Do you have time to gather info before primary radiation treatment?

We're generally pretty good here at telling low-risk guys they have time to do their due diligence and make up their minds, but I've never known fully what to say to the high-risk guys so this is very good to know.

On a personal note, at the time I was diagnosed I was certainly concerned with when I had to pull the trigger on some sort of treatment. Given that it took several weeks just to get the lay of the land, it was a strange time indeed. From time of diagnosis to my first lupron shot it was about two months...

Low-risk cases...you have all the time in the world. Aggressive treatments (any type) do nothing to increase your longevity.

What you're missing is that prostate cancer is very slow to begin progression, even in high risk cases. The other thing you're missing is that in the PSA testing era there is considerable lead time. A delay of 3 months has not been shown, on the average, to make any difference. It also does not mean that that is true in every single case, just that the risk of delay is not statistically significant across the population.

As is often the case with prostate cancer, the "conventional wisdom" that applies to other cancers does not apply here.

- Allen

Does the same delay hold for salvage radiation too? I hear that outcomes are better if you start it real early.

I'd add that giving oneself the extra time to study, see specialists, talk with people in your support systems and mull it over in your mind can lead to a better state of mind and more positive outlook. I was diagnosed in early November and saw doctors in Dec and January before deciding on a course of action. Then it took another month to get started. Knowing that I had some time to make a decision really reduced the stress level, and gave me more confidence once I finally settled on a treatment.

Really good thread here. After I was diagnosed in Jan 2016, I had to wait a week for the bone scan and ct scan. This was very stressful. Kept thinking about my younger brother.

Little brother had a high PSA around 2002 but a clear biopsy. He thought he was fine. He never went back to the urologist after he lost his job and health insurance. Several years later, he took a free PSA test at a music street fair. Stage 4 with bone mestases diagnosed in 2006 or 2007, with multiple lymph node infiltration. When he called me with the news, I had no idea that he had any issues with his prostate.

He was treated at Fox Chase primarily with HDT therapy but he died in 2012 at 57.

Back to my diagnosis in 2016, I kept thinking that I was late. Gleason 8 - I was sure that Every small ache or pain was caused by spreading PCa

After I received the first Lupron shot, I started listening to my urologist.

I just needed to know that treatment started.

When you watch someone die from PCa, you want treatment to start immediately.

Post Edited (Manfred) : 3/7/2016 9:19:05 PM (GMT-7)

Pencil me in as, not so much skeptical about the result, as worried about reading too much into it, especially for high risk guys. The study looks at a particular population, the sort of men who wind up seeking radiation treatment at the Fox Chase Cancer Center in Philadelphia, who were diagnosed by whatever screening such men undergo, and made their decisions about when to undergo treatment based, at least in part, on what their doctors told them about their disease, with those doctors knowing more about them than just their risk category. Nothing is random here and uncontrolled variables abound.

Reading the result too strongly -- as suggesting that a delay of another three, six or even nine months will never make a difference, even for high-risk men -- allows one, by a straightforward recursive argument, to show that treatment can be delayed forever, or for you pessimists, that prompt treatment will be just as useless as long-delayed treatment. Neither of these conclusions is true and the authors of the study did not intend to suggest them.

More subtly, most of the men in the study probably made their treatment timing decisions with the help of their doctors. If your doctor says you need to act quickly you should bear in mind that if you decide to delay treatment because this study says you can do so safely, you may be stepping outside the bounds of the study population, most of whom probably took their doctors advice.

Let me make clear that the study says that waiting more than 3 months for primary radiation (or surgery) makes no difference compared to waiting less than 3 months among men originally diagnosed with low, intermediate or high risk cancer. It does not apply to you, jpenn, because you were originally diagnosed with advanced metastatic cancer, and curative radiation or surgery was already not an option. It also does not apply to salvage.

PDA- The studies do not make the recursive argument you suggest. They show that a delay of 3 months did not make a difference in cancer control in any risk group. It does not follow, as you suggest, that waiting another 60 or 90 days would still not make a difference - although that is certainly true for low-risk patients, as proven by several active surveillance studies. Diagnosis in a different risk category certainly does make a difference in the probability of cancer control, but waiting a few months from initial diagnosis did not.

I do agree about the selection bias. These men were all treated at top tertiary cancer centers (Fox Chase and Columbia Physicians & Surgeons), and were presumably watched closely and treated expertly, so their results may not necessarily be as good in community practice. It is possible that such expert treatment increases the probability of cancer control in those who wait longer compared to those who seek immediate treatment.It's another good reason to get treated at the best place and by the best doctors possible.

The Columbia study concludes that "Patients can be assured that delaying treatment while considering therapeutic options will not adversely affect their outcomes." This is important. I have seen too many patients rush into hasty decisions, decisions that they later come to regret, based on their knowledge of other cancers.

corrected # of days

Tall,

I didn't mean to imply that the study said that. I don't think I did.

I intended the recursive argument as a caution against reading the result too broadly -- an absurd result that is reachable if the study results are misunderstood -- as I fear that some of our members might do. I was trying to point out the narrowness of the result -- that it applies only to newly-diagnosed men who have been reasonably vigilant with their health, were probably detected fairly early, and most likely planned their treatment in concert with their doctors.