Prostate Cancer Study Results

These are impressive graphs but I would be VERY careful.

Note that the source is a brachytherapy clinic. Much worse, when I tried a Pub Med search I came up with nothing. (yes, I do know how to search the medical literature) I did find that Peter Grimm, the credited first author, does publish on brachytherapy. I also found a slightly longer version of the report (but still nowhere near complete) at
www.seattleprostatecancercenter.com/pdf/posters/LowandIntermediateRiskProstateCancer.pdf

A close read shows, for example, that NO robotic surgery cases are included

I did not get much out of this report. It was difficult to read and I to felt it to be rather biased. Maybe if I understood it better I might get more out of it.
Thanks for sharing.

peace to you
dale

Obviously, Brachy would appear to be the treatment of choice based on these graphs from the seed therapy group.

As I understand it, this is no new research, but a compilation of 600 articles that fit the criteria.

I would have seeded, but with a Gleason 9, did not fit the criteria. That is a positive for surgery in my own book, that it is applicable to all stages and conditions like EPE, etc. I think if we had better diagnostic tools to tell the oncologist everything they needed to know, Brachy is a great form of treatment for certain PC cases.

No doubt in my mind ~ total bias. This is not a controlled study by any means.

This is the kind of report that makes me question the ASTRO bFRS system (Nadir+2) and the criteria used to determine the candidates in this study. The conclusions spell it out best.

1> This is not a randomized study.
2> Comparisons are confounded particularly because there was no pre-treatment stratifications.
3> Few of the studies used conformed to reporting criteria.

In other words, we need better data than what is assembled here to draw any conclusions. The group willing to say it appears that seed/combination therapy is performing better, is not telling us much because of the other conclusions. And this is a seed radiation center selling seed radiation.

Tony

I hate to say this, but this looks like a self promoting study.  I get upset when a DaVinci surgery Mill or old time advocate of open RP assembles data to make themselves look better than a 'competing' treatment modality. The same goes for Proton 'factories' or brachytherpy proponents.  They are just trying to sell their product.

I think most of us agree that there are several good ways to treat prostate cancer.  A lot depends upon the exact diagnosis, we know that one size does not treat all.  The data from this study appears to try to mislead the reader into thinking that brachytherapy is the best for everyone.  It purposly excludes more advanced cancer diagnosis from it's conclusion.  It also appears to have excluded DaVinci surgery, though I doubt that significantly changes their conclusions.

Brachytherapy is one of the best treatments for G6 results, but other studies seem to indicate that it should not be used for more agressive cancers.  Just as some DaVinci assembly line surgeons overpromote their product and make claims that in some cases are just plain not true, this study needs to be read with a suspicious mind.

Truly-truly TC, that sentence reasonates 'I am disappointed that the medical community does not have such data'. One of the reasons we all search our tails off and try to compare all data we can find and get those multiple opinions and treatments. Now should we suspect the medical community giving us the mushroom effect???? No doubt it works for them.  I know that is half glass but it does run across my thoughts.

Seems like the clinical trials usually lack some parameters or are dropped sometimes for reasons that we don't understand, too. Frustating as heck, been watching the PCa world for 7-8 yrs. and not to much in the way of break throughs, some little bits maybe.

My brothers  wife is a mulitple myleoma patient has looked into plenty of treatments even on a global basis to some degree, many mushrooms to look at with no real answers, makes PCa look alot more definable. He says that he read that the average cancer patient (generality and averages thing) is worth $500,000 to the medical community. I will leave my thoughts there on this...like Tom Hanks in Forest Gump...that's all I'm gonna say about that (Jenny...).

P.S.  Radio Therapy Clinics of Georgia (RCOG) was going to sign me on as a patient with high risk stats, I did not want to travel and be there for all those weeks and later preferred Dattoli "if" I were to chose that proceedure and distance parameter...I did not trust the local expertise to do this.

Post Edited (zufus) : 12/7/2009 5:02:16 AM (GMT-7)

Tony writes, "I am disappointed that the medical community does not have such data."

I am shocked that a generation after starting to use the PSA test, the medical community still doesn't have answers to a lot of key questions about prostate cancer.

And I share Zufus' suspicions as to why that is.

As for this new study, in the immortal words of John McEnroe, "You can not be serious!"

Zen9

David Crawford is a board certified radiologist and he is director of the radiation oncology center at UC. He was also Director of surgery. I am not sure what he is doing now that a new director of the cancer center is in place.
www.cpdr.org/speakers/crawford.html


Tony

He might still be. He did at one time run that center. But over time I have noticed that most researchers don't like that role. My oncologist was the facility Medical Director at the Nevada Cancer Institute, but he didn't like it. He is now focused on Genitourinary cancer research.

Crawford is a gem of a doctor but I don't think any on the "Expert Panel" are endorsing brachytherapy as the best therapy unconditionally as this website clearly does. I have put some feelers out this morning on this web page. Awaiting word from my personal "Panel of Experts".

Tony

Dr. Scholz is partnered with Duke Bahn, a radiologist, and it is the primary local therapy at his center. In any case, the role he played in this non-study is moot. Bostwick like you said is a pathologist. I show you his presence in many surgery non-studies as well.

These "Expert Panelists" did not endorse these findings into a study. I am not surprised. The study subjects include "Google-Study" Are you kidding me?

PCRI is Mark Scholz's institution. He is a co-founder of PCRI. It's interesting to note that the medical advisory board is mostly radiologists and only 2 Urologists ~ hardly prominent ones at that.

http://www.prostate-cancer.org/pcricms/node/30

I do respect these guys, but they are biased. I attended the PCRI summit this year and it was largely a lesson in radiology.

Tony

Andrew,
1st, this is not a study. Period. It's selected data used as an Ad at a radiology center website. At best it is designed to get more patients to do brachytherapy.

2nd, I have been treated with surgery, external beam radiation, and hormonal therapy. So I have been around the block with Urologists, Urologic Oncologists, Radiologists, and medical oncologists/hematologists, not to mention working in the advocacy front and as President of a large UsTOO chapter. I fully recognize that other primary treatment modalities would have me in the same boat I am in today. My problem with this webpage is in my opinion about seeds and studies below.

3rd, your comments about what I don't believe in are in direct conflict with conversations you and I have had together on the phone. I will reprise my position on each since you mis-stated them:

ADT3 ~ As I just told you on the phone, I am on the fence with ADT3 when compared to ADT using an LHRH agonist combined with an anti-androgen. I am not aware of any study that has been completed giving us data that shows adding Finestaride or Dutasteride to ADT improves any patient mortality rate. As I said, if my PSA climbs, I am in agreement with my oncologist that we will add finesteride when returning to ADT for peace of mind. There is a new study comparing these options, but we are 10 to 15 years away from useful data. Anyone electing to proceed with ADT3 should do so with the full understanding they are adding SE's to an already tough regimen of homonal therapy without medical history of whether or not it will work for them. This is commonly accepted anyway in cases where the disease is metastatic and I don't fault anyone choosing to do so.

Combidex ~ I have stated before that the use of ferumoxtran-10 is a tool that can help identify the presence of metastatic cancer in the lymphatic system. But it is 25% inaccurate, and this is not my opinion. It can lead to bad decisions if it alone is used. This is why it is only available in limited locations world-wide. The overall usefulness is still being studied, along with research to find a contrast that is more precise. Today Combidex is still not an accepted protocol in ANY country. It is still in the research phases even in Europe. These is a Phase II study in the US involving certain cases of brain cancer but it is very early and there are no results. John T can tell you these points are true as I don't think he disputes these points.

CDI ~ Color Doppler. Again a useful tool but not for all. I have recommended that some guys get one because their cases are very much in a gray area in deciding treatment and the extra data may help them. But CDI does not detect micro-metastatic disease, and no imaging does. While the accuracy of CDI is not real strong, it can be useful in selected cases. One should look at CDI as only a piece of their information gathering, and not solely base decisions on it.

Seeds ~ Again, I have stated that brachytherapy alone should be compared only to other mono-therapies alone. Comparing brachytherapy combined with other treatments to several mono-therapies, like this website does, it stupid. It's what makes this page biased. If you are going to add ADT or EBRT, or both, when comparing modalities, then you must do the same in the other modality options as well. It's a definite way to make the treatment you do look better in a graph by failing to do so. And it was intentional here that Surgery with EBRT and HT were eliminated in the comparison. I have stated for my position on this that seeds are a great option for a large population of prostate cancer patients, but not for all. Particularly those who are in the younger age groups that will definitely realize long term side effects that are well publicized, and have longer life expectancies.

Dr.s Strum, Leibowitz, Myers and the et. al. you might be referring to. It's the Et Al, that I believe is being biased against in general when discussing prostate cancer in web forums. I have never met Dr. Strum, but his reputation is well known as is his contributions to the research of prostate cancer. Dr. Leibowitz and Dr. Myers are cut from different molds. Myers believes in surgery in both advanced and local cases. Leibowitz actually believes in treating local prostate cancer with ADT3. I find that one fascinating. You will get drastically different approaches from these two alone. On the plus side these are great doctors for prostate cancer.

To your question of how many researchers, scientists, studies, etc. are not biased ~ I don't have that data. But usually when a study is reported before confirmed in a controlled study, or it is done with one doctors patient pool ~ I would be willing to bet it is biased.

I have never mocked anybody having slides sent to a 2nd pathologist and you won't ever find that I did here at HealingWell. In fact, I have frequently made it one of my top pieces of advice for new guys. I have even posted instructions on how to do so...There is a short list of prostate cancer pathologists floating around here, but they are not the only choices to get a solid pathology reading. Mine was confirmed by Epstein, but he did not change the results of my original one done at the City of Hope. So that guy at the City of Hope certainly didn't miss anything in his report so I concluded.

Andrew, since you are going to quote me, please refer to this list of responses the next time you quote my opinions on the above items so that MY side comes out of it.

To quote Dr Myers: "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data".

Sadly. Very true...

Tony

Tony,
Your bias is affecting how you see things.
1st, this was a study supported by many noted doctors from just about every field and major institution, and just because the results were posted on a seed site does not make it an ad or biased any more than a study favoring surgery being posted on any institution's site doing surgery is. If I were running a seed institution I would also be touting this study.
2nd, To infer that Scholz is biased because he has Bahn as a partner. Bahn is a cryosurgeon and Scholz certaintly doesn't recommend cryosurgery. Frankly he's biased because he has treated hundreds of cases of failed surgery and is intimately familiar with the results and permanent side affects.
3rd. You are quick to support all posts indicating surgery as the most effective option and quick to discredit any that don't share this view. You infer that any doctor who does not support surgery like Bostwich or Sholtz are biased. Maybe they are biased because the evidence supports their bias.
4th, You can't really compare the combo of seeds and IMRT to a combo of surgery and anything else. Seeds and IMRT is an established protocol widely recommended as a 1st choice treatment. A combo of Surgery and anything else is rarely a recommeded 1st option, but in too many cases ends up that way. Very few people choose a surgery combination when offered as a 1st option. It is mainly touted as the best chance of a one shot cure.

I admit my bias. I started out as most everyone else, believing that surgery was by far the most effective option. As evidence mounted, I changed my opinion, and more and more evidence is being presented that surgery may not be the most effective option for the vast majority of PC patients.

Thanks for clearifying your other positions to Ohio State; I agree with them. PC has many conflicting opinions among all the specialists and we must avoid letting our bias keep us from accepting new evidence that may not support our preconceived positions.
JohnT