Re: Re: The Epstein criteria as predictive for active surveillance

[Guest guest]

Jon,

The definition of ‘cure’ and ‘remission’ has

always been of interest to me in discussions over the years. Whichever definition

can be dug up applies to many men who choose Active Surveillance – they can

claim to be cured or in remission for as many years as men who choose

conventional treatment. In the end some AS men have failed  ‘cures’ or failed ‘remission’

in the same way as some men who have conventional treatment.

Of course, the only genuine final ‘cure’

is to die from some other cause – something I nearly did five years ago just

before my AS ‘remission’ failed J

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 ccnvw@...

Sent: Friday, 29 January 2010 8:02

PM

To: ProstateCancerSupport

Subject:

Re: The Epstein criteria as predictive for active surveillance

So what happens if biopsies indicating Epstein criteria are NOT

immediately followed by RP with a 'high probability of cure'?

The study below, like many similar results from AS programs, suggests

delaying surgery for 'low risk' cancers by 2 to 3 years or more had no worse

pathological outcomes (Gleason upgrade, capsular penetration, positive margins,

tumor volume, biochemical progression) than immediate RP. And, as pointed

out in the Sunnybrook AS program, most of those men who ended up leaving AS for

RPs did so because of indications of progression, but they were a relatively

small percentage of those accepted into the AS programs.

So, it seems that if 'cure' is defined at no biochemical progression

for 6 years., RPs for men meeting Epstein criteria have a high probability

of 'cure', and so do many/most men meeting those criteria that stay in

AS Treating cancers with little need for treatment apparently

provides a high degree of 'cure'. Duh....

The Best to You and Yours!

Jon in Nevada

--------------------------------------------------------------------------------

Is delayed radical prostatectomy in men with low-risk screen-detected

prostate cancer associated with a higher risk of unfavorable outcomes? -

Abstract

Cancer. 2010 Jan 11. Epub ahead of print.

van den Bergh RC, Steyerberg EW, Khatami A, Aus G, Pihl CG, Wolters T, van

Leeuwen PJ, Roobol MJ, Schröder FH, Hugosson J.

Department of Urology, Erasmus University Medical

Center, Rotterdam,

the Netherlands.

Strategies of active surveillance (AS) of low-risk screen-detected

prostate cancer have emerged, because the balance between survival outcomes and

quality of life issues when radically treating these malignancies is

disputable. Delay before radical treatment caused by active surveillance may be

associated with an impaired chance of curability.

Men diagnosed with low-risk (T1c/T2; prostate-specific antigen [PSA] =

< 10.0; PSA density, < 0.2 ng/mL; Gleason score, 3 + 3=6; 1-2 positive

biopsies) prostate cancer in the Swedish section of the European Randomized

Study of Screening for Prostate Cancer who received radical prostatectomy (RP)

were studied. One group received immediate RP, whereas another group received

delayed RP after an initial period of expectant management. These groups were

compared regarding histopathological and biochemical outcomes, correcting for

baseline differences.

Mean follow-up after diagnosis was 5.7 years (standard deviation [sD],

3.2). The immediate RP group (n = 158) received RP a mean of 0.5 (SD, 0.2)

years after diagnosis; the delayed RP group (n = 69) received RP after 2.6 (SD,

2.0) years (P < .001). After adjustment for small baseline dissimilarities,

no differences in RP frequencies of Gleason score >6 (odds ratio [OR], 1.54;

P = .221), capsular penetration (OR, 2.45; P = .091), positive margins (OR,

1.34; P = .445), RP tumor volume (difference, 0.099; P = .155), or biochemical

progression rates (P = .185, P = .689) were found between groups, although all

data were in favor of immediate RP.

With limited patient numbers available for analysis, differences in

intermediate outcomes between immediate RP and delayed RP were nonsignificant.

The delayed RP group may be subject to a selection bias. Prospective evaluation

of active surveillance protocols is essential.

doi:10.1002/cncr.24882

PubMed Abstract PMID:20066716

[Guest guest]

Sorry,

What is "AS" remission? And yes cure-what does cure mean from this cancer and for how long? The fund/prize might be doable if not for us but for our sons and grand children. I need your experience and help in defining "cure". I do not want a dime of this spent on another toxic substance to give me 2 months.

Denver and I do not know the institution has found enzymes particular to certain cancer and have actually cured them. I have looked on-line for such a fund or organization for the cure and have not found any. Maybe time to start our own non -profit fund/prize for curing it.

Your Thoughts,

Tom W.

To: ProstateCancerSupport Sent: Fri, January 29, 2010 3:14:48 PMSubject: RE: Re: The Epstein criteria as predictive for active surveillance

Jon,

The definition of ‘cure’ and ‘remission’ has always been of interest to me in discussions over the years. Whichever definition can be dug up applies to many men who choose Active Surveillance – they can claim to be cured or in remission for as many years as men who choose conventional treatment. In the end some AS men have failed ‘cures’ or failed ‘remission’ in the same way as some men who have conventional treatment.

Of course, the only genuine final ‘cure’ is to die from some other cause – something I nearly did five years ago just before my AS ‘remission’ failed J

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.prostatecancerw atchfulwaiting. 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: ProstateCancerSuppo rtyahoogroups (DOT) com [mailto: ProstateCancerSuppo rtyahoogroups (DOT) com ] On Behalf Of ccnvw@...Sent: Friday, 29 January 2010 8:02 PMTo: ProstateCancerSuppo rtSubject: [ProstateCancerSupp ort] Re: The Epstein criteria as predictive for active surveillance

So what happens if biopsies indicating Epstein criteria are NOT immediately followed by RP with a 'high probability of cure'?

The study below, like many similar results from AS programs, suggests delaying surgery for 'low risk' cancers by 2 to 3 years or more had no worse pathological outcomes (Gleason upgrade, capsular penetration, positive margins, tumor volume, biochemical progression) than immediate RP. And, as pointed out in the Sunnybrook AS program, most of those men who ended up leaving AS for RPs did so because of indications of progression, but they were a relatively small percentage of those accepted into the AS programs.

So, it seems that if 'cure' is defined at no biochemical progression for 6 years., RPs for men meeting Epstein criteria have a high probability of 'cure', and so do many/most men meeting those criteria that stay in AS Treating cancers with little need for treatment apparently provides a high degree of 'cure'. Duh....

The Best to You and Yours!

Jon in Nevada

------------ --------- --------- --------- --------- --------- --------- --------- -----

Is delayed radical prostatectomy in men with low-risk screen-detected prostate cancer associated with a higher risk of unfavorable outcomes? - Abstract Cancer. 2010 Jan 11. Epub ahead of print. van den Bergh RC, Steyerberg EW, Khatami A, Aus G, Pihl CG, Wolters T, van Leeuwen PJ, Roobol MJ, Schröder FH, Hugosson J.Department of Urology, Erasmus University Medical Center , Rotterdam , the Netherlands .

Strategies of active surveillance (AS) of low-risk screen-detected prostate cancer have emerged, because the balance between survival outcomes and quality of life issues when radically treating these malignancies is disputable. Delay before radical treatment caused by active surveillance may be associated with an impaired chance of curability.

Men diagnosed with low-risk (T1c/T2; prostate-specific antigen [PSA] = < 10.0; PSA density, < 0.2 ng/mL; Gleason score, 3 + 3=6; 1-2 positive biopsies) prostate cancer in the Swedish section of the European Randomized Study of Screening for Prostate Cancer who received radical prostatectomy (RP) were studied. One group received immediate RP, whereas another group received delayed RP after an initial period of expectant management. These groups were compared regarding histopathological and biochemical outcomes, correcting for baseline differences.

Mean follow-up after diagnosis was 5.7 years (standard deviation [sD], 3.2). The immediate RP group (n = 158) received RP a mean of 0.5 (SD, 0.2) years after diagnosis; the delayed RP group (n = 69) received RP after 2.6 (SD, 2.0) years (P < .001). After adjustment for small baseline dissimilarities, no differences in RP frequencies of Gleason score >6 (odds ratio [OR], 1.54; P = .221), capsular penetration (OR, 2.45; P = .091), positive margins (OR, 1.34; P = .445), RP tumor volume (difference, 0.099; P = .155), or biochemical progression rates (P = .185, P = .689) were found between groups, although all data were in favor of immediate RP.

With limited patient numbers available for analysis, differences in intermediate outcomes between immediate RP and delayed RP were nonsignificant. The delayed RP group may be subject to a selection bias. Prospective evaluation of active surveillance protocols is essential.

doi:10.1002/ cncr.24882PubMed Abstract PMID:20066716