Quality of life comparision study between treatment options

A study was posted on the New Prostate Cancer Infolink comparing quaility of life issues after Robotic, open surgery, Brachytherapy and Cryosurgery.

http://prostatecancerinfolink.net/2010/04/05/quality-of-life-after-first-line-treatment-a-prospective-comparative-study/

Summary of results:

Urinary functions: Brachytherapy patients had significantly better functions than robotic or open patients.

Sexual functions; Brachytherapy patients had significantly better return to sexual function. There was no difference in Robotic vs open.

Bowel funtions. No difference between any of the treatments.

JohnT

 

David,
The only thing that might change is the rate of biochemical reoccurance. There would be no change in the QOL as all procedures are done exactly the same whether it is a G6 or a G8. As to biochemical reoccurrance some studes show Brachy as superior in the higher gleason grades and others show surgery. From what I have researched the differences are not worth splitting hairs about and just about as good as a coin flip as to which is superior in the higher grades. In the lower grades there is absolutely no question that all treatment options have the same cure rate.
JT

John, thanks for sharing.  Of course this is not surprising to me given my personal experience as well as the depth of study on brachytherapy that I did pre-procedure.  Hopefully this will add perspective to the new guys who are contemplating their choices.

David, I think your commentary on side effects is extremely helpful...not only from your personal experience but from your constant observaions of the many patients who roll through here.  It's a lot easier to say "get it out" pre-procedure than from a post-procedure perspective of incontinence, ED, stricutures, etc, etc, etc.  I'm sure the new guys think John and I are biased because we have made a non-surgical choice.  But I think they find it hard to fault you when you encourage people to look at non-invasive/low SE options. 

Tudpock

Tud, I try to portray that neutrality with an open mind and heart. For any of the new brothers that come through our doors, I think its real important to be treatment neutral on our ends. Especially since it seems like lately, the bulk of the new guys have lower grade, Gleason 6 cases. For all of us that have been through the wringer with surgery and salvage radiation, I only wished I had been fortunate enough to have had real choices. Of course, there are those, whereby surgery is the best first hope without question.

It's hard to change the mentality of the 'I have to get it out of me immediately' line of thinking. A person would have to come to an understanding, that even with an agressive cancer indicated out of a biopsy, there is still plenty of time to go through the due diligence process of going through all the options, gathering professional opinions, and weighing it all out. It makes me feel a little sad for the guys that get the PC dx, and have a full treatment plan sceduled in a week or less. I realize that some may have done their due dillergence prior to their dx. Kind of my situation, as I had 3 biopsies spread over 18 months, and spent a lot of time reading/researching on the assumption that I would eventually be dx.

I may get shot for this one, but I still feel inside that some of the robotic "selling points" are being oversold. I know the hospitals have to drum up biz for the cost of the machines, but just doing a non-scientific review of our robotic guys, I am still not convinced they have any advantage in side effects or quality of life issues. And I have noticed that a lot of the new guys, still don't see or understand that robotic or open, it is a major complex surgery. Of course, less invasive with the actual operation with robotics, but still a very complicated surgery, and a whole lot can go wrong.

You ,and JohnT, and the other few that are on your seed path to me play an important role here, to give good working examples of how seeding with and without RT can be a good treatment. I am pleased on HW that we have at least you guys being in a position of giving an alternative to surgery.

David in SC

John, I fully agree with your very last statement there. I don't think it's so much that surgeons are lying or misleading on purpose, but they can't predict with any certainty what kind of side effects and/or quality of life issues their surgery patients will have to endure and/or suffer through after the fact. My chronic stricture saga, certainly wasnt' discussed or compensated for ahead of time. It's a combination of having a body that loves to over-scar, an unsually complicated bladder neck to urethra connection, and a more intensely bad reaction to the salvage radiation. The dr's that make me nervous, are some of the one's that are all but guaranteeing little or no side effects from their push for surgery. I don't see how anyone could do that with a clear conscious.

I too, am glad that at least now, that AS is being viewed as a credible alternative to those meeting the criteria. If I had been a low grade case on day one, I would love to know that I could buy some normalcy of life while monitoring smartly my PC situation, and safely too. The guys that just blow that off without a thought, that qualify, may wish one day that they had thought through more on that choice.

David in SC

David,

I think that many more men who qualify for AS, would consider AS, if they realize that we all do watchful waiting in one way or another from the time of diagnosis to the time we die. AS, done with proper medical monitoring, should be strongly considered by anyone who has what appears to be non-aggresseive cancer. 

It wasn't too long ago that this thread and it's originator wouldn't met the fury of the get it out of me asap crowds inquisition. That said there are still those who appear a few days after dx already having their surgery scheduled. Or those who schedule it as casually as a dentist appointment not really grasping the possible SEs that could adversely affect their quality of life issues. In fact bringing up or giving some priority QOL issues alone would bring the wrath of some here down on ones head not too long ago, I remember from personal experience. The fact that over treatment has been shown in quite a few recent articles have finally had an effect. Although many still think it's a cost cutting conspiracy or that the doctors motives or competence are in question be it from what are normally before then respected sources and individuals. Next needed is to better explain local and systemic PCa to those newly dx.

The times they are achangin

You know, I think most of the surgery guys accept other treatment options.  And with great tolerance for the inferences that many surgery guys have been misinformed, made hasty decisions, and are now leading miserable lives with the horiible side effects.

It does get a little tiring tho.  Why can't all of us just accept the treatments we have chosen, without either in a backhand way or a more direct lob, throw stones at the other treatment options ?  In spite of opinions of some, the "get it out of me" syndrome is not as prominent as it may seem.  There is sound logic to the risk of surgery, there is good reason statistically to choosing surgery, just as there is to choosing brachy, radiation, cryo, Hufu, etc.etc.

And we all get opinions for our uro's, radiation docs, and pc oncologist.  Some of those arguments are influenced by doctor personality, strength of argument, and geographic location.  I happen tobe fortunate to reside within close driving distance of 4 major cancer centers here in Ohio and Michigan.  Insurance also becomes a factor for many.

I am a satisfied surgery patient, who made an informed decision, and have had as good a result as I can expect so far.  I try not to be a surgery misisonary, trying to convert the lost.  I will share my experience willingly to those who ask.  Likewise, I encourage folks to get multiple opinions and seek education, and make informed decsions.  I will never be quoted on here trying to tell someone they made a mistake, or would be making a mistake following a certain protocol.  Hopefully we can all do the same.

God bless all you guys.

Realziggy, that can be a good thing. We don't want things to be standing still or stagnant. Education and research should keep things alive and well. Progress is measured by a willingness to accept new facts and to accept change when needed. That includes opinions. No one should be ashamed to change their mind or opinion about anything, when faced with new facts. That's how things get better.

Even though we represent a micro group of PC men and families, perhaps we are seeing the results even here in the past year of education, research, and knowledge with PC. Even the medical family is changing their views on some aspects of treatment, overtreatment, the value of AS, etc.

The hardest part to work on next, is the general fear factor of having cancer. All our adult lives, we are exposed to and taught to fear cancer, so when it hits us, or one of our brothers, its most human and normal to be paralyzed by fear, either inside or out, or both. Its also a normal part of processing the knowldege of having cancer, one of the normal steps in dealing with it. Except a person isn't suppose to get stuck at the fear stage, and that is the worse stage to make a major treatment decision. Just something to think about.

David in SC

When I was first presented with the diagnosis of PC, the only thing on my mind was "get rid of it immediately". My wife (Janet) and I had a consultation with a daVinci expert who has done somewhere around a thousand of these procedures. He, of course, would NOT recommend any one treatment over another. My wife finally threw her two cents into the pot and asked him that if HIS dad had my diagnosis (at 73 years of age) what would he recommend for his own dad. He did say that he thought he'd tell his dad to seriously look into radiation of some type. This daVinci Doc sure didn't push his services at all and we really appreciated that. Then after reading the many many posts here on HealingWell.com and communicating with others who went the Brachy route, we checked into the Brachy procedure for ourselves and that's what we have now decided on. Now just have to go in for another volume study towards the end of May and hopefully, a few days later get the seeds implanted and then get on with my life. This is my second bout with C and I beat it once so sure expect to beat the beast again.

Goodlife,
I went back and read all the posts and just don't see any attack on anyone's choices. Choices are made with information given and everyone has different criteria in making that choice and we have always supported that concept on this board.
This board is also about providing information and there is a belief system among doctors and patients that influences their decisions. That belief system is being challanged with new data and slowly patients and doctors are slowly changing their ideas about PC and treatments, When any established belief is challanged, whether medicine, politics, or religion people feel attacked.
I'm going to sart a new thread on PC beliefs that are being challanged.
JohnT

Goodlife:

In defense of realziggy's comments, he took a real beating (before your time) from "surgery guys" who ridiculed his choice of TFT.  So if he is a bit sensitive on this it is well placed sensitivity, IMHO.  Beyond that, while it is true that not two cases are alike, etc, etc, brachy is hardly still a "promising" treatment.  There is a ton of long term evidence re its' cure rates as well as QOL and this study that John shared is reasonably powerful...beyond the "gathering data" stage...

Tudpock

No disagreement from me.