Artist Mark, you sound peeved. I'm pretty sure no one here really ever intends disrespect to anyone else here, but there are differences of opinion. Sometimes I think the "relax a bit" message can come across as dismissive, and that's just unfortunate and unintended I'm sure. Also, many are on ADT which amps up emotional sensitivities.
So, anyway, this VHR category has limited value other than reinforcing what we already know, and as RobLee said succinctly, "Can we just say we all got it pretty bad and leave it there?"
For what it's worth, here's a study (late 2016) saying that HR vs VHR didn't make much of a distinction in outcomes. Interestingly, the entire cohort had RT to what I'd call a "modern" plan (78-82 Gy, plus pelvic lymph nodes to 46-50 Gy, and ADT), as some of us have had. Within that population, they found that "
Distant failure was dominant and local recurrence uncommon which challenges the notion that intensification of local therapy will further improve outcomes in patients with high-risk disease.". (Note, that statement also contrasts studies that others have reported here saying "half of all recurrences are local.").
Classifying high-risk versus very high-risk prostate cancer: is it relevant to outcomes of conformal radiotherapy and androgen deprivation?On the other hand, here's a different study (2014) saying VHR men have significantly poorer outcomes, particularly with becoming metastatic. Importantly, this was a study cohort of men who had radical prostatectomy,
not radiation. Generally, it's supporting aggressive multimodal treatments for folks like us. Today, I think most of us are already on that page.
From the article:"
Conclusions: Men who meet VHR criteria form a subgroup within the current NCCN high-risk classification who have particularly poor oncological outcomes. Use of these characteristics to distinguish VHR localized PCa may help in counseling and selection optimal candidates for multimodal treatments or clinical trials."
Very-High-Risk Localized Prostate Cancer