Good News for RP guys

Somebody said...

Surviving Prostate Cancer: Good News for Radical Prostatectomy Patients

So you had radical prostatectomy and things have been going pretty well. You feel good, and your PSA remains undetectable. It's been several years now; are you out of the woods?

"Overall, men are highly unlikely to die from prostate cancer after surgery — even men with high-risk prostate cancer. If you do not experience recurrence for several years, your likelihood of survival for 10 more years is outstanding."

"After radical prostatectomy, about a third of men experience a return of PSA," says urologist Misop Han, M.D. the David Hall McConnell Professor in Urology. "However, only a very small number of men who have had surgery ultimately die from prostate cancer. So, men contemplating surgery or those who have already had surgery may wonder, What is my chance of surviving from prostate cancer if I have not had PSA recurrence for several years after surgery?"

Han and Brady epidemiologist Bruce Trock, Ph.D., recently set out to answer that question, using the Brady's massive database to track results from more than 14,000 men who had surgery at Johns Hopkins between 1984 and 2013. They divided men into three risk groups: low, intermediate, and high. Then they calculated what they call the Conditional Survival probability — the likelihood of survival for 10 additional years.

They found that men in the low- and intermediate-risk groups had a very high probability — at least 96 percent — of not dying from a return of prostate cancer at 10 years, "regardless of the time duration without recurrence," says Han. "In other words, these men are highly unlikely to die from prostate cancer, regardless of whether they experience recurrence or not."

In the high-risk men, the probability of survival from prostate cancer at 10 years was 91 percent for those who experienced recurrence within one year. "However, if these high-risk men do not have recurrence for more than three years, their probability of survival from prostate cancer for 10 additional years is even higher — greater than than 99 percent.

"These results give much hope for men with prostate cancer," said Han. "Overall, men are highly unlikely to die from prostate cancer after surgery — even men with high-risk prostate cancer. If you do not experience recurrence for several years, your likelihood of survival for 10 more years is outstanding."

Post Edited (BillyBob@388) : 4/5/2016 5:57:50 PM (GMT-6)

JackH said...
PC is really a tale of two, or three, or really a large spectrum of many different diseases. We do members at both ends of the spectrum a dis-service when we lump them all together. So, I'm disappointed Dr Han talks about the overall 96% survival because that's really a completely meaningless number of all groups lumped together.

Fortunately, he goes on to speak more specifically of the high-risk cases. A high-risk case is generally one that you throw everything including the kitchen sink at. In these cases, for those who included RP in the mix, PC-survival is 91%. Looking at that sub-population is meaningful.

At the other end of the spectrum, he unfortunately does not mention that PC-specific survival for clinically low-risk men is the same whether they underwent RP or not. In other words, no benefits for men with low-risk PC who undergo surgery...only harms. Wish that Dr Han had also mentioned this fact as well.

JackH said...
Yeah, if I understood your comment, you're right.

Two points to build upon your comment...

Number one, the low- and intermediate-risk guys still include the unfavorable-intermediate risk cases. Still, Han groups too many different cases together.

Number two, from amongst the favorable risk cases there are unfortunately a small percent or slightly more number of cases which initially present as low-risk, and pretty much no matter what you do they are unstoppable and progress to death. The percent, as I said previously, is about the same for those who seek immediate treatment for low-risk who go on to die as it is for those who initially start out on AS, eventually move on to treatment, and unfortunately eventually die. AS does not mean you will never die from PC, but men die at the same rate as their compatriots who were initially diagnosed with the same kind of case details but went for immediate treatment. Treatment makes no difference in the longevity of this group, which is a very large group of newly diagnosed men.