Predicting Who Will Benefit from Prostate Cancer Surgery

In a recent thread of mine about my Onco visit, Mel mentioned Circulating Tumor Cells (CTC). I had not done any research on it and so of course I went looking. I thought it would be something of a test that I could look into as I venture further in the HT free zone of dealing with my rising PSA.

This may have been discussed here before and if it has I apologize for bringing it back. But with all of the discussion lately about ODOT and rush to treatments I thought it worthwhile for discussion.

This paragraph really caught my attention on the use and prognostic value of the test:

A central issue that men with prostate cancer, and their doctors, face is deciding if surgery (or other therapy) to eradicate the prostate is the best course of action. Surgery is most indicated when there is a strong likelihood that it will be curative. This is generally the case when the cancer is confined to the prostate gland.

Potential surgical failure can occur when the cancer has spread beyond the prostate gland. In this situation, surgery is not likely to cure the disease and many doctors will not recommend surgery.

Unfortunately, the surgeon often does not know the extent of the cancer before surgery is performed. However, in a landmark study, scientists at Columbia University in New York have discovered that CTC testing can predict which men with prostate cancer are likely to benefit from surgery.9 In this study, 138 men with prostate cancer scheduled for surgery to remove the prostate were tested for the presence of CTC in their blood. An eye-opening finding revealed that the men who were CTC positive were 12 times more likely to experience a potential surgical failure compared to those who were CTC negative. Moreover, the scientists determined that CTC status was superior to PSA levels and Gleason score at predicting potential surgical failure. In fact, every single person who was CTC positive with a PSA greater than 10 ng/mL had potential surgical failure. This compares to 76% of patients who were surgically cured with a PSA greater than 10 and who were CTC negative! All in all, CTC negative patients had an 87% chance for a surgical cure. The authors remarked that “this assay might be a useful criterion in the counseling…of patients on the value of surgical treatment for prostate cancer.”

www.lef.org/magazine/mag2010/apr2010_Circulating-Tumor-Cell-Assays_01.htm

This is a more recent report on the advancement of the testing:

/www.cellsearchctc.com/news-events/next-generation-circulating-tumor-cell-test-demonstrates-high-efficiency-and-accuracy

And for the really techy guys who dig deep into Pca research I found this paper:

www.translational-medicine.com/content/10/1/138

From what I see, the value of the CTC testing is for the folks before any sort of treatment is undertaken. I don't think it will help me very much. CRAP

Sonny

It sounds like a great tool.

Whether the cancer had spread was my biggest fear going into treatment.

Hey, I'll make a $2 bet....The COST of performing a CTC might make insurance companies balk at doing it routinely... Perhaps only a few labs CAN do it..Surgeons and R.O's certainly are not going to promote it...So that leaves GP's and medical oncologists as the ones who need to start beating the drum...

Thanks for the info,

I thought it had some use for folks in our situation. Guess not?

Mel

Fairwind:

I think we have a 4-tiered system now:

1) Those who have no insurance and have to fend on their own.

2) Those with minimal insurance

3) Those with good insurance

4) Those with Cadillac plans

#1 is a national disgrace. If someone of average means get a PC dx. without insurance, they could quickly have to go without necessary tx.

Mel

My RO didn't recommend the CTC test. He said it is so new there isn't a consensus on what it means for treatment planning. Whatever the number is would not change my plan. In any kind of test, the first question should be, "Will this affect our course of action?". If not, the test isn't useful. In my case, no change would ensue.

It's possible it may be more widely used, at some point, once it's value is more widely understood and accepted.

John t

You said
Ohio State, Andrew, received excellent care, the best doctors and expensive meds and he didn't have a dime in his pocket or any insurance.

So, you cite one exception. Seriously, do you really think someone of average means and a PC dx. would do just fine with no insurance?

Get real. We are very fortunate to have insurance. For the others, I guess Let Them Eat Cake is just fine???

Mel
"

Jerry (what a great name...)

I see Myers as mentioned by John T above.  For my situation, PSA testing is of limited value and he uses scans and various blood work, including CTC, to determine treatment.... including the timing of intermittant HT.

I get my bloodwork done through LabCorp and they offer this test.  They have locations across the country and I would assume this test is available there.

btw --- if anyone wants the info. I use to fight my insurance, I would be glad to provide what I have.

JL

John T. --- you might want to consult with Myers then. He sees value in it in my case.

John T said...
Mel,
This will never go away. Even countries with government paid care, Canada and England, there is a two tier system where patients can pay to go outside the medical system for services they deem are worth the extra cost.
The death rate from PC in the UK is significantly higher than that in the US as are the death rates for all cancers. The majority get care, but at a lower level.
Ohio State, Andrew, received excellent care, the best doctors and expensive meds and he didn't have a dime in his pocket or any insurance.

John they also don't get tested as we do in America. American rates started to improve vis-a-vis UK rates since we started PSA testing which gave us the ability to catch the disease early and afford it the better treatment/management we have in America.

Redwing,
It's not just one test that you would base a decision on. It's the preponderance of evidence combined. If you have a positive CTC and a high PAP plus nomograms that show a high degree of probability of not being contained, the chances are extremely high that you have systemic disease. This coupled with a high Gleason, a scan showing extra capsular extension and a high psa is a pretty good indicator that a local treatment will fail.
Jerry,
I did not mean that CTC could be not used for advanced cases to see how it is responding to treatments, which is apparently how Myers is using it. It's greatest use would be to screen patients for suitability of a primary treatment.