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Posted 6/12/2016 3:52 PM (GMT 0)
I looked at the American Cancer Society cancer statistics: www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2016/

On page twenty I read: "According to the most recent data, 10- and 15-year relative survival rates are 98% and 95%, respectively.
Then the table on page 21 specifies the 5 year survival rates for local and regional prostate cancer to be greater than 99%.

What does this tell me? No need to worry, watchful waiting will provide a 95% survival rate of 15 years for regional PCa?

Georg
Posted 6/12/2016 11:22 PM (GMT 0)
Those statistics are very encouraging for low risk PCa patients. BUT, you better be very sure that your risk has been correctly assessed. In Johns Hopkins' active surveillance program, you need to have an MRI, a fusion biopsy, and a second, confirming biopsy to determine your risk as accurately as possible. Also, testing every six months for as long as you are in the program. Watchful waiting (checking to see if you are alive five years later) is Russian Roulette. Only a strict active surveillance program can best ensure that you die of something else first.
Posted 6/13/2016 12:02 AM (GMT 0)
George, what you'll learn is that PC is multiple diseases, if you will. A relatively small, but significant percentage of cases are high risk, and they account for the 5% who don't live 10-15 years after diagnosis...and the untreated prognosis is not only short, but very, very nasty.

Therefore, the key question, as ASA mentioned, is what is your particular case information?

"Watchful Waiting" is an old, mostly discredited term that has generally translated into: "ignore it until you have frank, obvious symptoms, and then it's too late to do anything other than palliative care". The current process of dealing with low risk cases is to apply active surveillance...and the key is active. Catch it when it changes and then deal with it appropriately.

Also, statistics have some value...but they have zero predictive value for individual cases.
Posted 6/13/2016 2:14 AM (GMT 0)
George
What are your stats? As has been said, there's a large range of potential outcomes depending on your payhology. I'm one of the unlucky ones but still fighting.

Bob
Posted 6/13/2016 1:49 PM (GMT 0)
Averages and statistics are great for understanding and guidance, but they really can't be directly applied to any specific individual unless that individual is on the favorable side of the average. Intermediate and high risk men certainly are at greater risk than the general statistics report. To know how the statistics really work you have to break them down by risk level and you will see a different story for high risk than for the total population. Even then, they can not predict what will happen to any one individual. Each individual presents a different case and the outcomes can be very different even with similar risk factors.
Posted 6/13/2016 2:43 PM (GMT 0)

halbert said...
"Watchful Waiting" is an old, mostly discredited term that has generally translated into: "ignore it until you have frank, obvious symptoms, and then it's too late to do anything other than palliative care". The current process of dealing with low risk cases is to apply active surveillance...and the key is active. Catch it when it changes and then deal with it appropriately.


No, no, no. This statement quoted above is absolutely wrong, and bad information to spread.

George, from the little you've written here, you seem to be inquiring about Watchful Waiting as a possibility for you, and if so I apologize on behalf of the veteran members here at HW/PC for the mis-information which was provided to you, above, and I will correct it here. (And even you are not seeking information about watchful waiting for yourself, George, there may be others in the future who read this thread who might be misled by the bad, potentially dangerous, information above.)

Watchful waiting (WW) is a very real and very plausible approach for some men today. It has been around for a long time, and we have HW/PC members here today who are on WW. It has NOT been replace by Active Surveillance (AS), but today's "PSA era" has brought about a set of circumstances for AS as a new strategy for men with favorable-risk cases who choose to defer treatment (possibly forever). Neither AS nor WW are a "do nothing" approach, as you will see below...be aware that nobody recommends "do nothing" for anybody.

To fully understand both terms, one of the clearest most articulate definitions I've seen is found right here at HW/PC, in the "sticky" thread at the top of the page titled "Newly diagnosed with PC -- read this thread first" which is also found here:
www.healingwell.com/community/default.aspx?f=35&m=2652250
Once there, please scroll down to the entry dated 7/25/2013 for a definition of both terms. For your ease, I will copy/paste the entry completely here:

    Although frequently (mis-)used as interchangeable, the two terms “WATCHFUL WAITING” and “ACTIVE SURVEILLANCE” have some similarities, but have very different meanings. The term “Watchful Waiting” has been around a long time, whereas “Active Surveillance” is a relatively newer term created as a variant of “Watchful Waiting.” Read this to understand the important differences:



    What is “WATCHFUL WAITING?”

    Watchful Waiting (WW) is a strategy of using less intensive follow-up (fewer monitoring tests) and relying on changes in a man’s symptoms to decide if a treatment is needed. If symptoms appear, whether it is a lower urinary tract obstruction or bone pain from metastatic disease, treatment is introduced to relieve symptoms…so it is a palliative (not curative) therapy. This strategy is usually applied when the doctor & patient agree that he has fewer years of life expectancy and/or has other concomitant health problems, or because the patient believes strongly that he would prefer the risk of disease progression to the risks associated with aggressive treatments.

    WW has been around a long time, but the fundamental basis for modern forms of this strategy is that one is trying to avoid receiving treatment of any type for as long as possible so that the patient may optimize his quality of life, while recognizing that it may be necessary in the long term to intervene so that he has minimal impact from the potential morbidity and mortality associated with prostate cancer.

    WW may also be appropriate for a man who is suspected of having PC but for whom a biopsy is perhaps an unnecessary intrusion because of age or health. In such cases, even if a biopsy proved to be positive, curative therapy would not be recommended, which makes the biopsy somewhat futile.

    WW in these, or similar, scenarios may apply to men of any PC RISK category.





    What is “ACTIVE SURVEILLANCE?”

    Active Surveillance (AS) is a very different strategy of proactive, prospective therapy for carefully selected LOW-RISK men to measure the pace of disease progression (or lack thereof) by regular monitoring AND instituting deferred treatment with curative intent based on pre-defined change in the monitoring test results. Close observation over time is the best way to distinguish men who can be safely watched from the men who genuinely need treatment.

    This important element of “time” is unavailable at the moment of initial diagnosis…which has led to the mantra consistently provided to newly diagnosed LOW RISK men not to “rush” any aggressive treatment decision without understanding the likely “benefits” of aggressive treatment (many men are unaware of the uncertainty/controversies that aggressive treatment may not improve their survival, especially LOW RISK PC) versus the potential “costs” (many men are surprised post-op because they didn’t quite understand the gravity of the side effects).

    AS is a relatively new term as more-and-more of the PC clinicians have realized that not all cases of PC need aggressive treatment…and as a result prostate cancer is now frequently referred to as a spectrum of different diseases, rather than a single disease. It should be noted, however, that there currently is no universally accepted formal protocol for AS entry, monitoring, or exit; rather, attending clinicians tailor a program of care unique to each individual case but based on common foundations. While age is a consideration in some programs, Dr Laurence Klotz, considered a foremost authority on AS, has expressed that "the longer the patient’s life expectancy, the more stringent should be the AS criteria, but youth alone is not a contraindication for AS." Also worthy of note is the recognition that Klotz's program, and others, are now evaluating limited inclusion of men on the low-side of INTERMEDIATE-RISK PC (small amounts of Gleason pattern 4, and otherwise low-risk case characteristics).

    Those who may pursue AS may never need an aggressive treatment at all, or they may not need treatment for years, or they may need treatment after their next 6-month check-up. Most AS programs are holistic & integrative in their structure, and include supplemental patient education on lifestyle choices (diet, exercise and stress reduction) which has been demonstrated to slow or reverse PC progression in low-risk patients.

    Related to the efficacy & safety of AS, the Univ of California-Davis conducted a study several years ago which compared pathological outcomes of men who sought deferred surgery after a period of AS with those from a similar risk group undergoing immediate surgery, and concluded with these important points:
  • rates of Gleason upgrading to >/=7 did not statistically significantly differ
  • rates of pathological category pT3 did not statistically significantly differ
  • rates of positive surgical margins did not statistically significantly differ
  • rates of non-organ confined disease did not statistically significantly differ
    The study’s conclusion statement: “The present analysis did not show an association between RP after a period of AS and adverse pathological features for men with low-risk disease.” In other words, in a sample study population deferred treatment after AS did not have different outcomes from those who sought immediate treatment.





    The term “EXPECTANT MANAGEMENT” broadly encompasses both active surveillance and watchful waiting strategies.



Hope this helps clarify.

Post Edited (JackH) : 6/13/2016 9:47:13 AM (GMT-6)

Posted 6/13/2016 4:25 PM (GMT 0)

JackH said...

No, no, no. This statement quoted above is absolutely wrong, and bad information to spread.

JackH, Thank you for your detailed post. Everything you wrote is totally correct, as far as I know. However, Halbert and I were expressing our opinions, which are that WW is not a recommended approach. Now, you have pointed out the specific criteria where WW has valid application, such as limited life expectancy due to age and/or co-morbidities. That is a needed extension to the posts by Halbert and I.

But, your above quote is more like something I see on political forums, starting a flame war. Certainly recommending the newer, more comprehensive protocol, is hardly "absolutely wrong".
Posted 6/13/2016 5:37 PM (GMT 0)
Nope.

First of all, this is wrong: ""Watchful Waiting" is an old, mostly discredited term that has generally translated into: "ignore it until...", and in my opinion it is dangerous to give wrong information in a peer-to-peer forum which could be referred to later or found via search engine at any time in the future. WW is a perfectly viable option for some men, and we have HW/PC members today on WW. You both should go back and correct errors. (And probably apologize to our HW/PC members on WW.)

Second, you just wrote: "Halbert and I were expressing our opinions, which are that WW is not a recommended approach." Recommended by whom? By you? I'm talking about actual men and women with medical degrees (which does not include me). You should follow my lead...I don't give treatment recommendations. I give information. I give helpful information on topics where I am knowledgeable; and I don't generally speak up if I'm uninformed.

This has nothing to do with politics. It's about helping others.
Posted 6/13/2016 9:19 PM (GMT 0)
If I may, allow me to quote Dr. Walsh's book (revised edition):

First, on page 221, he mentions the Swedish protocol and says "For years, in Sweden, watchful waiting meant ignoring early prostate cancer and sending the man home, telling him to come back when he had some symptoms--when the cancer had spread--and eventually treating him with hormonal therapy." (sounds a lot like my statement: "ignore it until you have frank, obvious symptoms, and then it's too late to do anything other than palliative care")

Then, on page 228, he writes, "...However, active surveillance in the United States is not the same as watchful waiting in Sweden. In Sweden, doctors sent men home and told them to come back only when they had symptoms of advanced disease--at which point men either began hormonal therapy to treat metastatic disease or underwent palliative treatment to relieve urinary tract obstruction...."

Later, he adds, "In fact, we're mainly using the term "active surveillance" because it means to to be followed carefully, to delay definitive treatment only until it becomes clear that the tumor is growing."

(2012 edition)

Now, one can argue whether Walsh is definitive, but we do commonly recommend this book to newbies as a solid reference. HIS word I'll accept. And if in his words, watchful waiting means sending a man home until he has frank symptoms, then that's good enough for me.
Posted 6/13/2016 9:25 PM (GMT 0)
I don't see that Dr Walsh "discredits" Watchful Waiting. Not in the slightest. It is a completely viable option for men today...and men today, including some HW/PC members, are appropriately "on" Watchful Waiting.

It is also listed in the most recent NCCN PC Treatment guide.

Who "discredits" Watchful Waiting?

And why would anyone consider being on Watchful Waiting under the care of one's physician to be "Russian Roulette?"

Post Edited (JackH) : 6/13/2016 3:28:29 PM (GMT-6)

Posted 6/13/2016 9:28 PM (GMT 0)
Thank you for your posts! However, my question was not regarding watchful waiting vs. active surveillance.

According to these statistics, as I mentioned in my previous post, even patients with positive lymph nodes have a 95% chance to live over 15 years. This did surprise me.

So I thought some members of this forum may be familiar with these statistics and could explain why they show these excellent results. These results are hard to believe/understand for me.

George

Here is a chart of these statistics for 5 year survival: VIEW IMAGE
Posted 6/13/2016 9:29 PM (GMT 0)
Explain the facts?


FACT: Prostate cancer is one of the most common and least lethal of all cancers.
Posted 6/13/2016 9:48 PM (GMT 0)
Survival and quality of life are quite different. Many higher risk PCa patients are living with the unpleasant effects of powerful drugs and/or the side effects of various treatments. A glance at the threads on this or any prostate cancer forum will attest to that fact.
Posted 6/13/2016 9:51 PM (GMT 0)
JackH,

statistics can be misleading. This data shows, no matter what you do, you cannot die from PCa within five years? Provided you have no distant metastases of cause.

George
Posted 6/13/2016 10:15 PM (GMT 0)

George_ said...
JackH,

statistics can be misleading. This data shows, no matter what you do, you cannot die from PCa within five years? Provided you have no distant metastases of cause.

George


George, I would tend to say statistics are often mis-understood or mis-interpreted.

I read the complete passage you linked to. It's quite clear (to me) that they are talking about all men with PC...of which most were diagnosed with local PC.

I think that the question which you seem to be asking may NOT be provided in that data, but you seem to be trying to stretch it until it fits...you seem to be asking what is the 10- or 15-year survival of men initially diagnosed with just regional PC, rather than for "all stages combined." The report doesn't give that detailed break-out.

Post Edited (JackH) : 6/14/2016 10:29:05 AM (GMT-6)

Posted 6/13/2016 10:16 PM (GMT 0)
The large majority of us will die of something else. More like the darn stress of dealing with PC.Given this reality, there are three concerns: quality of life, quality of life, quality of life. I don't want to live the next 15 years hating my choice of treatment. Take your time and do your homework. Don't rush if you don't have to.
Posted 6/13/2016 10:19 PM (GMT 0)
cannot???? that's a pretty strong word to use. "Probably won't" is what the statistics say. And, 5 years, while considered "cured" in the language of most cancers, is not a long time in the world of prostate cancer.

Personally, when I was diagnosed at 56 yrs and 3 months, had (and still have) plans to live at least 25 more years.

What the studies DO show is that for low risk cases, active surveillance makes no significant difference in long term survival rates.
Posted 6/13/2016 11:00 PM (GMT 0)
Men can and certainly do die within five years of dx regardless of how aggressive the treatment is. We have had that happen to some on this board and certainly we have heard of others

The statistics are just what they are based on large numbers. No statistical analysis ever tells someone exactly what will or will not happen in their case.

Thankfully we have a cancer that most can live with for a very long time. Most, but not all.
Posted 6/14/2016 4:45 AM (GMT 0)
To JackH's point about misinformation on this web site and how it shouldn't be... I totally agree. Having said that...it ain't going to happen...it's people...its endemic in media ...politics..."religious" organization of all stripes and colors...you name it...its happening...to expect someone to apologize for it is pie in the sky. Unless someone is known to be maliciously spreading false hoods, an apology is pointless...To the ones who need{xtremely active verb}them...feggid about em imo... Im sorry{tee hee}... caveat emptor...obi-wan kenobe "Who's the more foolish... the fool or the one who follows him"
Posted 6/14/2016 4:57 AM (GMT 0)
Bololidat, While I usually appreciate your off-beat humor, and sincere attempts to inject levity into these often heavy dicussions, this one is a bit different.
Here we have a very involved member asking that two other members apologize for stating their opinions. While I have almost always agreed with JackH in the past...it ain't happening this one time.

Thanks for trying to obfuscate the tensions. But, this time is different.
Posted 6/14/2016 5:01 AM (GMT 0)
I did a search on your link and the five year survival for mets to lymph nodes and/or distant organs was 28%...I assume that was untreated... it was near 100% for contained or local spread which means{according to your link} no nodes cancerous... data dis...data dat...cat in the hat....I'll stick with my schtick...I like it lidat... tongue
Posted 6/14/2016 5:26 AM (GMT 0)
There was more than humor in that post...and your rejoinder made AbSolutely zero sense in any way to whatever your point is/was...seriously read what I posted, then read what you posted...no dots no connections... I struck some nerve of yours...but it had nothing to do with this subject or any point I made on the subject..good gravy....but then again I can't get into your head...I find that.. at least... comforting... I feel like I just ordered a sasparilla at the local saloon and the local tuff just called me out...

good luck with that....
Posted 6/14/2016 6:30 AM (GMT 0)
Bololidat, I see that you have over 4,000 posts here, and I have to admire that dedication.

That said, I find your gadfly comments to be superfluous and distracting.

Clearly, you care, and you can do better. Your "no dots no connections" regarding my postings ....Hmm, no serious intent or contribution on your part.

Do as you wish, a fly buzzing around in the area. Easily swatted aside. Too bad, you have the experience and perspective to be much more.
Posted 6/14/2016 4:49 PM (GMT 0)
JackH, you are right, the 10 and 15 year figures relate to all PCa patients overall.

However, the regional patients did include cancerous nodes. It says: „Spread to Regional Lymph Nodes“.

The figures are based on patients that received treatment, see the image below. Although quite a number of them apparently did „active surveillance“ which probably is the „No surgery or RT“ category. VIEW IMAGE
Posted 6/14/2016 5:43 PM (GMT 0)
George, I’m not sure if you have further question, based on you recent post, or if you “got it” now. You are correct, a regional case does mean spread to lymph nodes. The “no surgery or RT” is probably mostly AS, although in the older category of men there might be a sizable number of men on WW.


couple updates from earlier...

Regarding George’s use, just prior to my last posting, of the word “cannot,” as in this sentence:

George_ said...
This data shows, no matter what you do, you cannot die from PCa within five years? Provided you have no distant metastases of cause.


I would agree with both halbert’s and JNF’s rejection of the use of the word “cannot” as a verb in that sentence. The data certainly does not say that, in any manner of interpretation. The 5-year relative survival rate (for men initially diagnosed at local or regional stages) “approaches 100%,” but it is not 100%. It is greater than 99%, as shown in Table 8, for both Local and Regional stages at diagnosis.



Regarding ASAdvocate’s posting following my last post:

ASAdvocate said...
Here we have a very involved member asking that two other members apologize for stating their opinions. While I have almost always agreed with JackH in the past...it ain't happening this one time.


You misread what I wrote earlier yesterday. There was no “ask.” “Ask” implies that there was a request on my part. To the contrary, what I said was that you “should” apologize. “Should” indicates an obligation, duty or correctness. There was no request.

In a separate thread with Todd1963, we recently discussed about the appropriateness of quickly and unambiguously apologizing when appropriate and moving on. He quickly did. Your time is passing.



And finally, regarding ASAdvocate’s claim that:

ASAdvocate said...
Watchful waiting … is Russian Roulette.


I am baffled by that statement. Frankly, the closest analogy I can find to Watchful Waiting is “watching paint dry.” I believe that is about as far opposite as Russian roulette as one can imagine.

There have been some psychological studies I've read regarding the decision to pursue WW, and living life on WW. At the appropriate time, it can be quite calming. If I get some time, I'll see if I can dig them up...

Post Edited (JackH) : 6/14/2016 11:59:45 AM (GMT-6)

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