6-Year Update

Hi guys,

I haven't written in awhile. Just wanted to report that back in May I got my 6-year "zero."

Last fall I "retired" from volunteer coaching girls' rec league soccer after 21 years. My joints (especially knees) are starting to fall apart. If it's not one thing, it's another...

Now all I have to do is hang on for a few more years so I can retire from my real job...

I wish everybody the best.

kcragman

Congrats! Any and all good news brings much needed hope. May I ask what treatment put you in the zero club for 6 years?

Also want to recommend over the counter, Instaflex, for your knees. This will be my 40th year coaching high school Wrestling, God willing. No cartilage in left knee still OK with Instaflex.

Congratulations - I love to read about zeros.

BrownTrout:

Not sure why my profile is not showing up. I eventually graded out as a Gleason 9, stage pT3A.
I had robotic surgery done at George Washington Medical Hospital (a teaching hospital) in Washington DC where I was part of a study (the oldest part, I think) looking at using surgery alone on aggressive cases. In my case - as in most of the cases - it worked out just fine.

Thanks for the comment on Instaflex. I might give it a try. I've been taking glucosamine for years - but apparently I have other issues. If I do too much activity, the BACK of my knees swell up. What is too much? Depends on the day. I'm down to bone-on-bone on the left, and that was always my GOOD knee. Oh well...

All the best -

kcragman

Kcragman,

Congratulations on six years!

Can you post a reference to the study you were involved in. I am sure newly diagnosed G9s would like to read about the results from just surgery.

Wow, 77% recurrence free for G9 after 31 - 85 months with only DaVinci .... I would have thought the percentage would have been much lower. Not sure why I thought it would be lower ... Just did.

Thanks, congratulations on 6 years and best wishes. I will look for the article.

Congratulations and thanks for passing along the stats on successful surgery. I wonder if those of us on HW don't sometimes present a negatively skewed portrait of likely outcomes.

I wish you many more years of zeroes.

Goes in line with something my oncologist has told me from day one. Despite the apparent grim expected outcomes with a lot of Gleason 8's and higher, he said those cases are often much more predictable and even treatable with good outcomes, than often it is with some variety of Gleason 7 cases.

He has said that there are Gleason 7's that are very unpredictable, that can ultimately be hard to control long term.

David

kcragman said...
RCS:

Here is an excerpt from my 5/19/11 post. Wow, my memory is terrible. I wasn't the OLDEST participant - I was the YOUNGEST!!

"Some of the bottom lines are: With follow up to 85 months (average 31 months) there is a recurrence-free survival rate of 77%. The average recurrence was at 7 months - so if it recurs, it is usually pretty quickly. Once again, this is RALP only.

The study is in the Journal of Endourology, Volume 24, Number 12, December 2010. Title: Oncologic Outcome of Robot-Assisted Laparoscopic Prostatectomy in the High-Risk Setting.

Engel is associated with the George Washington University Hospital in Washington, DC."

I hope you can find it. Let me know if you can't. I have a paper copy somewhere. Maybe I can scan it and post it.

Good luck to you,

kcragman

http://www.ncbi.nlm.nih.gov/pubmed?term=%28%28%28Oncologic[Title]%29%20AND%20Robot[Title]%29%20AND%20Prostatectomy[Title]%29%20AND%20High[Title]

I had to copy and paste that link to get it to work.

Since I had one positive margin foci, I love this part: "There was no significant difference in surgical margin positivity (38% overall) or prostate size between recurrence and nonrecurrence cohorts."

Thx again, Kc!

J Endourol. 2010 Dec;24(12):1963-6. doi: 10.1089/end.2010.0305. Epub 2010 Nov 18.
Oncologic outcome of robot-assisted laparoscopic prostatectomy in the high-risk setting.
Engel JD1, Kao WW, Williams SB, Hong YM.
Author information

1Department of Urology, George Washington University Hospital, Washington, District of Columbia 20006, USA. [email protected]

Abstract
BACKGROUND AND PURPOSE:

Previous studies have demonstrated the feasibility of open radical prostatectomy in the high-risk setting. Management of high-risk disease with robot-assisted laparoscopic radical prostatectomy (RALP) is controversial. We examined biochemical recurrence in a selected cohort of high-risk patients who were undergoing RALP.
PATIENTS AND METHODS:

Men with high-risk prostate cancer who underwent bilateral nerve-sparing, nonsalvage RALP by a single surgeon without adjuvant or neoadjuvant therapy of any kind were identified. High risk was defined by preoperative prostate-specific antigen (PSA) level >10 ng/dL, Gleason score ≥8 on final pathologic evaluation, or stage ≥pT(3). Postoperative PSA value ≥0.2 ng/dL defined biochemical recurrence.
RESULTS:

A total of 73 men were identified. There was no significant difference in surgical margin positivity (38% overall) or prostate size between recurrence and nonrecurrence cohorts. Biochemical failure was significantly associated with higher pathologic Gleason score (P = 0.0085) but not pathologic stage (P = 0.22) or preoperative PSA level (P = 0.18). With follow-up to 85 months (mean 31.8 mos), biochemical recurrence-free survival was 77% with mean time to recurrence of 7.7 months. Recurrence occurred significantly earlier than later (P < 0.001).
CONCLUSIONS:

Reasonable short- to intermediate-term biochemical outcomes can be achieved in a recurrence-prone group of high-risk men who are undergoing RALP. RALP is feasible in a selected cohort of high-risk men who are undergoing aggressive local therapy.

Post Edited (BillyBob@388) : 8/18/2014 8:36:51 PM (GMT-6)