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Choosing not to treat, with localized p.c.

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User
Posted 09 Jan 2024 at 22:28

Food for thought. 

After 15 years, no difference in mortality by those who chose to treat the Cancer aggressively and those who chose to do nothing,  or am I missing something?

https://www.ox.ac.uk/news/2023-03-13-study-shows-delaying-treatment-localised-prostate-cancer-does-not-increase-mortality

User
Posted 09 Jan 2024 at 22:28

Food for thought. 

After 15 years, no difference in mortality by those who chose to treat the Cancer aggressively and those who chose to do nothing,  or am I missing something?

https://www.ox.ac.uk/news/2023-03-13-study-shows-delaying-treatment-localised-prostate-cancer-does-not-increase-mortality

User
Posted 10 Jan 2024 at 17:36

Re 15 years you need to add in the fact that most men diagnosed with PC are over 70. So chances are they won't get 15 years regardless.

I doubt you would get the same result if you only included those diagnosed in their 50s.

There is another study that shows anyone who has a prostatectomy will live longer than healthy men who don't.

You can prove anything with the right stats.

The nomograms available here are fun to play with:

https://www.mskcc.org/nomograms/prostate

 

Edited by member 10 Jan 2024 at 17:38  | Reason: Not specified

User
Posted 10 Jan 2024 at 18:45
So long as it's after the fact I'm cool with that. 😂😂
User
Posted 10 Jan 2024 at 19:36

My very subjective and individual point of view with a bit of my own experience: 

1) Biopsies, as explained above, have a relatively reasonable chance not to nail  100% the exact Gleason Score based on the samples they takeThere are many cases where stage and Gleason score change after the surgery vs the biopsy. So the point of AS relies somehow on the assumption the biopsy provides a 100% clear picture of the situation. This is not necessarely the case.

2) There might be progression during AS and the rate of progression is always at best an educated assumption, not a certainty. 

3) Would I like to leave a cancer inside my body? for me the clear answer would be no. 

4) AS is very effective because it brings down the costs and, at least short-term, the stress of the patient. But the truth is that the full risk is carried out by the patient on all the variables mentioned above. 

If I had been Gleason 3+3, no doubt I would have gone for treatment, with all these elements and risks at stake.

Edited by member 10 Jan 2024 at 19:38  | Reason: Not specified

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User
Posted 10 Jan 2024 at 14:53

Indeed, food for thought, that has already been nibbled at on here. I posted a link to the same source a couple of months ago.

The ProtecT results were one of the reason that in December 2020, when I was first diagnosed with PSA 5.6, T2a staging, Gleason 6(3+3) low volume and density with reasonable safety margins, Grade 1, low risk,  that I followed MDT meeting advice and opted for active surveillance.  

My PSA 3 monthly checks remained relatively stable. However, 20 months later, a follow up MRI and biopsy, revealed extensive disease progress, PSA 6.6, T3a capsule breached, bilateral disease, Gleason 8(3+5) high volume and density from 20 out of 24 cores, Grade 4, high risk.

Pathology after prostatectomy revealed the disease was even more extensive and Gleason 9(4+5) Grade 5

I believe 30% of men on AS will suffer disease progression and will require radical treatment.

Sorry for repeating my tale of woe but its taking much longer to heal than the surgery. 🙂

Edited by member 10 Jan 2024 at 17:57  | Reason: Add link

User
Posted 10 Jan 2024 at 17:36

Re 15 years you need to add in the fact that most men diagnosed with PC are over 70. So chances are they won't get 15 years regardless.

I doubt you would get the same result if you only included those diagnosed in their 50s.

There is another study that shows anyone who has a prostatectomy will live longer than healthy men who don't.

You can prove anything with the right stats.

The nomograms available here are fun to play with:

https://www.mskcc.org/nomograms/prostate

 

Edited by member 10 Jan 2024 at 17:38  | Reason: Not specified

User
Posted 10 Jan 2024 at 17:54

Originally Posted by: Online Community Member

You can prove anything with the right stats.

As Mark Twain said, "Lies, damned lies, and statistics."

PS:  Jonathan.  Thanks to your advice, my run of successful Invicorp erections continues. Is it wrong, that when I have decent sex, I think of you. 

Edited by member 10 Jan 2024 at 18:03  | Reason: Not specified

User
Posted 10 Jan 2024 at 18:41

Originally Posted by: Online Community Member

... those who chose to treat the Cancer aggressively and those who chose to do nothing...

"Do nothing" that is not the right choice of words, they chose to "monitor the cancer" many of them then went on to have aggressive treatment at some point in the study period. So they did not "do nothing".

Those in the group who monitored the cancer were more likely to then find it had metastasized at some point, which implies Active Surveillance doesn't always catch things as early as one would want.

I would hazard a guess that those now with metastatic cancer won't be best pleased with their situation, even though they are still alive 15 years after diagnosis.

So I think the study does show some negatives of AS. You may not be dead after 15 years, but you may be worse from a disease point of view than if you had aggressive treatment.

A big advantage of delaying treatment is that you delay the nasty side effects like impotence and incontinence, so AS is very good from that point of view. If you are unlucky it will result in worse disease many years down the line, but on balance it is probably worth the risk if it is offered to you.

Dave

User
Posted 10 Jan 2024 at 18:45
So long as it's after the fact I'm cool with that. 😂😂
User
Posted 10 Jan 2024 at 19:36

My very subjective and individual point of view with a bit of my own experience: 

1) Biopsies, as explained above, have a relatively reasonable chance not to nail  100% the exact Gleason Score based on the samples they takeThere are many cases where stage and Gleason score change after the surgery vs the biopsy. So the point of AS relies somehow on the assumption the biopsy provides a 100% clear picture of the situation. This is not necessarely the case.

2) There might be progression during AS and the rate of progression is always at best an educated assumption, not a certainty. 

3) Would I like to leave a cancer inside my body? for me the clear answer would be no. 

4) AS is very effective because it brings down the costs and, at least short-term, the stress of the patient. But the truth is that the full risk is carried out by the patient on all the variables mentioned above. 

If I had been Gleason 3+3, no doubt I would have gone for treatment, with all these elements and risks at stake.

Edited by member 10 Jan 2024 at 19:38  | Reason: Not specified

User
Posted 10 Jan 2024 at 20:23
Quote:

PS:  Jonathan.  Thanks to your advice, my run of successful Invicorp erections continues. Is it wrong, that when I have decent sex, I think of you. 

Yes it is very wrong on many levels, but like a lot of the information on this community, it was and always will be very helpful, (and funny), so we're all good. 

 
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