Prostate Cancer Study Results

We both have biases John,
I agree with your very strong opinions for the most part.

Just a note on Dr. Bahn. Dr. Bahn is a board certified radiologist and that is his registry to practice medicine in California. All you have to do is read his website to see the various approaches to treating prostate cancer. He speaks once a year at my UsTOO group. He is great to have around when I need speakers. He presents both cryotherapy and brachytherapy. At least he'd better! Because if he did endorse this website he is putting himself out of business. Cryo does not look so good in these graphs.

It would be a mistake to think it's fair to compare brachytherapy in combination with any other therapy to mono-therapies. You seriously need to look at those charts again and remove the blue stars and diamonds, especially in the higher risk groups to get accurate comparisons. Or you need to add diamonds and stars for those other therapies.

Surgery with EBRT and HT is the correct comparison in these charts. To not do it is totally misleading.

Additionally, and an important note: The ASTRO definition of bFSR is Nadir+2. If you had a PSA of 4 when your were diagnosed, and your PSA dropped to 2.3 after therapy with radiation, then you are not considered in relapse until your PSA reaches 4.3...only then do they backdate your relapse to the day your PSA went above 2.3. This case I use here was never in remission...even if the PSA had stayed at 2.3 for years. But until they backdated it, it was listed as cured in the ASTRO definitions.

It is very difficult to compare radiation to surgery which offers a more definitive and immediate notice of relapse or procedural failure.

Tony

David I love the last paragraph. That was my call originally. We knew I was 50/50 on the front end but I wanted to try to avoid introducing radiation at such a young age. My question of what if this fails was answered by knowing that phase II would likely involve radiation. Well as it turned out, radiation and homonal therapy was used. But if the surgery had worked, then I might have avoided both RT and HT. I might have ended up with incontinence and ED, but better to do business with the devil you know. As it turned out the surgery did not cause anything that serious like what the HT did. Why would I want to start there if I didn't have to?

But I am not knocking a treatment here. My bias is clearly against whoever made these charts with a definite skewing intended.

Tony

da Vinci Prostatectomy is the #1 choice for treatment of localized prostate cancer* in the United States, and is rapidly being chosen by more men, as well as their doctors, worldwide. da Vinci Prostatectomy is a minimally invasive, robotic-assisted surgical procedure that removes the cancerous prostate gland and related structures.

Which one of these do I believe ?  I read them both on the internet.  This quote is from the DaVinci website.

I have to beleve this is the truth.  Wait, the other site had more experts from around the world as an expert panel.

I really am confused !

It seems as tho we have spent a lot of time on this thread discussing biases, and not the meat of the arguments.  Can't both sides be correct ?  Why is the method I used better than someobe elses ?  Why can't we just be happy for the guys who have achieved vistory over PC, no matter what method they used.

Of course the Seed Insitute study shows a bias.  Of course the DaVinci site shows a bias.  Until someone shows me a study that shows a 100 % cure rate, then any method has a chance of not working. If I am in the 10 % that didn't work for a particular method, does that make me feel any better that I picked the best method ?

Probably not. 

Moderators, is this a legitimate post above here? Has it been cleared?

David in SC

Dr. Grimm,
Thank you for posting. Please understand my concern for biases on both sides. I am certain you are aware of your peers in different treatment modalities who would take time to critique your studies findings and offer their own studies and findings. I personally found exception as a layman in comparing a treatment regimen of interstitchal therapies combined with external beam radiation and hormonal therapies being compared to other first line treatment modalities alone. It's makes graphs appear biased and misleading.

As the President of a large UsTOO chapter here in Las Vegas and a long time moderator of this online forum, I do not criticize the patients selections of what they feel works best for them. Prostate cancer is a very individualized experience for the patient and comes with a great deal of uncertainty in the back of their minds going forward. So if we allow one doctor to post here on his specialty we must also allow the other with varying opinions to also post here and that is against forum rules to allow doctors here providing advice to our members. It is clearly outlined in our forum rules that this is a site for prostate cancer patients and their loved ones.

I am also a student of my own illness and the many fantastic doctors I have been blessed to know and have worked with in my work in advocacy. The rules here limit what I can allow and I can't allow my doctors to post here either. As the chapter leader at UsTOO I would readily welcome your speaking at them as we already have had Drs. Bahn, Leibowitz, Scholz, and many others of the PCRI group do. I will write you to propose that invitation even, and make me a smarter advocate along with our group there.

If you would like to seek further permission to post here as a member please contact our site owner at [email protected].

Thank you for understanding.

Tony Crispino
Chapter President
UsTOO International in Las Vegas
Forum Moderator at HealingWell