Re: PSAs Predict Long-Term Mortality for Metastatic Prostate Cancer

[Guest guest]

You’ve asked someone to put this

article into layman’s terms and I’ll give it a try, Debbie. But

before doing that I think it is very important to understand the term ‘median’

used in this (and other studies). Unfortunately this term is often

misinterpreted, both by laypeople and the medical fraternity. For example if a

study shows a median survival of 6 years, the assumption is made by so many

people that someone with a similar diagnosis only has 6 years to live. That is

not what is meant. The median survival time is the mid-point of a range of

survival times that might be expressed in months as well as many years. There is

an excellent article on the subject at http://tinyurl.com/6nwg7

It is entitled The Median Isn’t the

Message and it is by Jay Gould. I found it very useful and

heartening to read when I was first diagnosed. Although Gould was

not diagnosed with prostate cancer, he was diagnosed with mesothelioma a particularly deadly form of

cancer that had a median mortality rate of 8 months. But he didn’t die in

8 MONTHS. He survived 20 YEARS to die of a different disease.

Having said that, I’ll turn to the article:

The

study took men whose initial diagnosis included a PSA of 5.00 ng/ml or

higher.

The

men were treated with hormone therapy ADT (Androgen Deprivation Therapy)

for seven months – just which of the many options for this therapy

are not stated

Their

PSA was measured at the end of that time – seven months

69%

of the men had a PSA of 4.00 ng/ml or lower at that time: 48% had a PSA of

0.20 ng/ml or lower (this 48% is a sub-set of the 69%)

Median

survival was 13 months for patients with a PSA of more than 4.00 ng/mL, 44

months for patients with PSA of more than 0.2 to 4 ng/mL or less, and 75

months for patients with PSA of 0.2 ng/mL or less. The survival range is

not stated.

The

conclusion of the study was that a PSA of 4 ng/mL or less after 7 months

of ADT is a strong predictor of survival.

It

was acknowledged that Performance status, Gleason sum, bone pain, and

baseline PSA were also significantly associated with long-term morality and

the results the results were adjusted for these four factors.

It is not clear how your husband fits into

this scenario. Was his initial PSA higher than 5.00 ng/ml? Did he have ADT

(Androgen Deprivation Therapy) for seven months? What was his PSA at the end of

7 months?

If he fits the profile of the men in the

study one might conclude that survival rate is at the lower end of the scale of

rates predicted by this study, BUT the results have been adjusted for a number

of aspects, not least Gleason Score and without knowing how and what these adjustments

were it is simply not possible to transfer the results of this study to your

husband’s position.

Hope this helps?

All the best,

Terry Herbert in Melbourne, Australia

Diagnosed ‘96: Age

54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. August '06 PSA 27.4

My site is at www.yananow.net

As a

physician, I am painfully aware that most of the decisions we make with regard

to prostate cancer are made with inadequate data: Dr

“Snuffy” Myers.

>

> http://www.medpagetoday.com/Urology/ProstateCancer/tb/4001

>

I have read the article several times...... Could someone please

put it in laymans terms so I may understand.... My husbands psa has

never went to zero with casadex and eligard.... it went to 5.6 then

up to 6. something..New Psa will be in Sept..I cannot tell where my

husband falls into this story... March 1st injection

[Guest guest]

>

> Debbie,

>

> I would suggest printing out the article and bring it in to the

next

> doctors appointment. Ask him/her what the long term plan is.

> Unfortunately I do not remeber your husbands history. There are

> treatments that different cancers respond to. If one thing doesn't

> appear to be working then you switch to another. Be sure you are

> dealing with a docotor who keeps up to date on the newest

treatments. I

> have friends who go to large centers where they specialize in PCa

for

> evealuation and then back home to their normal doctor for

treatment.

> Where are you located? Nothing to worry about right now. Just

continue

> to read alnd learn about all the new options that are out there.

>

> Kathy

>

> > --- Re: PSAs Predict Long-Term

Mortality

> > for Metastatic Prostate Cancer

> >

> > Date: Fri, August 25, 2006 5:16 pm

> > To: ProstateCancerSupport

> >

> > Kathy,

Quick history on husband 55 yrs old..no other health problems.

FEB 06 /initial PSA 274. MAR 06/mets found.spine,pelvic,rib

MAR 06/HT Luperan and Casadax(casadex 2 x's weekly Injection evry 3

mo

May 06/psa 5.6 stopped casadex....July Eligard inject PSA 6.8

(rising) went back to casadex..this time daily

2nd appointment with a Med Oncology in Sept.. after we get a new

bone scan...I think things are not working...what do you think might

be the next step they might suggest? Also, someone else where we

live.. Near Pgh.Penna..usa...and does any of this history help to

figure out the info i was requesting from the previous article?

[Guest guest]

Debbie –

My number/cases are very similar:

Feb 05 PSA 217. met’s on spine,

hips, ribs, pelvis, one set of lymph nodes

Feb 05 started Lupron and daily Casodex

Apr 05 PSA 2.1

Aug 05 PSA 0.44

Nov 05 PSA over 4

>stopped Casodex

Dec 05 PSA 7+

Jan 06 PSA 1.7

>I got within three days of starting

Chemo (Taxotere) before the results of this PSA test came in, I also had new

scans

done which showed my spine was clearer,

the lymph nodes were clear and the other areas had shrunk and show no

new activity.

Feb 06 PSA 0.88

May 06 PSA 11.44

Again I had scans done which showed my

spine was almost clear, the lymph nodes remained clear and the other areas showed

no new activity.

Aug 06 PSA 54.66

>back on Casodex, no response…..now

I start Chemo in 9 days and counting. New scans are scheduled on Wednesday the

30th

~~~~~~~~~~~~~~

My point is to be patient, adjusting my

intake of Casodex took 5,6 or more weeks to have an impact.

Emerson

www.flhw.org

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Debbie

Sent: Sunday, August 27, 2006

12:41 AM

To: ProstateCancerSupport

Subject:

Re: PSAs Predict Long-Term Mortality for Metastatic Prostate Cancer

>

> Debbie,

>

> I would suggest printing out the article and bring it in to the

next

> doctors appointment. Ask him/her what the long term plan is.

> Unfortunately I do not remeber your husbands history. There are

> treatments that different cancers respond to. If one thing doesn't

> appear to be working then you switch to another. Be sure you are

> dealing with a docotor who keeps up to date on the newest

treatments. I

> have friends who go to large centers where they specialize in PCa

for

> evealuation and then back home to their normal doctor for

treatment.

> Where are you located? Nothing to worry about right now. Just

continue

> to read alnd learn about all the new options that are out there.

>

> Kathy

>

> > --- Re: PSAs Predict Long-Term

Mortality

> > for Metastatic Prostate Cancer

> >

> > Date: Fri, August 25, 2006 5:16 pm

> > To: ProstateCancerSupport

> >

> > Kathy,

Quick history on husband 55 yrs old..no other health problems.

FEB 06 /initial PSA 274. MAR 06/mets found.spine,pelvic,rib

MAR 06/HT Luperan and Casadax(casadex 2 x's weekly Injection evry 3

mo

May 06/psa 5.6 stopped casadex....July Eligard inject PSA 6.8

(rising) went back to casadex..this time daily

2nd appointment with a Med Oncology in Sept.. after we get a new

bone scan...I think things are not working...what do you think might

be the next step they might suggest? Also, someone else where we

live.. Near Pgh.Penna..usa...and

does any of this history help to

figure out the info i was requesting from the previous article?

[Guest guest]

Emerson wrote: Debbie – My number/cases are very similar: Feb 05 PSA 217. met’s on spine, hips, ribs, pelvis, one set of lymph nodes Feb 05 started Lupron and daily Casodex Apr 05 PSA 2.1 Aug 05 PSA 0.44 Nov 05 PSA over 4 >stopped Casodex Dec 05 PSA 7+ Jan 06 PSA 1.7 >I got within three days of starting Chemo (Taxotere) before the results of this PSA test came in, I also had new scans done which showed my spine was clearer, the lymph nodes were clear and the other areas had shrunk and show no new activity. Feb 06 PSA 0.88 May 06 PSA 11.44 Again I had scans done which showed my spine was almost clear, the lymph nodes remained clear and the other areas showed no new activity. Aug 06 PSA 54.66 >back on Casodex, no response…..now I start Chemo in 9 days and counting. New scans are scheduled on Wednesday the 30th ~~~~~~~~~~~~~~ My point is to be patient, adjusting my intake of Casodex took 5,6 or more weeks to have an impact. Emerson www.flhw.org From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of DebbieSent: Sunday, August 27, 2006 12:41 AMTo: ProstateCancerSupport Subject: Re: PSAs Predict Long-Term Mortality for Metastatic Prostate Cancer >> Debbie,> > I would suggest printing out the article and bring it in to the next> doctors appointment. Ask

him/her what the long term plan is.> Unfortunately I do not remeber your husbands history. There are> treatments that different cancers respond to. If one thing doesn't> appear to be working then you switch to another. Be sure you are> dealing with a docotor who keeps up to date on the newest treatments. I> have friends who go to large centers where they specialize in PCa for> evealuation and then back home to their normal doctor for treatment.> Where are you located? Nothing to worry about right now. Just continue> to read alnd learn about all the new options that are out there. > > Kathy> > > --- Re: PSAs Predict Long-Term Mortality> > for Metastatic Prostate Cancer> > > > Date: Fri, August 25, 2006 5:16 pm>

> To: ProstateCancerSupport > > > > Kathy,Quick history on husband 55 yrs old..no other health problems.FEB 06 /initial PSA 274. MAR 06/mets found.spine,pelvic,ribMAR 06/HT Luperan and Casadax(casadex 2 x's weekly Injection evry 3 moMay 06/psa 5.6 stopped casadex....July Eligard inject PSA 6.8(rising) went back to casadex..this time daily2nd appointment with a Med Oncology in Sept.. after we get a new bone scan...I think things are not working...what do you think might be the next step they might suggest? Also, someone else where we live.. Near Pgh.Penna..usa...and does any of this history help to figure out the info i was requesting from the previous article? Thank you

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[Guest guest]

Is your husband going to University of Pittsburg to one of the PCa

specialists? It appears that being proactive and engaged is important

for your husband. You may want to ask about one of the novel therapies

that are under trial.

Kathy

> --- Re: PSAs Predict Long-Term

> Mortality

> > > for Metastatic Prostate Cancer

> > >

> > > Date: Fri, August 25, 2006 5:16 pm

> > > To: ProstateCancerSupport

> > >

> > > Kathy,

> Quick history on husband 55 yrs old..no other health problems.

> FEB 06 /initial PSA 274. MAR 06/mets found.spine,pelvic,rib

> MAR 06/HT Luperan and Casadax(casadex 2 x's weekly Injection evry 3

> mo

> May 06/psa 5.6 stopped casadex....July Eligard inject PSA 6.8

> (rising) went back to casadex..this time daily

> 2nd appointment with a Med Oncology in Sept.. after we get a new

> bone scan...I think things are not working...what do you think might

> be the next step they might suggest? Also, someone else where we

> live.. Near Pgh.Penna..usa...and does any of this history help to

> figure out the info i was requesting from the previous article?

>

>

[Guest guest]

Yes he is going to UPMC a cancer center located IN Latrobe, Pa but affliatted with the Pittsburgh one..The doctor does not seem to specialize in prostate cancer..His bio says hematology/medical oncology..we asked about a trial that is going on right now and was told he could not participate because the pain he has they are not sure if its from pc or prior injury 11 yrs ago...> > >> > > Debbie,> > > > > > I would suggest printing out the article and bring it in to the > > next> > > doctors appointment. Ask him/her what the long term plan is.> > > Unfortunately I do not remeber your husbands history. There are> > > treatments that different cancers respond to. If one thing doesn't> > > appear to be working then you switch to another. Be sure you are> > > dealing with a docotor who keeps up to date on the newest > > treatments. I> > > have friends who go to large centers where they specialize in PCa > > for> > > evealuation and then back home to their normal doctor for > > treatment.> > > Where are you located? Nothing to worry about right now. Just > > continue> > > to read alnd learn about all the new options that are out there. > > > > > > Kathy> > > > > > > --- Re: PSAs Predict Long-Term > > Mortality> > > > for Metastatic Prostate Cancer> > > > From: "Debbie" debbie1022@> > > > Date: Fri, August 25, 2006 5:16 pm> > > > To: ProstateCancerSupport > > > > > > > > Kathy,> > Quick history on husband 55 yrs old..no other health problems.> > FEB 06 /initial PSA 274. MAR 06/mets found.spine,pelvic,rib> > MAR 06/HT Luperan and Casadax(casadex 2 x's weekly Injection evry 3 > > mo> > May 06/psa 5.6 stopped casadex....July Eligard inject PSA 6.8> > (rising) went back to casadex..this time daily> > 2nd appointment with a Med Oncology in Sept.. after we get a new > > bone scan...I think things are not working...what do you think might > > be the next step they might suggest? Also, someone else where we > > live.. Near Pgh.Penna..usa...and does any of this history help to > > figure out the info i was requesting from the previous article?> > > >>