No difference in mortality at 15 years for prostate cancer treatment options

[MillCreek]

As the demographics of this group skew heavily towards older men, this will be of interest.

A recent study of 1643 men in the UK with prostate cancer compared mortality figures for prostatectomy, radiation, or watchful waiting with close monitoring.  At the 15 year mark, mortality was low for all three treatment approaches and the survival rate was at 97%. What this means is that for the majority of men with prostate cancer, if you want to avoid the side effects of surgery and radiation, watchful waiting with monitoring might be a good treatment option.

https://www.nejm.org/doi/full/10.1056/NEJMoa2214122?query=featured_home

https://www.seattletimes.com/seattle-news/health/prostate-cancer-treatment-can-wait-for-most-men-study-finds/

[Ben]

That's really good info. I'm in the hereditary category. My dad had it and got the surgery. He "leaked" his whole life after that. He had his surgery in the mid-90s, and I know surgical techniques have vastly improved since then, but I'm all for avoiding anything intrusive if there are other options.

I haven't received the finger for five years now. The PA (female) at my current clinic doesn't do it, though my previous, also female doctor in CA did. As of now I've just been getting the PSA test. I'm not sure if that's good or bad. I've been thinking about switching to a regular doctor in the city. Ever since they closed the clinic in town, the next closest rural clinic in this group is only ten minutes less driving than one of the fancy medical centers in the city.

[MillCreek]

^^^The risk manager is a fan of internal medicine physicians for older adults.  The problem is finding one who has room for more patients.

[dogmush]

How often does watchful waiting turn into one of the other options in that 15 years?

I know very little about Prostate Cancer, to be honest.  Does it tend to be aggressive?  Or is this one of those diseases that by the time it gets around to killing you, something else likely already has?

[Ben]

How often does watchful waiting turn into one of the other options in that 15 years?

I know very little about Prostate Cancer, to be honest.  Does it tend to be aggressive?  Or is this one of those diseases that by the time it gets around to killing you, something else likely already has?

I need to research that related to prostate cancer myself. I know that when I started getting colonoscopies, that the doctor said it generally takes 20 years for the polyps to turn into something bad. Which is why I'm getting at most two more colonoscopies, then I'm just taking my chances. Unless they come out with less invasive tests for those who may be prone to it.

I had polyps my first two times, but nothing this last time. Though they did diagnose me with the Barrett's Esophagus, which is apparently always a precursor to esophageal cancer. So I guess I'm on my way to that no matter what, but my doctor has me on a plan to stretch out that time, hopefully significantly. I'm stuck getting esophageal probes every two years now though.

Edit: "Taking my chances" means doing the non-invasive tests.

[MillCreek]

How often does watchful waiting turn into one of the other options in that 15 years?

I know very little about Prostate Cancer, to be honest.  Does it tend to be aggressive?  Or is this one of those diseases that by the time it gets around to killing you, something else likely already has?

Most types of prostate cancer are very slow growing, but if it is present, you need to take a biopsy to be sure.  It is not uncommon that many men with prostate cancer end up dying of something else. I myself in my early 60's now have a PSA and DRE done every two years.

[lee n. field]

How often does watchful waiting turn into one of the other options in that 15 years?

I know very little about Prostate Cancer, to be honest.  Does it tend to be aggressive?  Or is this one of those diseases that by the time it gets around to killing you, something else likely already has?

Usually the latter, but it can be aggressive.  I had mine out in 2014.  PSA was rising  from one test to the retake.  By the time the organ was out, a bit of it had gone elsewhere. 

[RocketMan]

Most types of prostate cancer are very slow growing, but if it is present, you need to take a biopsy to be sure.  It is not uncommon that many men with prostate cancer end up dying of something else. I myself in my early 60's now have a PSA and DRE done every two years.

I read an article on this subject years back that stated that every man, if he lives long enough and doesn't die from other causes, will eventually die from prostate cancer.  I thought that was interesting.

[Lennyjoe]

Thanks for sharing the info.

On a side note, I’m tired of taking meds and still getting up 2-3 times at night and am considering prostate reduction surgery at 57 years old. Anyone know of any long term side effects of the reduction surgery or potential risks associated with such surgery?

[grampster]

Lenny, my dad and brother had the prostate scraping/reduction thing.  My brother said it's a very uncomfortable thing.  He had it twice and has had a couple urinary tract infections since.  Better than cancer though.

Barrett's Esophagus:  I've had acid reflux for over 60 years and that led to Barrett's.  Stable, no cancer.  My doc has me on Pantoprazole twice a day.  An acid inhibitor.  It is supposed to also have a healing property and keep, hopefully, Barrett's esophageal cancer at bay.  So far so good.

I had prostate cancer in 2005.  Age 61.  Long story with respect to all the options.  After exploring all of them, I went with surgery with the DaVinci robot by a top doc in that arena.  DaVinci has many positives.  No incontinence.  No more boners...but not dead.  The other options have worse side effects and if they don't work, preclude any surgery later.  I could write a lot about what I found, but not in the mood other than one friend did radiation and lost a kidney and a good deal of his health and another who watchful waited....died.

PS:  Lenny, as you get older you're gonna be getting up and peeing 1 or 2 or 3 times a night anyway no matter whether you have a prostate or not.

[BobR]

Thanks for sharing the info.

On a side note, I’m tired of taking meds and still getting up 2-3 times at night and am considering prostate reduction surgery at 57 years old. Anyone know of any long term side effects of the reduction surgery or potential risks associated with such surgery?

You are still young so some of the non-surgical removal such as Uro-Lift or something along those lines may be better for you. I know they were starting trial on a method where they shove a wire up your ureter and an expanding cage wire is supposed to open up the prostate. There is also a method where they embolize the prostate artery (PAE) to decrease blood supply which is supposed to make it smaller. Advances are being made every day. Only you and your Urologist can decide what is best for you.

bob

[Northwoods]

Past 80 and from my understanding very few men don’t have prostate cancer.  But for most something else kills them before the prostate cancer.  I’m 45 and if the doc wants to do a PSA test that’s fine.  The finger from what I’ve been told usually causes more problems than it solves.

[Lennyjoe]

Lenny, my dad and brother had the prostate scraping/reduction thing.  My brother said it's a very uncomfortable thing.  He had it twice and has had a couple urinary tract infections since.  Better than cancer though.

PS:  Lenny, as you get older you're gonna be getting up and peeing 1 or 2 or 3 times a night anyway no matter whether you have a prostate or not.

The current meds help somewhat but still hate getting up in the middle of the night several times.  Doesn’t sound like it will get much better later in life. 

[gunsmith]

my dad had multiple cancers, the official cause of death was prostrate cancer.  he was a heavy smoker and only ate processed food - only 58 when he died.
I quit ciggs in 91 and weed/drink in 95/ have tried to eat healthy since the seventies .... I'm 62 now. I often wonder if I should check but I loathe medical procedures 

[Northwoods]

The current meds help somewhat but still hate getting up in the middle of the night several times.  Doesn’t sound like it will get much better later in life. 

Thus far (at 45) if I get woken up by something else, e.g. the dogs, something outside, I’ll pee while I’m up, but even if I forget to pee before bedtime I never get woken up just by the need to pee. 

[MillCreek]

Pro tip: for the most accurate PSA levels, have the blood test done before the digital rectal exam.  There is literature on PSA increasing minimally after a DRE, although the clinical significance of this increase probably only pertains to measurements on the borderline of abnormal.

[HeroHog]

I take several prostate meds. Mine has been "large" for I don't know how long but cancer there hasn't been mentioned. At 65, 66 next month, with the current meds, I get up at 5:30 to pee after going to bed between midnight and 3am and drink several cans of Coke Zero (used to be Dr Pepper Zero/Diet Dr Pepper) before bed. Bladder cancer has been absent for some 8+ months now. I get scoped every 3 months for that and anything the least bit "off" gets biopsied.

Wish me continued luck!

PS: 99.99% of ALL my kin I have known has died from cancer. I have little doubt that I will succumb to it, eventually.

[gunsmith]

62 yrs old, I never get a real nights sleep anymore. minimum 3 visits to batroom per night