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

 

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

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."