MEMORIAL SLOAN NOMOGRAM - PROSTATE CANCER SURVIVAL

Bob, You are right. However these data used to predict results is from survivors that continued treatment. I am one of them. I had surgery in 2000 at the age of 50, unfortunately did not experience remission (post op PSA=0.18), in 2006 at a PSA=3.80 had Radiation (nadir PSA=0.05), in 2010 at PSA=1.00 started hormonal therapy (IADT). Along my journey I gave high considerations to quality of life over treatment. Today I am 66 and am enjoying life.

I hope your case is better than mine. I hope you manage to get (PSA<0.06) remission and that further treatment is done at the right timing, if any.

Best,

VG

Bob,

I think you are correct. The monogram predicts the status at each mile stone up to 10 years using data from those with PSA values lower than 0.2 ng/ml (predicting free biochemical recurrence). I am not so sure about the survival period (no death due to PCa in 15 years) estimated in percentage. It may include also those patients that would recurred and followed a salvage treatment. Otherwise the total number of patients (from the same cohort) used to create the mathematical formulas would be very low in high risk cases (high Gleason patherns, evident metastases lymph nodes involvement).

I believe that these kind of monograms (MSKCC and others) include the data of patients collected from hospitals, clinics and private doctors that have followed (in person) their patients during the first 3 to 5 years. The estimations are then done using mathematic regression tables without any specific check, therefore with high possibilities of being erractic. By experience, I have participated in such sort of collecting data (trials) done by JH during a 5 year period, to check on the benefit of taking a daily aspirin. But they only strictly followed my case contacting me personally in the first two years (free consultations). The added period was done with predictive mathematics, and some details sent from me annually via email.

Another fact that could influence the above basic data is the norms used at the source from where the data is collected. Some instituitions (and particular doctors) do not operate on risky cases to assure high percentages of successful outcomes in their corriculum. I read before about this practice used at JH and MSKCC.

My advice to you is to get a PSA test the soonest. You can do it privatly at a close laboratory. It is not expensive (approximately 25 Euros=$30) and it will mean alot in evaluating your next step, when comparing with the scheduled 3-month PSA.

Best

VG

I read a statistic recently from an authoritative source, some major cancer institute (I think it also was Sloan, but cannot recall for certain).  I do recall that the numbers pertained to the United States. It stated that the average new PCa patient, with newly discovered disease at metastatic Stage IV, who was yet to begin receiving initial treatment, has an average survival rate of over five years.

 Sloan has these predictive matrices for all forms of cancer. I suppose they are of some worth, but as Vasco so well notes, the test populations employed to gather the data can skew things radically.

By all accounts, PCa is among the most treatable of all common cancers, with among the longest survival rates.  Routinely, people with advanced pancreatic or brain tumors are told they have a few months. My brother's monther-in-law was diagnosed with pancreatic, and died four days later.  A statistical estimate of course is non-determanitive for any given individual; how long any given patient lives is not set by what some PhDs or statisticians put in a journal article. 

If ya gotta fight cancer, PCa is the way to do it !

max

Foamhand: Your comment applies to me too (and to many of our comrades). Does our doctor believe in the PSA?

At age of 45 (1994) my GP for 20 years (company's doctor for annual health check ups) started to check me for prostate cancer. It was his practice to include PCa in the screening program for those above 45. Every year the results were negative. But in the year 2000 (at 50 years old) my doctor wasn't at the check up day. A substituting doctor attended me instead, and such took me to comment that I was in the PSA screening program for prostate cancer.

This time the result was different. The PSA was 22.4 ng/ml. It was given to me three days later by my own GP. He was surprised and upset with the result but for me it meant nothing (???). What was the problem?
I was healthy, had no symptoms, full of energy and was successful in my professional life. I couldn't understand what annoyed him.

The fact is that he was of the group of doctors (in those times) that did not believe in the PSA so that his preferred screening test was the PAP test that measures prostatic acid phosphatase (common test at those times for Prostate health which is now replaced with the PSA around the world). He felt guilty for the many men he erroneously has tested with a negative to cancer result.

My PAP numbers were OK in all pre 5 years. From this first PSA result I was submitted to a series of other tests and exams (all negative) till a final sextant biopsy (all needles positive) diagnosed me with the bandit. In my regression calculations the cancer may have shown its face for the first time at my 46 years of age. Now it was too late already. The bandit escaped and hides somewhere. Never managed to take a picture of it. I become systemic.

As it may be incredible, the PSA is still today the only test for most of us that accurately (more or less) can "regulate" our status with the cancer providing information important in a treatment decision.

Best wishes in your journey,

VG

I could not agree with you more, Max.  My PSA increased from 2.3 to 5.2 over 4 years, and though my family doctor had the PSA test taken annually and observed the results, he did nothing about it.  And, I did not have any other urinary tract issues for which the rise in PSA could be attributed to.  Finally, after the PSA exceeded 5.0, he suggested that I consider seeing a Urologist.

The Urologist was no more than 5 seconds into the digital rectal exam, and he already had decided that he was going to perform a biopsy.  My biopsy was by no means pleasant, as I bled profusely for 3 hours after the biopsy, before he was able to stop the bleeding.  The biopsy came back 3+4=7, and after surgery, it was upgraded to 4+3=7, with the rest of the pathology being pT3a NO.

To those who say that the PSA test is not necessary, and results in too many unnecessary treatments, I say that they are entitled to their own opinions.  But do NOT make the PSA test unavailable to others who wish to have it (including not being effectively unavailable, due to lack of insurance coverage).  I would be more than happy to take ‘unnecessary’ and unpleasant tests, if there is a chance that cancer could be detected, and effectively dealt with earlier than later.  There is no question in my mind that if I had not taken the PSA tests, I would now be well on my way toward that early exit from life.

Well, I now feel that even if PSA (and its counterparts) are all we have, they should be used regardless and the upper limit should be lowered. If even one person can be caught earlier than I was and give them a better shot at a cure then it's worth it. For me, prostate biopsy was more of a mental challenge than what I actually experienced. Yes, it was an annoyance but not nearly as painful as I thought. Even if a biopsy comes back negative, It's still worth checking just like a colonoscopy. A bird in the hand is worth 2 in the bush as they say.