Staying Diligent

For many here they are familiar with my comments about ten year durations being shown in prostate cancer studies. As a support group leader I continue that mantra. I learned a few years ago that ten year studies results are good but they tend to talk about biochemical failure as the end point. The truth is that mortality is the only end point that matters and I don't buy much into ten year studies that don't use that as the end point for results. So it is in this article that shows that beyond ten years there is significant disease activity.

tinyurl.com/6v3hrbh

This report shows that mortality continues to occur in intermediate and high risk cases as far as 20 years after initial treatment. It does not matter what the initial treatment was. We lack the data on the radiation side because 15 years ago very few men had radiation as the sole source of therapy. The results of this study using radical prostatectomy at ten and fifteen years shows clearly that we must stay diligent and continue to monitor this disease.

This post is not intended to be a negative but rather a reality check. If you have ever been diagnosed with prostate cancer, you need to always monitor the disease regardless of the chosen therapy for the remainder of your life. This tends to be a general variance from any other cancer. "You get past five years..." is not a statement that applies to prostate cancer. In our disease if you get past five years cleanly, you need to keep monitoring the next five, and the next, and so on...

PS I just completed five years in this race...My next PSA is scheduled for May...

Tony

My father had a recurrence after 25 years treated successfully with no additional activity or treatments before he died 10 years later.

So, not only can it came back but it can be stopped again.

Hi Tony,
It was interesting to see that surgery for early stage as well as for more advanced stages had a survival benefit. This study seems to support the notion that debulking the oldest tumor present results in a survival benefit. At 15 years, 9.2% of the cohort died of PCa. By calculation using SEER numbers, 16.5% of those diagnosed with PCa here die of the disease. Then, those surgically treated in the study reduced their risk of dying from PCa at 15 years by 44.0%.

Your warning is well taken. One should always remain alert and diligent irrelevant of stage or treatment.

RalphV

good post.

John,
The only studies from Dattoli and Grimm are range from 3 to 14 years on the inclusion criteria and have a median of only 9 years. If you are including patients that were treated just three years ago with patents that were treated 14 years ago the study is not comparable. The patients included in the study I linked only includes participants that were treated from 1988 to 2003. There is not a single patient in this RP study that was treated less than 8, almost 9 years ago. if we could get a radiation study from that same period we would not be talking about the same technology one would use today to get treated for prostate cancer and the mortality data would be very different.

On the HIFU, we can see that many low risk cases get good disease control. The problem with that is that many of those treated could easily have done just as well with active surveillance. The early data on HIFU is still too early to provide mortality data with. We'll have to stay tuned for that. Should have good data that can compare to the RP study in another decade or so...

Tony

Post Edited (TC-LasVegas) : 11/30/2011 4:27:58 PM (GMT-7)

Ralph,
You outline what I think concerns me most about active surveillance. Early stage Gleason 6 prostate cancer is almost never fatal in ten years but that is not true when you add the extra years on and set mortality as the end points. I have a guy in our group in Las Vegas that had G6 in 1998 and decided to not treat it and just watch it. He is currently on the XL184 trial.

I can see why the NCCN, AUA, and others put the life-expectancy dates on their AS recommendations.

Tony

Paul I remember being 2 months into this and I can empathize with ya.

Being 5 years into an advanced stage and much better educated about this disease I am much more settled into a good frame of mind. Keep educating yourself and you take most of the fear and anxiety away. You'll know what I mean later but for now the hope here is that you understand to keep a good eye on your disease...

Tony

dude,
When you look at the numbers you see increasing disease activity and increasing mortality. But the good news is in the numbers. The fact is most men don't die of their prostate cancer they die with their prostate cancer and that's by a very large percentage. And your point about improving care is very true. The reason retrospective data like this isn't given the highest level of evidence grading (Level 1) by the USPSTF is because it doesn't apply looking forward necessarily. I love seeing all the new stuff coming out.

And you have another good reason to stay positive...I was 44 when I was diagnosed with advanced stage prostate cancer. All the data I have digested over time suggests I've probably had prostate cancer since being in my 30's. But I'm doing very well thus far. Each case is different but we all can do very well...

Tony