Probably the only way we'll be considered cured is when we die of something
other than prostate cancer.  It's never 100%. But if calling oneself cured
makes one sleep better at night then call it and sleep tight.

Ron S.

snip........

Hi David!

I had salvage RT some two years ago - six years after RP.

At that time I met another guy having salvage RT that had RP fifteen
years prior (yes, 15 years...). Probably this guy had considered
himself cured. Luckily for him, he carried on having regular PSA
tests...

Just

2 years without cancer    99%
5 years without cancer    98%
7 years without cancer    97%

This is from the Slone-Kettering nomogram, based on what I think you have
told us.  But..

7. What should I do with the results produced by the nomogram?

These nomograms cannot definitively answer the question of which treatment
is most appropriate for an individual patient. These tools simply provide
information useful for the decision-making process, which should be carried
out in consultation with a physician.

On August 26, David wrote:

Endless chewing over of the numbers will not change the fact that no one
considers a case of PCa "cured" until the passage of at least five years
from primary treatment (tx) with no recurrence. "Recurrence" is defined
differently by various entities. The ASCO (American Society of Clinical
Oncology) defines it as three consecutive rises in PSA. Also called
biological or clinical failure.

The uro, no matter what he claims, simply does not have any means of
being *certain* that PCa cells have not found homes elsewhere, likely
the lymph nodes, possibly bones. But maybe not. No one can tell.

Close enough, I think.

This guy thinks that, to paraphrase a piece of wisdom, eternal vigilance
is the price of optimum outcome. Keep testing.

It appears that there is a fairly good chance that there will not be any
recurrence. But I would not bet my life on it and kick back and forego
periodic tests to determine what's going on....

Caveat: Everyone is different.

Regards,

Steve J

"As a physician, I am painfully aware that most of the decisions we make
with
regard to prostate cancer are made with inadequate data."
-- Charles L. "Snuffy" Myers, MD
Medical oncologist. PCa survivor.

Hi David...I've responded within your original text...Best wishes and
good health, ron

On Aug 26, 4:17 pm, "David&Joan" <djmarch...@cox.net> wrote...snip...

More questions, were you a 3+4 or 4+3?  And, how many years down the
road are you asking about?

You can use the Hopkins' nomograms which give you a snapshot of how
Walsh's patients faired over time, your surgeon may do better or
worse.  I provided a hard and a web reference in the earlier thread.
If one of Walsh's men were a pathological 3+4 with organ-confined
disease and a pre-op PSA in the 4-10 range, then at 10 years post-
treatment he'd have about an 11% chance of biochemical recurrence, on
average.  If he were a 4+3, the number would increase to around 23%,
again at 10 years.  To a first approximation, recurrence rates are
roughly linear with time (actually, I suspect this is a worst case
assumption, because there does appear to be some flattening in the
curves for higher-risk men, that I'd like to believe is also there for
lower-risk men).  So, at 5-years cut the numbers in half; at twenty
years, double them.  Also, these numbers were projections for men
treated in 1999.  Walsh and others have found that men have better
results the later the year of surgery ("year of RP factor").  This is
probably due to a multitude of factors, some real, like improved
surgical methodologies, and some artificial, like Gleason grade
inflation.

PCa tumor cells can be detected in the blood system prior to
treatment, their concentration seems to generally parallel the
aggresiveness of the disease.  If none of them survived, and if the
prostate was effectively removed or ablated such that no cancer cells
remained in prostatic tissue, and no healthy prostate tissue remained
for the genetic error to be repeated, then, I think, you would be
cured.  Even if these conditions are not met, you may be "effectively"
cured.  That is, you may die from something else before detectable
concentrations of tumor cells reappear.

The numbers above give some idea of the odds.  To borrow and slightly
alter an old phrase, "Hope for the best, but verify."

David:

The one thing that is certain, this a very frustrating and confounding
disease. Even experts disagree on the treatment choices available and
just when and how to implement them.
Firstly, there are the many treatment options which is strictly an
individual choice, of course depending upon the educated guess work of
the Partin Tables and the small amount of biopsy samples taken.
Secondly, there the side effects from each specific treatment which can
be different for each individual.
Thirdly, there is the constant blood testing to see if the treatment has
indeed worked with the never ending 3 or 6 month psa tests. It kind of
reminds me of a prisoner going to the parole board.
Fourthly, if all that were not enough, there are the uncertainties of
being really cured 2, 5, 10, 15 years out! Please! It took x amount of
time for the PCa to be detected in the first place, and it stands to
reason that everyone is a test away from some kind of medical problem of
one kind or another PCa or not.
Fifthly, no one really knows how we really got the damn thing in the
first place and how to have prevented it from even happening! Of course,
not to mention the sexual frustration that can go hand in hand with PCa
and treatments and the psychological toll it takes on us in our
otherwise healthy bodies.
This tells me is that the current slash/burn methods for cancer are
really not excellent definitive cures at all, be it PCa or for any
cancer for that matter.
Until medical science delves much much deeper, until medical science
really understands the root of cancer; the prevention, as well as the
definitive cure will continue to be uncertain at best to us all. I feel
that medical science is only on the cusp of knowing what can ultimately
happen to us regarding the final outcome of such a complex disease as
PCa whatever the pathology may be. Again, some on this newsgroup have a
better knowledge of their final outcomes due to their advanced cases.
Even then, there may be cures for them too only years away.
I remember about 5 or 6 years ago when a friend of mine had to go for a
triple bypass surgery and a mitro valve repair. I assured him then that
everything would go well because it is was a pretty cut and dry
procedure, even if it is considered very a major surgery. After all, "it
was not cancer" I had told him. Only now do I really feel what I had
meant when I uttered those words, "It's was not cancer".

B.A.

Hello:

I've been staying away from the term "cured" in all my dealings with friends
who ask about it.  When I must refer to my status, I simply say that I am a
cancer survivor.  I will probably never know if it's gone.  But I am alive,
so it has not gotten me so far.  

--charlie

I think you're worried about the wrong thing.

I'm 3 years out from IMRT/pd seeds/8 months Lupron.  I recurred to
beat the band, went from PSA 1 to 60 in about a year.  This thing
almost killed me.

I'm back on Lupron and did 3 months of Casodex.  It seems under
control.  My PSA dropped like a rock. I'll get some blood pulled for a
PSA reading tomorrow.

I know I gotta watch this and the docs say that I'll be on Lupron
forever.

As bad as this is, consider that I know two guys who went into cardiac
arrest in their 40's.  Fortunately both survived.

Stuff happens.  We gotta deal with it.

Thus far, I have the following Lupron issues.  Intermittent sharp pain
in small joints.  Hot flashes, 3 or 4 times a day.  Some sleep
disorders.

On the other hand, I can still raise the flag. It's not easy and it
doesn't go all the way up the pole but it's better than nothing.

My fasting blood sugar is in the 100-110 range on two 850 glucophage/
day.

My weight is down 20 pounds from the peak last year.

I can run up 3 or 4 flights of stairs, then walk a half mile to cool
down.

If your PSA is under 1, just track it.  If it rises, see a medical
oncologist.   I think the focus should be your quality of life.

Diabetes, heart disease, stroke, other ailments are a bigger issue.
I don't like being on Lupron but so far, it's worked well.  I'm not
counting on it but I'm hoping for that silver bullet.  It might be
Provenge.  It might not.

-kh

I think my case may be similar to yours, and I've tried to make
estimates of recurrence sometime during my lifetime.  I believe that the
probability of recurrence in any given year is pretty small, so it would
be irrational to worry about it. My cancer was diagnosed and treated
when I was 67, and I am now 74.   There hasn't been a recurrence, and
while that might happen, it is much more likely that I will die of some
other disease, and that even if I do have a recurrence, it will have a
relatively minor effect on my life span and quality of life.

To see why it is difficult to make estimates of this kind consider the
following model of what might be happening in cases like ours.  The only
data we really have show the number of men without recurrence at any
given year after treatment for ten years or longer.   The data is noisy
enough in low risk cases so that it is not possible to determine the
shape of that curve, particularly for later years.   It  could be just
linear or it could tend to flatten out.   If it were linear, the risk in
any given year would actually be going up slightly with time, and if it
flattens out, the risk could be constant or could be decreasing over
time.   Now to make estimates you have to invent a mathematical model of
what is going on.  Presumably some men are cured completely and have no
trace of prostate cancer in their bodies.  For such men, recurrence is
impossible.   Other men may still have traces of prostate cancer which
the body keeps under control.  Such men may have a recurrence, but in
cases like ours, that risk may still remain small in in any given year.
 Unless you know just how the cases break up,  you can't really
construct a plausible model to use to make estimates.  The best you can
come up with is aworst case analysis, but that could be very far off.

My calculations show that in my case  T1C, PSA 4.5, Gleason 7=3+4, the
likelihood of recurrence within 25 years after my surgery is perhaps as
high as 23 percent, but probably it is significantly less than that.
Also, the model I am using may be entirely wrong.  I am now 74, and I
doubt very much that I will make it to 99, so it would be foolish of me
to worry about recurrence given what I know.  That doesn't mean that I
don't get up tight each year when I have my PSA tested, but that is the
only time I am bothered by such fears.

Remember that what is happening at the level of cells may be very
complex.   A naive model which might make sense to your or me may be far
wide of the mark.  Also, even an expert doing research in the filed may
not know enough to say just what is going on.  Think of the parable of
the blind men and the elephant.

As I said, it is quite possible that you now have no cancer cells in
your body at all.  But this is something that no one may ever be certain
about.  Even if a thorough autopsy is done after you die, it might not
be able to find cancer cells that are still present.  On the other hand,
some researcher might develop a test which can show the presence of a
small number of cancer cells tomorrow.  It is pointless, I think, to
conjecture about such things.

Good luck.