New NEJ 10 year study RE: "Active Monitoring shows 99% same survival rate for localized Cancer" as Surgery & Radiation

[JWS13]

What are your thoughts on the following:"New NEJ 10 year study RE: "Active Monitoring shows 99% same survival rate for localized Prostate Cancer" as Surgery & Radiation"All opinions welcome..** How may this effect those of us that have been treated other than having some comfort that PC is slow growing..or more importantly if we have a reoccurrence after treatment can we rely on this study to only do AS if cancer still localized on reoccurrence..

[Tall_Allen]

It has nothing to do with recurrent patients. ProtecT showed this several years ago:

prostatecancer.news/2020/02...

[JWS13 in reply to Tall_Allen]

I read your study...TA for the ED section ..need some easy clarification..Is the study saying that since I had IMRT (20 tx Kishan) that even though I went in strong with a strong erection that the top chance I will have now is maybe 34% or does the individual going in basis allow for a better number...In addition are they saying that I havve a 66% chance of NOT having a strong erection ever again...I thought that with IMRT your vacuolization is the SAME as other men my age (up to year 3 ) and then the radiation vasculation causes decline after that...and your ED would be increased at that point due to further radiation decline of the vascular tissues..(i don't know what % that is?)...

my point of the new study and how if effects recurrences is this..If in 3 -5 years I have a recurrence from some microscopic cancer that was not killed..Isn't that like a new cancer and if i followed the new studies conclusion if i just did AS or active monitoring wouldn't I then according to the study have a "new" risk of 99 % survival rate for 10-15 years w/o doing RT or Surgery which is what the study is alluding to? ..thanks ...your thoughts? do I have this right?

[Tall_Allen in reply to JWS13]

"Is the study saying that since I had IMRT (20 tx Kishan) that even though I went in strong with a strong erection that the top chance I will have now is maybe 34% "

No, it is not saying anything like that.

"In addition are they saying that I havve a 66% chance of NOT having a strong erection ever again."

No, it is not saying anything like that.

"I thought that with IMRT your vacuolization ..." Sorry, I have no idea what that is.

"If in 3 -5 years I have a recurrence from some microscopic cancer that was not killed.." recurrences are most often from untreated cancer.

[JWS13 in reply to Tall_Allen]

TA --can you give me the stats on the following ...put simply:

1. After 20 weeks of CT guided IMRT and 1.5 months of Orgovyx,

A. What can I expect the % chance of getting an erection hard enough for intercourse if I came into treatment at baseline that way 100% of the time? 1-5 years from tx? 5 years and going forward..

I thought in my research that I would be "good" for the first 3-5 years with radiation and then there would be an "aging" decline caused by the radiation TX. I also read that if you were "good" 2 years out that you would the probably be OK and have normal decline depending on your age?

B. I am taking flomax .4 mg and I am getting up 6-8 times a night ( killing my sleep) since my TX finished 2 weeks ago.

1. How long after TX do Urinary nocturia "bother" symptoms last? and in what time frame do they resolve?

* BTW - Dr. Kishan says "you are a very knowledgeable guy" -but we knew that.

Thanks Allen for input on the above..(simply put when will I likely after stopping Orgovyx get my erections back and for how long will they be strong before declining.. and generally to what extent of a decline ?)..TX again..Best JWS

[Tall_Allen in reply to JWS13]

Kishan can answer these questions for his practice. I can only give averages across all

A.About 60-70% probability of retaining full erectile function (I did). Better for younger men. Normal decline with age is expected.

B. It lasted 2 weeks for me. By a month, I was better than baseline. I think Motrin helped.

[NYC_talker in reply to Tall_Allen]

Hi TA. I have a lot of questions about this study and only the abstract can be read on the NEJM site. Perhaps you have some insights.

What were the Gleason scores of the people in the study? We already know that AS is best course for most with GS 6, but were these mostly men with GS 7, favorable and unfavorable?

I guess I'm wondering what is new here.

Also, the media reports on major news sites say, buried further down in the stories, that most of the men on AS eventually went on to get other treatment. But the takeaway in the headlines -- for those who don't read further down -- seems to be that men on AS (again, without telling us GS scores) did just as well as men who got other treatment over the entire 15 years, with no other treatment, thus that no other treatment is really needed except for those with high risk PC.

It doesn't seem like a a very responsible takeaway -- or am I wrong, and that is what the study is suggesting?

They also seem -- again, in media reports -- to be only using mortality as the indicator of success. That since there isn't a difference in death rates, all is good. But I wondered if in fact many who didn't get treatment early found themselves dealing with progression, needing more aggressive treatment later and QOL issues, even if they didn't die.

[JWS13 in reply to NYC_talker]

NYC...Well put.. i posted also given the "general" terms of the study (99% of the had same results as those having RT or PS ...does that mean the same for reoccurrences ?(that you can do active monitoring if you get a reoccurence 5 years after treatment?)

[Tall_Allen in reply to NYC_talker]

Not much new from the 10-year follow-up. I'll write it up when I get a chance.

Here's what I wrote at 10 years:

prostatecancer.news/2016/09...

prostatecancer.news/2020/02...

Media usually get it wrong. Very few were unfavorable risk - not enough to break out separately.

[TFU589 in reply to NYC_talker]

Not sure if you were able to get full article, had the same issue. I was able to get the full article by signing up to NEJM, not subscribing, and you can get 2 free articles/month.

[maley2711 in reply to Tall_Allen]

This is the 15 yr ProtecT update.

nejm.org/doi/full/10.1056/N...

A similar post provided that link thankfully !! Looking at Figures, what is a " person-yr" Surely something simple /obvious, except for this old brain!!!!

This is an informative update to the 10 yr update 5 yrs. ago....with a few surprises when compared to expectations upon review of 10 yr results. I especially noted the VERY high Gleason upgrade finding when post-RP pathology was reported!! Perhaps the modern use of targeted biopsies will decrease that upgrade number, but we won't know until studies of that!!!!

There are other weaknesses of this study...delayed treatment for a large number of men who were assigned to immediate RP or RT is one example. Also noted how newer risk -assignment tools like CAPRA from UCSF and Cambridge group assignment system give significantly different risk results compared to the older D' Amico system.

There must be some other very interesting observations that could be made when looking at all the variables for these men and how related to progression and death.

Highlights the urgent need for diagnostic PCa providers to have much more detailed discussion of early vs later radical treatment and expectations re side effects when making a decision for early/immediate treatment vs AS and good possibility of later treatment.

A striking fact was how many men died of a different cancer, and of course CV deaths, compared to PCa deaths.

TA has a blog re studies of results for men who delayed treatment 12 months from diagnosis.....basically, statistically, results same as for men choosing immediate treatment.

This ProtecT update aligns with the studies cited by TA. Will our diagnostic providers be honest about these study results, or fearful of fewer immediate procedures. ie immediate $$$$$??????

Are Centers of Excellence being any more forthright than typical community providers???

[maley2711]

Link Please ???? would like to read!!!

[allshallbewell]

It certainly gets my attention and leads me to consider more seriously the possibility that active surveillance might be the preferred course for the time being. How about you?

[PSAed in reply to allshallbewell]

Here is something else you might be interested in . Link originally supplied by ADTMan.

renalandurologynews.com/hom...

[allshallbewell in reply to PSAed]

Thanks!