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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[QUOTE=flyfisher37;3778775]Thanks Jim for your reply. You have given me a lot of useful information and hope as well! I do know that my Gleason score was an 8 after my initial biopsy before surgery, although my psa was only 4.1 at that time.

If my psa continues to rise ( I'm getting another test done in a month ), my urologists said I will probably be facing radiation therapy, which doesn't thrill me at all....[/QUOTE]

Hi flyfisher,

You're welcome - glad to help! We are all here for each other!

I'm sorry that you had that Gleason 8 cancer :(, but as you may have learned, your prospects, if the cancer is recurring, include a basis for hope and optimism, along with strong motivation to have some kind of follow-up therapy :cool:. That's the other main value of the Freedland tables as I see it: when they don't reassure, they motivate, giving us a clearer picture whether follow-up therapy is needed.

As daff said, there are good options, and I can add a few. I'll do that in a separate post later today I hope, as this post is mostly about the Freedland tables for your case and I don't want it to be too long.

Here's what the Freedland tables say for Gleason 8 prostate cancer that has recurred 3 years or more after surgery at Johns Hopkins, for different PSA doubling times (PSADT) when the recurrence develops:

PSADT..........% Surviving (Prostate Cancer Specific Survival (Average percent, then ....................95% confidence range)
---------------...--------------------------------------------------
...........................5 Years..........10 Years..........15 Years

>15 months*.......99% (98-99)..96% (93-98)...87 (79-92) :)

9 - 14.9 months...98% (75-100).90 (58-98).....72% (35-92) :)

3- 8.9 months......94% (74-99)...68 (37-89)....30% (10-63)

<3 months**.......83% (52-96)...30 (10-63)....02% (<1-38) :(

* ">" means "greater than"

** "<" means "less than"

You can see that PSADT is very important; in fact it's the most important of the three factors. You can also see that, with decent doubling time, survival was quite good even for Gleason 8-10 patients. :cool:

You will get a better handle on your PSADT after the next PSA test. Since it is such a key indicator, be sure it's done with the same brand of PSA test at the same lab. I hope you see no change, or even a lower figure. (It can happen!)

It's important to keep in mind that these survival figures were developed from a group of men who were treated a number of years in the past. That means those with the more challenging cases were not able to enjoy treatments and approaches that became available later, such as use of bisphosphonate drugs, particularly Zometa for well-advanced cases. The advances are making large, not small, differences in our prospects! :D Also, a peculiarity of surgical treatment of prostate cancer at Johns Hopkins is that hormonal therapy was typically reserved until the patient showed symptoms from recurrence :(. While not yet completely proven, there is accumulating evidence that early hormonal therapy is superior to later therapy. :)

The confidence range, following the average percent: the average projected is sometimes based on many cases, and sometimes on fewer. Obviously, the projection is more reliable if it is based on many cases and if the variation in results is smaller, in contrast to projections based on few cases, especially where the results vary a lot. The 95% confidence range is a statistical tool; it is a sound, highly reliable (95% confidence, 5% possibility that chance is behind the results) estimate that the true result (if all possible cases were studied) would fall in the range. For example, if the result is "99% (98-99)," as it is for Gleason of 8-10, recurrence at three years or more, and PSADT greater than 15 months, we have 95% confidence that the true result is 98% or 99%. This contrasts with the result for Gleason of 8 or higher, recurrence at 3 years or more, but PSADT of less than 3 months. While survival of 83% is projected, the true value is between 52% and 96%. It is clear that not that many cases fell in this category, and they probably had a wide variation in outcomes.

It is also clear that some men were able to do quite well even when they were in an unfavorable survival category, as is indicated by the upper limit of each confidence range in those categories. I am keenly aware of this kind of thinking, as two doctors well respected in prostate cancer circles (one at Johns Hopkins, the other at the City of Hope, Duarte, CA), gave me a prognosis of five years back in late 1999/January 2000. Obviously, I'm doing a lot better than they thought I would do! :cool: I'm thoroughly convinced we can do a lot to affect our prospects.

Do you know how much your PSA rose in the year before diagnosis when it was at 4.1? That's another important clue.

To be continued,

Jim





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