Radiation studies

Please post the surgery survival rates, along with Seeds. How significantly different are the results ?? Also, I wonder whether there are any biases. I can think of at least one--since seeds are usually give to older people, and surgery to younger people, the chance that they will die from other sources would be much higher for seeds patients, and thus the chance of dying from prostate cancer could be reduced by this strong bias.
I'm sure that I can think of others.
Interesting statistics, though.

These stats have nothing to do with survival rate. The numbers reflect biochemical free reoccurrances; They also have nothing to do with age.
Numbers published by Dr Walsh in 2007 in the Journal or Urology had cure rates for surgery for low, intermediate and high at 85%, 63% and 40%.
The Prostate Cancer Study Group averaging across 12 institutions came up with 85%, 70% and 40% for surgery, fairly close to Walsh's numbers.
A study by released by John Hopkins concluded that reoccurrances for surgery occurred an average of 5 years earlier than from seeds.
Studies for seed implants across 24 institutions averaged 95%, 85% and 75%.
The data is fairly consistant where ever you look.
I think the reaon for this is that with surgery the doctor will never get all of the prostate tissue and microscopic cells can be left at the margins, nerves or seminal vessicles or in the left behind tissue. Radiation will kill the cells in these hard to get at places.
In almost all cases of a local reoccurrance after surgery that requires salvage radiation, radiation would have done the job the first time. There is also a significant difference in incontinence rates and ED rates between surgery and seeds. Incontinence 8% to 0%,
and ED, 50% to 35%
JT

Jazzman,
There is about a 1% risk of developing secondary cancers from external beam radiation 20 years later. Did your doctor also tell you there is a .5% chance of dieing IMMEDIATELY from surgery or that complications like septic infection, major blood loss, and piercing of bowels during surgery is a much greater risk than getting a very curable secondary cancer from radiation? There is virtually no risk of secondary cancers due to brachytherapy as it does not affect any other organs and radiation dose extends only 1mm. I have been reading posts on various radiation sites for over 2 years and have never run across one incidence of secondary cancers. You chance of getting another unrelated cancer, a heart attack or a reoccurrance of PC is much more likely.
I think that doctors do a patient a disservice by over emphasizing the risks of one treatment and not mentioning the risks of the treatment they are recommending. I believe a patient deserves ALL the information concerning the risks of all treatments and these should be presented fairly. The main risk of external radiation is a 2-4% chance of major bowel issues and this should be a major concern to anyone considering external beam.; fortunately this doesn't exist in Brachytherapy.
The basic decision is that would you rather accept a .5% chance of dieing immediately versus a 1% chance of getting a curable secondary cancer in 20 years.
I doubt if your doctor presented the option is this manner.
JT

Thanks! Do you have the citations?

In comparing the cure rates for surgery and radiation one has to be careful in using only the clinical pathology. Most of the studies relating to surgery use the actual pathology. If a patient is clasified as a low risk G6 and later found to be a G7 many institutions reclassify him as an intermediate risk in reporting their data. Since radiation only deals with clinical pathology from a biopsy, and this is the only information a person has in which to base a treatment decision one must compare apples to apples. Many surgical studies report 95%+ cure rates for a G6, but this is only for confirmed pathology after the prostate is removed and after any upgrades. When based on clinical pathology, the only information available on which to base a decision, the cure rate drops to 85%.

John,

I have suspected that brachytherapy might have been superior when I first started researching this. Only because you are correct about only being able to classify people based on their biopsy score and not post op. pathology. So you know some people have a higher Gleason score and are misclassified. My uro. does brachy and is affiliated with the Seattle Institute. He also get published on Urotoday quite a bit, so he is no slouch. He did a 50 point mapping biopsy on me to dx. me. He recommended that I go to Johns Hopkins and have RP. He said he would do brachy on me if I wanted. I felt I did not want the radiation and his stats. for young people only when out 5 years. J.H. had 15-20 year data for surgery. I have seen some studies that showed better BCR with brachy. Long term though I don't know. This cancer runs such a long course. 10 years is nothing to be clear in my opinion.

Dear NY Sooner:

I think I am the longest tenured brachy patient on this site that "regularly" posts and I am almost 2 years post procedure with no ED or any other side effects.  JustJulie was a regular poster when I arrived at HW and her husband's procedure was in April of 2006.  As i recall from her last post earlier this year he was still having no ED issues.

Personally I am acquainted with a dozen or so brachy patients and only a couple admit to mild ED that is treated with Viagra.  However, that is clearly anecdotal and not "evidence".  But, in general, I think the stats are pretty clear that some 35% or so of brachy patients experience ED...which is less than the surgery rates...and one of the reasons I chose brachytherapy.

Tudpock (Jim)

P.S.  Your comment about never really knowing if the cancer is killed off is no worse for brachy than for surgery.  Witness the legions of surgical patients on this site who anxiously await every PSA test to find out if they have a recurrance...

 

Hi JT:

A belated thank your for a very comprehensive answer to a question that was posed to me on another thread.  Like you, I have read many of those studies but unlike you I didn't have the notes or recall to find them.  At this point you have hopefully provided enough information for the original questioner to complete his term paper.

Tudpock (Jim)

tud, that remark was out of hand, in my opinion

postop, i think your last post spoke a lot of truth. sometimes the line is crossed here between being helpful and pretending to be a doctor or med prof.

david in sc

LOL,
F8, I just looked outside. It's midnight here in the desert and the sky is not blue.

I'm just saying. ;-) But great analogy... Fitting for this discussion.

Tony

Jazzman1 said... The concern that I had about brachytherapy, and about radiation in general, is whether it can cause secondary cancers in adjacent organs 10 or 15 years down the line. It's a concern that was shared by my urologist and by a general oncologist I spoke with. It's a particular concern for relatively younger men.     Each patient’s goals and priorities in the treatment of their prostate cancer should individually be evaluated and considered to individualize treatment plans.   Due to the individual variation in the perception of quality of life—everyone sees this differently—objective evaluation of outcomes and side effects is difficult to generalize. Brachytherapy has in recent years become a widely accepted mode of treatment for prostate cancer, and rates of BCR are outstanding for patients with a favorable risk profile; generally on par with the surgical results for patients.   [Generally, good candidates for seeds have PSA less than 10 ng/mL, Gleason score of 6 or less, negative DRE, no history of BPH, and prostate volume below 60cc.]   Adding in external beam radiation (in addition to seeds) yields the best BCR results. The short-term side effects of brachytherapy are well documented.   However, the consequential late effects are less widely known and (therefore) less widely communicated.   For the young-ish patient, the concern over secondary cancers (raised by Jazzman 1 ) appears to be less significant than the other known consequential late effects of brachytherapy …but few new patients know to inquire deeply enough into these HRQoL (Health Related Quality of Life) issues and the time-scale of reported outcomes. American society often celebrates immediate gratification , and doctors tend to describe the immediate effects of a particular therapy.   Most studies only examine short-term; however, long-term effects may result in serious and debilitating problems or negatively affect QoL.   The young-ish patient who chooses seeds in order to reduce risk of erectile dysfunction (ED) may find significant reduction 3-6 years later.   The trade-off for immediate gratification (retaining erectile function in the short-term after treatment) may or may not have been worth it in the long-term (permanent loss of functionality at an “early” age).   Dr Michael Zelefsky, MSK’s Chief of Brachytherapy Service, reports 53% of patients potent before brachytherapy developed ED within 5 years of therapy.   Radiation thickens the walls of blood vessels, limiting blood supply th the nerves responsible for erections.   On the upside, the PDE-5 inhibitors (Viagra, Cialis, Levitra) are a generally effective solution for most men, but they become a permanent solution (versus a generally temporary solution, for only the short-term, after surgery). Urinary incontinence, rectal bleeding and frequency…also consequential late effects of brachytherapy.   Again, given that men have often been accused of thinking with our dxcks, the young-ish patient may be tempted to not think about blood-stains in the back of his pants 5- or 10-years down the road, but probably should.   Greater than 20% of brachytherapy patients required TURP or colonoscopy to manage chronic urinary retention or moderate to severe proctitis; the number shot up to over 40% for combined external beam radiation plus seeds.   These problems are not biochemical recurrences or secondary cancers treated by oncologists; rather, many patients rely on their primary care physician, gastroenterologist, or colorectal surgeon for the management of late complications after brachytherapy. With these factors in mind, the site www.prostate-cancer.com issues this words of caution: While brachytherapy is an effective prostate cancer treatment option, men who are much younger and in good health and who can reasonably expect to live another 20 years, may want to consider other treatments. Most of the conclusive data in LDR or HDR therapy does not extend past the twenty year mark. Most long-term studies do not extend past 10 to 15 years.    Here’s some troubling quotes (with references): ·          There is a perception among many urologists that complications of brachytherapy may be underreported.      http://onlinelibrary.wiley.com/doi/10.1002/cncr.20446/pdf ·          Brachytherapy-induced erectile dysfunction is more common than previously reported.   http://www.psychiatrictimes.com/sexual-disorders/content/article/10165/105988?pageNumber=2 ·          Although early proponents of prostate brachytherapy suggested that this treatment has a minimal effect on HRQoL (health-related quality of life), studies have found that it significantly affects HRQoL…     http://www.urotoday.com/prod/pdf/reviews/BJU1_sept2004.pdf   Enthusiasm for brachytherapy may be appropriately curbed with the inclusion of these longer term factors.   References (in addition to those cited above): ·          http://www.moffitt.org/CCJRoot/v8n6/pdf/540.pdf ·          http://www.urotoday.com/prod/pdf/reviews/BJU1_sept2004.pdf ·          http://www.nmanet.org/images/uploads/Publications/OC500_june.pdf ·          http://onlinelibrary.wiley.com/doi/10.1002/cncr.24223/pdf ·          http://onlinelibrary.wiley.com/doi/10.1002/cncr.20446/pdf ·          http://www.healthboards.com/boards/showpost.php?p=4300083&postcount=1  

Casey, I concur with Mel,
Good to see you again...and good post...

Tony