WifeofPie said...
Hi all,
We head to pre-op this Tuesday (5/9) for my husband's HDR brachy boost at UCLA (5/23). 5 weeks of IMRT will follow soon after.
Our docs are giving us 75-80% chance at cure. Yet...everything I'm reading online seems to pretty much point at G9 PCa as a chronic condition that will require lifelong management.
Does anyone with G9 actually move forward with no recurrence? I mean...I suppose the encouraging piece is that recurrence doesn't necessarily mean the disease is totally unmanageable. I'm trying hard to focus on the current fight and not to worry about the future, but I'm struggling with that.
Wife(may I call you Wife?),
Heck yes there are folks with G9 with no recurrence! Maybe many do recur, and far more G9's recur than do G6 or G7s. But that does NOT mean all is lost. Heck, even some surgery ONLY patients never recur, though I think your odds are better with some form of primary RT, though I can not prove it, just my feeling. Plus, even if he does recur, that is a long way from saying the PC is going to kill you or even cause serious problems. Yes, it might, but a BCR for sure does not guarantee a demise from PC, not at all.
Still, look at this 2014 study of over 30,000 men who had surgery for hi risk, and I think only 13% of them had some follow up RT. ( so remember, this is surgery only, for the most part)
www.renalandurologynews.com/prostate-cancer/study-supports-surgery-for-high-risk-prostate-cancer/article/338483/Somebody said...
In a study of 30,379 men (mean age 62.5 years) who underwent RP for Gleason 8-10 non-metastatic PCa, Naveen Pokala, MD, and colleagues at the University of Missouri-Columbia School of Medicine in Columbia found that the overall survival rates at 5, 10, 15, 20, and 25 years were 92.8%, 78.6%, 59.5%, 38.6%, and 20.0%, respectively. Cancer-specific survival rates were 96.4%, 89.5%, 82.0%, 72.9%, and 68.8%, respectively, the researchers reported online ahead of print in the World Journal of Urology.
“This is the first study to demonstrate excellent 20-year cancer-specific survival of men with Gleason 8-10 prostate cancer,” the authors wrote.
A total of 52.8% of patients had T2 disease, 73% had node-negative disease, 80.2% underwent lymph node dissection, and 12.9% had adjuvant radiation therapy. The study showed that pelvic lymph node dissection did not significantly affect overall survival.
Take special note of that
cancer specific survival rate of 69% at 25 years! And then recall once again this was a group that(except for a measly 13%) had ONLY surgery! And after 25 years, the sold majority had still not died of PCa!
Here is another one where(European study), far as I can tell, the patients had surgery only. These were all really high risk guys, G8-10, Mean PSA of 30(!) and about
60% had pT3b or greater and 10% had PT4. And 47% had lymph node invasion! So way high risk! Still, "
PATIENTS AND METHODS:
The study included 580 consecutive patients with pathological Gleason sum 8-10 prostate cancer treated with RP and pelvic lymph node dissection (PLND) at a single European institution between July 1988 and April 2010.................At 5 and 10 years after RP, BCR-free survival was 76.7% and 49.6%, respectively. Similarly, the 5- and 10-year CSS rates were 87.3% and 69.5%, respectively. Patients with specimen-confined disease (P < 0.001) and patients with negative LNs (P = 0.012) had significantly better CSS rates than their counterparts with less favourable pathological characteristics.". So at 10 years, even looking at the group as a whole including guys with LN+, 50% had still not yet had a BCR, and 70% had NOT died of PCa!
Most likely, you can get more advanced treatment than most in these groups got, since some of these had surgery 25 years ago, and things have advanced quite a bit since then. Still, just based on these studies, it is clear that all is not lost and it is even reasonably possible that there will not even be a recurrence. And if there is, that is still a long way from game over.