cites is at >> http://www.cdc.gov/cancer/prostate/screening/slides/slide19.htm. [quoted text clipped - 11 lines] > > http://www.cdc.gov/cancer/prostate/screeing/slides/slide20.htm NICK, you are correct. I was looking at the notes on the wrong slide. The Holmberg study is at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=2 2213857&dopt=Citation or http://tinyurl.com/le7yz The study was done during the 10 years prior to 1999, in Sweden, tracking 695 men newly diagnosed during that decade with PCa. The median follow-up period was six years. Virtually equal numbers of men got radical prostatectomies and did watchful waiting. 16 of the RP guys died of prostate cancer during the period, compared to 31 dead among those who did WW. For reasons that are not clear from the summary, more men who had RP died of causes OTHER than PCa than those in the WW group; as a result, 53 of the RP guys died of PCa AND other causes, versus 62 in the WW crowd. As a result, Holmberg says, "In this randomized trial, radical prostatectomy significantly reduced disease-specific mortality, but there was no significant difference between surgery and watchful waiting in terms of overall survival." Sweden has a goverenment-controlled, publicly-funded medical system, excellent but quite different from that of the U.S. Articles on the Web suggest that patients are treated in an assembly-line fashion, which is not great for WW. These differences, plus the advances in medical knowledge about PCa since the mid-1990s, still make me hesitant to put a great deal of weight to this one study's findings. And just my luck, I'd elect RP and a year later fall off the roof! (g) Alex Alex wrote...snip... > NICK, you are correct. I was looking at the notes on the wrong slide. > The Holmberg study is at [quoted text clipped - 15 lines] > significant difference between surgery and watchful waiting in terms of > overall survival." The Swedish study has continued on with time. The latest report, at a median follow-up of 8.2 years, is the first to see the expected difference in overall mortality between WW and RP...Best wishes and good health, Ron N Engl J Med. 2005 May 12;352(19):1977-84 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. 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. > The Swedish study has continued on with time. The latest report, at a > median follow-up of 8.2 years, is the first to see the expected [quoted text clipped - 3 lines] > N Engl J Med. 2005 May 12;352(19):1977-84 > Radical prostatectomy versus watchful waiting in early prostate cancer. > 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. [ snip ] I'm lousy at statistics, but this seems to be saying that 100% of the men in the RP group went through major surgery, with substantial risk of side effects, but that 85% of them received essentially no gain in life expectancy versus doing watchful waiting, and 8.6% died anyway. So that's 93.6% who either died despite undergoing the surgery or would have had the same lifespan if they had simply done WW. In sum, that seem like only 6.4%, or 22 of the 347 RP men, actually gained life expectancy. If this is correct, that's not an enormously impressive benefit for an operation that is the "gold standard" of care. According to one recent study (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 6234566&dopt=Abstract) of 11,000 Canadian men who got RP, the operation is not risky, but neither is it risk-free. Half of one percent died and 20.4% had "one or more complications" within 30 days of having the operation. Alex Alex wrote...snip... > I'm lousy at statistics, but this seems to be saying that 100% of the men in > the RP group went through major surgery, with substantial risk of side [quoted text clipped - 7 lines] > If this is correct, that's not an enormously impressive benefit for an > operation that is the "gold standard" of care. Hi Alex...Two points to consider. First, it is generally agreed that overall mortality is a poor measure of treatment success (as opposed to screening success, where overall mortality may be a useful metric) for slowly progressing diseases among elderly populations, such as PCa. Consider that when the trial starts both arms will have 0% deaths and when the trial ends, both arms will have 100% deaths; it is usually difficult to see significant differences in overall mortality in the intervening years. Despite the "noise" such a difference was seen and found to be statistically significant in the Swedish studies. Second, the study is only out to a median follow-up of 8.2 years. That means that many man are only 4, 5, 6 years into the study. Since PCa is a slowly progressing disease (even if you do nothing after diagnosis, you may well live another 10 or so years before clinical symptoms appear, death will take even longer). A study such as this one needs to get even further out in order for the mortality differences to maximize. An indication that overall mortality differences will increase further is presaged by the increasing differences in local progression, mets and PCa specific mortality seen between the WW and RP arms at 8 years. Whatever the magnitude of the differences ultimately turns out to be, your point is no less valid. Depending upon how many years a man personally believes he has left, and how he personally weights QOL versus living as many of those remaining years as possible, the reported differences may seem large or small...Best wishes and good health, Ron Hi Ron, Those two points are the crux of the matter. Day in and day out we hear the immediate side effects of treatment. On the other hand, silence about untreated disease progression. Are we to believe that as disease progresses untreated there are no symptoms that affect QOL? The study in question reports: "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)." Men that die of PCa have disseminated metastatic disease. At the time of death and for years before, there are symptoms that affect QOL. To shove and ignore this under the rug detracts from a realistic decision making process. Best regards, RalphV www.azustoo.org > Alex wrote...snip... > > I'm lousy at statistics, but this seems to be saying that 100% of the men in [quoted text clipped - 36 lines] > reported differences may seem large or small...Best wishes and good > health, Ron Maybe a few people should Goggle some of Berky's posts. Of course towards the end he didn't bother to post anymore because it was too much effort to sit at the computer. QOL with advanced PC is not good. Go up some steps and a leg will break throwing the man to the ground. It's not a simple break but rather a compound fracture requiring pins and maybe even a rod because the cancer has eaten the bone away. Or maybe it will begin to eat the brain and cause a change in personality. The list goes on and on. Bev > Hi Ron, > Those two points are the crux of the matter. Day in and day out we hear [quoted text clipped - 60 lines] > > reported differences may seem large or small...Best wishes and good > > health, Ron >>The Swedish study has continued on with time. The latest report, at a >>median follow-up of 8.2 years, is the first to see the expected [quoted text clipped - 11 lines] > > I'm lousy at statistics, I agree. You are lousy at statistics. but this seems to be saying that 100% of the men in > the RP group went through major surgery, with substantial risk of side > effects, You don't know how many had side effects or how severe they were. The most serious side effect of RP, serious incontinence is relatively rare. Impotence is more common, but it is also fairly common for all men above a certain age. It can also be treated and need not prevent a fairly normal sex life. Unless you create a complex model in which all these factors are taken into consideration, you can't quantify the degree of suffering from side effects. > but that 85% of them received essentially no gain in life I don't see where you got this number. The figures say that when comparing these groups, during the study, the number who died of anything was about 27 percent higher in the WW group than in the RP group. As ron points out, you can't estimate any relative increase in life expectancy until all the men have died, or pretty close to that. A median period of 8 years is too short. > expectancy versus doing watchful waiting, and 8.6% died anyway. of prostate cancer. About 24 perecent died overall. Even that figure is not too useful unless you know how many men that age you would expect to die within an 8 year period. > So that's 93.6% who either died despite undergoing the surgery or would have > had the same lifespan if they had simply done WW. I'm not sure just what you are dividing by what. It is certainly true that if a man knows there is a very strong chance that he will die in the next 8 years, he would be wise not to choose RP. Also, any man who is unlucky enough to die earlier than he might have reasonably expected could conclude in retrospect that choosing RP was not a wise choice. Unfortunately, we don't get to look into the future when making such decisions. Again, any conclusion about what happened to expected lifespans is not merited on the basis of the available data. > In sum, that seem like > only 6.4%, or 22 of the 347 RP men, actually gained life expectancy. Where does this come from? > If this is correct, that's not an enormously impressive benefit for an > operation that is the "gold standard" of care. You misunderstand the term 'gold standard". It means it is the oldest method of treatment with the most long term reliable data. So it is the standard against which other treatments must be compared. It doesn't mean it is the best treatment choice in every situation. Another thing you forget is that there is no such thing as an overall 'benefit' which can be attached to a choice of this kind. You have to look at the situation from the perspective of an individual making the choice. Which choice is best will depend on many factors, and it will never be possible to avoid uncertainties. In the present case, it is well known that for men past a certain age, RP or any other aggressive atempt to cure prostate cancer, is not a good choice. But for younger men with an extended life expectancy, it may be. Unfortunately, there isn't any simple arithmetic which can give you a certain answer. What you are doing here is rhetorically emphasizing the side effects of RP, without any detailed analysis, and then trying to minimize through silly arithmetic calculations the benefits. It sounds good, but it isn't particularly helpful. If you don't want to undergo RP, that is fine. That is a reasonable choice for many men. But don't try to convince other men who are considering it that it is useless on the basis of some numerology. > According to one recent study > (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 6234566&dopt=Abstract) > of 11,000 Canadian men who got RP, the operation is not risky, but neither > is it risk-free. Half of one percent died and 20.4% had "one or more > complications" within 30 days of having the operation. Unless we know more about the men who died and which men had what kind of complications, this is not very useful information. Any given man has to be concerned not with overall averages but what the risks are for him. > Alex >>>The Swedish study has continued on with time. The latest report, at a >>>median follow-up of 8.2 years, is the first to see the expected [quoted text clipped - 95 lines] > >> Alex Wow, Leonard, I'm not sure what prompted the sharp tone of your response. I was simply trying to participate in a discussion of the relative mortality risks and benefits of RP and WW raised by the CDC slide, and I acknowledged at the outset that I am not a statistician. I certainly may be wrong, both in my use of the data and in my conclusion. I may even be (fatally) wrong in electing WW for the moment. But scolding me for "silly arithmetic" and "numerology" seems needlessly harsh, and claiming that I attempted to "convince other men who are considering it (RP) that it is useless" is a mis-characterization of what I wrote. (Given the nature of this newsgroup, I am surprised that some participants choose to adopt a belligerant tone. It's not an especially effective way to persuade others, but it CAN cause some newbies to decide not to hang around. If even one guy doesn't get information that could have helped him because he was discouraged by needless hostility, that would be a real tragedy.) Let me respond to some of the points your raised. I wrote, "100% of the men in the RP group went through major surgery, with substantial risk of side effects..." You responded, "You don't know how many had side effects or how severe they were." True. I said "substantial risk." Not certainty, not X%. Just a RISK, which a regular reader of this NG will see translates into significant problems for SOME of those who elect RP. You are certainly right to note that I did not weigh QOL issues related to either RP surgery or to a lingering death due to PCa. Since that information was not provided in the study, I had no way to do so. More substantively, in response to my comment that, "In sum, that seem like only 6.4%, or 22 of the 347 RP men, actually gained life expectancy," you asked "Where does this come from?" Let me try to recap my analysis, so you can tell me where I went wrong. The two groups were randomly selected, so presumably both started the trial with similar risks of mets. In the WW group, 50 of the 348, or about 15%, died of PCa, and 298 or 85% did not. Presumably, therefore, a similar 85% of those who elected RP would NOT have died of PCa (as you noted, all this is for a very limited period of years, but that's what the study looked at.) So WITHIN THIS STUDY PERIOD this 85% of RP patients received no incremental lifespan from the surgery, because they would not have died even if, like the WW folks, they did nothing. In addition, 8.6% of those who got RP died anyway. So in my view, the 85% of the RP guys who would not have died even without RP, plus the 8.6% who died despite the RP, add up to 93.6% who did not receive incremental lifespan. How is this calculation (staying within the confines of the data provided by the study and the time period it covered) incorrect? You also say I "misunderstand the term 'gold standard'. It means it is the oldest method of treatment with the most long term reliable data. So it is the standard against which other treatments must be compared. It doesn't mean it is the best treatment choice in every situation." Dr. Patrick Walsh has a less conservative interpretation of the term than you do. He writes, "If cancer is confined to the prostate, there is no better way to cure it than radical prostatectomy. The goal of all other forms of treatement for prostate cancer is to be as good as the 'gold standard,' radical prostatectomy." (Guide To Surviving Prostate Cancer, p. 206.) Leonard, I am not evangelizing for WW or against RP. I am one year post-diagnosis, trying to figure out what to do. I am being treated by a team of PCa specialists who are regarded by their peers as among the best in the country, and they are telling me that AT THE MOMENT there is no need for me to rush a decision. So for the time being I am comfortable with active surveillance both of my cancer and of the research available to me. Should my situation change, I would not hesitate to switch to active treatment, such as RP, radiation, etc. Good health to you. Alex >What you are doing here is rhetorically emphasizing the side effects of >RP, without any detailed analysis, and then trying to minimize through [quoted text clipped - 3 lines] >convince other men who are considering it that it is useless on the >basis of some numerology. I'm completely baffled by this! Other than a blatant and inexplicable effort to trash Alex's thorough and seemingly reliable collation of the figures and then an additional insulting side-swipe by describing it as 'some numerology', what other means do we have, do ANY of us have, in trying to make a decision as to how to proceed? >>>The slide NICK cites is at >>>http://www.cdc.gov/cancer/prostate/screening/slides/slide19.htm. [quoted text clipped - 31 lines] > significant difference between surgery and watchful waiting in terms of > overall survival." Note first that fewer men died of all causes in the RP group than in the WW group. But it wasn't considered statistically significant. You have to understand what that has a precise technical meaning. Roughly speaking, it means that by choosing a small sample from a much larger population, e.g, all men in Sweden diagnosed with prostate cancer, the observed result might plausibly be attributed to biases arising simply by chance. (Of course, all these terms, including 'plausibly', can be made have precise tehcnical meanings.) Most important, 'significant' here doesn't mean just what it means in ordinary speech, where if something is not significant, you can safely ignore it. Another confusion about this study was that more men in the RP group died of causes other than prostate cancer than in the WW group. But again the results were not statistically significant, so one should not draw any conclusions from that fact. Note that the period of followup was rather short, median of about 6 years. To me the most startling result of the study was that in this short period, about twice as many men in the WW died of prostate cancer than in the RP group. Finally, it should be noted that the study continued and a follow-up paper showed that after more time the RP group continued to do better in terms of PC mortaility and, I believe, this time the difference in overall mortality was also significant. In addition, the RP group did significantly better than the WW group in terms of clinical signs of advanced metastatic prostate cancer. One has to now consider these two papers as confirming, in the Swedish context, the utility of RP relative to WW. However, it would be a mistake to generalize this to the US. Since PSA screening has not been common in Sweden, these men approached their doctors for other reasons, which probably had nothing to do with prostate cancer, but for one reason or another, the doctor ordered a biopsy and prostate cancer was diagnosed. But these cancers were diagnosed, on the average, five or more years later than would have been true in the US. Hence the cases were more advanced when diagnosed. It is not clear how a similar study in the US would come out. In fact, there is one such large scale study in progress now, but the results won't be in for several years. My guess is that it would take considerably longer for any difference in prostate cancer mortality to show up. The reason is that a non-trivial number of Gleason 6, PSA < 10, T1c cases which are treated today would in fact never amount to anything in the patient's life time if left untreated. Unfortunately, we don't know how many such cases there are or how to distinguish them from cases where the cancer is more aggressive and would kill the patient if left untreated. In Sweden, such men would live out their lives without every knowing they had prostate cancer, and the 695 men in their study represented generally more aggressive cases. I would expect a similar study done in the US to show less of a difference, because of greater dilution by relatively benign cases, and that it would take longer for any difference to show up because of earlier diagnosis. > Sweden has a goverenment-controlled, publicly-funded medical system, > excellent but quite different from that of the U.S. Articles on the Web > suggest that patients are treated in an assembly-line fashion, which is not > great for WW. These differences, plus the advances in medical knowledge > about PCa since the mid-1990s, still make me hesitant to put a great deal of > weight to this one study's findings. I don't think the way medical care is organized in Sweden has anything to do with the matter. The US is the only advanced nation in the world without some form of universal medical care. This suits some people fine, and you regularly see sniping at other countries, such as Sweden, which in fact do better than the US in overall medical care. The differences in prostate cancer treatment, I think, have more to do with differences in philosophy than how medical care is delivered. Even in the US, many medical authorities think that early detection and aggressive treatment of early prostate cancer is misguided. You constantly see statements in the media that prostate cancer is just part of aging and is essentially benign except for a small number of unfortunate men where nothing helps anyway. It is not impossible that this philosophy would become dominant, and then lots of things would change. For example, if two large studies, one studying treatment and the other screening, show no overall benefits from either, you can expect something like that to happen. Most physicians would stop doing PSA screening, insurance companies would stop paying for treatment, etc. Note also that even in the US, the overwhelming bulk of men diagnosed with prostate cancer are covered by one form of universal, government funded, medical care, i.e., men over 65 (Medicare) and veterans (VA). Several of the men here have been treated at VA hospitals. Some of the care they received was substandard, but some was also really excellent. The same could be said of men covered by private insurance. As is well known, universal medical care won't work in the US---except apparently for people over 65 and veterans. > And just my luck, I'd elect RP and a year later fall off the roof! (g) > > Alex > It is not clear how a similar study in the US would come out. In fact, > there is one such large scale study in progress now, but the results > won't be in for several years. http://patient.cancerconsultants.com Patients with Prostate Cancer Who Choose to Delay Treatment Require Routine Follow Up Journal of Urology Vol 164, No 1, pp 81-88, 200 Study in Canada "Watchful Waiting" for Selected "Good Risk" Men with Prostate Cancer May Be an Appropriate Approach to Therapy Journal of Urology 2002;167:1664-1669 Depends on how the term "recently" is interpreted. >>> The reason is that a non-trivial number of Gleason 6, PSA < 10, T1c cases which are treated today would in fact never amount to anything in the patient's life time if left untreated. But it is my understanding that a non-aggressive cancer such as the above, if not treated, can become aggressive later (is this correct?). >>>>The reason is that a non-trivial number of Gleason 6, PSA < > [quoted text clipped - 3 lines] > But it is my understanding that a non-aggressive cancer such as the > above, if not treated, can become aggressive later (is this correct?). Yes it certainly can, and often does. But just how often such cancers remain innocuous for extended periods of time is not known. I've seen some estimates placing it at about 15 percent, but I don't think that figure is too reliable. It is possible it is considerably higher. On the other hand, any man with an expected lifetime of less than 10 years, probably shouldn't consider RP. That would appply to many men over 70. Generally younger men with life expectancies of 15-20 years or more are usually advised not to choose WW because the chances of metastasis while waiting are deemed to high. There is also an intermeidate group, some men in their late 60s to early 70s with low tumor volume and other such indications for whom WW is now recommended by some urologists. There is ongoing research looking at various cellular markers which might help in the future, but so far it is a crap shoot. I asked two urologists that very question and both independently said there was little evidence to support the notion that Gleason numbers go up with time, at least neither was impressed with whatever evidence might be around. As for the non-trivial number of Gleason 6, PSA<10, T1c cases that never amount to anything, that's probably true. When first diagnosed, I was told if left untreated (these are also my numbers) I would have a 20% chance of being dead from PCa at 15 years. That leaves 80% still up and kicking. Of course, since many of these may be in the late stages of metastatic disease, I opted for treatment "just to be safe" since I was 60 at the time with no other health factors in sight. No regrets even with both major SE's a part of my life. Dave Perry > >>> The reason is that a non-trivial number of Gleason 6, PSA < > 10, T1c cases which are treated today would in fact never amount to > anything in the patient's life time if left untreated. > > But it is my understanding that a non-aggressive cancer such as the > above, if not treated, can become aggressive later (is this correct?). dave perry wrote...snip... > I asked two urologists that very question and both independently said > there was little evidence to support the notion that Gleason numbers go > up with time, at least neither was impressed with whatever evidence > might be around. Hi Dave...There are a couple of studies that have examined GS changes in men practicing WW over time. These studies support the contention that Gleason grade can increase with time. However, given the problems in accurately and reproducibly grading tumors, I can appreciate your doctor's skepticism. Another approach to test this hypothesis involves Ploidy analysis. It has been separately shown that tumor aneuploid content correlates with Gleason grade. Some early work on tumor Ploidy content did show an increase in aneuploid content over time, in support of the concept of Gleason grade changes (tumor de-differentiation) with time ...Best wishes and good health, ron And maybe the guys who volunteered for the WW already had other severe medical problems. And maybe the guys that fall off the roof after RP's would have never been able to get on the roof due to lack of strength, etc. if they were WW. Bev > >> The slide NICK cites is at > >> http://www.cdc.gov/cancer/prostate/screening/slides/slide19.htm. [quoted text clipped - 14 lines] > NICK, you are correct. I was looking at the notes on the wrong slide. > The Holmberg study is at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=2 2213857&dopt=Citation > or http://tinyurl.com/le7yz > [quoted text clipped - 23 lines] > > Alex I have often wondered why they do not do EBRT after surgery more than what they do. It would seem like a better way to assure a true kill. But I'm not a doctor just the wife of a survivor. I do know that many years ago things were different especially when it came to radiation as a treatment for PC. Large doses were beamed into the pelvis and that was it. Now they are figuring out that the prostate was not completely fried and returned to its normal round shape when it healed. Does that mean that the cancer came back, was it there all along, or is it a new round of PC? I have no clue. (My father-in-law) The same is true with those who have undergone RP. My understanding is they usually cannot remove every bit of prostate without ripping off the lower portion of the bladder so they remove as much as they can. If any prostate remains it can rebuilt itself. The prostate is one of the few human organs capable of regenerating from what remains. So a man who was assured that they removed all the prostate 10 years ago is now shocked to learn that he has maybe as much as a fourth to a third of a prostate. And we are right back to was the cancer there in the remaining piece of prostate or is it a new round of PC? (A close family friend) Is this normal? I have no clue. Does it happen often? More often than anyone here wants to consider. At 84 my FIL is taking Lupron and his heart will probably give out before the PC ever becomes a real problem. As for the family friend (78) he had EBRT to the prostate bed and that seems to solved his problem. Yet both men went undetectable for years before seeing a rise in the PSA. As for statistics, I don't think they mean a whole lot. This still is a disease that effects mostly older men. PSA testing is fairly new so men are now being screened earlier, treated earlier, and the success rate is rising no matter which treatment a man chooses. Brachytherapy is a better kill than just radiation. Radiation alone has changed considerably. Does the DaVinci robot do a better job of removing all of the prostate? I don't know. For every man who is Dx'ed with PC not everyone will receive treatment. For those that do, it might be too little too late. And for some they will probably see a return of the PC at some point in their life. I guess that is why we never use the word cured, at least, not yet. But I don't think anyone has ever come up with any real good statistics on surviving PC. Some men die of natural causes unrelated to PC, some die of un-natural causes (car accidents, etc.), some just move or get lost out of the data banks. Virginia maintains a data list of those with cancer. I think it is simple, name age, type of cancer. Then that is compared to the death certificates. So I guess you'd have to be Dx'ed in Virginia and die in Virginia to become a useful statistic. So I guess all Virginia could probably tell you is how many were Dx'ed this year with PC and how many died from PC this year. And I have no clue why Virginia even bothers to keep these records. I guess that still does not answer your questions. Bev > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. [quoted text clipped - 10 lines] > Are there cancer cells that were missed? If so, why not do EBR after > surgery? >I have often wondered why they do not do EBRT after surgery more than what > they do. It would seem like a better way to assure a true kill. But I'm > not > a doctor just the wife of a survivor. I would think because at this time, the SEs of EBRT are not comparably favorable to unnecessary EBRT. 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, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum >>I have often wondered why they do not do EBRT after surgery more than what >> they do. It would seem like a better way to assure a true kill. But I'm not >> a doctor just the wife of a survivor. > > I would think because at this time, the SEs of EBRT are not comparably favorable to > unnecessary EBRT. Right. Why get zapped if you don't need it. However I've noticed that some of the men in this group with high risk cases (high PSA, high Gleason, or positive margins) have had EBRT prescribed for them without waiting to see if PSA is still present after surgery. So, Bev, your suggestion is in fact followed in some cases. Alan > However I've noticed that some of the men in this group > with high risk cases (high PSA, high Gleason, or positive > margins) have had EBRT prescribed for them without > waiting to see if PSA is still present after surgery. > > So, Bev, your suggestion is in fact followed in some cases. My doc suggested that very course of action when my post-op biopsy came back with SVI. However, he backed off when my first PSA came back < 0.1. I often wondered if my PCa when systemic during the year between backing off and actually having EBRT. 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, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum Dick Smith??? I could use one... (lol) PCa returning in 10 - 15 years? I'm going to be 65 in Oct.... add 15 to that and I'll probably be trying to remember the name of the woman I just chased into a corner of the senior center... (To do what, I have absolutely no idea, but I'm sure I'll still be trying. (lol) However, if when they yelled in my ear that my PCa came back I'd probably immediatley go on an "all icecream" diet hoping for a heart attack before bone cancer... IMHO - needn't be yours... Paul Age: 64 10/04: PSA = 10.4,12 needle biopsy - Gleason 7 (“in a few samples”), T1C 11/04: RP “looks like we got it” - sparing one and a half bundles of nerves 07/06: PSA = less than 0.1 07/06: Good bladder control - STILL no erections > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. [quoted text clipped - 10 lines] > Are there cancer cells that were missed? If so, why not do EBR after > surgery? Hey Dick! I think I'm going to start a chill pill concession! You're in one of two groups. Either you have entered, or are about to enter, the 10 to 15 year survival group with undetectable PSA (have a BIG party, and please invite me!), or you are fixating too much on "what if" in the far distant future. Let's make one thing perfectly clear. The detection and treatment of PCa has changed radically over the last 20 years or so. Before that it wasn't even considered until there were symptoms - way too late. What that means is that PCa patients, who remain survivors today, as well as many of those who have died OF the disease over the past 20 years, can not be rationally statistically grouped in terms of survival statistics. They are products of widely varying diagnosis and treatment regimens. That means that most of the stats that anybody here can reference can not be proved to be convergent. They can't lead to any reliable quantitative conclusions. One may infer some qualitative rationale, but I would personally caution anyone about doing even that, particularly out 10 to 15 years. The PCa world, indeed the cancer world in general, is going to change radically over the next 10-15 years. That's as much a given as anything can be. It's also a similar given that those changes will be for the better. It's probable that the first question from each of us, upon diagnosis of PCa, was in effect, "How long have I got to live?" That's a natural response. Any good Uro/Oncoclogist should have couched his/her response in the scenario I just elucidated. Mine told me "3-7 years if it has spread and can't be cured using current technology, but that 's based on today's statistics, which are questionable and can be debated, and those statistics will change significantly over those same 3 to 7 years. Let's move forward without focusing on long term survival for now." Then I asked (as most of us did) "What does a cure consist of?", and he responded "There isn't any global definition. For my patients I define a cure as undetectable PSA for a minimum period of 5 years. Others have different definitions. Now let's get back to treatment and worry about long term survival when and if we have to." So playing with these numbers is not going to do anything but get you worried and depressed and, at worst, direct you toward wrong decisions. What is, is. What will be, will be. Live now. Live today. Give it your best shot. Leave tomorrow to tomorrow. Life is wonderful and abundant. We have been given only one chance at making it worthwhile. That's one thing all of us should have learned by now. I'll take some of those chill pills anyway. ;) Well stated! B.A. I agree pops. Just passed the 15 year point after radiation and am still here. Warren, peace >> What I really do not understand is why the odds >> seems to increase [quoted text clipped - 109 lines] > worthwhile. That's > one thing all of us should have learned by now. Congratulations! May everyone also do as well! KenA >I agree pops. > Just passed the 15 year point after radiation and am still here. [quoted text clipped - 71 lines] >> We have been given only one chance at making it worthwhile. That's >> one thing all of us should have learned by now. Wow! Well said! Bev > > What I really do not understand is why the odds seems to increase > > substantially that PCa returns after 10 or 15 years. [quoted text clipped - 65 lines] > We have been given only one chance at making it worthwhile. That's > one thing all of us should have learned by now. > What I really do not understand is why the odds seems to increase > substantially that PCa returns after 10 or 15 years. I haven't seen any such statements. Can you give a reference? > If a man was monitoring his PSA and PCa was found in the early stages > and subsequently had a RRP performed what are his odds of having PCa > return after 15 years? and Why? The odds of recurrence depend on a variety of factors such as pre-diagnosis PSA, Gleason stage, post-surgical pathology if treated, by RP, etc. There aren't too many figures for over ten years. If you go to the Sloan Kettering web site www.mskcc.org and do some searching, you will find a calculator which will allow you to estimate the chances recurrence for your particular situation. Here recurrence usually means a rise in PSA. The actual development of clinical symptoms may not occur until some considerable t |
Enable EMail Alerts
Start New Thread
Reply to this Message