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Adjuvant therapy? ~ The data continues to gain momentum.

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Posted 8/5/2010 7:11 PM (GMT 0)
Post at the InfoLink today on the use of adjuvant therapy...

tinyurl.com/2ekqw2a

I commented there as well.

The folks that this post applies to are stage 3 and/or lymph node positive cases. Some early stage 3 cases do have improved results, but better results are seen in cases where seminal vesicle invasion is present or larger disease. These results are regardless of Gleason grade. In fact those older studies shown in Strums book, and Walsh's book that show that adjuvant therapies are not clearly effective, have indeed been trumped by many studies since the 5-6 year period since those books were written. Both of these oncologists have gone on record as stating so in recent times.

This particular study focusses on ADT with a local therapy. I take the liberty to state that ADT with any combination will show improved results.

I hope so. I know I'm not complaining...

Tony
Posted 8/5/2010 9:28 PM (GMT 0)
Hi Tony,

Thanks for the URL to an interesting article. It maybe of great benefit to newly diagnosed brothers. To bad that it is a little to later for me.

Hope you're well. Keep up the good numbers.

All the best to you.

Mag

Posted 8/5/2010 9:31 PM (GMT 0)
Hi Tony,

When I was researching alternatives for treatment after my diagnosis I gave heavier weight to more recent studies. I found several that supported ADT with radiation as an accepatable and effective therapy for locally advanced PCa. Most said the best results were radiation and a two year duration of ADT. On the ADT there did not seem to be a large difference in whether it was single, double or triple blockade when looking at OAS. So far, I am satisfied with my choice and my last PSA was a 0.10. Hoping that was not an error and will repeat it in a few weeks.

Best to you.

Don

Posted 8/5/2010 11:56 PM (GMT 0)
It's not hard to belive that adjuvant therapy works with the higher gleason grades. HT works best when the tumor volume is still low. If surgery or radiation removes the bulk of the tumor then HT will kill the remaining cells that are still in the blood stream or in the margins. These are what usually cause a reoccurrance. It doesn't make much sense for the lower grades contained PC as the primary treatment has a very high probability of getting it all.
JT
Posted 8/5/2010 11:59 PM (GMT 0)
No this isn't for the T1/T2 guys unless they are N1 or M1 confirmed. There is some knowledge that the G8-10 guys with T1c may reap benefit in those stages, but you are really adding morbidity with smaller return. The best benefits I am seeing consistently are the clearly defined T3 and up guys.

Tony
Posted 8/6/2010 12:27 AM (GMT 0)
Great article Tony and thanks for sharing it. I read your reply and I think it was accurate.

peace to you my brother

Dale
Posted 8/6/2010 2:09 AM (GMT 0)
Now maybe they will eventually compare various other drugs to use prior or with primary treatments....well wishful thinking anyway.
Posted 8/6/2010 5:02 AM (GMT 0)
It's up to the people manufacturing and providing the various drugs, Bob. They certainly can start using study protocols to get statistical data. The problem is that many of the doctors using the numerous and various options use case study and not stringent study criteria. That's not to say that they are not on to something, it just makes it harder to report on their efficacy or for people to trust reported results.

Just a thought...

Tony
Posted 8/6/2010 12:41 PM (GMT 0)
Just my own bizarre ideas I would think prior treatment with estrogenics(maybe even Keto, Leukine and a few select other drugs) might have even better results, because they work on hrpca and Lupron or LHRH and even casodex are found inferior on that level. I think early refractive or risker patients could have an even better chance either for possible cure (I know bizarre thought) or longer remissions and survival times. But, there is no money or incentive for these money people to get excited about to work on such (except for the Journal Article from Nov. 2003 on DES, very objective findings and the docs commentary on it was priceless), I would say keep your eyes pealed to further findings that are outside what we call the norm.


Tony do you know how to get Dr. Premoli's published results on estradiol patches, he published it in his country I had heard from him about that directly, naturally our Journal publications were not interested even in mentioning his patient studies and results (yeah if it isn't done here it has no value???). I have read what UsToo.org had on this and some of that comes from Dr. Premoli, I am talking about either an abstract or Journal article from him, I would love to read it.

Posted 8/6/2010 3:35 PM (GMT 0)
On the subject of sequence of treatments there was an interesting article on Science Daily a few months back that related information from a small study where the patient received IMRT first followed shortly by surgery before the radiation damage set in. It appeared to be successful. I questioned my oncologist about this and he was not aware of the study and left me with a "no comment" sort of reply.

Don
Posted 8/6/2010 4:09 PM (GMT 0)
Here is one such study:
www.pcainaz.com/Pages/ETE_eng.pdf

They acknowledge that this is not a controlled study, but the results are decent. I am a gluten for punishment every time I mention that I don't like non-controlled studies here. But I am firm there and I think for good reason. But I don't turn the acceptance of data off, I just remain skeptical.

Tony
Posted 8/6/2010 4:14 PM (GMT 0)
Don,
That again is a single case study. Few doctors will jump all over it. Most surgeons will stay away from that type of surgery. i understand that Mayo has the best salvage RP program, but it's relegated to extreme cases. They call it tumor debulking and it does work for those patients who are in absolute need of it. And by "work" it has been known to extend survival...

One HW member here whose husband had that surgery was "divo"... She live in Connecticut. She is a well known artist, her husband a scientist. I haven't heard from her in a while, but I have her contact information...

Tony
Posted 8/8/2010 1:06 AM (GMT 0)
My question is probably one more of odds and statistics than studies that show the potential value of adjuvant radiation.

It comes down to the potential risks of radiation without a clear diagnosis versus the odds of having a surgical cure without the adjuvant therapy.  Probably even a third dimension to this dilema is the odds that the PC is systemic, and that the adjuvant will not get it either.

In my case with a T3 G9, this study would imply that I was a potential gainer by undergoing adjuvant therapy.  However with incontinence, and with excellent post-op PSA's, I chose to follow the surgeon's advice who said that more current thinking was to wait for rises in PSA before undergoing salvage.

So, now at 15 months and PSA < .01, I am getting cautiously optimistic that the surgeon may have gotten it.  In another 10 years I will be a little more certain.  But my question still remains unanswered.  Should I have underone adjuvant based on some of these studies that showed a 40 to 50 % chance of a curative treatment vs a 30 to 40 % with slavage treatment, and a 1 1/2 % chance of radiation tumors, and permanent incontinence, and potentially permanent ED.

I guess I am playing the odds here.  For a 10 % better chance of a cure, with potential or worse QOL issues, and the potential for radiation induced tumors, and rectal damge, etc., etc., I decided that the numbers weren't there.  I am waiting for PSA increases. 

I suppose my age plays a part here as well.  I guess my entire point of this post is that this is not a simple decsion that is easily arrived at, and nothing but upside.  There is a rather complex decsion tree here.

Posted 8/8/2010 3:06 AM (GMT 0)
Goodlife, we are the same age, but on paper, your stats are more serious, but then I have all the velocity issues. It's hard sometimes to know what to do with a post surgery secondary treatment. There are always gambles and tradeoffs, which was why I was hoping I didn't need to jump into SRT. In my case, I had pretty good reason from past experience that any radiation again would do a lot of damage to me, and it has proven to be the case. Your PSA numbers are outstanding when you consider your overall stats. So sometimes. we jump the gun, and sometimes, we miss the best shot, just not way of being certain. That's the hard part of PC to me, regardless of how educated one is with the facts, figures, treatment options, it still comes down to an educated guess at best in my opinion. And we all hope we are guessing correctly. In my case, and the jury is still out, but if my SRT fails to halt the PC, I will always be angry at myself for given in to SRT against my gut feeling. If I knew it wasn't going to work long term, I would have never put my body through the hell it has been and still is all these months later. Not a fair disease by any means, but we all have to do what we feel we have to do, and hope for the best. I hope your numbers stay good for a long, long time, and that you stay on the good side of the percentages.

David in SC
Posted 8/8/2010 10:56 PM (GMT 0)
David,

I thought of you as I wrote my post. If you had done adjuvant radiation and didn't need it, all of your trials for the last year would have been needless.

Since your stats necessitated SRT, then you paid your money and took your chances. You only had statisically a 25 to 35 percent chance once you started, so the odds weren't with you.

I would/will do exactly as you have done. I will go a step further and say that in all likelihood I will do HT as well if I think I can maintain a good QOL for a few more years. I see guys like Dale and others who have had some good years on HT. I see no real reason not to.

The point of my post was that SRT is a better gamble than Adjuvent. At this point it is a gamble.

Wishing you the best in the coming months. You have fought as good a fight as any on here. I think that if you can get the catheter situation under control, that your attitudes may change about HT if you are feeling well, and able to function like a normal guy. Life is good, and if HT can give us a few more years of good life, then there isn't a lot of downside.
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