RE: The Epstein criteria as predictive for active surveillance

[Guest guest]

B wrote:

> Active surveillance is gaining popularity as a management

> strategy for newly diagnosed low-grade prostate cancer. In

> 1994, Epstein reported PSA- and needle biopsy-based criteria

> for identifying potentially biologically insignificant tumors

> that might be safely managed by initial surveillance....

<http://www.urotoday.com/3341/browse_categories/beyond_the_abstract/beyond_the_a\

bstract__the_epstein_criteria_predict_for_organconfined_but_not_insignificant_di\

sease_and_a_high_likelihood_of_cure_at_radical_prostatectomy_by_michael_c_lee_md\

_and_eric_a_klein_md01262010.html>

What an odd study this is. Its conclusion is that men identified

by the Epstein criteria as qualifying for active surveillance

have an excellent chance at a complete cure by getting a radical

prostatectomy.

I guess their next study will show that, if you shoot yourself in

the foot, you have an excellent chance of killing that mosquito

that is biting you there.

The study did actually have some value. They showed that

pathology reports on excised prostates confirm that a high

percentage of men did indeed have organ confined, insignificant

disease. But they seem to be encouraging such men to have major

surgery.

Alan

[Guest guest]

So ,

Is there anywhere posted or otherwise a grant or amount of money/prize for the cure of PC. Not tratment but cure for PC!

If you are like many of us out there we feel there is money in prolonging treatment and not curing it.

If there is and I am starting to look for a foundation for such so I can go to fund raising folks up the ante for a cure.

Thanks,

Tom W

To: ProstateCancerSupport Sent: Thu, January 28, 2010 9:33:01 AMSubject: Re: The Epstein criteria as predictive for active surveillance

B <bigcrixyahoo (DOT) com> wrote:> Active surveillance is gaining popularity as a management> strategy for newly diagnosed low-grade prostate cancer. In> 1994, Epstein reported PSA- and needle biopsy-based criteria> for identifying potentially biologically insignificant tumors> that might be safely managed by initial surveillance. ...<http://www.urotoday .com/3341/ browse_categorie s/beyond_ the_abstract/ beyond_the_ abstract_ _the_epstein_ criteria_ predict_for_ organconfined_

but_not_insignif icant_disease_ and_a_high_ likelihood_ of_cure_at_ radical_prostate ctomy_by_ michael_c_ lee_md_and_ eric_a_klein_ md01262010. html>What an odd study this is. Its conclusion is that men identifiedby the Epstein criteria as qualifying for active surveillancehave an excellent chance at a complete cure by getting a radicalprostatectomy.I guess their next study will show that, if you shoot yourself inthe foot, you have an excellent chance of killing that mosquitothat is biting you there.The study did actually have some value. They showed thatpathology reports on excised prostates confirm that a highpercentage of men did indeed have organ confined, insignificantdisease. But they seem to be encouraging such men to have majorsurgery.Alan

[Guest guest]

Tom wrote:

> Is there anywhere posted or otherwise a grant or amount of

> money/prize for the cure of PC. Not tratment but cure for PC!

I'm not aware of any such prizes for any of the serious diseases.

It sounds like a good idea. We've had prizes for putting a man

in space, for going around the world without refueling, and

similar things. Why not a prize for curing cancer?

There are, however, many private, non-profit foundations (like

Lance Armstrong's Livestrong Foundation) that fund research.

> If you are like many of us out there we feel there is money in

> prolonging treatment and not curing it.

I think this is a factor in what drug companies spend, though not

in what NIH and NCI spend in the U.S.

As I understand it, relatively little basic research is funded

anymore by drug companies. Most of the money comes from the U.S.

government and some from the foundations. As you say, the drug

companies are more interested in chronic diseases than killers.

Hence the huge investments in ED, high blood pressure, diabetes,

heartburn, and so on, and relatively much less in cancer. It

does seem odd from a societal point of view that more money goes

into alleviating ED and heartburn than curing cancer.

> If there is and I am starting to look for a foundation for such

> so I can go to fund raising folks up the ante for a cure.

I don't know what the best foundations are. Maybe someone here

has opinions on that. I've heard it said that the American

Cancer Society spends too much of its money on administration and

not enough on real research, but I don't know if that's true.

In the long term, I think we need a lot more basic research in

biology and a lot more understanding of what cancer is and how it

does what it does before we'll develop many cures. But we're

getting there. It may not happen for us but might for our

grandchildren.

Alan

[Guest guest]

As you say Alan, a very odd study

demonstrating clearly Dr Whitmore’s old riddle: " Is cure possible? Is cure necessary?

Is cure possible only when it is not necessary? "

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 Alan Meyer

Sent: Friday, 29 January 2010 2:33

AM

To: ProstateCancerSupport

Subject: Re:

The Epstein criteria as predictive for active

surveillance

B <bigcrix>

wrote:

> Active surveillance is gaining popularity as a management

> strategy for newly diagnosed low-grade prostate cancer. In

> 1994, Epstein reported PSA- and needle biopsy-based criteria

> for identifying potentially biologically insignificant tumors

> that might be safely managed by initial surveillance....

<http://www.urotoday.com/3341/browse_categories/beyond_the_abstract/beyond_the_abstract__the_epstein_criteria_predict_for_organconfined_but_not_insignificant_disease_and_a_high_likelihood_of_cure_at_radical_prostatectomy_by_michael_c_lee_md_and_eric_a_klein_md01262010.html>

What an odd study this is. Its conclusion is that men identified

by the Epstein criteria as qualifying for active surveillance

have an excellent chance at a complete cure by getting a radical

prostatectomy.

I guess their next study will show that, if you shoot yourself in

the foot, you have an excellent chance of killing that mosquito

that is biting you there.

The study did actually have some value. They showed that

pathology reports on excised prostates confirm that a high

percentage of men did indeed have organ confined, insignificant

disease. But they seem to be encouraging such men to have major

surgery.

Alan

[Guest guest]

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

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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