How many men in US live with metastatic prostate cancer?

Great question Jerry. Has to be similar or greater than breast cancer. More men are dx with PCa and it is slower growing with longer survival times than breast cancer.

Sad about Olivia. That is another reason Lee watches hers so closely and is on a ten year regimen of Faslodex to guard against recurrence. Two shots a month at a cost of several thousands each shot. Thankfully no evidence of recurrence.

I would guess about the same number, 150,000...

There are a lot of stats available for prostate cancer, but none that I've seen that are specific to advanced prostate cancer. In the United States alone, an estimated 3,000,000 men have prostate cancer at some stage. The problem as we know, is that there is such a wide range in how advanced those cancers are. But what we know for sure is how many people die from it, and there are around 27,000 per year in the U.S. alone. The other day, I did a search "famous people who died from prostate cancer" I was surprised how many people that I didn't know died from prostate cancer but have heard of such as: Timothy Leary, Frank Zappa, Winston Churchill, Telly Savalas, James Herriot, Merv Griffin, Francois Mitterrand and many more. Seeing how almost every man will get it if he lives long enough, it's not surprising how many it kills.

As a man of science, I've learned to perform good first-pass estimates based on back of napkin math...

A few necessary, but fairly good assumptions:
1. the number of 150K survivors with metastatic (stage IV) BC is correct
2. constant diagnosis & death rates (fairly correct), so new cases of metastatic cancer (IN) equals deaths (OUT)
3. only those with metastatic die of the disease (correct)
4. assume identical survival rates (actually, 5-yr BC is 22%, 5-yr PC is 29%, for metastatic disease)
5. linear survival rates (probably good estimate for metastatic disease with no cure)

Assuming those similarities, a first estimate would be that the multiplication rate for the living is 150K living / 41K deaths (which is the number of BC deaths) = 3.6 living/deaths. Then, 3.6 living/deaths* 26K deaths (PC deaths) = 95K living.

Higher survival of PC (see assumption 4.) would increase that number.

Estimating about 100K men living with metastatic PC (in the US).



By contrast for scale, an estimated 2 million living men have been overtreated for PC in the US.

Post Edited (JackH) : 5/31/2017 2:46:02 PM (GMT-6)

No. That's just the number overtreated. And as I said, that's just there for perspective/scale. But since you asked...

These ratios pass the common sense test, too. Only several percent (3%) with metastatic PC, and mostly older (8% of 80YO, 2% of 55YO). Many times more fall into the low-risk group (nearly half) which is the largest group and heavily laden with younger-ish men who are living much longer.

You don't need to worry...you (12/12; 4+3) weren't overtreated, nor were you included in the count of overtreated in the US.

Post Edited (JackH) : 5/31/2017 12:53:04 PM (GMT-6)

The definition of overtreatment is someone who receives treatment for prostate cancer that would not have killed them.

While it's true that many have been overtreated, the problem is knowing which ones. For many, it comes down to a personal decision of living with the certain side effects of treatment or taking an uncertain risk. Everyone has to make their own decision based on what they feel is best for their life. So are those who choose early treatment knowing it may not be necessary overtreated? I don't think we can really know on an individual basis. What's important is that each person makes an informed decision and understands the risks and quality of life issues of treatment vs no treatment. If the patient makes an informed decision and gets the treatment they want, it's not over or under for them.

Here is some more back of the napkin SWAG.

American Cancer Society reports that 2.9 million men living in America have been diagnosed. Reuters recently reported that in the last several years Medicare reports that about 75% seek curative treatment within one year of diagnosis and that 17% pursue AS/WW. It doesn't say what happens to the other 8%.

Thus we could assume that 75% of the 2.9 million living have been treated, being approximately 2,175,000. JackH contends that 2,000,000 have been over-treated. This means that 92% of men treated were over-treated, thus shouldn't have been treated at all. I agree there has been far too much over-treatment, but is there any organization or expert in the field that is agreeing with the metric of 92%

Regarding the definition, that is technical, but certainly isn't practical. Many men that are appropriately treated die of something else. If I live for 10 years and die of an accident does that then mean I had been over-treated? Clearly the low volume, low PSA, G6 should not be treated unless or until he is determined to no longer at such low risk. Unfortunately far too many of these continue to be treated. Shame on the doctors that facilitate this. Thankfully it is reducing according to the Reuters article by about 8% per year.

But there are many men in the borderline area of intermediate risk that simply can't continue with the physical and mental rigors of AS. Faced with the prospect of dozens of future biopsies relatively non-invasive curative procedures like SBRT and HDRBT would probably be better for the long term health. How can this be over-treatment from a practical perspective?

JackH and starfinder both have valid points. Statistics are one thing, and Individuals are another.

I am also reminded of the Optimist who saw a glass as 1/2 full, a Pessimist who saw it as 1/2 empty, and an Engineer who wondered why the glass was designed at 100% over needed capacity!

Charles

Did they tell you which patients were overtreated?

Yes I understand the statistics and the methodology behind the terms "overdiagnosed" and "overtreated". And I agree that it is definitely a problem that should be addressed. Some have even called it an epidemic.

I am just trying to point out that it always has to come back to an individual making an informed decision about what's appropriate for their own treatment.

I am surprised that the three main factors do not include hammer/nail syndrome on the part of the physician. Combine that with doctor/God syndrome on the part of many patients and, I admit to having no stats, it feels like that should be near the top of over treatment reasons.

Over diagnosis is another term that does not sit well with me. I have read too many recommendations on doing away with PSA tests at some ages even though establishing a base line is critical in determining what later PSA tests actually mean.

I know that statisticians have to define terms and even make assumptions to produce some stats. If the assumptions are not provably wrong then the resulting stats are accepted. I saw above that over treatment was defined as: "The definition of overtreatment is someone who receives treatment for prostate cancer that would not have killed them." How do we know it would not have killed them? I am on AS for the fourth year. If a Gleason of 6 and receiving treatment is considered over treatment why do AS programs continue to test? Are those tests which often include biopsies over treatment? I do not have the number available but we know there are cases first diagnosed as a 6 but later were a 7 or higher and needed treatment.

I think there needs to be levels of stats. At level 1 we would have stats for which there are numbers for every stat. Number reported cases of PC diagnosed would be an example. Then there should be lower levels for stats that are based on definitions not backed entirely by facts. Actually I think they should not be called stats at all but estimates.

Rant off.

I was with a large HMO in California and on my own initiative asked for a DRE at age 50. I got a PSA test that my assigned Primary Care doctor ordered for me at age 52. Both completely normal. Thereafter, nobody ever discussed or ordered another DRE or PSA test (based, I assume, on the "statistics" and their working business-patient-cost-benefit model). I eventually retired and moved to Medicare and another secondary insurance. At age 65 I was in severe pain, and was diagnosed with very metastatic PCa and a PSA of 5,006.

I never had the chance to be "over treated".

During the past 3 1/2 years of my treatments, my medical insurance claims costs have far, far exceeded the costs of simpler tests and possible initial stage treatments, had I been diagnosed earlier by a very simple blood test. I am now guaranteed many more adverse impacts, side effects, and pain and suffering between now and when I die, to say nothing of the $ costs, and the impact on myself and my family of my probably dying 15 years earlier than I might have otherwise.

I majored in Math in college. I appreciate the power and mathematical beauty of statistics, and I value what good things mathematical tools can provide to complex societies, with all their socio-economic opportunities and constraints.

But, I am also a human Individual - more than a Patient, or a Medical Cohort, or an Insurance Policy Number, or my Medical Chart, or my latest Test Results, or my Scans Images, or my Tumors, "mets", or my Cancer. Beyond and despite those things is where I Hope to continue to Live and Love in this world, for as long as I breathe.

Just some thoughts,
Charles