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Posted 10/10/2012 5:15 PM (GMT 0)
http://www.internalmedicinenews.com/specialty-focus/nephrology-urology/single-article-page/active-surveillance-favored-for-low-risk-prostate-cancer.html

A new study that shows that immediate treatment vs AS produced a 1.8 month survival advantage over one's lifetime. This is pretty close to what the PIVOT study indicated. The benefit of 6 additional years without any of the side effects associated with treatment was the offset benefit of AS.

This at least quantifies the risks/benefits of treatment for patients. A trade off of losing 1.8 months of life for 6+ years of better quality of life. Of course these are averages of thousands of patients, but they do present a quantifiable risk/reward to patients to better enable them to make a decision. It also assumes that 60% of patients will eventually be treated, which is higher than most other AS studies that show a 35% progression rate. This may be understating the Quality of life benefits from AS.

JT

Posted 10/10/2012 5:24 PM (GMT 0)
they also need to quantify the QOL issues as these pertain to actual SE after treatment and mental issues in dealing with AS.

I may be in the minority, hopefully not and hopefully definitely not in the future as technology and doctors improve, but it's hard to sell someone like me on QOL when I have no physical effects form treatment.
Posted 10/10/2012 5:47 PM (GMT 0)
My initial diagnosis following biopsy was that I was Gleason 6 with cancer detected in only one side of the prostate. Following surgery, the pathology report indicated that I was a Gleason 7 with cancer in both sides of the prostate. Following my initial diagnosis, AS was a viable option. However, after the surgery, it became clear to me that I had made the right choice for my particular situation. Had I chosen AS, I may have bought myself another year or so before I may have had to change strategies. Did I sacrifice some QOL? Absolutely. Do I regret it? Absolutely not. I was not one of those people who can live sanely knowing that a cancer was growing in my body. The choice I made was good for me. Others may be able to watch and wait. It's all up to the individual.
Posted 10/10/2012 6:10 PM (GMT 0)
Like the Italian Guy said, only in spades. I was a borderline candidate for AS when I decided on surgery -- one positive biopsy out of four, one positive core out of fourteen, 3-4% cancer in that core, GS6(3+3) upgraded to GS7(3+4) on second opinion -- and I could have waited. In part, I decided on surgery because I was tired of biopsies. I expected some side effects but hoped that the surgery would let me stop worrying and start healing. When studies compute QOL I think they underestimate the bother associated with constant worry and the annoyance of repeated biopsies. As it turns out, I didn't get to stop worrying. But AS would have been a bad, bad idea for me.
Posted 10/10/2012 7:22 PM (GMT 0)
just got this on my twitter feed.

"So how do you know which treatment to choose? Pick active surveillance if your cancer risk is low, if you’re very old, or if you have chronic conditions such as diabetes or heart disease, says Dr. Etzioni. Consider prostatectomy if your cancer is a high-risk type, if you’re relatively young, or if you have a long life expectancy. “For men who do not fall into either of these groups, personal preferences are very important. The treatments do have unwanted side effects, including impotence and incontinence, but living with the knowledge that you have prostate cancer may cause anxiety that could affect a man’s quality of life in other ways.”

news.menshealth.com/protect-your-prostate/2012/10/09/?utm_medium=referral&utm_source=pulsenews
Posted 10/10/2012 7:58 PM (GMT 0)
I still wish more newly diagnosed men would chose AS, before getting talked into invasive treatments that they may or may not ever need. I never had the luxury of having AS for a choice, but I would have jumped on it in a heartbeat if I had met the criterea.

Even here among our smaller group at HW, look how many men have and are suffering the results of being treated for low grade PC occurances, in the areas of ED and/or incontinence, ridding themselves out of very minimal amounts of non-agressive cancers.

I am all about the QOL part of the equation. Mine sucks big time, not directly because of the cancer, but because of the treatments I have underwent to stop the cancer. The net effect is the same to me, because my QOL has been so greatly diminished, and replaced with relentless severe chronic pain and chronic fatigue.

If my cancer had been eliminated, perhaps I could say it was a good trade off, but considering my cancer is still in a run away situation despite primary and secondary treatments, none of this has been worth it to me. Think I would rather have taken my chances with the cancer, since the treatments did little if anything to slow down the cancer.

I have spent now from ages 56 to 60, being in a miserable situation with no end.

So I cringe, when I see someone jumping into surgery in particular, when they are diagnosed Gleason 6, 1 core, <5% cancer. To me, it looks like massive overkill to go through the risk of surgery and side effects. Not saying anyone is wrong, or they chose wrong, but just something to think about.

David
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