Life Expectancy if i choose no treatment, just walk away

[45RPM]

So was wondering if there is any research studies looking at life expectancy across nccn clinical risk categories, where patients opt out of any treatment. A strange question maybe, but just wondering what the 'do nothing' roll of the dice looks like from the stats

[Tall_Allen]

How long do you want to live until? If you only want to live another 20 years, you can probably achieve that just with hormone therapy and pain killers when the pain gets bad.

[45RPM in reply to Tall_Allen]

That's an interesting idea, what duration hormone treatment, like forever?

[Tall_Allen in reply to 45RPM]

Yes- "forever" won't be very long if you are using it palliatively. It is called "watchful waiting" (different from "active surveillance")

[Magnus1964]

No study that I know of. I guess my question to you is which treatments are you going to write off.....Chemotherapy, radiation, ADT drugs, etc?

[45RPM in reply to Magnus1964]

Hormone and chemo would prefer to go there only if it is my last resort later in my life where i can make a call at that point, but first start with minimum side effect options

Radiation like SBRT is something i want to explore further, but initial consult said i wasn't a suitable candidate.

Looking at nanoknife looks very attractive to me and I'd like to know if i am suitable - maybe i just zap those buggers and take my chances and watch it, or do this with ADT course

But the PNI is the wildcard in this that I don't have a full grasp on, also nomograms say likely EPE. mpMRI next week and discussion with RO coming up to see if can learn more, wonder if you think PSMA PET is something I should be forcing now?

[Magnus1964 in reply to 45RPM]

What do find objectionable about ADT drugs? There are some with fewer side effects, i.e. Casodex and others. Is it loss of libido or other effects?

[45RPM in reply to Magnus1964]

the worst case side effects are so crushing and something i would weigh heavily

[Magnus1964 in reply to 45RPM]

I can not stress this enough. Everyone responds differently to treatments. I for one have done quite well on treatments I feared. If you start a treatment and can not stand the side effects you can always stop. That is always your option.

With standard treatments you could have many years of quality life.

[Jimhoy]

After just looking at your profile, aren’t you too young for that. I can no longer identify the acronyms, and my interoperation of your dx #’s don’t tell me if you cancer is confined to the gland!!! If so, or even if you have some sprinkled around, why wouldn’t you want to zap them critters. EBRT can be done with little to no consequences!! Then you can chose to do nothing while monitoring your PSA but with a much better chance of survival. If you’re “other wise, in good health”, maybe estrogen patches could be an alternative to the dreaded leuprolide that we discussed can be a cake walk, a nightmare but likely something in between!! I am not a candidate for that because of my preexisting coronary artery disease.

Jc

[45RPM]

Thank you Steve. I understand in USA especially that PCa is over treated, and so i want to be sure i look at all treatment options and not just land on some old school standard of care that potentially crushes who i am. I just want to be open and fully consider the range of options from AS to radical before i make the call

[Steve507 in reply to 45RPM]

I did nerve sparing Robotic RP, 14 months later no side effects, feel great. I'd get a 2nd and 3rd opinion. Lots of good advice on here.

[45RPM in reply to Steve507]

glad to hear you are doing well, thanks for the advice, RP is something i am still weighing vs radiation, i do believe i should treat given my adverse factors, but still digging on info before making the call

[OldRadioGuy in reply to 45RPM]

I also had the nerve sparing Robotic RP 5 months ago (at 69) and have pretty much recovered urinary control and am hopefully waiting on erectile function (that does take much longer). It was a rough road initially but I felt the the path would be upward as opposed to the EBERT and 3 yrs of hormone therapy which would likely take me in the opposite direction over time. Best of luck whatever you decide.

[Steve507 in reply to 45RPM]

youtu.be/eTN2vXpSHd8(Not working as expected?)

This link might shed light.

[Steve507]

I attribute my poster child recovery to my age, nearly daily intense workouts, positive attitude, good surgeon, and a bit of luck. I had one focal positive margin, so I may have fallen on the side of cured nonetheless. Gleason 3+4 and PSA under 10 speak to long term aggressiveness of the disease.

[45RPM]

What i am looking for are any studies that have followed AS men over many years and report on outcomes. Here is an example below of the kind of info i seek. If you know of any others, please lmk.

urotoday.com/conference-hig...

Here is an excerpt (T2 or less):

"The long-term survival of active surveillance has been excellent. In Dr. Klotz’s most recent update of his prospective series published in 2015,5 there were 819 survivors with a median follow-up time from the first biopsy is 6.4 years (range, 0.2 to 19.8 years). One hundred forty-nine (15%) of 993 patients died, and 844 patients were alive; there were 15 deaths (1.5%) from prostate cancer. The 10- and 15-year actuarial cause-specific survival rates were 98.1% and 94.3%, respectively. An additional 13 patients (1.3%) developed metastatic disease and are alive with confirmed metastases (n = 9) or have died of other causes (n = 4). At 5, 10, and 15 years, 75.7%, 63.5%, and 55.0% of patients remained untreated and on surveillance. Looking deeper into the patients that developed metastatic disease, Dr. Klotz notes that these patients were the ones diagnosed with understaged intermediate risk disease, conferring prostate cancer mortality risk nearly 4-fold higher (HR 3.75).6

Dr. Klotz’s team has also shown that active surveillance is safe in young patients (< 60 years of age),2. In a two-center study, there were 417 and 1,667 men who began active surveillance at younger than 60 and 60 years old or older, respectively. At a median follow-up of 6.2 years there was no significant difference between men younger than 60 and 60 years old or older in the 5-year rates of biopsy progression-free survival (83% vs 83%), treatment-free survival (74% vs 71%), metastasis-free survival (99.7% vs 99.0%) or prostate cancer specific survival (100% vs 99.7%). Of the younger men, 131 (31%) ultimately underwent treatment, including for pathological progression in 67% and PSA progression in 18%. Significant predictors of biopsy progression and progression to treatment among younger men were 20% or greater involvement of any core on diagnostic biopsy (HR 2.21, p = 0.003) and PSA density 0.15 ng/ml/ml or greater (HR 1.93, p = 0.01). "

[maley2711]

45 rpm -

I'm seeing your question re "do noothing" 5 months after you posted. For what it's worth, I just posted this link on healthunlocked..you can use the search feature here, enter "memorial sloan kettering", and my post will be visible.

Here is the link contained in that post...

healthunlocked.com/api/redi...

One calculator , the "life expectancy", shows probability of PCa death with no treatment...data comes from Swedish data base, another calculator shows, pre-surgery, probability of PCa death, and cancer recurrence/progression, for men who have had surgery performed at MSK. This is NOT a prediction calculator..but it does show proabilities for 10 and 15 years in the future. Example...I entered my data, assuming good cardio health, etc, and this comparison showed 6% PCa deaths with no treatment, versus 1 death with treatment. I like the 1%, obviously, but 6% is not a bad risk either, considering the definite reduction in side effects when choosing no treatment!!!! 2-3 % of ALL men die from PCa, so the 1% and 6% numbers can be viewed with that in mind. Obviously, my risk , without treatment, is much higher for death from other cancers or cardiovascular problems!! Still, my MRI showed a 1.3 cm "lesion" rated PIRADs 3...so I think my risk is probably greater than 6%? these are horrible decsions, aren't they?

Wish I could find a way to make these nomograms more easily found by all men...any ideas anyone? I believe MSK reviews these numbers with their patients.