Survival Rates for agressive and conservative treatment

DrTea

I really angered my urologist yesterday. I asked why so few studies have compared active treatment options to just leaving prostate cancer to Mother Nature. I pressed for an age-adjsuted estimate of 10 year survival rates given surgery vs minimal treatment.

Put another way, I wanted to know if agressive treatment will raise my life expectancy by a year or a decade. Based on my doctor's anger, I could conclude that the benefits are tiny. But I would rather work from data than emotions.

How did all of you analyze the benefits of the treatments?

As to me:

I am 47 and the latest PSA was 4.8. A needle biopsy came back with a Gleason of 3+3=6 and a bone scan was cancer free. The urologist advised surgery. The radio oncologist said things are so unclear that she would not know what to advise to her husband.

bitaday

hello
you are only 47.your gleason score is 6 which is intermediate and the cancer is limited to prostate gland, so I think the best choice for you is RP.That will really improve the survival.
check http://patient.cancerconsultants.com

DrTea

bitaday said:

hello
you are only 47.your gleason score is 6 which is intermediate and the cancer is limited to prostate gland, so I think the best choice for you is RP.That will really improve the survival.
check http://patient.cancerconsultants.com

Thanks for the web link. I had seen that table, but not this link. The study was not randomized so its data is a bit doubtful.

That table has the sort of numbers I am looking for. Why does my urologist not have this sort of data readily available?

By that table, surgury raises my survival rate at 10 years from 77% to 87% . I consider this a modest gain. The table does not account for my age or other risk factors, but is a start.

According to the M.D. Anderson Cancer Center, of patients studied who had prostate surgery, "65% had trouble having satisfying orgasms" (from
Sexual Dysfunction is Widespread in Prostate Cancer Patients and Few Treatments Help at http://www.mdanderson.org/about_mda/news/display.cfm?id=3ade9b61-ef51-4b57-9e87623f28568513&method=displayfull&pn=033766c5-832a-11d4-aec800508bdcce3a)
I consider this a large downside.

Theses are just two two studies. I'm still looking. I've found the Swedish study "Radical Prostatectoy versus Watchful Waiting." That was controversial because the authors do not seem to have properly documented for incontincence and impotence. (Much of this debate is in the New England Journal of Medicine, along with the orginal article.)

mtrutsen

I faced a similar situation roughly a year ago. I was offered RP or radiation by the urologists with whom I consulted. Given the morbidities associated with these treatments and my uncertainty as to the agressiveness of my PCa, I considered the "Mother Nature" option as well.

Through reading and web research I found that the current practice of cryoablative prostate surgery has had promising results and cryo surgery still allows for the traditional treatments if the cancer reappears.

I opted for focal cryo surgery six months ago by an experienced urologists. Half of my prostate was frozen (destroyed). I have experienced no morbidities. At my 3 month follow-up my PSA was 1.37 from a value of 5.0 when diagnosed. I will continue to monitor my PSA as a measure of the effectiveness of this treatment.

My analysis: short term studies support effectiveness of cryo vs traditional treatments; low morbidities; extremely rapid recovery; all treatment options are still available; reasonable treatment cost.

DrTea

mtrutsen said:

I faced a similar situation roughly a year ago. I was offered RP or radiation by the urologists with whom I consulted. Given the morbidities associated with these treatments and my uncertainty as to the agressiveness of my PCa, I considered the "Mother Nature" option as well.

Through reading and web research I found that the current practice of cryoablative prostate surgery has had promising results and cryo surgery still allows for the traditional treatments if the cancer reappears.

I opted for focal cryo surgery six months ago by an experienced urologists. Half of my prostate was frozen (destroyed). I have experienced no morbidities. At my 3 month follow-up my PSA was 1.37 from a value of 5.0 when diagnosed. I will continue to monitor my PSA as a measure of the effectiveness of this treatment.

My analysis: short term studies support effectiveness of cryo vs traditional treatments; low morbidities; extremely rapid recovery; all treatment options are still available; reasonable treatment cost.

Thanks for the information on cyro, and good luck! My radio oncologist considers cyrosurgery to be experimental, but I am not ready to dismiss it so fast.

I found that the ACS has a calculator to get just the sort of survival of data I was wanting:

http://www.cancer.org/docroot/ETO/eto_1_1a.asp

It gives links to the titles and summaries of studies used to make the individualized estimates of survival.

stuart

One issue you should consider is your age...If you do nothing the cancer will progress...As you know if your cancer is within your prostate and you treat you have a good chance to beat it...The other issue is quality of life...The fact is treatment will result in changes...I am a five year survivor and I have had to make adjustments but I enjoy life so it's been worth it to me...

Willx

stuart said:

One issue you should consider is your age...If you do nothing the cancer will progress...As you know if your cancer is within your prostate and you treat you have a good chance to beat it...The other issue is quality of life...The fact is treatment will result in changes...I am a five year survivor and I have had to make adjustments but I enjoy life so it's been worth it to me...

I think Stuart has hit the nail on the head: your age should be a prime consideration. You will not find the "magic bullet" answer anywhere which is specific for your personal situation, and any option you choose has consequences - even watchful waiting. As for me, diagnosed at age 58, I am a nearly 8 year survivor, having chosen surgery; a friend of mine, with almost exactly the same starting point as I (age, low PSA, negative bone scan, score of 6), died 2 years ago of the disease.

Sure, more studies are needed, as well as better treatments. The problem is, none of them will likely be available by the time you need to decide what to do. Your life has already changed because of the diagnosis, and regardless of the treatment option you choose, will continue to change. Good luck!

jvancik

I'm 57 and had RRP 2 years ago this May 4...I am continent, have no ED and feel better than prior to surgery ... my understanding is that currently there is no cure for pc that has metastisized ... i.e. no one ultimately survives once pc metastisizes ... right now the only chance at cure is eliminating it ... and I for one would not go for watchful waiting at such a young age .... ....

2ndBase

My dx was a 50% chance of surviving two years and 2% for 10 years and was told I would die much sooner if I did not get treated immediately. Though I lost my job and insurance and was refused disability by SS I have survived about 3.5 years and plan to be around for several more even though it has metastisized and I deal with great fatigue and pain every day. If you have a cancer that can be removed with surgery and you choose to wait you do so at great risk to your longevity. In my case now that it has spread there is not conclusive data that supports further treatment except to deal with pain issues but then the side effects get pretty ugly. I plan to not receive any further treatment unless a cure is guaranteed by some new procedure.

nodawgs

I've been there, done that. My care is by M.D. Anderson Cancer Clinic-Houston. Age 47 isn't the ideal age to be diagnosed with prostate cancer because the stuff will kill you. If you were late 70s or 80s, it'd probably be a mere inconvenience and most die of age-related causes. Presuming the cancer is confined to the prostate capsule, you have only one shot at getting rid of the stuff, forever...otherwise likely dying from the crap due to your younger age. The top treatment is now proton beam therapy. It uses MRI 3-dimensional mapping of the tumor to drive the beam accelerator. As the focal point is on the tumor only, it can ablate all cancerous cells with virtually no damage to peripheral tissues, including the cavernous nerve bundle. Prob: there's only 4 proton beam therapy systems in the entire country and the latest, most up-to-date system went into operation only this year at M.D. Anderson-Houston (125-million bucks). Your second choice would be either (1) a nerve sparing radical prostatectomy or (2) a nerve transplant radical prostatectomy. Whether or not you are a candiate for either depends on the spread within the gland and whether or not your surgeon feels any remnant of cancerous cells could propagate via the spared (or transplanted) nerve tissue. Success rates are not 100% with either procedure, but M.D. Anderson pioneered the procedure and has the best success rate in the U.S.

If you are for some reason stead-fast, surgery-resistant, you could ask your onco if you are a candidate for bicalutamide (trade name "Casodex") monotherapy. Bicalutamide monotherapy is commonly used throughout Europe and large-scale European studes clearly show similar survival rates to total androgen ablation historically practiced in this country. The exception to the study was one small demographic in Scandinavia showing a disadvantage. However, the main difference important to all men is QOL (quality of life)...which is superior with Casodex-only, compared to any other protocol, hands down. There's a prob: bicalutamide monotherapy is an off-lable (non-FDA approved) use of Casodex, but is a far more ethical treatment protocol than the maiming alternatives. Most, if not nearly all cancer clinics (excluding M.D. Anderson) are unfamiliar with and may not offer this form of treatment. At your age, more traditionally-engrained, FDA-approved protocols would greatly degrade your quality of life. I was given the option of bicalutamide monotherapy and I got the impression that M.D. Anderson simply doesn't give a rats **** what the FDA thinks, and will assign the most ethical treatment for younger patients. Currently, bicalutamide (Casodex) is approved only as adjuvant therapy along with androgen ablation protocols. Bicalutamide monotherapy is a simple pill-a-day treatment protocol (nearly 500-bucks for 30 little pills). It merely blocks the hormone receptors of prostate cancerous cells to the presence of testosterone. In other words, the cancerous cells are "blinded" to the presence of testosterone, but your testosterone levels are not affected. You will feel as if you have no cancer whatsoever. This protocol will cause your PSA to drop like a rock, in your case, likely to a very small single-digit number or a fractional number. It can last for 2-years or more before a refractory response is indicated by a rising PSA. This happens due to mutant, prostate cancerous cells becoming androgen independent, i.e., cell mutations can now replicate without the presence of testosterone. Casodex now only partially works...controlling replication of androgen-dependent cancerous cells, only, but not the the mutant, androgen-independent cells. Your PSA can once again run rampant, requiring shifting to another protocol. The next protocol is leuprolide acetate (Lupron). This is bad stuff, a form of chemical castration resulting in loss of muscle mass, bone mineral density, and libido, among other side effects too numerous to list. If the cancer has already metastasized to the bones, make sure you get on Zometa infusions. The stuff isn't chemo, but given exactly like chemo. It induces apoptosis (cell death) in cancerous cells gnawing at your bones and increases the density of bone matter remaining, lessening the likelihood of bone fractures.

I was diagnosed with this crap at an age substantially older than you...age 60, yet I am now late-stage and the stuff will kill me, sooner more likely than later.

Oh, yeah...cryoablation? Cryo will definitely destroy the cavernous nerve bundle and carries with it the real risks of freezing the urethra, post-op sloughing of tissue, pain you've never imagined, and leaving cancerous cells left behind to replicate and metastasize elsewhere. A cryo surgeon will tell you they circulate warm, sterile water through the urethra during surgery to prevent freezing. Huh...doesn't always work...too many variables: digital dexterity while using 2-dimension ultrasound to guide the argon gas probe in 3-dimensions, placement of the temperature monitoring thermocouples, etc., etc. After cryo, if you want to maintain sexual function, be ready to spring for up to 35k for a 3-piece saline, inflatable penile implant. Cryo is not experimental, has been around for years, but was FDA approved for prostate cancer as recent as 2001. For an older dude in their late 70s or 80s...yeah...I'd say cryo as an RP may not be advised at their late age.

If you want to see my entire history with this stuff, I can be found in CSN under "nodawgs." There's a lot more there than what you see here.

Oh...one more thing. You looking for stats of prostate cancer? Well, there aren't many, compared to other types of cancer. Also, there have been no new drugs, trials with any measurable success, or much of anything else. The answer (to me) is quite simple. What large pharmaco is going to invest millions in R&D when the returns must come from a bunch of older, uninsured or under-insured guys, likely depending on Medicare, only. Nupe...the better target for stock-holder returns are forms of cancer striking large numbers of younger-age demographics where both husband and wife and working and have good group insurance. Oh, well...so goes the "business" of cancer.

Best of Luck on this!

Perry aka "nodawgs"

stuart

Like no dawgs, I'm taking 100mg.of casodex for the past year...This is after radiation...My PSA is 0.1...this may last for 2-3 years...But this is not curative...Your best chances to beat it is either surgery or radiation

drdina

My husband was diagnosed with prostate cancer almost 5 years ago. He was 56 at the time, Gleason score of 7. We went through the same thing you are going through now and at the end decided to forgo conventional treatment. He has changed his diet, taken supplements and undergone fasts and cleanses. He checks his PSA every three months. It goes up and down a few tenths of a point, but for the most part remains between 4 and 5. I am in the process of writing a book on prostate cancer and have been doing research. Though I have not found an age-adjusted estimate fo 10-year survival rates, I have found many articles questioning aggressive treatment for early stage prostate cancer. A study is in progress in Sweden where men defer treatment until the cancer progresses with symptoms. At the end of 10 years, 48% of the men remained untreated. The 10-year survival rate for the group was 90% and the projected 15-year survival rate is 62%. This parallels the 10-year and 15-year survival rates published by the American Cancer Society of 91% and 60% respectively. If you choose to forgo treatment, you will undoubtedly have to deal with doctors, family and friends who do not understand your decision. You will also have to live with the fact that there is cancer in your body. If this causes you too much stress, you're better off being treated. If you can look beyond that, you can defer medical treatment while monitoring the disease. There are many things you can do to improve your overall health and strengthen your immune system. Dr. Dean Ornish has an ongoing lifestyle study for prostate cancer with very good results so far. You may want to check it out.
Good luck!

mbeavers

drdina said:

My husband was diagnosed with prostate cancer almost 5 years ago. He was 56 at the time, Gleason score of 7. We went through the same thing you are going through now and at the end decided to forgo conventional treatment. He has changed his diet, taken supplements and undergone fasts and cleanses. He checks his PSA every three months. It goes up and down a few tenths of a point, but for the most part remains between 4 and 5. I am in the process of writing a book on prostate cancer and have been doing research. Though I have not found an age-adjusted estimate fo 10-year survival rates, I have found many articles questioning aggressive treatment for early stage prostate cancer. A study is in progress in Sweden where men defer treatment until the cancer progresses with symptoms. At the end of 10 years, 48% of the men remained untreated. The 10-year survival rate for the group was 90% and the projected 15-year survival rate is 62%. This parallels the 10-year and 15-year survival rates published by the American Cancer Society of 91% and 60% respectively. If you choose to forgo treatment, you will undoubtedly have to deal with doctors, family and friends who do not understand your decision. You will also have to live with the fact that there is cancer in your body. If this causes you too much stress, you're better off being treated. If you can look beyond that, you can defer medical treatment while monitoring the disease. There are many things you can do to improve your overall health and strengthen your immune system. Dr. Dean Ornish has an ongoing lifestyle study for prostate cancer with very good results so far. You may want to check it out.
Good luck!

I have been battling PC for 5 years now and the disease has metastized to the skeleton. spine ribs and who knows where else. It seems like I am trying to pull teeth when i ask the doctors about survivability aquestions. Always very evasive. Have you found a resource for age adjusted ssurvivability studies? If so i would be very interested in reading them. personal info 60 yrs had radiation hormone therapy and am now going thru Taxotere chemo. Thank you for any information you may be able to supply, Michael mbeavers on survivors network

sheinz

nodawgs said:

I've been there, done that. My care is by M.D. Anderson Cancer Clinic-Houston. Age 47 isn't the ideal age to be diagnosed with prostate cancer because the stuff will kill you. If you were late 70s or 80s, it'd probably be a mere inconvenience and most die of age-related causes. Presuming the cancer is confined to the prostate capsule, you have only one shot at getting rid of the stuff, forever...otherwise likely dying from the crap due to your younger age. The top treatment is now proton beam therapy. It uses MRI 3-dimensional mapping of the tumor to drive the beam accelerator. As the focal point is on the tumor only, it can ablate all cancerous cells with virtually no damage to peripheral tissues, including the cavernous nerve bundle. Prob: there's only 4 proton beam therapy systems in the entire country and the latest, most up-to-date system went into operation only this year at M.D. Anderson-Houston (125-million bucks). Your second choice would be either (1) a nerve sparing radical prostatectomy or (2) a nerve transplant radical prostatectomy. Whether or not you are a candiate for either depends on the spread within the gland and whether or not your surgeon feels any remnant of cancerous cells could propagate via the spared (or transplanted) nerve tissue. Success rates are not 100% with either procedure, but M.D. Anderson pioneered the procedure and has the best success rate in the U.S.

If you are for some reason stead-fast, surgery-resistant, you could ask your onco if you are a candidate for bicalutamide (trade name "Casodex") monotherapy. Bicalutamide monotherapy is commonly used throughout Europe and large-scale European studes clearly show similar survival rates to total androgen ablation historically practiced in this country. The exception to the study was one small demographic in Scandinavia showing a disadvantage. However, the main difference important to all men is QOL (quality of life)...which is superior with Casodex-only, compared to any other protocol, hands down. There's a prob: bicalutamide monotherapy is an off-lable (non-FDA approved) use of Casodex, but is a far more ethical treatment protocol than the maiming alternatives. Most, if not nearly all cancer clinics (excluding M.D. Anderson) are unfamiliar with and may not offer this form of treatment. At your age, more traditionally-engrained, FDA-approved protocols would greatly degrade your quality of life. I was given the option of bicalutamide monotherapy and I got the impression that M.D. Anderson simply doesn't give a rats **** what the FDA thinks, and will assign the most ethical treatment for younger patients. Currently, bicalutamide (Casodex) is approved only as adjuvant therapy along with androgen ablation protocols. Bicalutamide monotherapy is a simple pill-a-day treatment protocol (nearly 500-bucks for 30 little pills). It merely blocks the hormone receptors of prostate cancerous cells to the presence of testosterone. In other words, the cancerous cells are "blinded" to the presence of testosterone, but your testosterone levels are not affected. You will feel as if you have no cancer whatsoever. This protocol will cause your PSA to drop like a rock, in your case, likely to a very small single-digit number or a fractional number. It can last for 2-years or more before a refractory response is indicated by a rising PSA. This happens due to mutant, prostate cancerous cells becoming androgen independent, i.e., cell mutations can now replicate without the presence of testosterone. Casodex now only partially works...controlling replication of androgen-dependent cancerous cells, only, but not the the mutant, androgen-independent cells. Your PSA can once again run rampant, requiring shifting to another protocol. The next protocol is leuprolide acetate (Lupron). This is bad stuff, a form of chemical castration resulting in loss of muscle mass, bone mineral density, and libido, among other side effects too numerous to list. If the cancer has already metastasized to the bones, make sure you get on Zometa infusions. The stuff isn't chemo, but given exactly like chemo. It induces apoptosis (cell death) in cancerous cells gnawing at your bones and increases the density of bone matter remaining, lessening the likelihood of bone fractures.

I was diagnosed with this crap at an age substantially older than you...age 60, yet I am now late-stage and the stuff will kill me, sooner more likely than later.

Oh, yeah...cryoablation? Cryo will definitely destroy the cavernous nerve bundle and carries with it the real risks of freezing the urethra, post-op sloughing of tissue, pain you've never imagined, and leaving cancerous cells left behind to replicate and metastasize elsewhere. A cryo surgeon will tell you they circulate warm, sterile water through the urethra during surgery to prevent freezing. Huh...doesn't always work...too many variables: digital dexterity while using 2-dimension ultrasound to guide the argon gas probe in 3-dimensions, placement of the temperature monitoring thermocouples, etc., etc. After cryo, if you want to maintain sexual function, be ready to spring for up to 35k for a 3-piece saline, inflatable penile implant. Cryo is not experimental, has been around for years, but was FDA approved for prostate cancer as recent as 2001. For an older dude in their late 70s or 80s...yeah...I'd say cryo as an RP may not be advised at their late age.

If you want to see my entire history with this stuff, I can be found in CSN under "nodawgs." There's a lot more there than what you see here.

Oh...one more thing. You looking for stats of prostate cancer? Well, there aren't many, compared to other types of cancer. Also, there have been no new drugs, trials with any measurable success, or much of anything else. The answer (to me) is quite simple. What large pharmaco is going to invest millions in R&D when the returns must come from a bunch of older, uninsured or under-insured guys, likely depending on Medicare, only. Nupe...the better target for stock-holder returns are forms of cancer striking large numbers of younger-age demographics where both husband and wife and working and have good group insurance. Oh, well...so goes the "business" of cancer.

Best of Luck on this!

Perry aka "nodawgs"

Cryo
Perry is correct about cyro but his correct is as of about 10 years ago for whole gland cryo. What's under investigation now is focal cryo - just going after areas of the gland where there is cancer. They now know how to protect the things that need protecting - urethra, nerve bundle, bowel, urinary sphincter - by putting thermocouples in to ensure the good stuff isn't getting frozen along with the bad.

See http://alprostate.com/FAQ.aspx (my doc) and http://www.hopeforprostatecancer.com/ or if you are up for a clinical trial at Johns Hopkins, see http://clinicaltrials.gov/ct2/show/NCT00774436

I was treated (50% freeze) about 4 months ago, and within 3 months had no side effects except for reduced semen and no longer having to get up at night to go. My PSA is down - rebiopsy in October.

It's not for everyone, but at 60 with two spots of Gleason 6 cancer, it made sense to me. I feel I traded some likelihood of cure for a lower chance of side effects.

JoeMac

Assessment of Data
Aloha DrTea,
I made the choice of EBRT/IMRT with ultra-sound guidence after my PSA rose from 8 to 14 over six months. The needle biopsy all 12 were 5 to 70%. I believed that even though there was no test results of cancer outside of the prostate, I opted for a 1/2 plevic cavity dose + 1/2 prostate specific dose. There is just no surefire way to tell if a few cancer cells escaped the incapsulation and made their way to the lympth nodes. They would just not be detectable.
Unfortunately, my doc's, even though there was time, did not check me for uretha strictures or hemorrhoids, and I was in the 10% that got a burned rectum & damaged anis. I'm 1.5 years out, was able to stop wearing pads a couple of months ago, but still need that toilet somewhat handy. I feel like I lost a couple of years of my life, would I have still made the same choice of treatment, I do not know. Treatment can be bad stuff for a small precentage of men.
JoeMac