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Old 06-28-2007, 01:53 PM   #1
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Prostate Cancer - Life Expectancy

Here's a shot in the dark!

Does anybody know where I can find out the statistics regarding average longevity of a prostate cancer victim after their various treatments as compared to watchful-waiting?

Does that make sense?

 
Old 06-28-2007, 03:02 PM   #2
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Re: Prostate Cancer - Life Expectancy

The question is so general that it would have little relevance to know such figures which would include those diagnosed in various stages, general health, ages, etc. There are stats for specific types. I earlier posted one set, as follows:
People who reach a nadir of minus .10 to plus .10 and remain in that range have an unchanged life expectancy when compared to those with no PC. Among those who have a biochemical recurrence (Two consecutive PSA readings of .20), 50% will not go above .20 (Treatment is typically begun at
.40). Among the 50% whose PSA continues to climb, the median time for metastases is eight years, with death five years after that.
There probably are other studies that are similar or that contrast at least to some degree, but these are the best stats I have found regarding prostatectomy.

 
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Old 11-18-2007, 07:36 PM   #3
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Re: Prostate Cancer - Life Expectancy

Quote:
Originally Posted by Flyfisher View Post
...
People who reach a nadir of minus .10 to plus .10 and remain in that range have an unchanged life expectancy when compared to those with no PC. Among those who have a biochemical recurrence (Two consecutive PSA readings of .20), 50% will not go above .20 (Treatment is typically begun at
.40). Among the 50% whose PSA continues to climb, the median time for metastases is eight years, with death five years after that.
There probably are other studies that are similar or that contrast at least to some degree, but these are the best stats I have found regarding prostatectomy.
This thread caught my eye as I'm getting familiar with the board by reading older posts. This post caught my eye because there is better, much more optimistic information, though I think I understand generally where your numbers came from: RP patients that recur without much of an attempt to combat the recurrence other than the limited chemo available a decade ago, which makes little sense to me. I've been interested in prognosis since diagnosis in late 1999 with a challenging case - initial PSA 113.6 and a rock hard prostate, etc. - and two respected doctors giving me three good years and two declining years. Of course, that prognosis is now out the window.

As I near the eight year point doing great with a fine quality of life, I've concluded that it is very difficult to give a reliable estimate in 2007 because so much progress is being made, assuming that patients will take advantage of that progress, and because pessimistic estimates by doctors often seem to be based on their failure to keep up with progress outside their own specialty.

One correction - the PSA nadir (low point) cannot be less than zero, so it cannot be negative. Also, different institutions and different studies have different definitions of recurrence, though many use hitting .1 or .2 on one or repeated tests after an RP.

Patients on triple hormonal blockade, my therapy, and one often used to combat recurrence, typically are able to use it effectively for ten to eleven years according to some doctors with long experience with that approach, before having to move on to second line hormonal therapy (often ketoconazole with hydrocortisone). One study, with a highly respected senior author, of patients treated basically in the 1990s found that once patients finally no longer would respond to hormonal blockade (the hormone refractory stage), they survived an average of 40 months if they did not have bone metastases at that time and 68 months if they did not have bone metastases then. Another study with a highly respected senior author but different patients found similar results. This does not even consider that radiation may be tried and work for a while before hormonal blockade, and it does not consider that substantial advances are being made almost yearly with drugs that can be used for late-stage patients (for example, Leukine) and with chemo drugs and chemo combinations. Other approaches are also being tested.

You can see that if a patient goes through all these stages and you add up the years, you get a pretty substantial number of years.

Jim

 
Old 01-18-2008, 04:20 AM   #4
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Re: Prostate Cancer - Life Expectancy

Hi everyone
i have just joined the forum, thanks everyone

I have Prostate cancer. I am 47. By the time it was detected it was in my every bone. I was treated with Harmone blockers. PSA went down to 0.6. in July 2007. When this was detected in Oct2006 psa was 63.

In Nov, i got my pain back and PSA got upto 20. Doctors decided to put me on docetaxel (Taxotare). the first dose was given on 17 dec 07, the second on 5 Jan 08. next is on 28 Jan 08. Besides, 10 mg 3 tabs per day of prednisolone for 3 days after the chemo.

Anybody has anything that would help me
How long will i live?

Pradeep

 
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Old 01-18-2008, 05:28 AM   #5
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Re: Prostate Cancer - Life Expectancy

be alert; this is off topic -- i'd wondered why we'd seen nothing from the ol' flyfisher in a while, and i see on this thread that he's listed as banned. i must have missed that. does anyone recall why he was banned?

i hope he's doing well -- he and i are contemporaries in this journey. following his progress and hearing him encourage me was quite a help to me.

 
Old 01-18-2008, 08:09 AM   #6
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Re: Prostate Cancer - Life Expectancy

Quote:
Originally Posted by gpradeepraj View Post
Hi everyone
... I have Prostate cancer. I am 47. By the time it was detected it was in my every bone. I was treated with Harmone blockers. PSA went down to 0.6. in July 2007. When this was detected in Oct2006 psa was 63.

In Nov, i got my pain back and PSA got upto 20. Doctors decided to put me on docetaxel (Taxotare). the first dose was given on 17 dec 07, the second on 5 Jan 08. next is on 28 Jan 08. Besides, 10 mg 3 tabs per day of prednisolone for 3 days after the chemo.

Anybody has anything that would help me
How long will i live?

Pradeep
Hello Pradeep,

My wife and I traveled to Europe last year and our seat mate was a woman from your city who was working at a hospital near me in Virginia. She was going back to visit her family. As I remember it, it was cold in Virginia, requiring heavy coats, but it was going to be very hot when she reached her destination. She was a wonderful seat mate.

I'm sorry you got such a virulent case of prostate cancer at a young age. I was somewhat older when I was diagnosed, age 56, in late 1999. I had a challenging diagnosis but not as challenging as yours (PSA 113.6, all biopsy cores positive with Gleason 7, but no detectable metastasis). My story and a followup are posted starting 11/20/2007 and 12/7/2007.

You may already know this, but your treatment matches the standard of care in the US for men in your situation: docetaxel plus prednisone. That was proven just in the past few years to have a survival advantage of several months over the older standard of care, mitoxantrone plus prednisone. Some survivors misunderstand that they will only live several months longer if they take the drugs and have to endure all the side effects. That's not so. What it means is that even the previous standard of care resulted in a survival advantage, but that the now current combination is several months better than the previous standard. I went to the US Government website [url]www.fda.gov[/url], for our Food and Drug Administration, and got a lot of hits by searching for " "prostate cancer" docetaxel prednisone ". The FDA has abundant information available that I plan to review more fully if I someday need this therapy.

However, the "length of survival" data leave out a vitally important part of the story. That's because what you see in most tables are reports of "median" survival, which as you probably know is the break point where half the patients do better and half do worse. That median information would be fine, except that typically in trials many patients simply do not respond to a therapy, or they have a minimal response, yet they are included in the statistics and graphs, and this waters down the survival advantage so that it does not look as large. (As I understand it as a layman with no enrolled medical education, doctors can spot non-responders fairly quickly and should then try something different.) For those that do respond, it would be most helpful to us to know the median survival of just those patients who had a substantial response. It would also be most helpful to see survival graphs charted only for patients who had a substantial response.

I was privileged to be a survivor representative at a medical conference that included many leading prostate cancer researchers, and I was able to raise this issue with some leading researchers. They reacted with great interest, not previously realizing the importance of this information to survivors considering therapies, so I'm hopeful for the future. Unfortunately, I don't think you will see that kind of information in most past trial reports or in FDA hearing records, and it will probably still take some time before the idea takes hold.

Let me ask you a question or two about your hormonal blockade that no longer seemed to work. In the US there is a problem in that most doctors administering blockade therapy to patients are urologists rather than oncologists, and they generally are not well informed on managing blockade therapy. For instance, they will often not test for testosterone levels at all to see if the blockade is working, and if they do, they tend to use a level of below 50 ng/dl as an indicator of success instead of below 20 ng/dl. If the therapy is not working sufficiently, many are unaware that they can decrease the interval between shots for Lupron or Zoladex, or correct administration errors such as injecting into fat instead of muscle, expulsion of the Zoladex plug, or improper mixing or preservation of the drug before administration. Oncologists are usually much more knowledgeable in administering this therapy. I'm thinking you are seeing an oncologist now, so these things may not be issues. Was your testosterone level tested before your doctor determined that hormone therapy was no longer adequate?

Another issue is incomplete hormonal blockade. While the LHRH-agonist (Lupron, Zoladex, Trelstar, Viadur, Eligard) takes care of testicular testosterone if properly administered with interval adustment if needed, the adrenal glands also produce a typically small amount that is not addressed by the LHRH-agonist. In many men that small amount may not do much harm, but in some men, an abnormally large amount is produced when the body senses that testicular testosterone has been shut down. The adrenals can account for up to 40% of normal testosterone, and if that happens, it will wreck a hormonal blockade therapy program.

The solution is an antiandrogen drug, preferably in the US Casodex (bicalutamide), with flutamide if that is not feasible, at a dose of 150 mg/day for metastatic or risky cases, from what I've heard (remember I'm a layman not a doctor). Even then, a small amount of testosterone still often gets by, and some of it is converted to dihydrotestosterone, DHT, which is far more harmful than testosterone, up to ten times more efficient at fueling prostate cancer in some men. That conversion can be virtually shut down by 5-alpha reductase inhibitor (5-ARI) drugs, either finasteride (the older drug), or Avodart, which appears to be superior to finasteride. That triple therapy (LHRH-agonist, antiandrogen, and 5-ARI) has been my therapy on an intermittent basis. Some men with fairly widespread metastases have had impressive responses, though typically that therapy is more effective when the cancer is at an earlier stage.

This is already long, but if you are interested, I could pass on some thoughts about drugs like Zometa that help preserve bone density while sometimes stabilizing or even reversing bone metastases, and other drugs that have sometimes produced dramatic responses in late stage patients, drugs like leukine. Nutrition, exercise and stress reduction also appear to play a strong supportive role.

I get a lot of my information from leading doctors who take the time to communicate to groups of patients, but I confirm much of what I hear and read from evidence from the same research reports that doctors study, available on [url]www.pubmed.gov[/url], the US Government's National Library of Medicine site that covers published research from all over the world, making free abstracts of studies available. To me this is one of my country's great gifts to the world, and in a way it is a partial repayment for all the benefits my country has enjoyed from the talents of people coming here from all over the world, especially including your country.

With all the resources now becoming available to late stage prostate cancer patients, I think it is very difficult to say how many years you will have. It is quite possible that the time you gain because of your current therapy will enable you to live to take advantage of another therapy that does not yet exist.

I hope this helps, and I hope your therapy is successful.

Jim

 
Old 01-21-2008, 10:32 AM   #7
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Re: Prostate Cancer - Life Expectancy

Dear pradeep
sorry to read your story i have the same prognosis except no metastatis or lymphnode involvement -- i had a pre psa of 55 - went thru rp/radiation/2 years of hormone tretment with calutide and lupron and chemo with taxotere and prednisone.. my psa post surgery is .05 but has gone to .10 last report doubling time of 18 months.. i think you would be better to combine taxoter with another chemo drug - that is what my oncologist had recommended.. hang in there -- enjoy every day of your life-- you are almost same age is myself-- i found out mar 06 at 46years ...check about vaccine treatment ... that does give some extra time

pkpatel

 
Old 01-21-2008, 11:06 AM   #8
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Re: Prostate Cancer - Life Expectancy

Quote:
Originally Posted by gpradeepraj View Post
How long will i live?
I have nothing to sell so I'll be brief...

Try a web-search for...

"Sloan-Kettering - Prediction Tools: Prostate Cancer"

I found it to be pretty helpful.

Best wishes!
__________________
robotic LRP; Jan2007

Last edited by able5; 01-21-2008 at 01:16 PM.

 
Old 01-21-2008, 03:45 PM   #9
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Re: Prostate Cancer - Life Expectancy

Have you tried Strontium 89, a radioactive isotope which is effective in retarding bone metastases and alleviating the bone pain? Find a radiologist/oncologist to administer Strontium 89.
No one can tell how long you'll live. Statistics based on studies can give only averages based on aggregates. Each individual will follow his own destiny. The better and more up to date your treatment the better your chances.
May you live long and without pain.

 
Old 01-30-2008, 07:47 PM   #10
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Re: Prostate Cancer - Life Expectancy

Too many variables to give a simple answer. Watchful waiting for how long ? What grade and stage cancers are you comparing? When and at what stage was treatment initiated? What treatments? How competent was the specialist rendering treatment? Was the treatment considered successful? Were the patients being compared of comparable risk staus?etc.,etc.

 
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