Another long term study. Median followup 18.6 years.

Seems that if you are organ confined Gleason 6, you are largely home free if you have surgery, but, of course, it doesn't say what happens if you don't have surgery. If you are Gleason 7 or more, surgery may or may not save you.

Good paper, Chris.
I am printing copies for my UsTOO group. In fact it will be an interesting handout as we have a surgeon speaking at the next meeting...We need more long term studies like these...

Thanks for the post.

Tony

This is very discouraging. 55% of the men treated with surgery had psa that had risen. The only good news is that only 4% of the G6s had failures. Again the evidenc is pretty clear that the PC stage has much more impact than the treatment. A 45% success rate for any treatment is not what I would call a success.
JT

I have studied this document and I have some interesting points I think that need to be considered. Here is what I see, I welcome what you might see:

1> If the median of this cohort is 18.6 years that means that at least 50% cohort was initially treated before 1992 and everyone else since. In 1992 the standard of treatment was radical prostatectomy. Radiation was still a wide beam that had many poor side effects. Seeds, Cryo, just about any other approach was still in the infancy stages as compared to todays versions.

2> Current technologies, drugs, and follow up hormonal and chemo care was not available back in 1992 and for many years since. So it is very likely that survival numbers have improved with time.

3> Surgeon experience matters! Ugh! All our new members and lurkers need to pay careful attention to this point. It is crucial!

4> There is a lot of disease activity that takes place after the ten year mark! But it does not necessarily mean death by prostate cancer.

5> There is a disease control and survival benefit with RP to all patients in the cohort regardless of risk category, but the benefit is more pronounced with men that have Gleason 7 or higher disease who also have significant lymph node dissection.

Peace...

Tony

Post Edited (TC-LasVegas) : 1/29/2011 10:15:54 PM (GMT-7)

John T,

I think the 55% recurrence rate is somewhat skewed due to the fact that this study has a lot of patients from before 1992 (Pre PSA).  Most people then presented with clinical symptoms and palatable cancer.  Recurrence was almost always going to happen for these men.  But let's say the 55% is accurate, even today,  only 24% of those with recurrence died of PCa.  Or, 25% did not die at the time of this study.  I don't think the paper is very detailed.  I would like to see all the particulars of this study.

Also,  I believe it said 4% of the G6 failures occured after 10 years, not only 4% of G6 people failed.  It also stated that none of the G6 failures developed metastatic cancer.  I don't know if it was any of the G6 or any of the 4% of the G6 that failed after 10 years.

We really need to get the details of the paper.

I haven't had a chance to study any of these abstracts in depth; one would of course like to see the entire articles rather than abstracts; and all prior caveats expressed by others about "mixing and matching" studies - particularly studies involving pre-PSA era patients - should be recalled.

Having said all that, #585 may give those of us who are Gleason 7's some rare insight into our situation as compared to Gleason 6's and Gleason 8-10's.

And #285 should rekindle a lively debate.

Zen9

Chris,

You have initiated one of the meatiest threads on PC in a while. My thanks to you and the rest who have contributed. I will be chewing for a while.

One of the hardest things for me and PC is not knowing. As Alf points out, they are still statistics, but statistics can be presented in ways that are more reassuring than the Uro saying "you have cancer". As someone pointed out, 3 out of 4 did not die from PC. Another point was that living 15 years with BCR was possible.

This was what I needed to hear today.

Goodlife

David,
I have to take exception to your train of thought about statistics. Yes, everything boils down to an individual situation, but so does everything in life. Without studies and statistics we would not know if treatments were effective, in fact we wouldn't know if we even needed treatment until it was to late to affect anything. They are not perfect, what is? but they give us a good idea of what to expect and are very useful in decision making. The very idea of statistics and studies is that there are variations and they are to be expected. How else are we to get any type of factual information to guide our decisions except from studies. The only other options are trial and error and anacdotal stories or just using your gut feel.
I would never consider a treatment, test or medication without some study or statistics showing its effectiveness. Without data decisions are only as good as a coin flip.
JT

It seems rather silly to me for anyone to suggest that statistics dont matter because they only reflect OTHER people's results.

Obviously, if medicine didn't try to gather the individual results based on degree and state of pca, and then try and take an overview of who ended up where using whatever series of solutions (RP, Rad, etc..), then why bother?

To suggest that studies and stats are of no value because they represent the results of OTHER people, or to say "I dont want to know what happened to others, I want to know what is going to happen to me"...

Then you shouldn't be looking at anything other than your maker.

Because HE or SHE may decide you were NEVER going to die of pca, but that you WILL be hit by that bus next thursday.

In my opinion.

Purg casts cold water on threads such as this one because he comes at the Healing Well forum from a different angle than some of the rest of us do.

His vision - and the vision of many others - is of a forum where one can get and give emotional support to fellow prostate cancer patients (past or present).  There is absolutely nothing wrong with that vision.  Obviously, however, it is ultimately incompatible with a lively discussion of papers, abstracts, and statistics pertaining to prostate cancer and its treatments.

In contrast, some of us come here in an attempt to follow the developing science - a halting, uneven, fragile development, to be sure, but one in which we have more than a passing interest.  This is doubly true if - like me - you are advising newly diagnosed men who contact you.

Obviously, this is not necessarily an either-or situation; some come here for both reasons.  But for those who come here solely for one or the other reason, perhaps the best option is to simply participate in the threads that interest you and leave the others alone.  Telling us the limitations of statistics isn't all that helpful; we already know their limitations.  Conversely, impatience with frequent "personal updates" is misplaced emotion.

This forum is by nature schizophrenic, and that's OK.

Zen9

Post Edited (Zen9) : 1/31/2011 9:40:11 AM (GMT-7)

zen: i love being stereotyped and pigeon-holed on my views. it wasnt me that decided that HW was primarily a patient to patient support site, kind of has to do with the owner of the site's intention. i am not "throwing cold water" on anything. or does that simply mean that if one has a different opinion, perhaps negative to the normal ebb and flow of thread, it's a "negative" thing?

i think it does a terrible diservice to all here, newcomers especcially, when certain people (not you) come across as self-made experts in complicated medical matters. there is also a fair amount of "doctor bashing", which does not help a new comer, who already has enough fears going to choke a goat. when i want real medical advice, i go to my doctors, and unless common sense tells me different, i am compliant to my doctors, their advice, and their orders.

and zen, sadily, in my opinion, there are men here that are OCD about stats and reports, and they make decisions based on biased reports, instead of listening to their own doctors. There are guys here, that I am sure that their doctors cringe everytime they see them, because they are the "know it all" kind of patients, or worse yet, the "wilkipedia patient", that comes armed with questionable reports and stats.

there is a good place for numbers and reports, i have made my entire working life off of numbers. A PC journey is not about having a check list and picking the best dr. money can buy, going to the best facility, running numbers through a nonogram and looking sweet. We have plenty of brothers here that made all their choices like they were ordering a luxury car, going off the options list, and despite all their learning, still end up with miserable results. Were there choices wrong? Probably not, but goes back to each human body reacts in its own unique way. It's that simple.

My original point, was not to put too much faith into loaded reports and stats, that a person like us, can't really prove or disprove. I would make no medical decision off of anything that the reliability couldn't be proven in some real way.

David in SC

Bob Cape:

I do believe you missed the spirit of what was meant in English Alfs and my post concerning reports and data. No one is against pure facts.