My first contact with a urologist was a couple of years ago when my PSA went up. He wanted to do a full biopsy. I countered that I’d like to try an MRI. It showed no cancer. Another a year later showed a mark which led to a fusion biopsy. The results were Gleason 3+3. I asked about AS. He told me it’d be too hard to manage. Next, he had my wife and I meet a radiologist who explained radiation. As I was leaving the office I saw the urologist and he asked if I’d like hormone shots today? I left this practice and found another who told me I was a good candidate for AS. My recent work history was in spiritual care in nursing homes and a hospital. You learn the importance of advocating for yourself. Like many things in healthcare, this news is important to those with lo grade prostate cancer.
Interesting and encouraging piece Howard. However AS still appears not to be a slam dunk....it may also depend on who the patient is (compliance) and who is doing the monitoring or what protocols are being followed with the monitoring.
Well stated, Howard, "risk of treatment v. lower risk of metastasis with surgery or radiation." How is it we die in this nation judged low risk? Peter Albell, EAU's Scientific Congress Office and German urologist, states, to paraphrase, "Still don't know enough about biology of this disease." What is unequivocal, is, the power of this newsletter not only to spread the word but equally, to elicit response, worldwide. Thanks, Igor! And to each respondent here, thank you also.
I asked my urologist Dr. Brian Helfand, an AS guru from NorthShore University Health system outside Chicago, to comment: "This is a study that was designed many years ago. Therefore, this trial represents 15-year data .which is important to obtain for prostate cancer trials since the tumor growth rate is slow.
"It is important to understand that subjects in this trial were randomly assigned to one of three groups: active surveillance, surgery and radiation. The active surveillance arm is different from many protocols today. Nonetheless this study shows that for many men with low-risk and favorable intermediate-risk prostate cancer, you can achieve similar cancer outcomes whether you watch patients or provide definitive treatment. However, while it did not reach statistical significance, there is about a twofold lower risk of metastasis and dying from prostate cancer with surgery or radiation. These differences were more prevalent in men with intermediate-risk disease. However, this potential benefit should be weighed against the risks of treatment."
What this study lacks unfortunately, is a random comparison of men who NEVER treated compared with treated men and how many untreated men would have ended up on Hormone Therapy at 15 years. Suppose that number would be less than 20% (compared with 7.2% for surgery and 7.7% for radiation) I think some men, including myself, might give up further Prostate Cancer Testing entirely and the anxiety that comes with it.
This quote is from the NEJM article regarding the 3 control groups (AS, PT, RT) at 15 years:
"Long-term androgen-deprivation therapy was initiated in 69 men (12.7%), 40 (7.2%), and 42 (7.7%), respectively"
Howard, Thank you so much for this info, great news!
It's a pity that most of Moscow's urologists can't read this because at time being, they don't accept AS protocol for men even with low and favorable intermediate PC risk (Gleason 3+3 and 3+4)... Regards from Moscow, Russia.
Steve, I don't the studies by heart. But I know of similar studies in Canada. My urologist in 2010--my second opinion--cited a study by Dr. Klotz as I recall showing a 5-year survival rate for men on AS, surgery or radiation. Howard
The WSJ headline is worthy of the Daily Mail ... sensational and confusing!
I've already had men contact me asking why they got treated .... simple answer - you had more aggressive disease.
Protec-T is very helpful in supporting wider spread implemementation of AS for suitable candidates. Take note AUA!
What I am not sure Protec-T asked - and I plan to spend more time looking at the study this morning - is whether men who elected interventional treatment had lower levels of anxiety than those on AS.
Thanks to an eagle-eyed reader, I had to update some figures. When I was diagnosed after a rising PSA with a single tiny core of low-risk Gleason 6 cancer in 2010, I faced a dilemma--one urologist was urging me to undergo aggressive treatment--which 94% of us with low-risk disease did then--or roll the dice on AS, a then little used protocol of close monitoring with PSAs, MRIs and biopsies on a regular basis. (Today, the proportion who choose to be treated is 40%—better but still high compared to the 6% in Sweden and 9% in Michigan.) I shouldn't be writing at 4 a.m.
My first contact with a urologist was a couple of years ago when my PSA went up. He wanted to do a full biopsy. I countered that I’d like to try an MRI. It showed no cancer. Another a year later showed a mark which led to a fusion biopsy. The results were Gleason 3+3. I asked about AS. He told me it’d be too hard to manage. Next, he had my wife and I meet a radiologist who explained radiation. As I was leaving the office I saw the urologist and he asked if I’d like hormone shots today? I left this practice and found another who told me I was a good candidate for AS. My recent work history was in spiritual care in nursing homes and a hospital. You learn the importance of advocating for yourself. Like many things in healthcare, this news is important to those with lo grade prostate cancer.
Good points, Anthony. Race can be an issue. Also, anxiety, family pressures not a slam dunk. Howard
Interesting and encouraging piece Howard. However AS still appears not to be a slam dunk....it may also depend on who the patient is (compliance) and who is doing the monitoring or what protocols are being followed with the monitoring.
Thanks, Steve. Appreciate the support. Howard
Well stated, Howard, "risk of treatment v. lower risk of metastasis with surgery or radiation." How is it we die in this nation judged low risk? Peter Albell, EAU's Scientific Congress Office and German urologist, states, to paraphrase, "Still don't know enough about biology of this disease." What is unequivocal, is, the power of this newsletter not only to spread the word but equally, to elicit response, worldwide. Thanks, Igor! And to each respondent here, thank you also.
I asked my urologist Dr. Brian Helfand, an AS guru from NorthShore University Health system outside Chicago, to comment: "This is a study that was designed many years ago. Therefore, this trial represents 15-year data .which is important to obtain for prostate cancer trials since the tumor growth rate is slow.
"It is important to understand that subjects in this trial were randomly assigned to one of three groups: active surveillance, surgery and radiation. The active surveillance arm is different from many protocols today. Nonetheless this study shows that for many men with low-risk and favorable intermediate-risk prostate cancer, you can achieve similar cancer outcomes whether you watch patients or provide definitive treatment. However, while it did not reach statistical significance, there is about a twofold lower risk of metastasis and dying from prostate cancer with surgery or radiation. These differences were more prevalent in men with intermediate-risk disease. However, this potential benefit should be weighed against the risks of treatment."
Igor, maybe you can find a sympathetic doctor on Moscow? Meanwhile, stick with us. Howard
What this study lacks unfortunately, is a random comparison of men who NEVER treated compared with treated men and how many untreated men would have ended up on Hormone Therapy at 15 years. Suppose that number would be less than 20% (compared with 7.2% for surgery and 7.7% for radiation) I think some men, including myself, might give up further Prostate Cancer Testing entirely and the anxiety that comes with it.
This quote is from the NEJM article regarding the 3 control groups (AS, PT, RT) at 15 years:
"Long-term androgen-deprivation therapy was initiated in 69 men (12.7%), 40 (7.2%), and 42 (7.7%), respectively"
Howard, Thank you so much for this info, great news!
It's a pity that most of Moscow's urologists can't read this because at time being, they don't accept AS protocol for men even with low and favorable intermediate PC risk (Gleason 3+3 and 3+4)... Regards from Moscow, Russia.
Steve, I don't the studies by heart. But I know of similar studies in Canada. My urologist in 2010--my second opinion--cited a study by Dr. Klotz as I recall showing a 5-year survival rate for men on AS, surgery or radiation. Howard
This is good news for those of us on AS.
Are there any other studies that confirm the same? What have studies in the US shown?
The WSJ headline is worthy of the Daily Mail ... sensational and confusing!
I've already had men contact me asking why they got treated .... simple answer - you had more aggressive disease.
Protec-T is very helpful in supporting wider spread implemementation of AS for suitable candidates. Take note AUA!
What I am not sure Protec-T asked - and I plan to spend more time looking at the study this morning - is whether men who elected interventional treatment had lower levels of anxiety than those on AS.
Thanks to an eagle-eyed reader, I had to update some figures. When I was diagnosed after a rising PSA with a single tiny core of low-risk Gleason 6 cancer in 2010, I faced a dilemma--one urologist was urging me to undergo aggressive treatment--which 94% of us with low-risk disease did then--or roll the dice on AS, a then little used protocol of close monitoring with PSAs, MRIs and biopsies on a regular basis. (Today, the proportion who choose to be treated is 40%—better but still high compared to the 6% in Sweden and 9% in Michigan.) I shouldn't be writing at 4 a.m.