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"Risk of Death with and without Definitive Local Therapy when Gleason Pattern 5 present"

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Posted 10/3/2017 11:33 AM (GMT 0)
This is an interesting retrospective SEER database analysis of survival in the presence of Gleason Type 5 cells. It's meant as a hypothesis-generating analysis, retrospective, with risks of selection bias and so on. Having said that, it is still interesting. The link is to a free full-text version of the analysis.

Risk of Death from Prostate Cancer with and without Definitive Local Therapy when Gleason Pattern 5 is Present: A Surveillance, Epidemiology, and End Results Analysis.

Look at Figure 2. My take on that graph is if you have Pattern 5 cells, do something. In that database, while there are differences in survival between various treatments, they're all rather similar when compared to the no-treatment survival rate.

It's sobering to note the high mortality rate for those with Type 5 cells that don't have treatment. With dominant Type 5, the survival without treatment is about 50% at 8 years; this is a serious enemy.

Figure 3 notes primary Type 5 is worse than secondary Type 5 (sigh...). However, with treatment, the survival rate at 8 years is still over 75%, so that is quite encouraging!
Posted 10/3/2017 1:28 PM (GMT 0)
Thanks for the link!
Posted 10/3/2017 1:59 PM (GMT 0)
You are right, not a lot of difference for PC specific survival rates at 8 years, with surgery + RT at the top by a hair, BT only though very close.

But a much more noticeable difference in over all survival, in favor of surgery. (But I am not sure which one is at the very top, having trouble with the colors) I suppose that is mainly due to the fact that, historically, the men who choose RT are often older and not as healthy as the group that chooses surgery? So they would be expected to die of something other than treated PC at a higher rate than the presumably healthier surgery group?
Posted 10/3/2017 2:20 PM (GMT 0)
Thanks for the link 57.-- you are always on top of this g9 stuff!!!! NEPOL
Posted 10/3/2017 2:27 PM (GMT 0)
Thank you for posting the link, Redwing57. It is an interesting and sobering read. Also very revealing regarding the nature of the (infrequent) cases of high-grade prostate cancer compared to other common cancers. 75% survival at 8-years (with treatment) is indeed quite encouraging. Some of the other more lethal cancers when diagnosed at advanced stages might be more like a staggering 25% survival at 1-year.

The curves are interesting, Fig. 2 in particular. Advanced PC is not curable, but one can clearly "buy time," although the lines probably come close to converging again if the axis were stretched out to 20-years. It was the words of Dr Willet Whitmore (head of Urology at MSKCC at the time, known as being the "father of modern urological oncology") who said nearly 50-years ago about advanced PC that "Buying time is the name of the game."

Continued good luck to you, Redwing57!

"My cancer didn't make life uncertain; it exposed the uncertainty of life. In losing my sense of tomorrow, I appreciated what time I had — in a way I never knew I had — and found today."
--Dr Wendy Harpham, "I Have Today"
Posted 10/3/2017 2:28 PM (GMT 0)
BillBob - as we can read in the discussion part:

"Although we can argue why surgery may or may not be superior to radiations in this very high-risk cohort, in the absence of a contemporary randomized prospective trial comparing these modalities with modern dose-escalated radiotherapy and surgical techniques, we cannot know if the differences are real."

so we don't know which therapy gives longest survival.
Posted 10/3/2017 2:37 PM (GMT 0)
Thanks Redwing! It pretty much tells the story hey?
Posted 10/3/2017 4:33 PM (GMT 0)
Those observations about surgery, choice to be treated or not, and so on are part of the problem with this kind of analysis. That's the "selection bias" problem, and it's important in retrospective studies. They're not randomized prospective studies, the good kind. They have inherent factors that are hard to separate.

Guys choosing surgery are likely to be younger and healthier, with less advanced (better contained) cases even with pattern 5 cells. So, outcomes may be better because of that self-selection process.

Similarly, radiation folks may be older, not healthy enough for surgery, or more advanced such that surgery isn't a good option.

Choosing not to treat? Those may be guys old enough, or advanced enough, that they're not expecting that any treatment would have been helpful. Thus, a shorter survival time would be expected anyway.

Those are complicating factors that people doing these analyses try to control for, but they're inherently involved. There will never be a study where guys are randomized into three arms like that!

So, do treat such reports with some judicious caution, but they're still interesting.
Posted 10/3/2017 5:49 PM (GMT 0)
The survival of those with type 5 cells seems surprisingly long to me with, or without, treatment. My pathology showed focals of type 5, so it’s nice to see positive news once in a while. Thanks.
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