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    Monday, October 04, 2004

    Health Matters: The New York Times had a detailed and lengthy discourse on the state of John Kerry's health, including every single injury he's ever had, his cholesterol readings, and his brush with prostate cancer:

    Mr. Kerry could become the first "cancer survivor" to be elected president, but he rejected the term as creating an unfair stigma. He is free of any vestiges of the cancer and characterized it as a nonissue in an interview in Las Vegas on Sept. 16. "I am cured," he said. "I am cancer-free, and the percentages of me being cancer-free 10 years from now are about as good as they get."

    Mr. Kerry's doctors said they had told him that he was cured. They based their optimism on an array of tests and concluded that he had a less than 3 percent chance of a recurrence in the next nine years. Even if the cancer came back, it could be treated without seriously interfering with presidential duties, Mr. Kerry's doctors and experts said.

    ...The pathology report was the best that Mr. Kerry could receive: the cancer was confined to the left side of the prostate gland. And on the Gleason scale, a standard measure of the severity of prostate cancer, Mr. Kerry's score was 6 out of 10, considered a very favorable finding.

    If Mr. Kerry had a recurrence, Dr. Walsh said, "he would be astonished, and so would I, and I am telling you this with the very conscious understanding of what happened to Senator Tsongas."

    Dr. Peter T. Scardino, the chief urologist at Memorial Sloan-Kettering Cancer Institute in Manhattan, who is not connected with Mr. Kerry's case, said that while "there are no guarantees," he agreed with the prognosis given Mr. Kerry. "Something bizarre could happen as an exception to the rule, but it would be extremely surprising," Dr. Scardino said.

    A Gleason score of 6 isn't exactly the "best that Mr. Kerry could receive." The higher the Gleason score, the worse the cancer is. The maximum score is 10. Kerry's prostate cancer was actually of moderate severity:

    Grade refers to the histologic type, characterized by the Gleason score, with the prognosis worse for higher-grade cancers. Prostate cancers are often classified into three grades. Grade III includes those with a Gleason score of more than 7, grade II includes those with a Gleason score of 5 to 7, and grade I includes those with a Gleason score of less than 5. In the Hybritech study,1 the Gleason score was less than 7 in 60.0 percent of the black men and in 75.1 percent of the white men who were found to have prostate cancer. Patients with clinically localized cancer of a lower grade are considered to be the best candidates for curative treatment, especially radical prostatectomy.

    ...Clinical outcomes after surgery for localized prostate cancer are known to be good. A recent multi-institutional study that pooled the results of radical prostatectomy in men with clinically localized prostate cancer found disease-specific 10-year survival rates of 94 percent for grade I cancer, 80 percent for grade II cancer and 77 percent for grade III cancer.

    That's not exactly the less than three percent chance his surgeons told the Times he had, and they were talking about recurrence, not survival. They may have done other testing on the tumor to arrive at their very low predictions, but that detail is missing in an otherwise exhaustively detailed report. Despite having a moderately high Gleason score, his PSA level was low, a factor definitely in his favor, and although he had a less-destructive-than-usual surgery to remove the prostate and preserve the nerves, the evidence so far is that the newer surgery has the same survival rates as the older, more extensive removals. But is his prognosis for a recurrence really less than 3%?

    BONUS: Senator Kerry's urologist has made a movie of his nerve-sparing technique, in case you're interested.

    posted by Sydney on 10/04/2004 08:24:00 PM 0 comments


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