Number Needed to Treat and Twilight Zone

I'm 51 was just diagnosed with PC, 3+4, in two cores, PSA 4.3, 3.1, 4.1. I don't have MRI info because of my metal hips. My Surgeon says MRI would be useless.

I've been through two consultations and both surgeons agree, RP is the best way to go. Last surgeon stated the Number Needed to Treat is 4 men to save 1 life. I am a little confused. I was too much in shock to ask sensible follow-up questions. My interpretation is that 4 men must go through RP in order for one to receive a benefit. In other words, it does little to benefit the other three.

Am I right? If taken at face value, it would seem to be a big risk. However, if I add in the chance for metastasis, BPH and on-going treatments, it is well within my acceptable guidelines. I would rather take a few months of ED than years of uncertainty and various other treatments. I would just hate to go through this process and, in a few months, read about a new stem cell treatment that makes RP moot. I tried to get into one Clinic trial but was informed my cancer was not great enough (needed to be in two areas, not three). I guess that's good news. Anyone else seen that Twilight Zone episode where the Astronaut takes off on a 20-year journey to another planet just to arrive and have the entire space command there to greet him (technology improved so rapidly since his departure). I know it probably won't happen but a war has been declared. And while we may not quickly win the was against all forms of cancer, the PC skirmish might just be one of our first victories. Surgery scheduled for March 30, so If I'm going to get off this ship I need to do it now.

Ground Control, help?

I think the surgeon is referring to the tendency towards overtreatment.

Might you be a candidate for AS (Active Surveillance)?

Maybe someone could chime in. Not sure if you meet the criteria.

Mel

Hello Brava and welcome. If you were "just diagnosed" and have surgery scheduled for March 30 then you may be moving way too fast and possibly have not done your due diligence to make an educated decision on your treatment. Don't let ANYONE push you into a radical treatment until you have done your homework.

May I suggest the following:

1. Read the sticky thread at the top of our forum that is designed for newly diagnosed patients. Then read Dr. Walsh's, "Guide to Surviving Prostate Cancer" and Dr. Scholz', "Invasion of the Prostate Snatchers".

2. Get second opinion on your biopsy pathology from an expert such as Epstein or Bostwick. Reading these slides is an art and you need an expert to do it; make sure you know what you are dealing with as it will affect your treatment choices.

3. Depending on your expert pathology reading and the percentages of cancer in each of the cores you might be a candidate for Active Surveillance of your cancer. In other words you may delay treatment for a long time or indefinitely.

4. If you determine that you need treatment, then look at the options provided beyond surgery. Yeah, you might have "a few months of ED" or you might have a limp willy for life. With your stats there are many treatment options that are likely to cure you. But you will likely have to meet with specialists in each area to get yourself educated and make a good decision. You should talk with experts in LDR Brachy, HDR Brachy and SBRT in addition to surgeons. Tell us your geographic area and some of our members will be able to suggest excellent doctors.

I'm just saying don't be rushed. Take a deep breath and make sure you get this right the first time.

Jim

brava said...
Last surgeon stated the Number Needed to Treat is 4 men to save 1 life. I am a little confused. I was too much in shock to ask sensible follow-up questions. My interpretation is that 4 men must go through RP in order for one to receive a benefit. In other words, it does little to benefit the other three.

No, that number—the number needed to be diagnosed and treated—which the last surgeon gave you is not correct.

The European Randomized Study of Screening for Prostate Cancer (ERSPC) is an on-going study which reports on the latest result of both the number needed to be invited (to be PSA tested) and the number needed to be diagnosed (and treated) to save one life.

ERSPC reports updates every several years, and over time the numbers (based on the nature of the study) decline over time and will eventually plateau out. After 13 years, the numbers are still going down but at a slowing rate.

According to their most recent update in October 2014, a total of 781 men needed to be invited to screening (“NNI”=number needed to invite) and 27 to be diagnosed and treated (“NND”=number needed to diagnose, and the study's assumption is that all diagnosed are treated) with prostate cancer to avert one death from the disease. Next update, that number will go down again. Some models have been created to predict the leveling-out point which I've read are in the 4-5 range. This might be what the doctor is talking about, but is talking about a projection not the current value.


http://www.erspc.org/

http://prostatecancerinfolink.net/2014/08/07/erspc-mortality-data-at-13-years-of-follow-up-published/

Post Edited (JackH) : 3/10/2016 2:34:46 PM (GMT-7)

Thanks Brothers,
I have a second appointment with a Radiation oncologist at JHU in two weeks. I had Johns Hopkins review my biopsy results and they confirmed the original findings. Decided to go with JHU for treatment.
Thanks so much
Brava

thanks, I live in Maryland, Montgomery County. Traveling is not a problem.

halbert said...
...I agree, you can...and should...slow down. PC is a notorious slow grower, page down for an earlier thread about 'how much time can I wait'. At your numbers, many docs will say that you have 6 months to make a decision. And then schedule after that. Take a deep breath, slow down. You have time--unlike other cancers--take the time and really do your research. You've got one chance to do it right...

Take your time, plenty of time. You have some excellent guidance in this thread.

JHU doesn't do much HDR Brachy, which may be one of the better choices for you. HDR monotherapy is not done in as many places as some. There are a number of posters here that have had HDR mono. With the hip replacements it may be an obvious choice.

There is no "one best treatment" for everyone. Different situations, different personalities, different trains of thought.

You have plenty of time. You have a lot to learn, take the time to learn it and digest it and you will find what is the best for you.

An informed you is the best advocate for your final results, and consequential side effects which have the potential to be permanent.

As a suggestion, take at least three months to make a decision on treatment. That gives you plenty of time to educate yourself and make an informed decision. You really likely have a lot more time than 3 months.

"I've been through two consultations and both surgeons agree, RP is the best way to go"

well, yeah. that's how these guys make their living.

ed

Ask the RO's about their thoughts on the long term possibilities of side effects and secondary cancers from the radiation. You are only 51 and have a long time in front of you. In general there is a bias toward surgery when you are young and radiation when you are old.