Why should nerve-sparing surgery have an effect on PYLL?

I was diagnosed with prostate cancer in October, 2005. My minimally invasive surgery 2 months later was very successful. My PSA since then has remained less than 0.1.

My question, however, is not about me. It’s in regard to a friend of mine who was diagnosed with early stage prostate cancer about 2.5 years ago. I don’t know what his PSA was at the time, nor do I recall his Gleason score or exactly what stage his cancer was, but during his “watch and wait,” period, he has had a few biopsies and several PSAs. The PSA levels have steadily decreased. Because his most recent PSA was down to less than 1.0, his primary care physician told him that he’s now probably cancer-free. Is this possible? Could a biopsy, or repeated biopsies, somehow remove the cancer? Does cancer ever disappear without treatment?

Tom

*****Answer*****

Tom,

Not too likely, even as his overall risk is low (as implied by a low PSA).

Arnon

I would characterize this a rather different way.

It seems to me that there are significant numbers of men who do appear to get good outcomes from HIFU at 5 years, with low to minimal rates of complications. There are also men who get not-so-good or poor results from HIFU because either they get good oncologic results with significant side effects or they get poor oncologic results (with or without significant side effects).

The problem is that we don’t seem to able to know up front who will and who will not do well in order to apply HIFU primarily to those who will benefit the most and with the least risk of complications. This is nothing new in the world of prostate cancer. We see the same problem with almost every form of active primary therapy. And on top of this is the issue of whether the people who do do well on HIFU are, in fact, the men who would have done as well or nearly as well on active surveillance, which is a separate question.

These guys were all palpable tumors, T2s, T3s and T4s.

How do the strong advocates of HIFU explain these discouraging findings? (I’m aware that some centers for HIFU and advocates report results that look good at the 1- and 2-year time points but do not report available results from the same series that turn discouraging at the 5-year point and later.)

*****Answer*****

Thomas,

Have a look at this discussion thread on the social network.

Arnon

The formal results of this trial have still not been published (which is really rather embarrassing in my personal opinion since it is now > 8 months since these data were initially presented). However, these are the data reported by the principal author of the study; he has given the same data at other presentations, and there is no reason to believe they are inaccurate.

You do need to appreciate that the 10-year mortality rate among men diagnosed with low- and intermediate-risk prostate cancer in the PSA era is really extremely low indeed, which is precisely the point behind the conclusions from this study. Why are we aggressively treating men with a reasonable life expectancy of 10 years and less who are actually highly unlikely to die of prostate cancer when they are much more likely to die of other age-related problems first?

I’m not sure of your husband’s age or general health, but 4 weeks post-op is certainly not long enough to be concerned about an erection.

I had DaVinci prostate removal 2 years ago (nerve sparing and localized cancer contained in the capsule) by an excellent surgeon. It took 2 months for total continence to return, and about the same for some rectal pain to subside. To this day an erection without some sort of mechanical intervention is not possible. Shots will do it with no problem, but I do not tolerate those well. I personally prefer a vacuum pump, which does well. I am now — after 2 years — capable of achieving a slightly firm appendage on my own, but it is not sufficient for intercourse. I am 54 years old and in great health and fit. The point is that everyone is different and the recovery period for each will be different. Be patient and support your husband as much as possible through his recovery. There are many ways of achieving closeness and intimacy without the actual act. If you both are anxious, then ask about the injections, because they do work, but don’t let your husband get discouraged because his recovery doesn’t happen as quickly as you or he think it should.

Greg

There were 731 men enrolled.

If 48% of the population died, that’s 351 men.

If “7.1% of those who died were evlauated as having died or probably died of prostate cancer” that’s 7.1% of 351 = 25 prostate cancer deaths in total.

So after 10 years, only 25 men out 731 died of prostate cancer? And half of the 731 weren’t treated?

Something isn’t right.

It kinda depends on the exact nature of your diagnosis. If you join our social netwoek we might be able to give you some assistance in considering your opportunities.