Study: Surveillance Is for Middle-Risk Prostate Cancer - & more evidence of the success of LDR BT

RCS, I don't disagree, but I suggest you add these important caveats:

-- clarify this is for favorable-risk PC cases (many thousands of cases per year)
-- importance of close adherence to AS protocol which triggers deferred treatment in roughly 30% of men eventually

-- not just BT, but any mode of aggressive treatment for favorable-risk men

NKenny said...
It's baffling when I see guys write something like, "oh yeah, right...like I was gonna consider AS with my 4+5 case." Your point?

Are you talkin' to me? Are. You. Talkin' To ME?

Taxi Driver -- what a movie. *sigh*

Actually, I did consider it. Prior to surgery I was either very low risk or a very low intermediate risk, depending on which pathologist you decided to believe. I talked to two surgeons and both recommended Active Surveillance. My uro tried to, sorta, slide me into it sideways, saying "how about we wait a few months and do another biopsy. Then we'll see..." He was surprised when I decided to go ahead with surgery anyway.

Ok, what seems to be missing in all of these conversations is clear data that truly compares all three treatment options for low-intermediate risk patients. AS gets compared to surgery, AS compared to BT, BT compared to surgery...but has anyone actually put all three together in a coherent way?

This would of course, require the researchers to put their personal opinions about the "other guys" aside for the good of all.

Anyway, I'm on the sidelines of this one now. For good or ill, it's academic for me. And, being 3 days post surgery, I'm probably not as detached about it as I will become. So, excuse the rant.

Focusing simply on the AS implications, I see no conflict between what TA shared 20 months ago, the UC-Davis study and the info shared by YoOP on this thread. In fact I think they are consistent and continue to make a good case for AS. The underlying implication is that over treatment of PC is fairly rampant and that favorable risk patients can and most likely should strongly consider AS with little risk to their mortality.

IMHO, it's too bad most patients and their doctors don't see it that way.

Jim

Works Out,

Drs Thompson and Vickers made this point (posted much earlier in this thread...where you can also find the original Tall Allen posting on this with the full discussion):

*  The point is, if you have a choice of a dollar today or a dollar 10 years from now, take the dollar today. But if you have a choice of a curative treatment for prostate cancer today or a curative treatment for prostate cancer 10 years from now, choose it 10 years from now.

 

Works Out, based on what you present: "a family history of a father who was diagnosed younger than I was but with his Pca already advanced. Family history and rising PSA's led me to a MRI and then a positive biopsy" - I believe you are going down the right path. From what I understand, that would preclude you from being a "favorable" intermediate risk.

Guys across the board here - I started this thread simply for discussion, and because I hate to hear about 'overtreatment.' I am not in a position to decide if this is sound logic or not, again, I simply posted to share what I found - and yes from two perspectives, the potential of expanding who might consider AS, as well as more facts/results on the benefits/success of LDR BT.

Works Out, the criteria for the Chicago study which "Yoop" posted--who get included/precluded or not--was earlier in this thread.
* GS of 3+3 or 3+4
* a percentage of positive biopsy cores of <50%
* at most one NCCN determiniant of intermediate-risk cancer (GS=7, PSA 10-20ng/mL, and T2b or T2c)

Very common.

Quite naturally, men who come from a family history of PC get PSA tested more often. Men over 50 years old are more likely to have at least a small measurable amount of PC, and so men over 50 from a family with PC is more likely to get diagnosed with PC.

Yoops. Looks like you have been burning the midnight oil again.

All this information has given me a major head rush (not very hard to do)

Although no longer relevant to guys like us, it will certainly help those new guys who are still searching out there treatment plan.

Even if they are now leaning more towards AS (for whatever reason) it will still not take away the fact that some guys are just not wired for that. Thinking back now in my post treatment situation can I honestly say I would of been comfortable with AS......Hmmmmm. I honestly am not sure I would of been.

Doctors can only advise. Ultimately it is US who have to make that final choice.

Thanks for all your hard work in gathering this information Yoops. Even though it may be like LDR brachytherapy for my brain

RCS,

It is all trade-offs. You are right that cancer tends to grow -- to get worse over time -- it is cancer after all -- but that is set against the advance of medical technology, which gets better every year. Tomorrow's incrementally-worse cancer can be treated with tomorrow's incrementally-better technology.

Similarly, the extra time a man spends without having to endure the side effects of treatment -- the time he spends on AS -- is also time he spends dealing with the anxiety of the untreated diagnosis. A man who remains potent and continent but is sick with worry may not be better off than a man learning to deal with "the new normal" after treatment.

Peter,

I agree ... I was just pointing to what I considered "a" flaw in applying the doctor's analogy to a G7.

Shaba,

I think you are spot on when suggesting some of us might need psychological help with the anxiety.

KThere are a couple important perspectives these most recent posts overlook.

Regarding the psyche of the AS patient, I think Dr Klotz (probably the most renowned AS doc) described it best when he reported how many of his patients feel "ebullient" about their decisions to pursue AS, particularly when they see the BS that their similarly favorable-risk friends have gone through. Relevant and notably, the Klotz program includes ongoing patient education...never stop learning. It took me about 2 years to realize that my own 3+4 favorable-risk case was probably over treated, and i have been fairly deeply immersed.

Another point which seems to have been incorrectly "assumed" is that Prostate cancer always advances and/or always causes a problem if low-risk cases. The "always" part is simply not correct. The word "if" was missing from one of the sentences above. Many, many thousands of men live their lives with Prostate cancer and die of other causes, and most of them never knew that they had PC. Never knew it. Others of us stumbled into a set of circumstances which set a sequence into motion...PSA, biopsy, panic. "You have Cancer...but luckily you are 'in time' and I can 'cure' you."

Post Edited (NKinney) : 2/21/2015 12:32:42 PM (GMT-7)

NKinney,

Based on the following articles, I feel that about 1 in 3 cancer patients need psyche help.

consumer.healthday.com/mental-health-information-25/anxiety-news-33/cancer-diagnosis-may-also-lead-to-mental-health-woes-692389.html

www.cancer.gov/cancertopics/pdq/supportivecare/depression/HealthProfessional/page1

Post Edited (RCS) : 2/21/2015 12:52:49 PM (GMT-7)