Long Term Outcome for Treatment Choices

"From the figures, it is apparent that, with low risk disease, the surgeon will leave cancer behind 15-20% of the time and, therefore, you will likely need post operative radiation, 15-20% of the time."

"External radiation does a good job of treating the prostate and the area immediately around it, where cancer can spread. The reason the external radiation fails in some low risk disease is likely that the dose delivered is not sufficient enough to control the disease in the prostate itself."

"Why might there be an advantage to brachytherapy approaches? For intermediate risk patients, the risk of disease beyond the gland increases, subsequently, any treatment that just treats the prostate, such as surgery, has a higher risk of failing."

"Implantation alone, or in combination with EBRT, do appear, on the graphs, to do better than either surgery or external beam radiation. Seed implantation is likely better than surgery in intermediate risk disease due to the high local control rate of seed implantation and its ability to treat an area beyond the capabilities of surgery."

"However, we have chosen, for high risk disease, to recommend a combination of six months of hormonal therapy during which both external beam and seed implantation are given." 

JNF said...
I just read an enlightening article by Peter Grimm in the current issue of PCRI Insights. The article uses over 18,000 studies to compile results of all the various treatment choices and is separated by low, intermediate, and high risk at diagnosis. It is the type of information that I would have found very useful before I was treated.


Read it at www.prostate-cancer.org. Click on Insights and look for the May 2011 edition. The article is entitled "Long Term Outcomes for Prostate Cancer Therapy Choices" and is found under the heading :Which PC Therapy has the Best Long Term PSA Control (pdf)".



As I understand, Peter Grimm DO is a pioneer in permanent seed brachytherapy. Not only does it report on treatment efficacy, but it also compares side effects of the various therapies.

I gives a different picture than this report.

>>Note:

This article is from Doctor Peter Grimm, whos

specialty is brachytherapy. Unbiased, perhaps.<<

point taken.

ed

F8 bias...who isn't.

I see that among us John T looks likest the smartest using seeds, IMRT, and some HT thrown in.   As he says this may be some of the best reporting yet, but not perfect.   For example I had read another report recently that found that early failure from robotic is much worse than open surgery.  

These reports are in line with other studies I have seen, I think from the Prostate Study Group (John T refers to from time to time) and the information my urologist provided.   He has evolved into a very descriminating surgeon (like Walsh) and is now doing more HDR procedures than surgeries.   He will only perform surgery in very low risk cases.   He takes the attitude that the cancer is most likely worse than the clinical staging and biopsy indicates and does not want to subject a person to both surgery and radiation.

I think the report also shows the significant improvement in radiation treatment over the last 15 years with ever improving technology.  

You are one of a few surgery patients on this forum who espouse a review of multiple options.  When I say that, I'm accused of radiation bias but when you recommend it (as someone who had surgery for his initial treatment) it carries some weight since you can't be accused of the same bias I have...

Thanks,

Tudpock (Jim)