RE: cure was: 60/40 towards surgery

[Guest guest]

Kathy, you say:

<snip> If men are considering

surgery then this is information that might help them make a decision pro or

con surgery.

Surely the information would only be of

value if there was comparable information for all other treatment options?

As you know only too well, there are very

few prospective studies that go beyond five years in the US. There are

some retrospective ones, but that is not the best data base to work from. The only

prospective long term studies are Swedish studies and they do demonstrate

recurrence after 20 years.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net  and www.prostatecancerwatchfulwaiting.co.za 

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Monday, 7 January 2008 11:23

AM

To: ProstateCancerSupport

Subject:

cure was: 60/40 towards surgery

Curious. I hear quoted a 30% recurrence rate with surgery

frequently. How many years before you get this percentage? 5 years? 10 years?

20 years? What happens to the other 70%. Are they considered cured? Even

if they die of something else does that mean they were cured of their PCa? Does

anyone know of a study on younger men and recurrence? Also I think I remember

reading a study a while ago that the longer there is no recurrence, the less

likely you are to have a recurrence?

If men are considering surgery then this is information that might help

them make a decision pro or con surgery.

Kathy

[Guest guest]

Terry,

I guess the blanket statement that there

is a 30% recurrence is a little misleading. Stage, PSA, PSA velocity, Gleason,

etc can all make a difference. I am still frustrated that we do not know what

the status is of the men who have not recurred.

One study, large, from one institution

said:

OBJECTIVES: In 1998, D'Amico et al. suggested a model stratifying

patients with prostate cancer into those with low, intermediate, or high-risk

of biochemical recurrence after surgery according to the clinical TNM stage,

biopsy Gleason score, and preoperative prostate-specific antigen level. We

studied the performance and clinical relevance of this classification system

over time, in the context of the stage migration seen in the contemporary era,

using data from a high-volume, tertiary referral center. METHOD: From 1984 to

2005, 6652 men underwent radical prostatectomy at our institution for

clinically localized prostate cancer (clinical Stage T1c-T2c) with follow-up

information available and no neoadjuvant or adjuvant therapy before biochemical

recurrence. Biochemical recurrence-free survival (BRFS) was estimated using the

Kaplan-Meier method, and the BRFS rates between the D'Amico risk groups and by

era were compared using the log-rank statistic. Finally, the distribution of

patients among the three groups was compared over time. RESULTS: The 5-year

BRFS rate was 84.6% overall and 94.5%, 76.6%, and 54.6% for the low,

intermediate, and high-risk groups, respectively (P <0.0001). In the

contemporary era, a very small fraction (4.9%) of patients undergoing radical

prostatectomy at our institution were in the high-risk group, with most (67.7%)

in the low-risk group (P <0.001). CONCLUSIONS: The D'Amico classification

system continues to stratify men into risk groups with statistically

significant differences in BRFS. However, the major shift in the distribution

of patients among the three risk groups over time suggests that the clinical

relevance of this classification scheme may be limited and diminishing in the

contemporary era.

PMID:

18068450 [PubMed - in process]

Another

study on advanced PCa:

Berglund RK, JS, Ulchaker JC, Fergany A, Gill I, Kaouk J, Klein EA.

Section of Urologic Oncology, Glickman Urological

Institute, Cleveland Clinic Foundation, Cleveland, Ohio

44195, USA.

OBJECTIVES: Locally advanced prostate cancer is frequently treated with

radiotherapy and androgen deprivation because of the greater rate of

extracapsular disease and the concern that radical prostatectomy (RP) may not

be curative in most cases. A case for surgery for locally advanced disease may

be made on the basis of a lower rate of local recurrence compared with

radiotherapy in our comparative database, data suggesting a survival advantage

with pelvic lymph node dissection in those with positive nodes, and the

observation of improved survival in those with metastatic disease treated by RP

compared with radiotherapy. We report on the feasibility of RP as a primary

treatment modality for locally advanced disease. METHODS: A total of 281 consecutive

patients treated by RP between January 1998 and June 2004 were reviewed.

Locally advanced disease was defined as clinical Stage T2b or worse,

prostate-specific antigen level greater than 15 ng/mL, and/or a Gleason score

of 8 or greater. Data on the pathologic characteristics, operative

complications, and follow-up were obtained from a prospectively maintained

institutional review board-approved database. RESULTS: Pathologic

examination demonstrated organ-confined disease in 11.7%, extracapsular extension

in 56.9%, seminal vesicle involvement in 23.1%, and positive lymph nodes in

8.9%. The overall complication rate was 9.7% compared with 6.9% for all

patients undergoing RP. At a mean follow-up of 34 months (range 1 to 78), 198

(70.4%) of 281 patients had an undetectable prostate-specific antigen level at

the last follow-up examination. CONCLUSIONS: RP for locally advanced prostate

cancer is feasible, with acute morbidity similar to RP for more localized

disease. Furthermore, RP results in short-term biochemical recurrence-free

survival similar to that of combined radiotherapy and androgen ablation.

PMID:

16678888 [PubMed - indexed for MEDLINE]

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

Herbert

Sent: Sunday, January 06, 2008

7:35 PM

To: ProstateCancerSupport

Subject: RE:

cure was: 60/40 towards surgery

Kathy, you say:

<snip> If men are considering surgery then this is

information that might help them make a decision pro or con surgery.

Surely the information would only be of value if there was

comparable information for all other treatment options?

As you know only too well, there are very few prospective studies

that go beyond five years in the US. There are some

retrospective ones, but that is not the best data base to work from. The only

prospective long term studies are Swedish studies and they do demonstrate

recurrence after 20 years.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with

inadequate data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Kathy Meade

Sent: Monday, 7 January 2008 11:23

AM

To: ProstateCancerSupport

Subject:

cure was: 60/40 towards surgery

Curious. I hear quoted a 30% recurrence rate with surgery

frequently. How many years before you get this percentage? 5 years? 10 years?

20 years? What happens to the other 70%. Are they considered cured? Even

if they die of something else does that mean they were cured of their PCa? Does

anyone know of a study on younger men and recurrence? Also I think I remember

reading a study a while ago that the longer there is no recurrence, the less

likely you are to have a recurrence?

If men are considering surgery then this is information that might

help them make a decision pro or con surgery.

Kathy

[Guest guest]

Kathy,

The discussion wasn’t about survival

rates – it was about recurrence rates in men who chose surgery and who

therefore were no longer ‘ cured’ .

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net  and www.prostatecancerwatchfulwaiting.co.za 

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Monday, 7 January 2008 1:36

PM

To: ProstateCancerSupport

Subject: RE:

cure was: 60/40 towards surgery

Terry,

I guess the blanket statement that there is a 30% recurrence is a

little misleading. Stage, PSA, PSA velocity, Gleason, etc can all make a

difference. I am still frustrated that we do not know what the status is of the

men who have not recurred.

One study, large, from one institution said:

OBJECTIVES: In 1998, D'Amico et al. suggested a model stratifying

patients with prostate cancer into those with low, intermediate, or high-risk

of biochemical recurrence after surgery according to the clinical TNM stage,

biopsy Gleason score, and preoperative prostate-specific antigen level. We

studied the performance and clinical relevance of this classification system

over time, in the context of the stage migration seen in the contemporary era,

using data from a high-volume, tertiary referral center. METHOD: From 1984 to

2005, 6652 men underwent radical prostatectomy at our institution for

clinically localized prostate cancer (clinical Stage T1c-T2c) with follow-up

information available and no neoadjuvant or adjuvant therapy before biochemical

recurrence. Biochemical recurrence-free survival (BRFS) was estimated using the

Kaplan-Meier method, and the BRFS rates between the D'Amico risk groups and by

era were compared using the log-rank statistic. Finally, the distribution of

patients among the three groups was compared over time. RESULTS: The 5-year

BRFS rate was 84.6% overall and 94.5%, 76.6%, and 54.6% for the low,

intermediate, and high-risk groups, respectively (P <0.0001). In the

contemporary era, a very small fraction (4.9%) of patients undergoing radical

prostatectomy at our institution were in the high-risk group, with most (67.7%)

in the low-risk group (P <0.001). CONCLUSIONS: The D'Amico classification

system continues to stratify men into risk groups with statistically

significant differences in BRFS. However, the major shift in the distribution

of patients among the three risk groups over time suggests that the clinical

relevance of this classification scheme may be limited and diminishing in the contemporary

era.

PMID:

18068450 [PubMed - in process]

Another

study on advanced PCa:

Berglund RK, JS, Ulchaker JC, Fergany A, Gill I, Kaouk J, Klein EA.

Section of Urologic Oncology, Glickman Urological

Institute, Cleveland Clinic

Foundation, Cleveland,

Ohio 44195,

USA.

OBJECTIVES: Locally advanced prostate cancer is frequently treated with

radiotherapy and androgen deprivation because of the greater rate of

extracapsular disease and the concern that radical prostatectomy (RP) may not

be curative in most cases. A case for surgery for locally advanced disease may

be made on the basis of a lower rate of local recurrence compared with radiotherapy

in our comparative database, data suggesting a survival advantage with pelvic

lymph node dissection in those with positive nodes, and the observation of

improved survival in those with metastatic disease treated by RP compared with

radiotherapy. We report on the feasibility of RP as a primary treatment

modality for locally advanced disease. METHODS: A total of 281 consecutive

patients treated by RP between January 1998 and June 2004 were reviewed.

Locally advanced disease was defined as clinical Stage T2b or worse,

prostate-specific antigen level greater than 15 ng/mL, and/or a Gleason score

of 8 or greater. Data on the pathologic characteristics, operative

complications, and follow-up were obtained from a prospectively maintained

institutional review board-approved database. RESULTS: Pathologic

examination demonstrated organ-confined disease in 11.7%, extracapsular

extension in 56.9%, seminal vesicle involvement in 23.1%, and positive lymph

nodes in 8.9%. The overall complication rate was 9.7% compared with 6.9% for

all patients undergoing RP. At a mean follow-up of 34 months (range 1 to 78),

198 (70.4%) of 281 patients had an undetectable prostate-specific antigen level

at the last follow-up examination. CONCLUSIONS: RP for locally advanced prostate

cancer is feasible, with acute morbidity similar to RP for more localized

disease. Furthermore, RP results in short-term biochemical recurrence-free

survival similar to that of combined radiotherapy and androgen ablation.

PMID:

16678888 [PubMed - indexed for MEDLINE]

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Terry Herbert

Sent: Sunday, January 06, 2008

7:35 PM

To: ProstateCancerSupport

Subject: RE:

cure was: 60/40 towards surgery

Kathy, you say:

<snip> If men are considering surgery then this is

information that might help them make a decision pro or con surgery.

Surely the information would only be of value if there was comparable

information for all other treatment options?

As you know only too well, there are very few prospective studies

that go beyond five years in the US. There

are some retrospective ones, but that is not the best data base to work from.

The only prospective long term studies are Swedish studies and they do

demonstrate recurrence after 20 years.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with

inadequate data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Kathy Meade

Sent: Monday, 7 January 2008 11:23

AM

To: ProstateCancerSupport

Subject:

cure was: 60/40 towards surgery

Curious. I hear quoted a 30% recurrence rate with surgery

frequently. How many years before you get this percentage? 5 years? 10 years?

20 years? What happens to the other 70%. Are they considered cured? Even

if they die of something else does that mean they were cured of their PCa? Does

anyone know of a study on younger men and recurrence? Also I think I remember

reading a study a while ago that the longer there is no recurrence, the less

likely you are to have a recurrence?

If men are considering surgery then this is information that might

help them make a decision pro or con surgery.

Kathy

[Guest guest]

Recurrence rates depend upon the staging of the cancers at surgery,

whether or not there was radiation or hormone therapy combined with

the surgery, the skills of the surgeon, and just plain random factors

peculiar to the individual cancers.

The key point seems to be that one cannot assume to be 'cured' for

decades following any prostate cancer treatment. Consider this quote

by Dr. " Snuffy " Myers during the final panel discussion of the 2007

PCRI National Prostate Cancer Conference:

" People can relapse 20 years after surgery. Swanson's Seattle paper

showed relapses finally stop after 25 years. ... It's a time

bomb. ... So this is why if you've had a radical prostatectomy or

radiation therapy and your PSA is undetectable you shouldn't say Oh I

beat this disease. Even if 10 years later your PSA is undetectable

you can't stop having those PSAs done, you can't step back and say I

can forget about that disease, you'd be living a fools paradise. "

This comment is particularly telling as Dr. Meyers is considered

a 'survivor' of advanced prostate cancer, but, he obviously does not

consider himself 'cured'.

Dr. Meyers attributed such recurrences to latent cancer cells

circulating outside of the prostate that are 'turned on' by as yet

unknown factors long after treatment. The discussions indicated that

such cells have been found outside of the prostate even for cases of

early prostate cancers where pathologies after RP show the tumors to

be fully confined within the prostate. The panelists indicated that

tests ('CTC tests') are being developed to screen for these

circulating tumor cells cells, however, the significance of their

presence is as yet unknown.

Truly there is a lot that is as yet unknown about our disease...

The Best to You and Yours.

Jon

PS: It appears that the paper Dr. Myers was referring to was from the

Long-term follow-up of radiotherapy for prostate cancer

G.P Swanson, M.W Riggs, J.D Earle

International Journal of Radiation Oncology * Biology * Physics

1 June 2004 (Vol. 59, Issue 2, Pages 406-411)

>

> Curious. I hear quoted a 30% recurrence rate with surgery

frequently. How

> many years before you get this percentage? 5 years? 10 years? 20

years? What

> happens to the other 70%. Are they considered cured? Even if they

die of

> something else does that mean they were cured of their PCa? Does

anyone know

> of a study on younger men and recurrence? Also I think I remember

reading a

> study a while ago that the longer there is no recurrence, the less

likely

> you are to have a recurrence?

>

>

>

> If men are considering surgery then this is information that might

help them

> make a decision pro or con surgery.

>

>

>

> Kathy

>

[Guest guest]

Terry,

Recurrence is why I mentioned the two

studies. They were the most two current studies in Pub Med I could find that

had recurrence statistics..

They say: : The 5-year BRFS

rate was 84.6% overall and 94.5%, 76.6%, and 54.6% for the low, intermediate,

and high-risk groups, respectively (P <0.0001). In the contemporary era, a

very small fraction (4.9%) of patients undergoing radical prostatectomy at our

institution were in the high-risk group, with most (67.7%) in the low-risk

group (P <0.001). CONCLUSIONS: The D'Amico classification system continues

to stratify men into risk groups with statistically significant differences in

BRFS. However, the major shift in the distribution of patients among the three

risk groups over time suggests that the clinical relevance of this

classification scheme may be limited and diminishing in the contemporary era.

BRFS is a model for risk or recurrence.

Has nothing to do with survival. If I am reading correctly, they are getting

better at determining patients who will have the best outcome from surgery and are

becoming less likely to do surgery on men who will need other treatments and

therefore they can avoid surgery, and the potential side effects at least at

this facility.

The second study said:

Furthermore, RP results in short-term biochemical recurrence-free

survival similar to that of combined radiotherapy and androgen ablation.

You said there were no studies that

compared RP with radiation. This one did for locally advanced disease.

They also said:

: At a mean follow-up of 34

months (range 1 to 78), 198 (70.4%) of 281 patients had an undetectable

prostate-specific antigen level at the last follow-up examination.

This supports the 30% recurrence for locally advanced disease at 34

months.

Neither statistical outcome was related to survival. Both studies were

facility specific.

All I was trying to show was that based on this limited but current

data the 30% statistic may be overstated for men with early disease. Staging is

very important when choosing a treatment.  We need to be careful about making

sweeping statements that may not be specific to a particular man. We cold be unintentionally

be increasing anxiety.

I do not know of any treatment that comes with a guarantee although the

doctors seem to be getting better at determining which man is best suited to

which treatment or at least which treatment is less appropriate for which man.

Kathy

 

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

Herbert

Sent: Sunday, January 06, 2008

10:30 PM

To: ProstateCancerSupport

Subject: RE:

cure was: 60/40 towards surgery

Kathy,

The discussion wasn’t about survival rates – it was

about recurrence rates in men who chose surgery and who therefore were no

longer ‘ cured’ .

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with

inadequate data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Kathy Meade

Sent: Monday, 7 January 2008 1:36

PM

To: ProstateCancerSupport

Subject: RE:

cure was: 60/40 towards surgery

Terry,

I guess the blanket statement that there is a 30% recurrence is a

little misleading. Stage, PSA, PSA velocity, Gleason, etc can all make a

difference. I am still frustrated that we do not know what the status is of the

men who have not recurred.

One study, large, from one institution said:

OBJECTIVES: In 1998, D'Amico et al. suggested a model stratifying

patients with prostate cancer into those with low, intermediate, or high-risk

of biochemical recurrence after surgery according to the clinical TNM stage,

biopsy Gleason score, and preoperative prostate-specific antigen level. We

studied the performance and clinical relevance of this classification system

over time, in the context of the stage migration seen in the contemporary era,

using data from a high-volume, tertiary referral center. METHOD: From 1984 to

2005, 6652 men underwent radical prostatectomy at our institution for

clinically localized prostate cancer (clinical Stage T1c-T2c) with follow-up

information available and no neoadjuvant or adjuvant therapy before biochemical

recurrence. Biochemical recurrence-free survival (BRFS) was estimated using the

Kaplan-Meier method, and the BRFS rates between the D'Amico risk groups and by

era were compared using the log-rank statistic. Finally, the distribution of

patients among the three groups was compared over time. RESULTS: The 5-year

BRFS rate was 84.6% overall and 94.5%, 76.6%, and 54.6% for the low,

intermediate, and high-risk groups, respectively (P <0.0001). In the

contemporary era, a very small fraction (4.9%) of patients undergoing radical

prostatectomy at our institution were in the high-risk group, with most (67.7%)

in the low-risk group (P <0.001). CONCLUSIONS: The D'Amico classification

system continues to stratify men into risk groups with statistically

significant differences in BRFS. However, the major shift in the distribution of

patients among the three risk groups over time suggests that the clinical

relevance of this classification scheme may be limited and diminishing in the

contemporary era.

PMID:

18068450 [PubMed - in process]

Another

study on advanced PCa:

Berglund RK, JS, Ulchaker JC, Fergany A, Gill I, Kaouk J, Klein EA.

Section of Urologic Oncology, Glickman Urological

Institute, Cleveland

Clinic Foundation, Cleveland,

Ohio 44195, USA.

OBJECTIVES: Locally advanced prostate cancer is frequently treated with

radiotherapy and androgen deprivation because of the greater rate of

extracapsular disease and the concern that radical prostatectomy (RP) may not

be curative in most cases. A case for surgery for locally advanced disease may

be made on the basis of a lower rate of local recurrence compared with

radiotherapy in our comparative database, data suggesting a survival advantage

with pelvic lymph node dissection in those with positive nodes, and the

observation of improved survival in those with metastatic disease treated by RP

compared with radiotherapy. We report on the feasibility of RP as a primary

treatment modality for locally advanced disease. METHODS: A total of 281

consecutive patients treated by RP between January 1998 and June 2004 were

reviewed. Locally advanced disease was defined as clinical Stage T2b or worse,

prostate-specific antigen level greater than 15 ng/mL, and/or a Gleason score

of 8 or greater. Data on the pathologic characteristics, operative complications,

and follow-up were obtained from a prospectively maintained institutional

review board-approved database. RESULTS: Pathologic

examination demonstrated organ-confined disease in 11.7%, extracapsular

extension in 56.9%, seminal vesicle involvement in 23.1%, and positive lymph

nodes in 8.9%. The overall complication rate was 9.7% compared with 6.9% for

all patients undergoing RP. At a mean follow-up of 34 months (range 1 to 78),

198 (70.4%) of 281 patients had an undetectable prostate-specific antigen level

at the last follow-up examination. CONCLUSIONS: RP for locally advanced

prostate cancer is feasible, with acute morbidity similar to RP for more

localized disease. Furthermore, RP results in short-term biochemical

recurrence-free survival similar to that of combined radiotherapy and androgen

ablation.

PMID:

16678888 [PubMed - indexed for MEDLINE]

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Terry Herbert

Sent: Sunday, January 06, 2008 7:35

PM

To: ProstateCancerSupport

Subject: RE:

cure was: 60/40 towards surgery

Kathy, you say:

<snip> If men are considering surgery then this is information

that might help them make a decision pro or con surgery.

Surely the information would only be of value if there was

comparable information for all other treatment options?

As you know only too well, there are very few prospective studies

that go beyond five years in the US.

There are some retrospective ones, but that is not the best data base to work

from. The only prospective long term studies are Swedish studies and they do

demonstrate recurrence after 20 years.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with

inadequate data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Kathy Meade

Sent: Monday, 7 January 2008 11:23

AM

To: ProstateCancerSupport

Subject:

cure was: 60/40 towards surgery

Curious. I hear quoted a 30% recurrence rate with surgery

frequently. How many years before you get this percentage? 5 years? 10 years?

20 years? What happens to the other 70%. Are they considered cured? Even

if they die of something else does that mean they were cured of their PCa? Does

anyone know of a study on younger men and recurrence? Also I think I remember

reading a study a while ago that the longer there is no recurrence, the less

likely you are to have a recurrence?

If men are considering surgery then this is information that might

help them make a decision pro or con surgery.

Kathy

[Guest guest]

Kathy,Have you looked at the nomogram on the Sloan-Kettering Site? http://www.mskcc.org/mskcc/html/10088.cfmRegards, [ProstateCancerSupp ort]

cure was: 60/40 towards surgery

Curious. I hear quoted a 30% recurrence rate with surgery

frequently. How many years before you get this percentage? 5 years? 10 years?

20 years? What happens to the other 70%. Are they considered cured? Even

if they die of something else does that mean they were cured of their PCa? Does

anyone know of a study on younger men and recurrence? Also I think I remember

reading a study a while ago that the longer there is no recurrence, the less

likely you are to have a recurrence? If men are considering surgery then this is information that might

help them make a decision pro or con surgery. Kathy

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

[Guest guest]

[ProstateCancerSupp ort] cure was: 60/40 towards surgery

Curious. I hear quoted a 30% recurrence rate with surgery frequently. How many years before you get this percentage? 5 years? 10 years? 20 years? What happens to the other 70%. Are they considered cured? Even if they die of something else does that mean they were cured of their PCa? Does anyone know of a study on younger men and recurrence? Also I think I remember reading a study a while ago that the longer there is no recurrence, the less likely you are to have a recurrence?

If men are considering surgery then this is information that might help them make a decision pro or con surgery.

Kathy

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

[Guest guest]

Re nomograms:

I spent quite a bit of time in a state of anxiety " agonizing " over

the results of various nomograms including the Sloan Kettering. My

initial GS of 4+4=8 and PSA of 5 put me in an area that I definitely

did not like.

However study of actual longer term results of folks with about the

same specs made me realize that the results varied all over the

place, and were not necessarily following the nomograpy " predictions. "

Each of us is different. So with that in mind I sort of put the

nomogram thing behind me and went on with my research. The thing

that comes to mind re nomograms is that they are indeed useful in

characterizing an " average " but in the end they are statistics.

My opinion is that nomograms really serve little purpose in a

personal decision for a primary treatment modality. If you look at

the range of disease characteristics and the fact that any and all of

them have been " successfully " treated by any and all of the

modalities, the value of the nomogram sort of fades a bit. The docs

may use the nomogram in recommending a combined treatment like

pelvic bed radiation and/or ADT along with whatever primary method,

but to me you can almost decide on that by knowing your Gleason and

PSA when dx. So the nomogram is a tool, but in my opinion there are

others just as good if not better.

Fuller

>

> Kathy,

>

> Have you looked at the nomogram on the Sloan-Kettering Site?

>

> http://www.mskcc.org/mskcc/html/10088.cfm

>

> Regards,

>

>

[Guest guest]

Re nomograms:

I spent quite a bit of time in a state of anxiety " agonizing " over

the results of various nomograms including the Sloan Kettering. My

initial GS of 4+4=8 and PSA of 5 put me in an area that I definitely

did not like.

However study of actual longer term results of folks with about the

same specs made me realize that the results varied all over the

place, and were not necessarily following the nomograpy " predictions. "

Each of us is different. So with that in mind I sort of put the

nomogram thing behind me and went on with my research. The thing

that comes to mind re nomograms is that they are indeed useful in

characterizing an " average " but in the end they are statistics.

My opinion is that nomograms really serve little purpose in a

personal decision for a primary treatment modality. If you look at

the range of disease characteristics and the fact that any and all of

them have been " successfully " treated by any and all of the

modalities, the value of the nomogram sort of fades a bit. The docs

may use the nomogram in recommending a combined treatment like

pelvic bed radiation and/or ADT along with whatever primary method,

but to me you can almost decide on that by knowing your Gleason and

PSA when dx. So the nomogram is a tool, but in my opinion there are

others just as good if not better.

Fuller

>

> Kathy,

>

> Have you looked at the nomogram on the Sloan-Kettering Site?

>

> http://www.mskcc.org/mskcc/html/10088.cfm

>

> Regards,

>

>

[Guest guest]

Fuller,

You are absolutely correct. This is a tool

that is developed and verified on evidence. It may not include all the alternatives

where the evidence is not as strong. Treatments not included may be viable

alternatives for individuals. Everyman should look at the studies and use the

tools available but ultimately your decision is yours and should not be solely

based on any tool or what someone else did. Use the tool but make the decision

independently. Each man has to live with his decision and that will be better

if you make the decisions yourself.

Kathy

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

Sent: Monday, January 07, 2008

7:37 AM

To: ProstateCancerSupport

Subject:

Re: cure was: 60/40 towards surgery

Re nomograms:

I spent quite a bit of time in a state of anxiety " agonizing " over

the results of various nomograms including the Sloan Kettering. My

initial GS of 4+4=8 and PSA of 5 put me in an area that I definitely

did not like.

However study of actual longer term results of folks with about the

same specs made me realize that the results varied all over the

place, and were not necessarily following the nomograpy " predictions. "

Each of us is different. So with that in mind I sort of put the

nomogram thing behind me and went on with my research. The thing

that comes to mind re nomograms is that they are indeed useful in

characterizing an " average " but in the end they are statistics.

My opinion is that nomograms really serve little purpose in a

personal decision for a primary treatment modality. If you look at

the range of disease characteristics and the fact that any and all of

them have been " successfully " treated by any and all of the

modalities, the value of the nomogram sort of fades a bit. The docs

may use the nomogram in recommending a combined treatment like

pelvic bed radiation and/or ADT along with whatever primary method,

but to me you can almost decide on that by knowing your Gleason and

PSA when dx. So the nomogram is a tool, but in my opinion there are

others just as good if not better.

Fuller

>

> Kathy,

>

> Have you looked at the nomogram on the Sloan-Kettering Site?

>

> http://www.mskcc.org/mskcc/html/10088.cfm

>

> Regards,

>

[Guest guest]

Ran my numbers through this calculator and I sure hope it's correct.

Percentages much more optimistic than most others to the tune of 97%

compared to about 75% for 10 year cure probability.

>

> Kathy,

>

> Have you looked at the nomogram on the Sloan-Kettering Site?

>

[Guest guest]

I've also noticed that it's more optimistic than some of the other calculators but have no idea whether it's more accurate. I did see that the calculator has a 'historical' tab that uses old data and is less optimistic.Regards, Dave Re: cure was: 60/40 towards surgery

Ran my numbers through this calculator and I sure hope it's correct.

Percentages much more optimistic than most others to the tune of 97%

compared to about 75% for 10 year cure probability.

>

> Kathy,

>

> Have you looked at the nomogram on the Sloan-Kettering Site?

>

Looking for last minute shopping deals? Find them fast with Yahoo! Search.

[Guest guest]

Don't know WHY that message popped up again!! I did NOT send it

again.

Fuller

> >

> > Kathy,

> >

> > Have you looked at the nomogram on the Sloan-Kettering Site?

> >

> > http://www.mskcc.org/mskcc/html/10088.cfm

> >

> > Regards,

> >

> >

>