Local PCa Side Effects ~ Watchful Waiting has 'em too...

Selmer,
On your first thought,  you are not correct in saying I am stuck on that I believe all men an WW will fail.  I never said that.  But for most, the longer they go with it will experience disease progression.  I said that one should expect between 7 and 10 quality years before disease progression leads to decision time.  Even with disease progression it can still be actively monitored if it is right for that patient.  For example, some patients died of other causes in the study at UCSF that Mike blogged on.  The mean age of the study was 63 years old.  The older a person is the more likely they will have better QoL with active surveillence.  However, many of those patients were over 63.  Some much older.  This skews the expectations of WW for the younger groups. 

Again, I'm am not recommending anything.  But when Surgery/Radation offer 80-90% cure rates for localized cancer, and WW could mean going to ADT after five years like the 50% at YANA who were on it more than 5 years ~ it sounds like a bad deal to me.  Others might not mind the risks.  But they also may not know how rotten ADT is.  I have had all three treatments and if I could have avoided one of them it would have been the ADT.  Until you have tried it, you can't say it's better then ED.  Quite the contrary, it causes it and worse.  Even if a guy would only have a 10% chance of ending up on ADT in 10 years, I would tell them to try the surgery or radiation. 

And I am fully aware that most men diagnosed at the median age of 64, as in the study above, will die with PCa not because of it.  But I am not willing to tell a 50 year old to WW because a 64 year old or older did it and he died of other causes.

And when I go on WW, don't mind me, like other patients of advanced disease, if I prefer to be proactively seeking additional therapies that may improve my chances to avoid the mortality stats.  The odds of it failing for me are too great not to.

Tony

Post Edited (TC-LasVegas) : 3/31/2009 10:33:56 PM (GMT-6)

Selmer that is an excellent synopsis. 

If I am reading correctly, they took surgical cases of over a thousand men that would have qualified for active surveillence under their criteria and showed that 21% actual surgical pathologies were stage III or higher and 28% of Gleasons were upgraded and not truly favorable for AS at all.  So I guess there is a case that wants to do AS they should have every imaging test available to verify that it's likely to work out for them, my recommendation is to keep repeating them.  Counterpoint, if some of these guys were 74 or older, they could probably have proceeded with AS even with stage III if their life expectance was under ten years...

The next paragraph went on to say...

Active Surveillance for Low Risk Prostate Cancer 

A cohort of 262 men from 4 institutions were evaluated for disease progression using univariate Cox progression analysis. Eggener et al (page 1635) report that a re-staging biopsy was valuable for excluding patients from active surveillance. If a higher number of cancerous cores were found on the second biopsy then patients were not placed on active surveillance and outcomes improved.

Thank you again.  This discussion allowed me to look into this further.  I still believe Active Surveillence is risky business but it can be a good option for many. 

Tony