Successful Prostate Cancer Treatment?
You want your prostate cancer treatment to be successful. You need information on the most successful prostate cancer treatment. Often, a successful prostate cancer treatment is measured by survival. If the patient does not die from prostate cancer, was the treatment was successful? At the Prostate Cancer Treatment Research Foundation, we use a much higher standard. We want the cancer to go away, and never come back. That is what we call success; anything else is failure.
The following dialog is offered in question-and-answer form to help you understand why our study results focus on preventing prostate cancer recurrence, and why it is the preferred measurement of treatment success.
How do we Determine a Successful Prostate Cancer Treatment?
Measuring the Prostate Specific Antigen (PSA) level is the most important, and most common test to measure success of treatment of prostate cancer.
First, regardless of the treatment you receive, it is the test you will have each time you have a medical visit, and it is the test you and your doctor will use to determine if your cancer is controlled or not.
Second, if PSA levels become elevated after treatment, it will mean you need further tests and very likely further treatment. The tests and subsequent procedures following an elevated PSA level after treatment can significantly worsen the quality of your life. Before deciding on an initial treatment, you need to understand how well that treatment does at controlling the cancer. What is the chance that you will need further treatment? PSA progression rates provide a level playing field to compare the different treatments.
Initially, PSA is used as a cancer screening tool. But after treatment, PSA is used to monitor for the recurrence of cancer.
Why Measuring Survival is Less Important than Measuring PSA?
Using survival as the measure for a successful prostate cancer treatment does not tell you whether the cancer is gone. Only PSA level can tell you that. If you fail the initial treatment, you can live with prostate cancer for many years. For example, one treatment can have a prostate cancer control rate of 80%, but because patients can live with their cancer for a long time, the survival rate may be 90%. It is very important to know the likelihood of requiring additional treatment and also the effects of additional treatment. Failure of the primary prostate cancer treatment will have a large impact on the quality of life.
The measurement used by the Foundation, “Percent PSA Progression Free”, is an estimate, prior to treatment, of a particular treatment failure rate, and the likelihood of not requiring additional treatment. Survival measurement does not provide this important information. Please understand this important point. If the survival rate of competing treatments are equal, this does not mean the cancer control rate, long term side effects, or the quality of life are equal.
Why Survival is a Poor Measurement of Success?
After initial treatment, a rising PSA level indicates treatment failure. For this reason it is a strong indicator of a successful prostate cancer treatment. Survival reflects not only cancer treatment deaths but also all other reasons for death. For example, comparing a younger patient group receiving surgery with an older population receiving radiation can lead to very misleading results. The members of the older group may have other medical problems, and their survival rate may not have anything to do with success of the prostate cancer treatment, because other factor were responsible for their deaths. Many researchers don’t bother to tell you that their patients are 10-15 years younger, and in better health, than the comparison group.
Why would the author of an article, or cancer center marketing material choose to only tell me about survival and not PSA control?
The authors who write those articles have all done PSA testing on their patients so they are certainly capable of reporting PSA-based results. The only reason not to report them is that usually, the PSA results are poor and reporting overall survival makes their results look better. Prostate cancer treatment is a business. Bad results are rarely reported in medical literature because all medical literature is voluntary. Editors and publishers have no requirement for an author to follow any specific rules when reporting results.
What is the Impact on my Life if the Cancer Returns?
Fortunately, with backup treatment, survival can still be good. However cancer failure is accompanied by diagnostic tests and treatments that are ongoing for many years. While death can be often averted by secondary treatments, these treatments can come at a high cost to quality of life and much greater expense. It is better, by far, to choose the most effective treatment, and eliminate the cancer on the first try.
Here is an example: Consider a patient whose PSA rises after surgery. He will typically undergo 7 weeks of IMRT radiation, where the control rate is about 30%. Therefore, for a sample of 100 patients treated with surgery, if the failure rate from surgery is 30%, 30 patients will receive second treatment of radiation, and only 10 of those will have long term cancer control. The other 20, who fail the secondary treatment, will likely receive lifelong hormonal and or chemotherapy treatments. This treatment castrates the men and costs the system tens or hundreds of thousands of dollars per year per patient. Typically they will eventually fail this therapy and continue to suffer, as more experimental (and more expensive) approaches are attempted.
Please see our For Patients page to learn more about comparing treatment methods, and to access our study results.