Who Remained Prostate Cancer Free?

You want your prostate cancer treatment to be successful. But how does one measure prostate cancer treatment success. Often, a successful prostate cancer treatment is measured by survival. If the patient does not die during treatment, was the treatment successful?  Even if the cancer returns?  Prostate Cancer Free Foundation, aims for 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 Best Method for Measuring Prostate Cancer Treatment Success

Measuring the Prostate Specific Antigen (PSA) level is the most important, and most common test to measure success of treatment of prostate cancer.  Regardless of the treatment you receive, the PS Blood Test is the test you will have each time you have a medical visit.  This is the test you and your doctor will use to determine if your cancer is controlled or not.  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, and your cancer returns, 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 95%. It is 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 once the cancer returns.  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.