30 Year Data on Untreated PC

http://prostatecancerinfolink.net/2012/11/16/30-years-follow-up-of-men-with-initially-untreated-localized-prostate-cancer/

New data released for > 30 years for patients who received no treatment for PC. 15.4% died from PC, but since this was started before the era of psa it is unknown what the risk classifications were and we can assume that most men had some type of symptom which led to the Dx. This seems to be just slightly higher than the death rate we are currently seeing with all the treatments both local and advanced.

To my simple mind it seems that we have made little progress in the last 30 years regardless of all the advances we have made in treatment and detection.

I'm thinking that some types of PC will eventually kill you regardless of what you do and most will not regardless of what you do.

JT

John, I fully believe in your ending sentence:

"I'm thinking that some types of PC will eventually kill you regardless of what you do and most will not regardless of what you do."

My doctor would agree with those sentiments. He feels it really depends on the specific PC variant one is dealing with. Some are incredibly indolent in nature (the regardless what you do or don't do varieties), and others are very aggressive by nature (and wont respond to treatment regardless).

Knowing the exact variant at dx could sure save a lot of trouble and anxiety about treatment choices or non-treatment choices.

david

"I'm thinking that some types of PC will eventually kill you regardless of what you do and most will not regardless of what you do."

I don't draw the same conclusion here. While yes many cases will be more aggressive than others, we don't know what these numbers of prostate cancer specific mortality will be 30 years from now. 30 years ago we were pretty limited with options. I think it's better to look forward than backward into history. We have far better tools today. Retrospective studies like this take the future and specifically ignore it.

Tony

"I'm thinking that some types of PC will eventually kill you regardless of what you do and most will not regardless of what you do."

Not sure if this is true. But i would add......the purpose or intent, of being treated, is (i would hope) to not only prolong life, but to promote a good/better quality of life.
For many people, not all, but many, i think the act of being treated in some form, by itself increases quality of life by giving the patient a sense of self control
I have not yet been diagnosed, just coming up on my first biopsy this week, but i know if i was, i would feel better mentally, knowing that something is being done to at least try to eradicate what ails me. But thats me, i know everyone is different.

Jerry, not to burst your balloon, but while your personal "motto" may be different, and as always, I hope you win, win, and win some more, in reality the statement that John made still will hold true to an unfortunate sector of those with PC. There are plenty of cases, where regardless of what treatments one undergoes, simply don't work, and the cancer will kill the patient. That has nothing to do with one's personal attitude and "fighting spirit", its simply the reality of the beast, PC.

Plenty of people die every day from various cancers, despite undergoing courageous and even heroic fights. It doesnt suggest that one simply give up and say, screw it, it just means you balance everything out - your fight vs. the reality of your cancer.

david

When first diagnosed my research indicated 8 years without treatment based on my stats. I am now almost six years out. To this date I have had no and never have had any symptoms of the disease. My HT has failed (based on PSA) and the RT did not work. QOL is less due to weakness from HT and loss of sexual function due to RT. Has the treatment been worth it all? If I make it past the 8 year mark then maybe I can attribute it to the treatment. In some ways I think the treatment just stirred stuff up.

Makes me wonder if I would have been better off without treatment. And better off not knowing that I had the high PSA. (ignorance is bliss) This crap weighs on my mind sometimes and more now that I am retired and have more time on my hands and no work distractions.

Time will tell if I am in the 15% or the majority.
Don

I think it comes down to being able to distinguish the indolent vs the non-indolent variants. We just don't have those tools available now.

John T
Facts and figures, sticks and stones directly from the "dark ages". Studies from Europe that showed 44% and 22% survival due to prostate screening versus our US deeply flawed study that showed no difference. Civilian hospitals are screening their patients under "informed consent" while federal medical facilities have to operate under the "no screening" recommendation of the USPSTF.
I hate to see any of our 21/2 million Vietnam vets who are at "high risk" die from a disease that could have been detected and cured instead of waiting for metastatic symptoms to occur. Every generation sacrifices, but the Vietnam generation continues to do so! We destroyed a nation (Iraq) based on facts..I refuse to bury my head in the sand and rely on science based facts that are distorted to suit a particular purpose.
Bill--One of those "old men"
Nov 2007---2.72 psa & dre--ok
Feb 2009---4.89 psa and climbing--recheck in 6 months--new Dr
July 2009---4.70 psa--lower than 6 months ago--continue to monitor--a PA and not Dr.
Dec 2009--No psa--urinary frequency--diagnosis--old age--PA
July 2010--Emergency urinary symptoms--psa-4.86 and rock hard prostate
August 2010--biopsy--5 gleason 8's and 4 gleason 7's out of 10 cores with core involvement of 80% and 50% tissue with pni on both sides.
Sept--initial consult--"kill the messenger" high risk gleason 8 with surgery recommended.--bone & ct scans negative--thick adrenal gland?
xxxxxxxxxxxxxxxxxxxxxx
received my medical records for RO at6 another facility and read for the 1st time my "history" which was never discussed with me..Lieutenant--How Dumb?
Feb 2011--79.2 g's IMRT completed after casodex and lupron--casodex discontinued and lupron for 3 years--1 year to go.

QOL* IS an important aspect to our PC fight as John T tried to explain. There are at least 35+ variants of PC and then toss in the many body types dictating reaction to treatment and mental attitudes.

The best initial diagnosis is key but John T can tell you that even that may not discover all.

*Quality Of Life

Post Edited (Trepidation) : 11/18/2012 3:19:13 PM (GMT-7)

Newporter,
I'm not questioning psa screening, but it probably doesn't do much for anyone with a 25 year life expectancy and neither do treatments. The average age of PC patients at Dx is 67 and we are talking about adding just a couple of months of survival for these patients.
As I said the largest benefit is to younger patients in both screening and treatment.
We don't know a lot about the patients in the study as psa was not yet discovered, so this was an unscreened population that we can assume that by the time they were Dxed their PC was already well established and much futher along than we would be seeing today. Even with late diagnosis the mortality rate of 15% is about what we are seeing today in Dxed patients. Many of the patients classified as localized were already most likely already systemic. The Hopkins data had much better information on which to classify patients as local, such as psa data <20 and the benefit of post op pathology which is unavailable for the patients in the study.
Gunfighter,
I was a grunt in a heavily defoliated area and I don't think for a minute that Agent Orange caused my PC. I Got more exposure to dioxins playing golf or working in the garden. Inherited genes, age and a poor diet most likely had much more of a causual effect.

This is the reason why the commitee earlier this year recommended that men not have a routine PSA done, unless they are having some type of symptoms. I believe they said that about 20 men would have to be treated to save 1 from dying of CaP.

Okey, Doeky .... unless you happen to be that 1 poor guy !

Undoubtably, CaP is "over diagnosed and over treated". The big risk is the long term side effects a guy may have from some treatment modalities if they are the 19 out of 20 that didn't need to be treated. But it's not possible to predict the 1 poor guy who needs treatment, or the 19 who don't.

My preference would be to get my PSA tested yearly, get a biopsy if it becomes necessary ( elevated or rapidly increasing PSA ) and catch it early so the treatment doesn't need to be so severe. Just my personal opinion.

There are lots of doctors who have said the same thing as this 30-year study conclusion; basically that there are a lot of patients who get treated for cancers that won't kill them, and others get treated for cancers that will kill them anyway. Both sides of this point which are notable:   First, we recognize that some (not all) of the advanced cases (of which there are only a minority of the total number of PC cases diagnosed) are in fact unstoppable.   It was Dr Willet Whitmore—known as the father of modern day PC oncology—who said decades ago that PC survival has less to do with treatment than with the biology of individual tumors .   That being said, however, the reality is that most men will die with, not of, prostate cancer.   In fact, the number one killer of men with prostate cancer is heart disease .   We recognize that many of the cancers that doctors are finding and treating today are what's called " pseudodisease "—tumors that will never cause harm, let alone death.   Many of these men are being treated for anxiety rather than the disease. There are large healthcare entities and professional trade organizations who have built lucrative careers by labeling men with “cancer.”   Even though this quote was from decades ago, it seems prophetic to today's situation: “The current state of prostate cancer may not be good medicine but it sure is good business.”  

Casey said: " We recognize that many of the cancers that doctors are finding and treating today are what's called "pseudodisease"—tumors that will never cause harm, let alone death. Many of these men are being treated for anxiety rather than the disease."

And this is based on what randomized study that shows that the actual REAL rate of overtreatment is ______????

Why are 30,000 men STILL dying of the disease here? Tell them about pseudodisease and anxiety...I am sure they will agree with you.

RalphV