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

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Posted 2/21/2015 8:05 PM (GMT 0)
Thankfully, today's PC case profile is nothing like in the days of our grandfathers. The decision to or not to pursue AS is heavily influenced by the "trusted physician" who has just told us we have cancer, but he can save us. The real question is whether the favorable risk guy need saving. Uncomfortable realities of self-motivation may cloud the physician's judgement.

Treatment decisions regarding prostate cancer management have life-altering consequences. At the moment of treatment choice, the main reason for rejecting active surveillance is fear of disease progression. This fear is not based on reality for low risk cases. Confident reassurance by a knowledgeable physician goes a long way toward countering this. Referring to microfocal Gleason pattern 3 prostate cancer with phrases like ‘‘it is a normal part of the aging process,’’ ‘‘a pseudo cancer,’’ ‘‘has no potential to spread,’’ and ‘‘present in most men your age’’ are effective at reducing patient anxiety. A change in terminology by pathologists to terms that use words other than cancer have been proposed including the term IDLE lesions (indolent lesions of epithelial origin).

Time to revisit what we are now labeling as "Prostate cancer."
Posted 2/21/2015 9:01 PM (GMT 0)

halbert said...
NKinney, and some of us watched our fathers, grandfathers, uncles, or brothers not get treated until it was too late.

Think that's the crux for me. My dad went in one year from having a PSA not thought to being indicative of any problem, to the following year a PSA that was thought to be a problem (I don't know what either of the PSA's were). Biopsy and then surgery found he had PC that was already well spread. Apparently a nasty aggressive strain. Do I have the same? I don't know. Would a genomic testing like Polaris with relatively good results let me feel confident enough to pursue AS? I don't know.
Posted 2/21/2015 9:18 PM (GMT 0)
Works Out, I hear you. My father was treated with 1st generation cryotherapy in the early 90's, and died in 2004. When I told my mother I had PC, her (almost) first words were, "you're not going to do some experimental treatment, are you?"

As far as potential side effects go, I look at it like this: If I wind up with minor or occasional incontinence, that doesn't worry me too much. As far as ED goes, I had no problems before surgery, so I shouldn't have any untreatable problems after (75% or better chance). I'm 56 years old, with a 56 year old post-menopausal wife with a low libido who reports pain with sex. She can't do any of the common hormone based treatments because of BC in her family history. So, we get by and know we're not 18 anymore. I'm not worried about ED, even if it happens.

On the other hand, I'm going to do everything in my power to hit the trifecta.
Posted 2/22/2015 7:50 PM (GMT 0)

Phenom said...
I don't understand this. What would they be waiting for to initiate treatment? PSA over 20? That seems awfully high to wait for. I had six of 12 cores + with good %s of cancer. Would that be enough? And are they saying that less than 1% of low and favorable intermediate-risk patients would die of prostate cancer no matter whether they were treated or not? If that's true, of course none of these men should ever be treated.

That's what it sounded like to me at 1st. But remember, every man(I think) in this study was treated with BT. And whether low risk or intermediate risk, only 1% died of PC, not really much difference between the groups. Most will die of something else, of the few that died most likely.

So I guess the point is: since people with G6 safely start with AS, and since in this group that was treated there was no difference in death rates form PC, then maybe that means 3+4 is also safe for AS?

Somebody said...
Researchers estimated and compared the risk of PC-specific mortality (PCSM) and all-cause mortality (ACM) following brachytherapy among men with low-risk and favorable intermediate-risk PC in a prospective cohort study of 5,580 men (median age 68 years) at the Prostate Cancer Foundation of Chicago between 1997 and 2013. Men with favorable intermediate-risk PC, who had no more than half of all prostate biopsies containing PC, were included in the study and were treated with prostate brachytherapy alone.

The researchers found that men with favorable intermediate-risk did not have significantly increased risk of PCSM and ACM when compared to men with low-risk PC after a median follow up of 7.69 years. Additionally, the absolute estimates of PCSM were less than one percent in men with low-risk and favorable intermediate-risk PC, suggesting that men with favorable intermediate-risk PC may also be candidates for active surveillance.

So risk of death from PC, for men receiving BT was < 1% regardless of being low or intermed. risk. Therefore, if AS is safe for 6, it most likely is also safe for 7s(3+4) plus BT is very effective for either.

Post Edited (BillyBob@388) : 2/22/2015 1:32:05 PM (GMT-7)

Posted 2/22/2015 8:04 PM (GMT 0)

BillyBob@388 said...
...then maybe that means 3+4 is also safe for AS?


There's this: prostatecancerinfolink.net/2014/11/24/active-surveillance-for-men-with-gleason-3-4-7-disease/
Posted 2/22/2015 8:27 PM (GMT 0)

halbert said...
NKinney, and some of us watched our fathers, grandfathers, uncles, or brothers not get treated until it was too late. It's truly a dilemma, and there are no simple answers. I take a lot of comfort in looking at where we are "today" compared to where we were 25 years ago when my father was diagnosed. And have every hope that when my newborn grandson is 50 years old...and I'm long gone from this earth, that things will be much, much further along than they are now. By then, they will be able to differentiate between true low risk and aggressive cancers, and the patient will be able to make truly informed decisions. Yes, the things we do today will see barbaric to them...just as what they did 50 years ago seem barbaric to us.

It is a dilemma for sure. Just lost a HS buddy- 2 or 3 years younger than me- to PC. The obit was the first I even heard he was sick. I wonder what my situation would be if I had added a few more years before my G9 with pos margin foci and SV+ was diagnosed? Heck, I'm not at all sure what my situation is now. But I would not complain if I had been able to have found this and to have done something about it several years earlier.
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