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Posted 3/10/2009 7:10 PM (GMT 0)
I found the following stats on BRFS (Bioehemical Relapse Free Survival) in "The Prostate Treatment Book" published by Seattle Prostate Institute/Swedish Cancer institute.

As in all studies the data may not be perfect, and combines data from various studies and hospitals. but it's the 1st head to head comparison that I have run across.

Risk Group      5 year BRFS                                 10 year BRSF

                  Surgery       3D CRT    Seeds    Seeds     Seeds/ERBT

Low              83-85%       90%         87-94%   87%          84-85%

Intermediate  50-65%        70%        82%         76%         77-90%

High              28-32%       47%         65%        --            46-57%

The low risk group survival rate is pretty much equal for all treatment options and matches everything else I have read. So in treating low risk PC, the side affects are more important than the treatment option when it comes to making a decision.

In the high and intermediate risk groups there is a difference in the BRFS. This makes sense to me as these groups are at higher risk for extra capsular extension, seminal vessel invasion and tumors close to the urethea which are all more difficult to get a clear surgical margin.

If your surgeon or radiologist is quoting higher cure rates than these then he should be able to clearly explain why.

JohnT

Posted 3/10/2009 7:27 PM (GMT 0)

JohnT,

Thank you for posting this info. I have a couple of questions.

1. What criteria establishes risk category?  2. Are percentages shown survival rates, or cancer-free rates?

Thanks,

Smokie

Posted 3/10/2009 7:50 PM (GMT 0)
John...the numbers are a little lower than the Partin tables...do you have the publication date on your source? What about surgery at the 10 year BRFS...the columns didn't show that one or I am misreading the table. And I would also be interested in how they classified the risk category as well...i.e. Gleason Scores, PSA, staging etc.

Smokie.. I believe the percentage is the amount of people that do not have a recurrence of cancer as measured by the rise in PSA over a specific time, I think around three consecutive increases at three months apart...although John can correct me if I am wrong.
Posted 3/10/2009 10:00 PM (GMT 0)
If anyone is claiming better mortality rates they are not dealing with anything more than bias. Still today many top hematologists feel that surgery is the best starting point for stage II, III and even some IV. Not because they feel it is better but because there is real data over longer periods of time. Over longer periods radiation therapy have bigger risks time includind collateral cancers like bladder and rectal to name a couple.

Unfortunately, these numbers appear good for conformal radiation for localized cancer at the ten year mark, but they do not have any reinforcement concerning mortality. When I went into this game I still had 39 years of life expectancy left. Surgery was an obvious call. Men enduring xRT and holding up for 39 years is a quite a different story. I do understand that real data for 25+ years survivals are for those who has EBRT and burned everything in the area, but you get the point. Newer technologies like 3D conformal, IMRT, IGRT, PBT, and brachytherapy and helped deliver radiation with less SE's but still the mortality rates in the end are unmoved. Systemic treatments are, in the long term, appearing like they are going to have the solution.

The news on Finasteride as a preventive drug isn't great but promising for many. But we still need that knock out punch...and for me it was not local therapy.

I know I would feel better with it.

Tony
Posted 3/10/2009 10:30 PM (GMT 0)
Smokie and Les,
The book was published in 2003 and may be a little behind. The number reflect PSA low and stable, survival rates are much higher. As in any study there ae always diffferences in staging that's why they are hard to compare apples to apples because different institutions have their own criteria in staging, but in general low risk is Gleason 6 or less and PSA under 10. High Risk is Gleason 9 and 10 with PSA over 20. There are a lot of disagreements on intermediate risks. There was no data on surgery at the 10 year period, I don't know why.
Posted 3/12/2009 9:26 PM (GMT 0)
Thanks John
The information maybe dated a little, but still very relevent. I think most of these studies show the mean age above sixty and with more and more younger men being diagnosed the stats will change. I often wonder if the bodies immune system plays a big factor in the recurrence issue than is mentioned. Meaning that the older we get our immune system isn't as healthy and therefore cannot fight off the residual cancer cells as effectively. This would mean that a young man with residual disease would have a better chance of not incurring a chemical failure and would skew the stats upward, while the older men with less immune resistance would more likely to see a chemical failure and skew the stats downward. So you are correct in that it is nearly impossible to compare apples to apples between any two studies, but still very important for the decision factors one must make regarding initial treatment.

Thanks for the info...very informative
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