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Mayo Clinic Study Shows Advanced Prostate Cancer Previously Considered Inoperable May Be Operable, Curable

Posts: 797
Joined: Jan 2010

An interesting read for anyone who has had surgery or considering with Gleason 7...

ScienceDaily (Apr. 12, 2005) — ROCHESTER, Minn. -- New findings from Mayo Clinic indicate that cT3 prostate cancer, a disease in which the cancer has spread locally from inside the prostate to immediately outside it, is operable and has 15-year cancer survival rates of almost 80 percent.

"These patients have a better chance if they undergo surgery and are living longer than if they undergo radiation therapy," says Horst Zincke, M.D., Ph.D., Mayo Clinic urologist and senior study investigator.

Treatment of this type of prostate cancer has been controversial, as it is a stage 3 cancer in which the malignancy has spread. Due to its advanced stage, some physicians have considered it inoperable via radical prostatectomy, according to Dr. Zincke. He explains that many patients come to him for a second opinion after being told their cT3 prostate cancers could not be surgically removed.

"It's considered inoperable by some urologists and referred to radiation oncology," says Dr. Zincke. "They think surgery can't be done because the cancer is outside the prostate. Currently, only 15 percent are referred for surgery."

The problem with radiation therapy as the first line of treatment for cT3 prostate cancer, according to the Mayo Clinic researchers, is the cancer survival rate, which is 79 percent at only five years. In contrast, with radical prostatectomy, 79 percent of the patients lived at least 15 years. Says Dr. Zincke, "So, obviously surgery does a better job for these patients."

Dr. Zincke also explains that when malignant prostate tumors are high grade -- more aggressive -- they are not especially responsive to radiation therapy alone.

He believes the current trend away from surgery is a disservice to patients. "Patients are being denied surgical treatment when indeed they could have had surgery," Dr. Zincke says.

The cancer survival rates for cT3 prostate cancer with radical prostatectomy not only approach those of cT2 prostate cancer (cancer confined to the prostate), which is 90 percent at 15 years, but they are even more impressive due to the ages of the patients, says Dr. Zincke. "It's significant because the average patient is only 62 years old," he says. "So, a 15-year survival is a long time."

In addition to a favorable survival rate for the cT3 prostate cancer patients studied, the Mayo Clinic researchers also found urinary incontinence rates and complications were akin to those for cT2 prostate cancer.

Some of the patients studied with cT3 prostate cancer had additional, or adjuvant, therapy after surgery, such as hormone therapy or radiotherapy. Dr. Zincke indicates that adjuvant therapy is necessary for patients whose prostate cancer affects the lymph nodes. Surgery alone may be sufficient treatment for those without lymph node involvement. Approximately 50 percent of the cases of cT3 prostate cancer do not involve the lymph nodes.

The study also found that 25 percent of the patients were overstaged -- told that they had a cT3 prostate cancer, a more advanced form, rather than what they really had a cT2 prostate cancer in which the malignancy is confined inside the prostate.

Dr. Zincke points to following patients over 15 years post-treatment as a strength of the study. "The highest incidence of prostate cancer death is not reached until 11 years after treatment, so 15-year data is significant," he says. "In contrast, five-year data is less meaningful."

Dr. Zincke recommends that patients with cT3 prostate cancer seek a surgeon who performs at least one prostate surgery per week and has completed at least 300 prostate surgeries. He explains that currently only 3 to 4 percent of urologists are doing more than one prostate cancer surgery per week. As they seek an appropriate surgeon, he encourages patients that "if someone tells you your cT3 prostate cancer is inoperable, don't give up."

With more common use of prostate-specific antigen (PSA) testing in the United States, more prostate cancers are now caught earlier, before the cancer spreads. Thus, the frequency of cT3 prostate cancers seen at Mayo Clinic has declined to 3 percent of all prostate cancers. Canada and Europe have much higher rates of cT3 prostate cancer, as PSA testing is not conducted as frequently and more cancers are discovered later than in the United States, allowing the cancers more opportunity to spread outside the prostate.

This study was conducted as a single-institution, retrospective study of 5,652 men who had radical prostatectomy at Mayo Clinic for confirmed prostate cancer.

The title of the paper is "Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer Since the Advent of Prostate-Specific Antigen Testing: 15-Year Outcome." The first author is a former Mayo Clinic urology fellow, John F. Ward, M.D., Division of Urology, Naval Medical Center, Portsmouth, Va. Other Mayo Clinic authors include Jeffrey Slezak, Eric Bergstralh, and Michael Blute, M.D.

randy_in_indy's picture
Posts: 495
Joined: Oct 2009

Very Interesting! My staging was increased to a 7 so I feel lucky that it was contained with no postitive margins. I also feel lucky that I found a surgeon team that was performing on average 3-4 davinci's per week all year long with over 1,200 under his belt. Man was I lucky...so far! Thanks for the study and hope your enjoying the yellow snapper...just hope there is no microscopic oil particles in that flesh. I dove in Panama city over the 4th weekend and saw no sign of oil above or below the water...also saw about 4 Goliath Groupers from 200-400lbs at one of the wrecks we dove and tons of really nice eating AJ's.

Pawly Island is the bomb! You lucky dude!

Randy in Indy

Posts: 797
Joined: Jan 2010

Randy...From your various post you sound like you are recovering well and I am happy for you....Yes what I have surmised in this journey so far is that a whole lot of what happens is just “luck” or what I say “throw of the dice”…. Hey I am a healthy guy (still am what an oxymoron that is) see the doctor all of the time then one day “BAM”…I got PCa Gleason 4+3 positive mid right margin and seminal invasion (for us surgery guys with pathologies for comparison)…I am also finding out that these pathology reports are a little like “tarot card” readings with some subjective stuff in them….

Hey remember that each and every day is a bonus day and make the most…This summer down at Pawleys has offered some of the best surf and surf fishing I have seen in about a decade…Limiting out on Yellowtail Snapper this past Sunday in an hour or so (the limit is 10) on shore with a fish that should be at 25-40 feet of water is pretty amazing….I am getting ready for the fishing this weekend after this post.. A few more weeks down here and back to Atlanta for my 16 year old to start school on August 5th (can you believe that!)

Oh and there is no Oil here in the Atlantic...

Best to all in your journey

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