Statistics for Recurrance after RP ?

I'm 56 and have been on AS for five years. I've had four biopsies; three of which found small amounts of GL 6. Over this five year period my PSA has climbed from 5 to 12. My doctor isn't too concerned about the PSA because I have a rather large prostate (60 cc's), but he is concerned that cancer was found in different locations yet believes the cancer is still within the prostate. Due to my age, excellent health and life expectancy he recommends a RRP. I'm scheduled for the later part of September.

My question is this: If the cancer has not escaped the margins what is the possibility for a full cure?

Matt

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Matt- Can not speak about stats, but I had RP in Jan. 2010. The cancer was contained in the prostate and to date I remain cured. Psa, the test they use to see if any other cancer popped up, remains <00.1. Good Luck, Regards Inkhorn

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Dear Matt,
Was the determination of positive locations made by standard 12 point blind biopsy
or was a 3T MRI used to scan the prostrate and surrounding area. Then a MRI Guided biopsy done to look a precise suspected areas.
Wayne

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Matt -- I had RP two years ago. According to the post-RP pathology report my margins were clear and so were the seminal vesicles. All good news! However, I had perineural invasion within the prostate - - something you can't know about until you've had RP and a pathology study. Recently I've had biochemical recurrence and did salvage radiation. So, apparently, a small focus of PCa escaped via the perineural invasion. PCa is insidious and looks for any means possible to migrate out into the body. My pre-RP Gleason was 7 but my post-RP was 9 so clearly biopsy missed some spots. I had the 12-sample biopsy. Good luck.

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Wayne, when you refer to blind biopsies are you referring to ultrasound guided? If so, yes, they were blind, but I would imagine they explore new areas as well as repeat known hot spots with some accuracy. I'm at UC Davis in Sacramento. They do not utilize MRI for prostate evaluation or biopsies. I asked to be referred to UCSF for a multi-paramtetric prostate MRI (not MRI guided biopsy), but was told MRI's are not yet sensitive enough to be trusted for treatment decisions. That may be true, but I'd bet money they are better than ultrasound for biopsies.

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HangtownMatt;
A 3T(esla) MRI would be the way to go. I have found that the places that say they don't us e them are, by and large, places that do not have a 3T machine. NIH, MSKCC and many of the other major centers do use it. IF you are in CA, I would recommend you go to UCSF. They are a well respected prostate center. Dr. Peter Carroll is one of the best robotic surgeons in the country.
I began this sage last month when I learned of my diagnosis. Once the shock wears off, then you get serious. This group is very helpful and I have learned a lot from it (I am a physician). Have been to 4 centers and have my MRI coming up before surgery.
If the cancer has not escaped the margins, that is an excellent prognosis. The final pathology report will tell the tale. There are nomograms out there that will give you the percentages for cure, etc.. This is an elusive disease with many controversial treatments. My advice is to stick to the tried and true, get as much information as you can and stick with the best centers. If someone tells you that they have no complications and can cure all, run, do not walk, out of that place!

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Regarding MRIs - - I forgot to mention that I did not have an MRI because I have an artificial hip. The metal in the artificial hip causes the MRI "signal" to scatter obviating its usefulness. I was told this, independently, by my urologist, my radiation oncologist, and also the urology department at Mayo Clinic. Just thought I'd make mention of this for anyone considering an MRI that has an artificial hip implant.

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Dear Matt,
When Bill53 gave advice about running from a place, when UC Davis told you the New 3T MRI’s were something you did not need, that qualified for a run. As you read the links below this will become clear. Each man’s treatment choices should be based on the best information possible. A 12 point biopsy without a precise location to investigate is 12 shots in the dark that is not what you want to base your future quality of life on.
I was the second man to have Focal Laser Treatment for low grade (GL/6) localized prostate cancer. This took place in Nov 2009. In Jan 2013 I went to The National Institute of Health in Bethesda Maryland and had a 3T MRI with internal and external coils to enhance the image. The scan showed the 2009 treatment to be a success. The scan showed one suspicious area which they thought was inflammation but to be sure did an MRI Guided Biopsy which proved negative. I do a PSA every 6 months and a 3T MRI with coils at NIH every year. Thus far I am cancer and side effect free. Should cancer return( there is no cure all), I still have the option of Focal Treatment again or whatever treatment fits the situation with the least harm done. I Pray you will consider the NIH clinical trial which is the first link, in my opinion one of the best Research Centers in the World. They do not want your money only your help in proving new technology can prevent the over and under treatment of prostate cancer which is now destroying the quality of men’s lives on a scale that is appalling. The intense Research over the last 5 years should give you pause to consider, tried and true, add to that, search on this site or google, concerning side effects of radical surgery or radiation. Whatever your treatment decision, make it on the best image you can get not only of the prostate itself but also the surrounding area. By the way the NIH gave me the following formula for PSA numbers as my prostate is large as well. 7.68 divided by prostate size (60) should equal .15. You come in at .128 however you did not mention the time frame of increase, the velocity and doubling time are very important.
God Bless
Wayne
http://clinicaltrials.gov/ct2/show/NCT01377753
http://www.harvardprostateknowledge.org/improved-magnetic-resonance-imaging -mri-may-aid-detection-of-prostate-cancer
http://www.foxnews.com/health/2013/04/09/new-prostate-cancer-technology-cou ld-lead-to-more-targeted-therapies/#ixzz2SQJ6JE2n
http://www.mskcc.org/videos/thermal-prostate-tumor-ablation-interstitial-la ser-therapy
UCFS University of California, San Francisco
505 Parnassus Avenue, M-391
San Francisco, CA 94143-0628
415-476-1537
http://blog.radiology.ucsf.edu/abdominal-imaging/prostate-biopsy-at-ucsf-be nefits-outweigh-the-risks/
http://smart-biopsy.com/

http://www.health.harvard.edu/blog/prostate-cancer-lives-as-it-is-born-slow -growing-and-benign-or-fast-growing-and-dangerous-201308146604

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>>>

My question is this: If the cancer has not escaped the margins what is the possibility for a full cure?

<<<

Take a look at the nomograms on the MSKCC website:

You'll find some answers to your question in the "Post-Radical Prostatectomy" section.

Note that "full cure" isn't a scientifically-used term. You can talk about "5-year non-recurrence rate", or "10-year non-recurrence rate".

After a "clean" surgery -- with "negative margins" (no cancer that the surgeon missed) -- I think the 5-year non-recurrence rate is something over 90%. That is, there's less than a 10% chance that the PCa will recur in 5 years.

Although my cancer was Gleason 6, and I had negative post-surgical margins, I never think of my cancer as "cured". Some men -- not many -- will have recurrences more than 5 years after surgery. The curve of "new recurrences" never quite goes to 0.

. Charles

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Sorry -- forgot to paste the link:

http://nomograms.mskcc.org/Prostate/PostRadicalProstatectomy.aspx

. Charles

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With initial stage of G6 low risk cancer the overall reoccurrence rate is 15% (MSK and Hopkins). This is because some G6 cancers are upgraded to G7 after surgery and some already have extracapsular extensions. If the tumor is truly a contained G6 the reoccurrence rate is less than 5%. Even if there is a reoccurrence with a true G6, metastasis is very rare as G6s do not metastasize. In 17,000 surgeries for G6, not one case of metastasis was found.

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On the other hand - my bother in law had a G6 and now has metastatic prostate cancer in his ribs. It is possible.

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Every case of a G6 metastasis was found on further investigation to be a G7 and not a true G6. G6 cancers due to their DNA cannot live outside of the Prostate environment. If this actually happened it would be an extremely rare occurrence due to a variant. All current evidence supports that true G6 cancers are unable to metastasize. Large volume G6 tumors can grow into the anal regions or into the bladder if not treated and cause serious harm. There is no evidence that they invade the lymph system or the bones.

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I sure hope the pathologist was correct when he said my husbands was a G6 post surgery.
Does anyone know do labs have more than one person look at the prostate?
net_bug

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Dear Matt,
I was not sure you would see the post on the main site this morning from Tim-B, so I am pasting it here. Dr Peter Pinto is head of the research study I am in at The National Institute of Health.

http://clinicaltrials.gov/ct2/show/NCT01377753

Praying you feel like reading.
God Bless
Wayne


Medical Rabbit Hole (Washington Post article on AS)

• By Tim-B • Today at 8:06 am • 2 replies
• In Treatment options


I have had similar feelings about the information and advice received from some I've seen. I do not distrust the motivations nor intentions of those I've met, but think it is emblematic of the complexity in treating this disease.

There is but one guarantee in life and that is one day, it will end. Until then, I will continue to question, research, consult and evaluate. As I move forward with whatever forms of treatment I may chose, I know that no one person has all the answers and the only one that knows what is best for me, is the one looking back at me in the mirror.

Best to all in your pursuit of life and happiness

http://www.washingtonpost.com/national/health-science/when-his-psa-score-sp iked-prostate-surgery-loomed-but-nih-offered-another-way/2013/02/25/077f66c 0-42f9-11e2-8e70-e1993528222d_story.html

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Wayne, I can appreciate that this might be a good opportunity for those living close to NIH and/or those with time and money, but I do not meet any of these conditions. I live in CA. NIH is in MD. Reading the trial requirements I'd have to travel cross country a minimum of eight times and incur hotel, meal and other expenses. I have two teenage children. One a Junior in HS and the other starting at UC Berkeley tomorrow. For most of us in this position, time and money are two commodities we simply do not have. Also, I'm still employed; not retired. Another time constraint.

I haven't responded to this (my own) thread because I was a bit turned off by your original reply where you suggested I run from my doctor because he does not have 3T MRI. Please don't take this the wrong way, because I know you are trying to be helpful, but in my position it came across as insensitive and irresponsible. You are not familiar with my situation or my doctor. I've been under his care for AS for the last five years. As a matter of fact, he saved me from a vulture who wanted to take my prostate five years ago upon diagnosis. This doctor is my 2nd opinion and was the first to explain, to me anyway, that some treat this strictly as a business. He strongly suggested AS knowing that the possibility for newer and better treatments were on the horizon. For the last fives years I've been attending two sometimes three different support groups to gather information. I spoken with other doctor's and followed the annual PCI seminar. I know people he's performed surgery on and I trust they are honest with the positive results. I've reached a point where treatment is highly recommended, and I've always been a proponent of RP due to my age and GL6. To be truthful, I'm not sure how much more time I have before I miss the window for a totally encapsulated high probability cure. Yes, it would be great if they had, or he would refer me for, a 3T MRI. I doubt I'd use it to postpone surgery, but it would be reassuring to know there is not a visible tumor escaping the capsule prior to opening me up. I do believe I have a competent surgeon. Five years ago he had more that 250 Da Vinci's under his belt. To leave him now, over a 3t MRI dispute, could be like throwing the baby out with the bath water. By the way, his name is Dr. Christopher P. Evans at the UC Davis Medical Center.

Once again, PLEASE, do not take this the wrong way. I too am only trying to be helpful; especially to those in my situation This is a high anxiety situation to begin with. Many of us have busy lives full of responsibilities. Most are doing their best to connect all the dots. Not everyone is in a position to take chances on clinical trials of pursue some options. There isn't anything wrong with the information you provide. It is very helpful and please continue to do so. I just hope you reconsider your delivery.

Matt

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Hangtownmatt: There are many dozens of possible scenarios. You really won't know until you get the pathology report after your surgery. Be sure to get a copy of it from Medical Records as soon as its available so you can bring it home and study it. I had postive margins and extraprostatic extension but no metastasis and my PSA dropped from 6.28 to 0.00, three months post-op.

Good luck with your surgery.

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With Prostate Cancer there are NO guarantees, just probabilities and even though the chance for a "cure" was minimal, we took it anyway...as the doctor was explaining all of the facts and the low probability of a cure and the high probability of side effects my husband quoted Jim Carey and said "so what your saying is,....there's a chance" a bit later toward the end of the exam the doctor said...oh and by the way, I caught the reference....Dumb and Dumber. :)
We felt strongly that we needed to have the best chance there was for a cure. RALP, radiation and ADT.
His cancer was Gleason 10 so active surveillance was not an option. The side effects of treatment suck, but sometimes I believe not being alive will suck worse!

Continue to research and advocate for yourself, you are the one who has to live with your choices.

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>>>
All current evidence supports that true G6 cancers are unable to metastasize.
<<<

The problem is, you only know _after_ surgery that it's a "true G6".

Before surgery -- with biopsy results in hand -- you can only say:

. . . The samples in the biopsy are all G6.

The biopsy might have missed a bit of G7 tumor.

So you must have surgery, to find out if you needed surgery.

. Charles

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Prostate Ca is an adenocarcinona(glandular) all of which have a propensity to spread to bone, liver, lung, brain. Depending upon your age and other medical conditions, you have a choice to remove the tumor completely or try other means, many if which are still not shown to totally rid the tumor. If you are under 70, the best means to a total "cure" is to remove the gland and tumor.

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Dear Matt,
My most sincere apologies for causing stress in delivering information.
I am Praying for your swift and full recovery.
God Speed
Wayne

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