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I've been meaning to ask you this for a while (because, every now and then, I read statements like this one that you made earlier today: “Remember that in ten years, when you may need treatment, the treatment will be better and the side effects less”). In fact, I went back and briefly searched through the archives and found two more with very similar wording. On April 2, 2014, you said: “…in 12 years there is a good chance that there will be treatments and possibly a cure that has no really bad side effects”. Finally, just a little over a year ago on November 1, 2013, you had this to say: “One thing I like men to remember that barely have prostate cancer (like yours) is that it will be at least 10 years before it might become life threatening and by that time there will be better treatments with lesser side effects”.
My point is this. You seem so certain that there are better treatments to come that have less side effects, and you even go so far as to put these advancements on a timetable. Can you tell me what you base these rather bold predictions on? Is it simply that you are taking the successes to date in these areas and extrapolating this progress into the future, or do you know something that I (and maybe other readers of this forum) do not?
It is clear from reading your posts that we both support AS for the right individuals. Where we differ, unless you can give me tangible evidence to back up your predictions, is that I see you possibly pinning the hopes of these men on advancements in these areas that may never come in the next decade. In other words, I would like to see these men on AS monitor their cancer and seek treatment if and when there are signs of progression, and not push the envelope by waiting too long for improvements that do not come soon enough.
Please understand that there is no disrespect meant in writing this post. I am actually hoping to learn something that I did not know from your answer. Otherwise, it is simply a difference of opinion that will allow readers to decide for themselves what mindset they choose to follow.
The timetable is set by when I estimate the person I am talking to will need treatment to stay alive and not when a cure is available.
There is progress being made every day. Most of my information comes from the research papers available through the PubMed site and conferences. I am not a doctor or a reseach scientist at a major drug company.
With the new drugs that have come out in the last two years PC is getting close to being a curable/chronic condition and not a deadly one for most men. At my local cancer center they have just started to using gentic testing for PC cases to see if they can come up with the best treatment protocol depending on the genetic makeup of the PC cells.
I agree with you that if AS is showing a GS 4 & 3 or any of the other indicators that the cancer is getting aggresive one should get treated. I think you would agree that the treatment you receive in 10 years will be better than the one you would receive today.
You may find some of my early posts with Terry where we discuss mortality statistics. My point was that your chance of dying from PC is a lot higher than 1 in 36 once you have already been diagnosed with cancer so I am an ACTIVE Surveilance proponent and not the "ignore and hope it will go away" type.
Interesting discussion. I agree that new therapeutics including current in phase 3 trials will greatly improve the overall disease free progression and quality of life for persons being treated with advanced PCa. However how many of us would be prepared to stay on AS until such time as advanced PCa becomes apparent?
Thank you for your reply. I only have this to say in response. You said “I think you would agree that the treatment you receive in 10 years will be better than the one you would receive today”. To that I say: while I believe that is likely to be the case, I would not go so far as to bet my life on it…which, in a nutshell, is the point I was making earlier. In other words, in the face of evidence of possible progression, I would not delay treatment in favor of holding out for a better one down the road. I hope we are both in agreement on that.
Below is a snippet from the Australian Cancer Council.
Active surveillance entails close follow-up of patients diagnosed with low-risk prostate cancer. The objective is to avoid unnecessary treatment of men with indolent cancer and treat only those who show signs of disease progression, to avoid treatment-related effects that may reduce quality of life. Definitive therapy is offered at a time when disease progression is detected and cure is deemed possible.
The optimal protocol for active surveillance is uncertain. Monitoring usually involves prostate specific antigen (PSA) testing, digital rectal examination (DRE), prostate biopsies, and, in specialised centres, consideration of multi-parametric prostate magnetic resonance imaging (MRI). Evidence is lacking about the optimal frequency of monitoring and the most appropriate triggers for intervention. Whilst many active surveillance protocols have been reported in the literature, these vary in their inclusion criteria and monitoring procedures. To date, these active surveillance protocols have not been validated in randomised controlled trials. More importantly, they have not been examined with respect to overall and/or prostate cancer-specific mortality.
John,
This is a copy of Roger's post above that is very relevant to this thread:
Another report on Active Surveillance
I found this report interesting:
Prostate Cancer Surveillance Appears Safe Through 15 Years
Frontline Medical News, 2014 Dec 15, MA Moon NEWS
Dr. Laurence Klotz
Active surveillance appears to be safe through 15 years of follow-up for men who have low-risk prostate cancer, according to a report published online Dec. 15 in the Journal of Clinical Oncology.
In extended follow-up of a prospective cohort study begun in 1995, 993 men (current median age, 68 years; range, 41-89 years) with low-risk prostate cancer were assessed. Active surveillance consisted of PSA testing every 3 months for the first 2 years after diagnosis and then every 6 months thereafter, with repeat biopsy at 1 year and then every 3-4 years until the age of 80. These study participants were offered radical intervention only if the disease showed signs of progression, said Dr. Laurence Klotz of Sunnybrook Health Sciences Centre, University of Toronto, and his associates.
A total of 149 patients died, 819 were alive, and 25 were lost to follow-up. Only 15 men (1.5%) died from prostate cancer, and an additional 13 men with confirmed metastases either are alive (9 patients) or died from other causes (4 patients). Overall, the risk of dying from another cause was nearly 10 times greater than that for dying from prostate cancer (HR, 9.2). Even among men younger than 70, who had lower competing risks of death from other causes than older men, the risk of death from another cause was almost six times greater than that for death from prostate cancer (HR, 5.8), the investigators said (J. Clin. Oncol. 2014 Dec. 15 [doi:10.1200/JCO.2014.55.1192]).
The rate of patients who developed PSA failure during follow-up was 2.8% at 5 years and 10.2% at 10 years after diagnosis. These outcomes are consistent with those in low-risk patients managed with initial definitive intervention such as radiotherapy and surgery, Dr. Klotz and his associates added.
This study was supported by the Prostate Cancer Research Foundation of Canada. Dr. Klotz and his associates reported having no financial conflicts of interest.
