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How to interpret statistical outcomes of cancer recurrence in case of radical prostatectomy?

User
Posted 08 Jul 2021 at 17:23

59 male
4+3=7 Gleason
PSA 7.8 ng/ml
T2c

Preoperative risk assessment Model from John Hopkins predicts the following statistical outcomes from radical prostatectomy:

Recurrence Probability Following Radical Prostatectomy
Probability of Biochemical Recurrence (detectable PSA level) at :

3 years after surgery: 10% (3-30)
5 years after surgery: 16% (5-46)
7 years after surgery: 22% (7-58)
10 years after surgery: 28% (9-68)

(All numbers represent predictive probabilities with a 95 percent confidence interval)

Question: is it correct to assume that total risk that a recurrence will be encountered during 10 year period is (10+16+22+28)%?

So total would be 76%?

This is insanely high if so and in this case I don't understand why one shouldn't just stick to radiation instead of surgery.

Prostate Cancer Research Institute says the following:

"With surgery the problem is that the bladder and rectum are only millimeters from the prostate. Incomplete cancer removal (positive margins) is therefore a frequent problem. In a study of 9,300 men undergoing surgery for Azure at Johns Hopkins, 80 percent developed recurrent cancer over the subsequent 15 years. "

So this information says that during 15 year period 80% of men developed recurrence.

The problem is, I still have doubts if I'm calculating the % risk correctly, any help?

Goal of this is to understand if I should go with radical prostatectomy based on statistical outcomes or just stick with radiation (each doc recommends something else based on what they are selling).

 

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 08 Jul 2021 at 21:03

Hi,

On question 1, the answer is 28%. i.e the increase in risk in each period is in the order of 6%.

 On question 2, the answer is indeed 80%

Obviously  I have no idea if these numbers are correct in themselves- but that's how they are to be interpreted.

 

You are right to try to get some hard data on which to base your decision, but as you are finding, its not an easy task. Apart from anything else you really need to get below the skin of these aggregate numbers, and narrow the analysis down to something which better  reflects your own particular context ( age, other medical history, etc as well as the basic PCa numbers). Others on here are well versed in the arts of data sourcing, and may well chip in.

 

My experience of the surgeon vs oncologist views of the world was different to most, in that the surgeon nudged me towards RT and the onco nudged me towards surgery. If you read enough of the conversations on here you will see that - as a broad generalisation, surgery and RT offer  similar 'success' rates. The main difference is in the risk of potential side effects ( which may yield to probability analysis) and how you feel about them ( which won't - its highly subjective).

 

Good luck! 

User
Posted 09 Jul 2021 at 01:23

I agree with oldfogey. Don't add the figures together 28% is the total chance after 10 years.

As for the second question, that is applying to high risk disease, and indeed if we feed a high gleason, a high psa and a high tumour stage into the Hopkins calculator we get 72% chance after 10years, which I guess is about 80%chance over 15 years.

So with your diagnosis, and prostatectomy you have a very high chance of no detectable cancer in 10years, you probably have the same chance from RT.

I think realistically anyone with this disease should be thinking not so much about a cure but more about how far we can kick the can down the road.

Life expectancy for a man in the uk is about 85. If you get diagnosed at 65 and you find a treatment which has about 50% chance of holding the cancer at bay for 20 years, you haven't got much to complain about.

If you get diagnosed at 85 I would say you have been lucky to get to that age, sure have treatment you may live longer, but you may just have to bow out gracefully.

Sadly if you get diagnosed at 45 you have been dealt a rotten hand in life. You might make 65, you might even be lucky and be cured. At least you weren't born in Afghanistan, Lesotho or Mozambique where getting to 50 without being shot dead or dieing of malaria, or another tropical disease is unusual. 

Dave

User
Posted 09 Jul 2021 at 01:31
As stated above, the stats are cumulative so over a period of 10 years, there is a 28% probability that the cancer will recur. However, men in the UK do slightly worse that men in America so your chance of recurrence is slightly higher than 28%.

For the second stat, this was specifically related to men with high risk cancer - so they had been diagnosed with high PSA, high Gleason grade and/or T3 or above - it isn't that surprising that so many had biochemical recurrence. Some of the 80% probably didn't even get the initial 'congratulations, the op was successful' conversation but they probably knew that was a risk before they agreed to surgery.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 09 Jul 2021 at 05:14

What I think you have missed is that even if you have biochemical recurrence following prostatectomy after X years, there are many tools in the box to keep it at bay, including hormone and radiotherapies, and various new ‘wonder’ drugs.

Who knows? In ten years time there may be a complete cure for the disease.

I’m three years cancer-free, post-op, but if I look at the Memorial Sloan Kettering Hospital Nomogram prognostication, it doesn’t look too good fifteen years hence, by which time I will probably have died of something else. Am I bovvered? Nah!

Best of luck.

Cheers, John.

Edited by member 09 Jul 2021 at 05:26  | Reason: Not specified

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User
Posted 08 Jul 2021 at 21:03

Hi,

On question 1, the answer is 28%. i.e the increase in risk in each period is in the order of 6%.

 On question 2, the answer is indeed 80%

Obviously  I have no idea if these numbers are correct in themselves- but that's how they are to be interpreted.

 

You are right to try to get some hard data on which to base your decision, but as you are finding, its not an easy task. Apart from anything else you really need to get below the skin of these aggregate numbers, and narrow the analysis down to something which better  reflects your own particular context ( age, other medical history, etc as well as the basic PCa numbers). Others on here are well versed in the arts of data sourcing, and may well chip in.

 

My experience of the surgeon vs oncologist views of the world was different to most, in that the surgeon nudged me towards RT and the onco nudged me towards surgery. If you read enough of the conversations on here you will see that - as a broad generalisation, surgery and RT offer  similar 'success' rates. The main difference is in the risk of potential side effects ( which may yield to probability analysis) and how you feel about them ( which won't - its highly subjective).

 

Good luck! 

User
Posted 09 Jul 2021 at 01:23

I agree with oldfogey. Don't add the figures together 28% is the total chance after 10 years.

As for the second question, that is applying to high risk disease, and indeed if we feed a high gleason, a high psa and a high tumour stage into the Hopkins calculator we get 72% chance after 10years, which I guess is about 80%chance over 15 years.

So with your diagnosis, and prostatectomy you have a very high chance of no detectable cancer in 10years, you probably have the same chance from RT.

I think realistically anyone with this disease should be thinking not so much about a cure but more about how far we can kick the can down the road.

Life expectancy for a man in the uk is about 85. If you get diagnosed at 65 and you find a treatment which has about 50% chance of holding the cancer at bay for 20 years, you haven't got much to complain about.

If you get diagnosed at 85 I would say you have been lucky to get to that age, sure have treatment you may live longer, but you may just have to bow out gracefully.

Sadly if you get diagnosed at 45 you have been dealt a rotten hand in life. You might make 65, you might even be lucky and be cured. At least you weren't born in Afghanistan, Lesotho or Mozambique where getting to 50 without being shot dead or dieing of malaria, or another tropical disease is unusual. 

Dave

User
Posted 09 Jul 2021 at 01:31
As stated above, the stats are cumulative so over a period of 10 years, there is a 28% probability that the cancer will recur. However, men in the UK do slightly worse that men in America so your chance of recurrence is slightly higher than 28%.

For the second stat, this was specifically related to men with high risk cancer - so they had been diagnosed with high PSA, high Gleason grade and/or T3 or above - it isn't that surprising that so many had biochemical recurrence. Some of the 80% probably didn't even get the initial 'congratulations, the op was successful' conversation but they probably knew that was a risk before they agreed to surgery.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 09 Jul 2021 at 05:14

What I think you have missed is that even if you have biochemical recurrence following prostatectomy after X years, there are many tools in the box to keep it at bay, including hormone and radiotherapies, and various new ‘wonder’ drugs.

Who knows? In ten years time there may be a complete cure for the disease.

I’m three years cancer-free, post-op, but if I look at the Memorial Sloan Kettering Hospital Nomogram prognostication, it doesn’t look too good fifteen years hence, by which time I will probably have died of something else. Am I bovvered? Nah!

Best of luck.

Cheers, John.

Edited by member 09 Jul 2021 at 05:26  | Reason: Not specified

User
Posted 09 Jul 2021 at 06:40

Originally Posted by: Online Community Member

I agree with oldfogey. Don't add the figures together 28% is the total chance after 10 years.

As for the second question, that is applying to high risk disease, and indeed if we feed a high gleason, a high psa and a high tumour stage into the Hopkins calculator we get 72% chance after 10years, which I guess is about 80%chance over 15 years.

So with your diagnosis, and prostatectomy you have a very high chance of no detectable cancer in 10years, you probably have the same chance from RT.

 

Thank you so much, this clears things up a lot. It seems that the "study" was done for especially high risk patients and not my group, therefore the results in study are "worse".

 

Next question: how do I determine the right treatment for me and balance risk % of side effects from both surgery and radiation? Is there some large scale objective recent study comparing the side effects?

And if there is recurrence after radiation, what can be done? They say surgery can't be done, so more radiation can be done or something else? Hormone therapy?

Originally Posted by: Online Community Member
As stated above, the stats are cumulative so over a period of 10 years, there is a 28% probability that the cancer will recur. However, men in the UK do slightly worse that men in America so your chance of recurrence is slightly higher than 28%.

For the second stat, this was specifically related to men with high risk cancer - so they had been diagnosed with high PSA, high Gleason grade and/or T3 or above - it isn't that surprising that so many had biochemical recurrence. Some of the 80% probably didn't even get the initial 'congratulations, the op was successful' conversation but they probably knew that was a risk before they agreed to surgery.

Thank you! Makes sense. Question: do you know where to find link to original study?

 

Originally Posted by: Online Community Member

What I think you have missed is that even if you have biochemical recurrence following prostatectomy after X years, there are many tools in the box to keep it at bay, including hormone and radiotherapies, and various new ‘wonder’ drugs.

Who knows? In ten years time there may be a complete cure for the disease.

I’m three years cancer-free, post-op, but if I look at the Memorial Sloan Kettering Hospital Nomogram prognostication, it doesn’t look too good fifteen years hence, by which time I will probably have died of something else. Am I bovvered? Nah!

Best of luck.

Cheers, John.

Thank you. What made you choose surgery over radiation?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 09 Jul 2021 at 07:29
Quote:

Originally Posted by: Online Community Member

What I think you have missed is that even if you have biochemical recurrence following prostatectomy after X years, there are many tools in the box to keep it at bay, including hormone and radiotherapies, and various new ‘wonder’ drugs.

Who knows? In ten years time there may be a complete cure for the disease.

I’m three years cancer-free, post-op, but if I look at the Memorial Sloan Kettering Hospital Nomogram prognostication, it doesn’t look too good fifteen years hence, by which time I will probably have died of something else. Am I bovvered? Nah!

Best of luck.

Cheers, John.

Thank you. What made you choose surgery over radiation?

I spoke with two surgeons and at least one oncologist (can’t remember if it was two) and they all recommended prostatectomy. A friend with PCa put me on to one of the top surgeons in Europe, and he carried out the surgery on the NHS, which costs twenty grand privately at his clinic.

Unfortunately, he or his bloody robot lopped two inches off my penis and left me with a limp dick, albeit totally continent.😉

I and three friends were all diagnosed with PCa at the same time three years ago, two had surgery by top rated surgeons and one by his local NHS guy. They all had recurrence a few months after the op, and had to undergo adjuvant radiotherapy.

So should they have opted for just RT in the first place?

We are all doing fine now.

Cheers, John.

 
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