55 YO, G6 Making Decisions

Hi Mikla, I’ve been traveling, so please forgive my late reply.   I think you've got a good feel for the jist of the NCCN guidelines.   Congratulations on sticking closely to the steps "0" and "1" for newly diagnosed men, which is spelled out in the sticky thread (at the top of the page of threads) titled, "Newly diagnosed with PC? - read this thread first."   You'd be amazed at how many don't follow   There may be more to learn if you are still talking about being concerned -- due to a very low risk case of PC -- about living a long life.   I forgot which PC oncologist said this and I have to paraphrase, but this commentary is notable: "aggressive treatment for low risk PC won't make your life longer, but living with the treatment side effects will make it feel a whole lot longer."   Once one has confirmed his initial diagnosis to be very low risk (step 1; done), my recommendation ( and this is the only place in my post where I will inject my own personal recommendation ) is for men to learn more about the low risk PC overtreatment epidemic.   (In a poll conducted here at HW, members overwhelmingly felt this was likely a piece of information newcomers like you should know about , but typically would not know about ; see the "Newly diagnosed..." sticky thread.)   The medical profession is increasingly taking responsibility for this problem, and for fixing it, but they say patient education is a key component to solving the issue.   It sounds like you already have a feel for how life is all about managing risks; another of the rules of thumb (paraphrasing) is:   if you are diagnosed with low risk PC from a single biopsy and you move to immediate aggressive treatment without a second confirmatory biopsy a year later, then your risk of being overtreated is high.   We had a good thread ( HERE ) on AS a few months ago with some references to two of the leading PC experts discussing the considerations for deferred treatment for low risk men—Dr Andrew Vickers from Memorial Sloan Kettering Cancer Center, and Dr Ian Thompson, Director of the Cancer Therapy and Research Center of the Univ of Texas Health Sciences Center.   I’ll copy/paste from the discussion transcript s:   ·          Dr Thompson:   “ The point is, if you have a choice of a dollar today or a dollar 10 years from now, take the dollar today. But if you have a choice of a curative treatment for prostate cancer today or a curative treatment for prostate cancer 10 years from now, choose it 10 years from now .” ·          Dr Thompson:   “ If the only thing that matters to a man is curing his cancer, then he should be treated. It doesn't matter what you do . But if quality of life is important to him, then a consideration is active surveillance.” ·          Q&A o     Q:   Dr Vickers:   “ How do we encourage more patients to accept active surveillance, to not be aggressively treated? How do we encourage urologists not to overtreat patients with low-risk disease?” o     A:   Dr. Thompson:    “Tell them what the scientific studies show. On active surveillance, your likelihood at 5-10 years of needing treatment is 30%, on average. Now, we are seeing that even higher-risk, low-volume Gleason scores of 3+4, for example, behave very much the same as those with Gleason scores of 3+3 .”      

To use the Partin table it appears you need to know the Clinical stage. But I'm confused. How can you know the clinical stage - oc, epe,sv+ or LN+? Iunderstand the variables predict the path stage, but how do you know which "T" number to use preop?

Hi Casey... I've watched that video before. It really does not say much more than what is in other studies and what I have included in my thought process.

As far as the over-treatment epidemic, I don't get caught up in that. I think there are many who will because they just believe their doctor and do what (s)he says. For those of us that do research and/or ask questions, I think we are pretty comfortable with making our own mind up, with consideration from others... including our doctors.

A big part of that is sharing the research with those close to you (the ones that are impacted by the decision) and getting their input and nod on what ever course of action is taken.

Thanks again!

PeterDisAbelard. said...
Njs,

Not sure what to make of this statement in your study: "Of 1,111 men who fulfilled the D'Amico low risk criteria, those with a surgical delay of 6 months or more were significantly older, had a higher proportion of African American men, and a lower proportion of clinical stage T2a (vs T1). It seems like a lot to try to control for. That's often a problem with retrospective studies.

I think the point is that age, race and T1 stage are likely causal factors for delaying surgery. Clinical stage was apparently controlled for in terms of time to biochemical recurrence:

"On multivariate analysis with prostate specific antigen and clinical stage, surgical delays of 6 months or more were significantly and independently associated with time to biochemical progression."

But it does not mention trying to control for age or race, so I agree that is a potential weakness (e.g. if older men or black men are more likely to have higher Gleason grade disease).

njs, this post is in response to your question to me posted in this thread on 11/17/2013, which I didn’t notice until now.   I don’t typically read every posting in every thread—in many threads, I simply respond to the post/question raised by the original poster.   Sometimes this leads to me (unknowingly) repeating what someone else may have already said, or sometimes missing if someone has a question back to me.   I simply don’t have/don’t make time to read all posts.   (This is related to why I sometimes post in colored font; an issue people have commented/speculated about , but nobody has ever actually asked “why do you post in green?”) This appears to have gotten compounded by the fact that I’ve had davidg (and another member) on my system “Ignore” setting ever since he returned from being banned from HealingWell this past summer (June/July timeframe) due to the inappropriate and venomous ad hominem attacks (attacking posters, rather than the issues).   I was hoping he would have been permanently banned from the site, but when he re-appeared a month or so later with no regrets or apologies, I just figured life would be easier if I simply used the tools made available to us for such situations…the “Ignore” feature (the thumbs-down icon one sees next to a posting when logged into the site).   So, your post from yesterday was a bit jumbled/unclear to me, but I think I figured it out by reviewing the entire thread.   So, sorry for the late reply, but on 11/17/2013 you asked about my comment on deferred treatment.   Frankly, Dr Ian Thompson’s comment which I posted yesterday was entirely enlightening from the big picture perspective because it further emphasizes the point the treatments are continually improving and that treatments today have better results than 5-years ago, and treatments 5- or 10-years from now will have better results than today.   Treatments for low-risk men in the 5-10 year timeframe from now will likely be radically different anyhow, much less invasive, more targeted, etc.   (The “Prostate Snatchers” will have been chased-off, I’m confident.)   That being said, if you look up Dr William Shappley’s prospective study from a couple years ago you will find the two key metrics for the study group (the early-treatment group) and the control group (deferred treatment) were better , in both cases, for the control (deferred) group.   It wasn’t better by much, but it was better.   The complete results (per thousand) were:                                                                     Control                 Study                   Developed mets                      7.2/1,000             8.1/1,000                   PC-specific death                    2.4/1,000            2.6/1,000   Two key takeaways reinforced from this study:   (1)   The key difference between the two groups was that the study group (early treatment) suffered the “harms” of treatment without gaining any benefit in these two key metrics, and the control group (deferred) obviously didn’t suffer those side-effects.   (2) The results highlight that there is a very infrequently occurring variant of PC which often disguises itself, but is simply untreatable…early treatment does not stop it.   Best wishes…