Lack of volunteers impedes cancer research

An important article from the New York Times, a paper that should be commended for its excellent coverage of cancer over the past few years.

Forty Years' War - Lack of Study Volunteers Hobbles Cancer Fight

Excerpt:

There are more than 6,500 cancer clinical trials seeking adult patients, according to clinicaltrials.gov, a trials registry. But many will be abandoned along the way. More than one trial in five sponsored by the National Cancer Institute failed to enroll a single subject, and only half reached the minimum needed for a meaningful result, Dr. Ramsey and his colleague John Scoggins reported in an editorial in the September 2008 issue of The Oncologist.

How to Choose a Cancer Center (ehow)

I have just published a quick guide on finding a top cancer center near you (for those of you in the U.S.)
http://www.ehow.com/how_5264421_choose-cancer-center.html

Stephenson nomogram revalidated

The Stephenson nomogram, which predicts the outcome of salvage radiation, has been revalidated: http://www.ncbi.nlm.nih.gov/pubmed/19466946 .

The electronic version, a calculator, can be found here:
http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx

The updated paper version of the nomogram is here, but I find the digital version much easier.

The upshot of the validation is that the nomogram is a good rough guide to probability of success. It's better at the two ends of the risk spectrum (high and low) than it is for men in the middle, however.

Less than 0.1

I couldn't wait any longer, so I called for my PSA results. Once again, less than 0.1!

The Question

The Question comes up periodically, whenever it's time. The Question haunts my dreams, occupies my waking hours, and adds a tinge of uncertainty to everything.

What's my PSA?

If it remains less than 0.1, all will be well,and the Question will quickly recede in my mind, at least until the next test date approaches.

If my PSA is anything else, life will change radically, assuming it's not a lab error. It would mean my cancer was systemic, and incurable with today's medicine. There might be a second PSA test to confirm, with an interim waiting period of a few weeks to 3 months, or I might head straight to the medical oncologist--a prostate specialist. With a rising PSA after surgery and salvage radiation, there would be only one realistic option. Castration.

How's that for drama?

Now, I almost certainly would not choose surgical castration, but rather medical castration. Most people are squeamish about the word "castration" and so we say hormone therapy, or androgen deprivation--but the effect is the same. I would become a eunuch, lose all interest in sex, and hopefully the cancer would be stalled for years. And while it was stalled, I would probably stay on the therapy. If all went well, perhaps it would stave off metastasis for a decade or more. More likely, it would last a few years. There is intermittent therapy, where you get to take holidays from androgen deprivation, but it doesn't sound all that great to me either way.

In the next few days, I'll find out the answer to the Question.

Salvage Radiation: Nomogram updates

It looks like the Memorial Sloan-Kettering Salvage Radiation Therapy nomogram on Nomograms.org (direct URL: http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx ) has been updated. It's now easier to use and the response makes sense. It used to give your result as post-surgery rather than post-radiation.
I had been thinking that the nomogram was too pessimistic, compared to the paper version. But what I didn't realize was that four months after the paper version was released in the Journal of Clinical Oncology, an erratum was published that corrected a mistake in regards to pre-radiation androgen deprivation (hormonal therapy). The corrected PAPER version of this important tool is here: http://jco.ascopubs.org/content/vol25/issue26/images/large/zlj0150759390003.jpeg ; however, I see no reason to use it because the digital nomogram is much easier, quicker to use, and less prone to human error.

Now both paper and online versions tell me that I've got a 39% chance of being progression free at 6 years. That jibes pretty well with Catalona's research that showed that long term success with prostate salvage radiation is uncommon--only about 25% of patients overall are progression free at 10 years. Of those who had a complete response to radiation, as I did, Catalona found that 35% were free from PSA progression.

The full text of the original article (remember, the nomogram in this original article is not correct) is here: http://jco.ascopubs.org/cgi/content/full/25/15/2035.

If you have a rising PSA after prostatectomy, and you're considering salvage radiation, I encourage you to read the original article and use the online nomogram at Memorial Sloan-Kettering.

FLHW

I just ordered some bracelets from FLHW.org (Faith Love Hope Win), a charity run by David E. David is a guy about my age with advanced prostate cancer. His blog is one of the most compelling pieces of autobiography on the web.

I urge you to visit http://www.FLHW.org, buy a few bracelets, and read David's blog.

I think you'll agree that David is a true hero.