Safety of Active Surviellance

Short of a pathology report with second optinions, how do you become comfortable that the cancer is low risk? This would be my issuer.

Yep John T, once you say the word cancer a lot of us freak out, even though our stats say sit back and relax. I think you provide a good service here to the newbies who want some options after being diganosed with slow growing, Gleason 6 cancer instead of surgery with multiple complicatons. I still say to the day that I die that I want my cancer out, regardless of what the stats say due to family history of other, terminal cancers. Keep giving us the newest updates....

signature hope it works now

Less than 15% of men diagnosed would qualify for active surveillance using the standards that are out there today. We just don't know as much as we think we do because the studies used today are level II-2 or lower like this one and the longest studies are using a span of 8-10 years after diagnosis with a 35% drop out rate. Many will do well with AS, most will drop out for some form of treatment given enough time. 8-10 years is not enough time to determine mortality rates in prostate cancer for a Gleason 6 man. In this study, most patients were not on AS for even a year before treatment. The longest was on AS for 6 years and the median was 18 months.

I'm not certain this study tells us much. Certainly the amount of evidence will improve as we mature the clinical trials.

Tony

I think in time there will be PCa differences established. I believe those who have it like Tony at a young age is one thing while most of those who find it lets say at 55+ will be quite another. I can see the latter group just having it as a fact of aging like baldness, increasing loss of libido, cataracts etc. It will be monitored routinely and treatment call upon when warranted. What will be different is that threshold will not be the knee jerk reaction as it is today with too many. In addition less invasive less loss of quality of life treatments like my TFT will become more common than todays over used radical treatments. There's a track record there already comparing the present use of lumpectomies to past mastectomies in breast cancer. There are many similarities in the treatments of breast cancer and PCa with the former receiving more funding and being years ahead in research at this time. As time goes by better diagnostics will be established. I personally think one of the best things I had done was my 3D 45 needle saturation biopsy, but I digress.


Bottom line is that there are huge differences between low risk PCA and those with high risk numbers. One size does not fit all for treatments. Only through panicked eyes do they and that's natural for most when first hearing they have cancer. What should be mandatory for all is a period of education and never a rush to treatment. Quality of life issues and risks need to be brought up and faced before any decision is made. For there are no do overs afterward.

The longest AS guys are in the 10 to 12 year range. The typical Gleason 6 case is about 6-7 years before the majority have decided on intervention. The best place I know to look for some comparative cases is at yananow.net. There are 950 members that are at the site and about 60 AS cases. Terry Herbert, the Sitemaster there is a Gleason 7 case that made it 7 years before he had signs of progression. He is on intermittent ADT. I had dinner with him in June and his PSA was pushing 20. He wanted to wait until he returned to Australia to restart Zoladex.

Should he have been an AS case? He was 54 when Dx. Some men would take 14 years as success as Terry does. But Ziggy is correct, a younger man would want better long term results.

Here's the YANA cases on AS:

www.yananow.net/Experiences.html

Tony

Thanks for the link, Tony, it's an interesting case study. It would be interesting to know if Terry maintains the same perspective on AS today that he had 10 years back. I was surprised to read that he had TURP with known PCa, unless I'm misunderstanding something? I don't think that would be done in the U.S.?

I guess I'm still of the opinion that folks embarking on an AS program today are likely to fare better than those of 10-15 years ago. Of course I have no crystal ball, but I have to believe the advances of the past decade in diagnostics, imaging, pharma etc., are going to have a positive impact going forward.

Tony, you know the drill, a free lunch or dinner always tastes better, lol

The above study and the Sweedish National Health Study, just released, (New Prostate Cancer Infolink Sept 2) show the same thing as all the other studies: patients on AS for low risk PC have the same result if treated in a couple of years as if treated immediately. The point everyone is missing is that not everyone that is on AS is on forever. If the PC shows signs of progression in a few years you get treatment and have the same result. The fear that I must do something now or it may escape is completely unfounded. Most progression is identified in the 1st three years.
To clearify Tony's statement: guys that are in STUDIES have been on AS for 10-12 years, but many men have been on it for much longer, and most don't know it. The majority (70%) show no signs of progression in 7 years, but about 30% decide on treatment anyway without signs of progression.
JT

Tony, I have always felt the criteria you state for the safe use of AS is good advice. If we are lucky enough to live long enough to see better pre-treatment testing, i.e. the indolent vs. agressive strands, then I think the case for safe AS would be easier to make, and some treatments could indeed be eliminated. Until they can get the big gamble out of the formula, I can't see a dramatic change in thinking on AS as an alternative.

John, your statement, "The point everyone is missing is that not everyone that is on AS is on forever. If the PC shows signs of progression in a few years you get treatment and have the same result. The fear that I must do something now or it may escape is completely unfounded. Most progression is identified in the 1st three years." is clear as a bell and backed by experts and studies.

I don't know why this is such a hard concept for some to grasp and why some keep throwing in red herrings that attempt to get away from this basic point.

Tudpock (Jim)

AS - When diagnosed with a T1C Gleeson 6, I was initially told that AS was one approach for inital consideration.  It was noted that "Most men can't stand waiting more than 2 years and get cut anyway"..

When a Second-Opinion suggested Immediate-Action, I deferred to this opinion.

When the Post-Mortem was undertaken on the removed gland, (less than 5 months after diag') , it was shown that the  PC was about to escape the capsule.

The bottom line is that had I chosen AS, then the next time I checked, I could have been in a far more serious position.

 

The argument used on me was most valid - If they could offer 95% guarantee of cancer cure by having the operation TODAY, why risk anything by postponing things.  The percentages MUST reduce with time..

There will always be valid reasons why different paths might be chosen , but surely Putting-off the inevitable, just because you can, has to carry a significant risk.

 

I know of friends on AS, who have heart conditions, and in the end are forced into an operation, because "we can't wait any longer".. 

Surely - Their heart condition won't be any better, when older, or is it a case "Well we got a few more years -- if the heart goes now, it does not matter as much  "

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