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Have been cruising through several Prostate Cancer websites that seem to have the same statistical message when it comes to performing pathology on prostates of men in their 50 & 60s that died of unrelated causes. Seems that around 30% of them already have some level of cancer cells already detectable as found during the pathology review. That would leave me to speculate that if several hundred men aged 50+ to 60 or so were to have a fairly saturated biospy say 20 cores or so, 20% or so would have detectable cancer in their results. Now, without being able to differentiate between dangerous vs. non-dangerous forms, the initial fear factor at diagnosis could result in many unnecessary or premature cure treatments such as the radical prostectomy. I think the medical community owes the prostate cancer patient a better read at diagnosis to avoid these situations, otherwise it could be just done to make the surgeon/oncologist richer.
According to some studies you're a bit under in your calculations.
There is a general acceptance that the percentage of men with cells identifiable as "prostate cancer" is roughly equal to their age - so about 60% of men in their 60s, 70% of men in their 70s and so on might be found to have these 'cancer cells' if their prostate gland was examined thoroughly (it would have to be removed first of course!) You make a good point about the effect of a saturation biopsy, which would undoubtedly find many of these cells. The first oncologist I saw back in 1997 said, in his opinion, by the time men hit 80 the incidence of 'prostate cancer' would be about 100%.
It is because of this disparity betwen the number of men with these cells and the number of men who die from the disease that it is said that more men die WITH prostate cancer than FROM prostate cancer. the percentage of male deaths from prostate cancer in the US is about 3% - compare that to an estimated incidence of 30% or higher!
You are also right when you say that better tests are required to distinguish between the dangerous forms of the disease that WILL kill you and those that won't. But there is not much incentive to come up with a test that would decimate a very profitable business.
But there is a huge incentive (nobel prize) and billions of dollars for any company that can come up with a test to tell you if you have a deadly form of cancer. The reason there is no test yet is because the problem is very difficult.
You have to know the genetic makeup of every cancer cell in your body because you may have 99.999% non-killer cancer cells but it is the 0.001% that will still kill you. Not only that but the non-killers can mutate into killers.
So where does that leave the person with a low risk initial diagnosis on whether or not to follow active surveillance or choose radical treatment? The only answer I have found that makes sense requires very close monitoring & more frequent biopsy follow up for active surveillance vs. just going for a treatment which has undesirable side effects. But yet there is experts in this field who now claim that not all prostate cancer diagnosis require treatment, especially low risk graded tumors. I can only conclude that there is not a clear case for supporting active surveillance as a good decision long term (even in initial low risk patients) without more definitive means to score the nature of the cancer's potential behavior. Not a very comforting thought if you are thinking of following this path, thanks for the feedback!
Tom,
I saw a survey of doctors' attitudes towards medical treatments and doctors will generally recomend more aggressive treatment for their patients but have less aggressive treatment for themselves. When you know what the side effects are like you are willing to gamble a little on quantity of life for better quality it seems, at least for doctors.
If you are Gleason 6, low percentage of cancer, low PSA and your doctor agrees then just go with active surveillance. There will probably be far better treatments with no side effects by the time you might need it. Also, eat a prostate healthy (also known as the heart healthy)diet from now on. Try it for a year, you can always change your mind.
Thanks for the feedback Frank, I am considering just doing the AS for a while with the monitoring that goes with it. In the meantime I am looking for a better test to give me a read on the total amount of cancer in my Prostate & the aggressive nature of it.
The biopsy does a pretty good job at total amount of cancer in the prostate and the Gleason Score is not bad at determining how aggressive the cancer is. After three biopsies over a few years you will probably have as good an idea as any new techniques coming out in the next 5 years but who knows?
Remember, almost nothing is certain in cancer analysis and treatment. That is why doctors always try to avoid answering the question "how long do I have to live?"
There was a conference on AS - a first! - held earlier this month. Jon Nowlin (who has been practising AS for five years now - a third of my fifteen years) posted an excellent summary of the conference which I posted here under the header NIH conference on Active Surveillance and Dr Meyers video - there it is down below.
Although there is, as ever, a considerable disagreement among the 'experts', there seems little doubt that there is in fact a clear case for supporting active surveillance as a good decision long term for the right diagnosis.
I guess it depends how you define 'long term'. When I was diagnosed in 1996,'long term' was said to be five years!! So my fifteen year survival is a deal longer than that and I think I may make twenty if my heart condition doesn't get me first:-)
