HealingWell
Search Close Search
☰

Effectiveness of Surgery and Seeds/Radiation..

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 1/20/2022 8:17 PM (GMT 0)
(please no flamethrowing or derogatory comments. just simply digging for accurate data)

So, after reading Dr.Mark Sholz book, The Key to Prostate Cancer, I realized much of his belief on which treatments are most effective, is based on a study that was done where the researchers combed the literature for studies that showed long term results of different treatments.

These results are on the internet here..
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/

There are three graphs. One for Low Risk, Intermediate Risk, and High Risk.

Seeds and external radiation seems to have a large advantage over surgery alone in it's curative effect and length of time you are cured.

But.... they only show surgery alone. Not surgery with adjuvent or salvage radiation data.

Anyone familiar with this data or does anyone have info on the effectiveness of surgery WITH some radiation?
Posted 1/20/2022 9:12 PM (GMT 0)
"Seeds and external radiation seems to have a large advantage over surgery alone in it's curative effect and length of time you are cured."

in this case the treatments are administered in succession and if they fail then prostate cancer was already systemic. i had triple play. we threw the kitchen sink at the cancer. the belief was my cancer was most likely out of the capsule so we needed to not only treat the prostate but also the prostate bed, and quickly! my uro gave me a 60% chance that i would be cancer free after the treatments. that was 12 years ago and you can see by my signature i am cancer free. i have never once been incontinent and i can have sex with the aid of cialis

what i've seen with surgery in many high risk cases is the patient will have surgery and the doctor will tell him "we got it all". so when PSA starts rising there is denial, confusion and a bevy of tests given to confirm BCR. while the clock ticks and the cancer spreads. and when salvage radiation is administered it is often late in the game which means many guys who could have been "cured" WERE NOT.

i've watched that scenario unfold many times here. and i have seen many high risk guys go under the knife who were not prepared for the possible need of follow up treatment. the only plan they had was to get it out.

i am against surgery mostly because of the life-changing side effects but surgery with timely follow up treatment can be just as effective in curing prostate cancer. but in all my years here that's been more of a ideal than reality. it's been really hard to watch
Posted 1/20/2022 9:46 PM (GMT 0)
So F8, It looks as if you still have the prostate in, as I don't see RP in your treatment info.

What Dr. Sholz says in his book, I think he believes that the reason the seeds/radiation is showing to be more effective is micro-mets.

He is saying that they are finding mets come out earlier in the disease progression than they earlier thought.
AND, that with RP, some micro mets are left behind, while the seeds/radiation can mop up local micro mets.
Posted 1/20/2022 9:51 PM (GMT 0)
I am searching right now for information on Surgery (RP) with adjuvant radiation (ART) effectiveness.
THis is not shown in the graphs.
Posted 1/20/2022 9:57 PM (GMT 0)

groundhogy said...
So F8, It looks as if you still have the prostate in, as I don't see RP in your treatment info.

What Dr. Sholz says in his book, I think he believes that the reason the seeds/radiation is showing to be more effective is micro-mets.

He is saying that they are finding mets come out earlier in the disease progression than they earlier thought.
AND, that with RP, some micro mets are left behind, while the seeds/radiation can mop up local micro mets.

well wouldn't surgery + adjuvant radiation and ADT produce a similar result? i think we are saying roughly the same thing
Posted 1/20/2022 10:00 PM (GMT 0)

groundhogy said...
I am searching right now for information on Surgery (RP) with adjuvant radiation (ART) effectiveness.
THis is not shown in the graphs.

the vast majority of surgeries followed by radiation that i've observed in my many years here have been salvage radiation. and many of those were late in the game because of denial, confusion and a plan not being in place
Posted 1/20/2022 10:17 PM (GMT 0)
Yes, salvage has been used historically and all of the docs will offer that... as you said.

There are papers being written about radiation being administered soon after RP now. It is showing better results than waiting for the PCa to start growing again.

BUT.. it is being met with... "Oh, but we can't overtreat these poor men". Let's under-treat them, they will feel better. lol.

I think a little over treatment never killed nobody.
Under treatment kills people.
Posted 1/20/2022 11:15 PM (GMT 0)
Ok, this isn't from scientific papers directly, but I found this...

https://prostate-center.com/rt-after-rp/

It's a blog from a prostate doctor.

So, If I remember correctly, is it about 25% of men that have RP will have a relapse and rise in PSA?

Then this guy says, of the men that get salvage radiation, about 50% are then cured.

So of 100 men that get RP, 25 have a subsequent rise in PSA, they go on to have SRT where 12.5 of them get cured.

So if you go the RP route, you can guesstimate 87.5% will eventually get cured?

Does that sound right?
Posted 1/20/2022 11:28 PM (GMT 0)
Groundhogy,

The bottom line is that the risk of metastatic disease AND recurrence after monotherapy (surgery or any of the radiation options without ADT or Chemo) increases with the risk strata.

This is where the nomograms come into play.

Also, while it is rare for a G9 to be cured by surgery alone, there ARE situations where high risk men can benefit from surgery as part of a multi-pronged treatment plan. One immediate example would be a man with a very large prostate, where brachytherapy isn't a good choice because of difficulty placing the seeds. Also a man with a very large prostate might not tolerate radiation very well because the gland swells, potentially causing urinary issues.

Also note that at the higher risk levels (G8, 9, 10), the possibility of metastatic disease that is undetectable at the time of primary treatment is high. All of these factors play into the final treatment recommendation.

Groundhogy, I don't recall your G scores or biopsy results, so making a specific comment to your situation is not possible.
Posted 1/20/2022 11:48 PM (GMT 0)

groundhogy said...
Yes, salvage has been used historically and all of the docs will offer that... as you said.

There are papers being written about radiation being administered soon after RP now. It is showing better results than waiting for the PCa to start growing again.

BUT.. it is being met with... "Oh, but we can't overtreat these poor men". Let's under-treat them, they will feel better. lol.

I think a little over treatment never killed nobody.
Under treatment kills people.

they're quick to snatch the prostate of a G6 and they are worried about overtreatment? the prostate snatcher is THE reason that some people believe you're better off not knowing your PSA lest you be snatched by the snatcher... if you can believe that reasoning
Posted 1/21/2022 12:58 AM (GMT 0)
With my particular high risk situation, sequence of events, and Cleveland Clinic calculator, the 10 year probability of freedom from recurrence was 49% after my surgery. Adding adjuvant radiation increased the 10 year probability to 85%. Was I over treated with nondetectable PSA? Maybe, but it was my decision alone to make.

I am not going to tell anyone to plan on having surgery and adjuvant radiation as the way to go unless there are limitations on radiation or major urinary issues to address. However, if your pathology goes south on you, it provides a calculable benefit.
Posted 1/21/2022 1:12 AM (GMT 0)
" Adding adjuvant radiation increased the 10 year probability to 85%. Was I over treated with nondetectable PSA? Maybe, but it was my decision alone to make."

only survivors are overtreated
Posted 1/21/2022 1:49 AM (GMT 0)
Has anyone followed the link i gave and looked?

The results are .. well not quite stunning.. but interesting.

I am very interested in what the wise men here think of them.

Also if you look at the low risk group, you can see the surgical option is much better, as micro-mets i guess are not spread
Posted 1/21/2022 2:03 AM (GMT 0)

groundhogy said...
Has anyone followed the link i gave and looked?

The results are .. well not quite stunning.. but interesting.

I am very interested in what the wise men here think of them.

Also if you look at the low risk group, you can see the surgical option is much better, as micro-mets i guess are not spread

why on earth would a low risk guy have surgery? are you telling me a course of radiation like seeds or SBRT is much less effective on low risk PC? sorry, i don't believe that at all
Posted 1/21/2022 2:12 AM (GMT 0)
F8, click on the link and look at the data.

For low risk, seeds and radiation are just as effective.

But surgical outcomes are better.
Surgical outcomes drop as you go intermediate and high risk. I guess due to the micro-mets
Posted 1/21/2022 2:18 AM (GMT 0)
There are a plethora of reasons an individual will choose one treatment over another. It's not only about cancer control, or side effect potentials. F8, you are clear in your opinion of what is always wrong. However, that choice may be right for some man, who's situation you know nothing about.

From a cancer control perspective, for Low to low-intermediate risk men, where monotherapy is indicated, both surgery and basic radiation (all modes) show roughly equal cancer control results.

I'm one of the surgical men who has had a great outcome, at low-intermediate risk. I also acknowledge that when things move into the high-intermediate risk or higher, that radiation as primary becomes a much better choice from a cancer control perspective.
Posted 1/21/2022 2:36 AM (GMT 0)

halbert said...
There are a plethora of reasons an individual will choose one treatment over another. It's not only about cancer control, or side effect potentials. F8, you are clear in your opinion of what is always wrong. However, that choice may be right for some man, who's situation you know nothing about.

From a cancer control perspective, for Low to low-intermediate risk men, where monotherapy is indicated, both surgery and basic radiation (all modes) show roughly equal cancer control results.

I'm one of the surgical men who has had a great outcome, at low-intermediate risk. I also acknowledge that when things move into the high-intermediate risk or higher, that radiation as primary becomes a much better choice from a cancer control perspective.

we all make our choices and live with the results. but i am against surgery and that message is for the undecided. read this board for a few years and you'll realize that most guys with life-altering SEs had surgery as a primary treatment. sure they might be "cured"

at first we are so relieved that we have beaten cancer a damp diaper or a hopelessly limp penis may not be a big deal but as time passes it becomes a big deal. hence: "only survivors are overtreated"

so if surgery or seeds will do the trick for low risk guys why on earth would a man opt for surgery -- if he has a choice?

i think you did have a great outcome but didn't you recently say you were experiencing incontinence?
Posted 1/21/2022 2:37 AM (GMT 0)

groundhogy said...
Ok, this isn't from scientific papers directly, but I found this...

https://prostate-center.com/rt-after-rp/

It's a blog from a prostate doctor.

So, If I remember correctly, is it about 25% of men that have RP will have a relapse and rise in PSA?

Then this guy says, of the men that get salvage radiation, about 50% are then cured.

So of 100 men that get RP, 25 have a subsequent rise in PSA, they go on to have SRT where 12.5 of them get cured.

So if you go the RP route, you can guesstimate 87.5% will eventually get cured?

Does that sound right?

i don't think it's that simple
Posted 1/21/2022 2:38 AM (GMT 0)
In my twelve years of researching possible treatments (I am a Gleason 6 on active surveillance), I have never read any large scale, peer-reviewed, multi-institutional study that showed another treatment matching the non-recurrence results of SBRT/Cyberknife. Not even close.



Also, I never seen a study where surgery had better results than a combination of EBRT and a brachytherapy boost for high risk patients.

Just my opinion, based on my research.
Posted 1/21/2022 2:45 AM (GMT 0)
ASA
Click on the link and look at the data.
You can compare the results of many treatments and further your personal research
Posted 1/21/2022 4:30 AM (GMT 0)
I have been viewing those graphs for several years. The obvious reason why I don’t place much weight on them is because the studies are retrospective and mostly involve men treated many years ago, before the age of modern radiation, which began in the 2004-2009 timeframe. The RT equipment used to treat the great majority of those men has not been used for at least a decade.

I only value studies involving radiation where IMRT or SBRT were exclusively used. In earlier, less sophisticated times, there were many problems with radiation treatments. Not now.
Posted 1/21/2022 1:39 PM (GMT 0)

ASAdvocate said...
I have been viewing those graphs for several years. The obvious reason why I don’t place much weight on them is because the studies are retrospective and mostly involve men treated many years ago, before the age of modern radiation, which began in the 2004-2009 timeframe. The RT equipment used to treat the great majority of those men has not been used for at least a decade.

I only value studies involving radiation where IMRT or SBRT were exclusively used. In earlier, less sophisticated times, there were many problems with radiation treatments. Not now.

THIS is the biggest problem with studies of this type. How far back are they looking? A second issue with studies that discuss side effect profiles is that they are almost always based on voluntary responses by patients who fill out questionnaires of the "how would you rate your X" type--which are notoriously bad for a multitude of reasons.
Posted 1/21/2022 2:08 PM (GMT 0)
Validating or invalidating studies for subjective reasons does not lead to better answers. You need the study of the studies then the study of the study of the studies which determines the need for more information is necessary to complete the study. It does take an infinite amount of time to do this so do not expect a quick answer.
Posted 1/21/2022 2:20 PM (GMT 0)
Mumbo, Totally agree. Studies take years from the last treatment to being able to publish any conclusions with confidence. I would love to see very recent SEER data on treatment choices, as that information does not require any subsequent patient follow-up. But, even that data is apparently QC'd for years before being made public.

My issue with treatment outcomes, is, of course, that the equipment and/or techniques tabulated are no longer in use by the time of publication. Just the way things are....
✚ New Topic ✚ Reply