prostatectomy for Gleason 8-10

bob33462

Found this study - interests me as a Gleason 8 who is having a prostatectomy

 

Longterm outcome following radical prostatectomy for Gleason 8-10 prostatic adenocarcinoma- Analysis of 75,416 patients

Abstract: 717
Date & Time: May 5, 2013 03:30 PM
Session Title: Prostate Cancer: Advanced (I)
Sources of Funding: None

Introduction and Objectives
This study evaluates the long term survival following radical prostatectomy (RRP) for non-metastatic Gleason 8-10 prostate adenocarcinoma. (CaP)

Methods
All patients that were 75 years or less with Gleason 8-10 CaP that underwent RRP were identified form the SEER 18 database. Patients with metastatic disease, other modalities of treatment, with more than one primary cancer were excluded. Data was analyzed for demographics, stage at presentation, treatment modality and overall (OS) and cancer specific survival. (CSS).

Results
75, 416 patients were identified. The mean age was 61.4 years (range 26-75), 81.5%(n=61494) were white, 12.3% (9307) were Black and 6.1% (4615) belonged to other races. 46,286 (61.4%) patients also underwent Pelvic lymph node dissection (PLND) and 6167 (8.2%) patients underwent adjuvant radiation after surgery. The OS was 94%, 80%, 38% and 18% at 5-, 10-, 20 and 25-years respectively. The corresponding CSS was 94%, 88%, 68% and 64%.

The OS in patients that underwent PLND was 95% and 84%. There was no significant survival difference in the CSS in patients that underwent PLND or RRP alone. The CSS was 98% and 92% in PLND and 98% and 94% at 5 and 10-years respectively in the RRP alone group.

The OS in patients that received adjuvant RT was 90%, 70%, 38% and 18% respectively and the CSS was 94%, 78%, 58% and 48% at 5-, 10-, 20- and 25- years respectively. The CSS for patients that did not receive adjuvant RT was 98%, 91%, 70 and 65% at 5-, 10-, 20- and 25- years respectively.

Conclusions
Excellent long term survival can be achieved with RRP for G 8-10 Cap. PLND for these patients does not seem to increase survival significantly. Patients that required adjuvant radiotherapy had a significantly poorer survival when compared to patients that did not require adjuvant radiation.

Authors

Pokala, Naveen (Columbia, MO); Trulson, Jerry; Kiran, Ravi 

VascodaGama

Credit for QoL should weigh too

Hi Bob,

I have followed your other thread and noticed your positive mindset pre surgery. I believe you know well about your status and the risks of the treatment.

You surely know that most doctors would not recommend surgery to a patient with Gleason 8, voluminous cancer (13 positive out of 14 cores), positive DRE, and high PSA histology. However, against the odds you decided for the radical prostatectomy and I admire your endeavor.

The risks that most doctors talk about do not regard cure but the possibilities that the therapy may not be effective or sufficient to treat a patient with certain particulars. In your case, this would relate to the possibilities in future for recurrences, which would need further treatment, and therefore more risks for the side effects.

The study you printed above just takes that as a conclusion. They say that “…Patients that required adjuvant radiotherapy had a significantly poorer survival…”. In other words, if the patient status shows possibilities to existing extra capsular extensions pre surgery then a Gleason 8 to 10 guy may expect poorly results.

I read before in this forum, the stories of many Gs9 survivours that did successful surgeries. They had chosen the treatment thinking in having it as a sequential. Surgery would debulk the bigger tumour (the gland) and additional adjuvant radiation would cover extra prostatic extensions in the bed of the prostate and at the close lymphatic nodes. Some of these guys have still go further and included hormonal treatment, completing it with a protocol of chemotherapy. To which I call “The mother of all therapies”. All weapons in one goal.

We all aim cure when choosing a treatment, but nobody can assure us such a result. In that regard I think we all should give credit to the quality of living and discuss with our physicians (if possible) about the details before going to knife. Their approach to the procedure may be different and it may lead to lesser complications. For instance, a neoadjuvant radical prostatectomy (RP) with decisive adjuvant RT can exclude cutting (or less cutting) at the sphincter (to be radiated latter) so that the chances of incontinence are diminished. This would be a long step for quality living over treatment.

I wish you the best outcome.

VGama

 

bob33462

VascodaGama said:

Credit for QoL should weigh too

Hi Bob,

I have followed your other thread and noticed your positive mindset pre surgery. I believe you know well about your status and the risks of the treatment.

You surely know that most doctors would not recommend surgery to a patient with Gleason 8, voluminous cancer (13 positive out of 14 cores), positive DRE, and high PSA histology. However, against the odds you decided for the radical prostatectomy and I admire your endeavor.

The risks that most doctors talk about do not regard cure but the possibilities that the therapy may not be effective or sufficient to treat a patient with certain particulars. In your case, this would relate to the possibilities in future for recurrences, which would need further treatment, and therefore more risks for the side effects.

The study you printed above just takes that as a conclusion. They say that “…Patients that required adjuvant radiotherapy had a significantly poorer survival…”. In other words, if the patient status shows possibilities to existing extra capsular extensions pre surgery then a Gleason 8 to 10 guy may expect poorly results.

I read before in this forum, the stories of many Gs9 survivours that did successful surgeries. They had chosen the treatment thinking in having it as a sequential. Surgery would debulk the bigger tumour (the gland) and additional adjuvant radiation would cover extra prostatic extensions in the bed of the prostate and at the close lymphatic nodes. Some of these guys have still go further and included hormonal treatment, completing it with a protocol of chemotherapy. To which I call “The mother of all therapies”. All weapons in one goal.

We all aim cure when choosing a treatment, but nobody can assure us such a result. In that regard I think we all should give credit to the quality of living and discuss with our physicians (if possible) about the details before going to knife. Their approach to the procedure may be different and it may lead to lesser complications. For instance, a neoadjuvant radical prostatectomy (RP) with decisive adjuvant RT can exclude cutting (or less cutting) at the sphincter (to be radiated latter) so that the chances of incontinence are diminished. This would be a long step for quality living over treatment.

I wish you the best outcome.

VGama

 

QoL Was Considered

Hi VGama,

Thank you for your reply.

The local Urologist who did the biopsy did suggest radiation along with Lupron, even before he recieved the ct and bone scan results. The more I looked at other options I decided to get a second opinion from a larger hospital group. I selected Cleveland Clinic (CC) down here in Florida. The Urologist I spoke to there told me that because of my current voiding problems radiation would make me  very miserable and that surgery would be a better option.  A Radiation Oncolgist, who has his own radiation company, agreed with the CC Urologist and told me if I were his father he would advise me to have surgery.

Also, I have a relative, an Internest at a major hospital group in Boston, and he input all the parameters of my disease into the hospital's software and the first line of treatment thta came up was surgery.

So, I am not sure where you found your support for your comment below? One reason I wanted to go with surgery was that if radiation failed surgery was not possible.

You have been around this disease for a long time and I do respect all you have to say and your experiences.

"You surely know that most doctors would not recommend surgery to a patient with Gleason 8, voluminous cancer (13 positive out of 14 cores), positive DRE, and high PSA histology. However, against the odds you decided for the radical prostatectomy and I admire your endeavor"

While I agree the  below are the results of the study I posted, the Gs 8 - 10 are lumped together. I have been reading where there is a lot of support in the Uroglogic community to separate the 8's from the 9-10's group. My thinking is that if the 8's were separated out, their results would not have so poor. Also, While I did have two cores that were 8 the majority were 3+4=7  

You, it appears,  are assuming I will need adjuvant radiotherapy, although many 8 -10's did not.

As an aside, I still intend to have a consult at the Mayo Clinic to see what they say.

"The study you printed above just takes that as a conclusion. They say that “…Patients that required adjuvant radiotherapy had a significantly poorer survival…”. In other words, if the patient status shows possibilities to existing extra capsular extensions pre surgery then a Gleason 8 to 10 guy may expect poorly results."

Again, thanks for your input.

Bob

hopeful and optimistic

bob33462 said:

QoL Was Considered

Hi VGama,

Thank you for your reply.

The local Urologist who did the biopsy did suggest radiation along with Lupron, even before he recieved the ct and bone scan results. The more I looked at other options I decided to get a second opinion from a larger hospital group. I selected Cleveland Clinic (CC) down here in Florida. The Urologist I spoke to there told me that because of my current voiding problems radiation would make me  very miserable and that surgery would be a better option.  A Radiation Oncolgist, who has his own radiation company, agreed with the CC Urologist and told me if I were his father he would advise me to have surgery.

Also, I have a relative, an Internest at a major hospital group in Boston, and he input all the parameters of my disease into the hospital's software and the first line of treatment thta came up was surgery.

So, I am not sure where you found your support for your comment below? One reason I wanted to go with surgery was that if radiation failed surgery was not possible.

You have been around this disease for a long time and I do respect all you have to say and your experiences.

"You surely know that most doctors would not recommend surgery to a patient with Gleason 8, voluminous cancer (13 positive out of 14 cores), positive DRE, and high PSA histology. However, against the odds you decided for the radical prostatectomy and I admire your endeavor"

While I agree the  below are the results of the study I posted, the Gs 8 - 10 are lumped together. I have been reading where there is a lot of support in the Uroglogic community to separate the 8's from the 9-10's group. My thinking is that if the 8's were separated out, their results would not have so poor. Also, While I did have two cores that were 8 the majority were 3+4=7  

You, it appears,  are assuming I will need adjuvant radiotherapy, although many 8 -10's did not.

As an aside, I still intend to have a consult at the Mayo Clinic to see what they say.

"The study you printed above just takes that as a conclusion. They say that “…Patients that required adjuvant radiotherapy had a significantly poorer survival…”. In other words, if the patient status shows possibilities to existing extra capsular extensions pre surgery then a Gleason 8 to 10 guy may expect poorly results."

Again, thanks for your input.

Bob

.

Bob,

Three years ago I was an advocate for a man with heart disease, large prostate, problem with urinating who was diagnosed with a Gleason 3+4=7, we visited various doctors to include a surgeon and a radiation oncologist. The surgeon told us that his prostate would be adverserly affected with radiation and my friend would have problems with urinating long term. The radiation oncologist told us that the prostate after radiation would atrophy and shrink in size. Contrary statements.

Because of his heart condition, instead of surgery, my friend decided to have radiation. At first there was short term swelling of the prostate, and my friend had to use a catheter. After the initial time, the prostate, in fact, did shrink in size, and he is doing fine.

My friend was not prescribed Avodart as you had been which shrinks the prostate. I would imagine that your prostate is probably smaller than his was,   as a result of you taking Avodart and prostate size reduction.You would be a candidate for a combination hormone treatment and radiation. You would not have to suffer additional side  effects of surgery, which is a local treatment, and most properly would not get all of the cancer since you have large volume disease. You would still require hormone and radiation treatment.

Also another man(who was also prescibed Avodart) that I know, with a large prostate, and I  a small volume of Gleason 4+4=8 had radiation and is doing fine as well..urinating is not a problem

As a lay man, I am simply sharing information about two of my friends with large prostates who had been successfully treated with radiation. I wish you the best. Good luck.

 

Good luck

VascodaGama

Your choice is the best and you should trust it

Hi Bob,

Please take my above comment as informative only. I believe you did well your “home work”, educating well about PCa and its treatments, and are well informed and ready to proceed with a trustful treatment. Surgery is an option and it has been chosen successfully by many guys in this forum. Radiation would have been another option and nobody could tell you which one would have a better result. We have to follow our instinct and set in the one we most feel comfortable with. Our choice is the best and we should trust it.

In your case surgery will also treat the existing urinary voiding problem, which is a matter of concern too. I think that you are reasoning well and that your treatment will be successful. You need to care now for choosing/finding a good team of physicians that will operate on you. In your next consultation at Mayo you have still the chance to “round the corners” on any particular you want to know (maybe get some information with regards to the comment of Hopeful above).

In regards to a future salvage treatment (radiation), nobody can tell now if such becomes necessary. But I think that one should have in mind the possibilities of such a need if our case does not assure to be organ confined (OC). Urologists around the world use predictive statistics of their own or input the data of their patients into the famous Partin Tables provided at the site of Johns Hopkins. Surely we know that the OC group has the best chances for immediate cure, therefore no need to think/worry about future SRT.
In a similar case of yours, these tables indicate a chance for organ confined (OC) of a 24%; extraprostatic extension (EPE) of 48%; seminal vesicle involvement (SV+) of 18% and lymph node involvement (LN+) of 10 %.
Though, the scores are low for OC that would not mean a negative result. My comment is just informative and precautious.

You can read details and input your scores in this site;
http://urology.jhu.edu/prostate/partintables.php

Please note that I am not a doctor. You should gather evidences to the best you can and advance with something you feel confident.

Best wishes and luck in your journey.

VGama

bob33462

VascodaGama said:

Your choice is the best and you should trust it

Hi Bob,

Please take my above comment as informative only. I believe you did well your “home work”, educating well about PCa and its treatments, and are well informed and ready to proceed with a trustful treatment. Surgery is an option and it has been chosen successfully by many guys in this forum. Radiation would have been another option and nobody could tell you which one would have a better result. We have to follow our instinct and set in the one we most feel comfortable with. Our choice is the best and we should trust it.

In your case surgery will also treat the existing urinary voiding problem, which is a matter of concern too. I think that you are reasoning well and that your treatment will be successful. You need to care now for choosing/finding a good team of physicians that will operate on you. In your next consultation at Mayo you have still the chance to “round the corners” on any particular you want to know (maybe get some information with regards to the comment of Hopeful above).

In regards to a future salvage treatment (radiation), nobody can tell now if such becomes necessary. But I think that one should have in mind the possibilities of such a need if our case does not assure to be organ confined (OC). Urologists around the world use predictive statistics of their own or input the data of their patients into the famous Partin Tables provided at the site of Johns Hopkins. Surely we know that the OC group has the best chances for immediate cure, therefore no need to think/worry about future SRT.
In a similar case of yours, these tables indicate a chance for organ confined (OC) of a 24%; extraprostatic extension (EPE) of 48%; seminal vesicle involvement (SV+) of 18% and lymph node involvement (LN+) of 10 %.
Though, the scores are low for OC that would not mean a negative result. My comment is just informative and precautious.

You can read details and input your scores in this site;
http://urology.jhu.edu/prostate/partintables.php

Please note that I am not a doctor. You should gather evidences to the best you can and advance with something you feel confident.

Best wishes and luck in your journey.

VGama

Thank You

VGama and Hopeful thanks for your information and best wishes!

Wishing you both the best -----

 Bob

VascodaGama

bob33462 said:

Thank You

VGama and Hopeful thanks for your information and best wishes!

Wishing you both the best -----

 Bob

PET trial for Gleason scores above 8

Bob,

I do not know if this post is late or if it helps you. There is a trial on-going for an image exam to guys diagnosed with high Gleason scores of 8 to 10, in which requirements you fit and could be involved. This would help in verifying OC status for you to make a better decision. Please discuss with your doctor or contact directely the responsable for detailed information in here;

https://clinicaltrials.gov/ct2/show/NCT02420977

Best

VG

bob33462

VascodaGama said:

PET trial for Gleason scores above 8

Bob,

I do not know if this post is late or if it helps you. There is a trial on-going for an image exam to guys diagnosed with high Gleason scores of 8 to 10, in which requirements you fit and could be involved. This would help in verifying OC status for you to make a better decision. Please discuss with your doctor or contact directely the responsable for detailed information in here;

https://clinicaltrials.gov/ct2/show/NCT02420977

Best

VG

PET Trial

Thanks VGama-

I checked,  not yet recruiting - I am scheduled to go to surgery on May 20th, but hope to have it sooner -

 

Thanks again for looking-

Bob

bob33462

Johns Hopkins Article News for Radical Prostatectomy

Surviving Prostate Cancer: Good News for Radical Prostatectomy Patients

So you had radical prostatectomy and things have been going pretty well. You feel good, and your PSA remains undetectable. It's been several years now; are you out of the woods?

"Overall, men are highly unlikely to die from prostate cancer after surgery — even men with high-risk prostate cancer. If you do not experience recurrence for several years, your likelihood of survival for 10 more years is outstanding."

"After radical prostatectomy, about a third of men experience a return of PSA," says urologist Misop Han, M.D. the David Hall McConnell Professor in Urology. "However, only a very small number of men who have had surgery ultimately die from prostate cancer. So, men contemplating surgery or those who have already had surgery may wonder, What is my chance of surviving from prostate cancer if I have not had PSA recurrence for several years after surgery?"

Han and Brady epidemiologist Bruce Trock, Ph.D., recently set out to answer that question, using the Brady's massive database to track results from more than 14,000 men who had surgery at Johns Hopkins between 1984 and 2013. They divided men into three risk groups: low, intermediate, and high. Then they calculated what they call the Conditional Survival probability — the likelihood of survival for 10 additional years.

They found that men in the low- and intermediate-risk groups had a very high probability — at least 96 percent — of not dying from a return of prostate cancer at 10 years, "regardless of the time duration without recurrence," says Han. "In other words, these men are highly unlikely to die from prostate cancer, regardless of whether they experience recurrence or not." In the high-risk men, the probability of survival from prostate cancer at 10 years was 91 percent for those who experienced recurrence within one year. "However, if these high-risk men do not have recurrence for more than three years, their probability of survival from prostate cancer for 10 additional years is even higher — greater than than 99 percent.

"These results give much hope for men with prostate cancer," said Han. "Overall, men are highly unlikely to die from prostate cancer after surgery — even men with high-risk prostate cancer. If you do not experience recurrence for several years, your likelihood of survival for 10 more years is outstanding."