Survival Rates for agressive and conservative treatment

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"