North and Handera, your banter is just so spot on about this disease…When I was first diagnosed, we were at a family gathering and my wife was in the kitchen, crying to her sister-in-law Fran about my bad biopsy report.
My wife later told me that Fran looked at her perplexed and said “What’s the big deal, It’s JUST prostate cancer!”
That’s the attitude most people seem to have when it comes to this disease - just a common ho-hum annoyance similar to the skin lesions that friendly dermatologists zap in a few short seconds. But the general public is ignorant of so many different types, stages and outcomes; it probably should be reclassified - something along the lines of Type 1 and Type 2?
Also, we can kick around the numbers from these 15 year studies until we’re old(er) men and what they mean but I’ll offer another wrinkle.
Two years ago a retrospective study looked directly at the need for ADT in salvage cases. They concluded that such “grievous harm” was done by ADT - fatal heart attack and stroke as well as exacerbation of diabetes - that it should only be considered in men with PSA values of 0.7 or more. People were dying - not from PCa but from the effects of ADT! So death certificates would read “myocardial infarction” or “cerebrovascular accident” - not “complications caused by metastatic prostate cancer”.
So Alan, when you read that the mortality rate in a certain cohort was this or that, please remember that many of these men - the 356 who died from “all causes” after 15 years - probably DID die from prostate cancer in a sense because it was the ADT used in their treatment that killed them before the disease did.
In fact the first RO I consulted cited this study when he told me that I would not be placed on ADT. He was very quick to accept this study.
I then got a second opinion from Sloan Kettering who basically said that whenever this disease comes back it really has to be considered more aggressive regardless of PSA cutoffs so ADT was recommended.
So in 15 years will they be looking back at that PSA study and conclude that perhaps ADT should have been used? Not used? Hard to say, but I chose ADT for 6 months simply to hedge my bet: if the study was correct, 6 months of ADT wouldn’t kill me…but if it was wrong, not having the ADT just might.
Phil