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Posted 2/1/2012 4:49 PM (GMT 0)
http://news.yahoo.com/study-compares-3-common-prostate-cancer-treatments-001014540.html

Draw your own conclusions. The article says the results are preliminary and not definitive.

Mel

Posted 2/1/2012 5:40 PM (GMT 0)
3.7, 6.7, 7.0% report side-effect problems with Brachy, Surgery, Beam Radiation....These differences look insignificant to me..

Now the COST of these treatments are CERTAINLY significant, but since "somebody else" is paying for it, nobody worries about that too much....

What REALLY counts, how effective are these treatments when compared to each other at curing the patient or prolonging his life, well, we are going to need another grant before we can look at that....

Here is a question I have...What percentage of PC patients who have had surgery as their primary treatment end up being treated with beam radiation also?
Posted 2/1/2012 6:11 PM (GMT 0)
interesting.
Posted 2/1/2012 6:37 PM (GMT 0)
I know this study admits it is very preliminary; but as far as the US health care system goes, I truly believe that these cost studies will be playing a significant role in what treatments we will be allowed to have in the future. With health care costs rising at least twice the rate of inflation and the Government paying for Medicare and the Government paying for much of the new upcoming Health Care mandate. Cost will be the overriding factor in the near future with the way this Government is running out of money. I had to laugh at this study when they said: "Our analysis is one of the first to examine the quality of life and financial costs of these three very common prostate cancer treatment strategies for more than five years after treatment.". In my opinion, any study that looks a the pros and cons of different strategies for PC needs to look at the study group at ten, at fifteen years and at 20 years being PC is usually so slow growing. A good definitive study will need to compare the different types of seed therapy and different external beam therapies over a very large study group for several decades just to get a good comparison of radiation treatments. The same needs to be done to compare open vs robotic. At the risk of sounding like a cynical grumpy old man, I really believe there will be more and more inaccurate studies performed, published, and adopted to reduce cost rather than improve health care. The way this study used a five year period of time definitely lead one to believe that all treatments are pretty much equal when they really may not be if it was performed over two decades. I can only hope that I will still have the option for External Beam Radiation therapy IF I someday need a second tier treatment strategy.
Posted 2/1/2012 6:57 PM (GMT 0)
Fairwind said... Now the COST of these treatments are CERTAINLY significant, but since "somebody else" is paying for it, nobody worries about that too much.... I can't tell if this was written intentionally in jest, or what.  Because it is unclear, I'll assume it wasn't.   There have been others here who have also previously posted the (mis-) perception that the only financial cost of their aggressive treatment was their out-of-packet costs...but this short-sightedness baffles me.    We all pay much more than out-of-pocket in the more subtle “hidden” costs of jacked-up insurance premiums and higher taxes (most PC treatments are paid by Medicaid).   Expensive treatments for PC are a tremendous burden to our society, especially when you consider the gross PC overtreatment that is epidemic in this country.   We have limited, not unlimited, financial resources to spend on medicine…if we eliminated about 1/3 of the total aggressive treatments that are performed on patients who probably don’t need any treatment whatsoever, think of the billions that could be spent on more important causes.   I can think of more than a few…  
Posted 2/1/2012 7:03 PM (GMT 0)
Desert:

You are correct, but here is the rub:

It is nice to do longitudinal studies. But by the time you complete say a 15-year study, there will be new methodologies.

For example, we know the Varian Arc IMRT machines are superior than what was done 10 years previously (or at least we think so).

So, what good is studying something that was new say 15 years ago.

While there is some benefit, that tx. is outmoded today

Mel

Posted 2/1/2012 7:18 PM (GMT 0)
On the same subject, how much does it cost to produce and deliver a shot of Lupron or any of its clones?? Many of us know the price that is charged, around $2000 a shot....Is this drug really that expensive to produce??

In 2009, before Provenge, Medicare paid $1.2 Billion dollars for the drugs used to treat Prostate Cancer. Just PC.

When Congress passed Bush's Medicare drug benefit, negotiating with the pharmaceutical manufacturers over price was expressly forbidden, thus protecting drug makers profits and providing a windfall for the entire drug industry..

I believe the VA does indeed negotiate prices and can obtain and dispense drugs MUCH cheaper than Medicare...

What a system, where the lobbyists write the laws..
Posted 2/1/2012 7:25 PM (GMT 0)
Side effects seem low in relation to other studies and leave out ED all together. Also are these side effects ones that require futher intervention and cost which would leave out minor incontinence and other common issues associatied with treatments that may not contribute to added costs, but certaintly affect a patient's life.
Posted 2/1/2012 8:19 PM (GMT 0)
Casey, why don't you show your "signature" sometimes. Several people have mentioned, that t hey don't remember seeing a signature from you. I don't even have a clue what you were diagnosed at, or how you were or weren't treated. With some of your harsh opinions about treatment, I wanted to refresh my own memory to as how your handled your PC. Could you do that as a courtesty for us?

THanks,

David in SC

David,
I know one of the other mods has contacted you about this. For all others, if you have any questions regarding this please talk to a moderator or the Admin in email. Ultimately we have to sort these things out and we already have determined that Casey is an eligible poster. Thank you for understanding.

Tony

Post Edited By Moderator (TC-LasVegas) : 2/2/2012 3:33:48 PM (GMT-7)

Posted 2/1/2012 8:52 PM (GMT 0)
Actually my treatment costs are the lowest with Cryo TFT. In fact the only time insurance balked at any of my treatment was for the more expensive 3D saturation biopsy. Once when it was explained why it was mandatory for TFT it was approved. Meanwhile my only SE continues to be perhaps a 60% drop in ejaculated volume.
Posted 2/1/2012 9:05 PM (GMT 0)
Casey59: When I say the Government I mean the bill will be put upon the taxpayers and working future generations. We all know there is no free lunch/treatment.

Compiler: with a name like that you must be a programmer. The RUB is duly noted. It would be nice if they would at least start them as soon as a new technology comes to market and the Doctors get past the learning curve. Once the study gets going it needs to keep going until enough data is acquired. I decided last October to go with surgery, but found very little evidence comparing davinci vs open. I sure wouldn't have gone with robotics in 2006 or 2007 with robotics being so new. My own Uro told me you cannot trust studies done by your own doctors. They always paint the most positive picture of their results. Maybe this is why kathleen sebelius wants all of our medical files uploaded from our doctors servers to HHS servers. I will say that I'm not in favor of this because I really feel the information will be abused someday. PLease don't think I'm paranoid: I haven't killed anyone that those voices in my head tell me to kill. All joking aside, I have met someone that claimed to have a chip installed in his head by the CIA. He was a nut.
Posted 2/1/2012 11:26 PM (GMT 0)

Fairwind said...
On the same subject, how much does it cost to produce and deliver a shot of Lupron or any of its clones?? Many of us know the price that is charged, around $2000 a shot....Is this drug really that expensive to produce??

In 2009, before Provenge, Medicare paid $1.2 Billion dollars for the drugs used to treat Prostate Cancer. Just PC.

When Congress passed Bush's Medicare drug benefit, negotiating with the pharmaceutical manufacturers over price was expressly forbidden, thus protecting drug makers profits and providing a windfall for the entire drug industry..

I believe the VA does indeed negotiate prices and can obtain and dispense drugs MUCH cheaper than Medicare...

What a system, where the lobbyists write the laws..

Well Fair, I think someone, somewhere is having a lend of the US people so far as medical costs and medicines are concerned. Without wishing to detract from the thread or open a debate about the pros and cons of a private vs universal health system. Here are some facts. Australia for instance has a duel system (very similar to the Canadians) which also includes a Pharmaceutical Benefits Scheme (PBS). Under this scheme no one can pay more than Au$35-40 (about US$37-80 shocked) for any prescribed drug. Anyone on any sort of benefit (aged, invalid, widowed, unemployed etc) has a max of about Au$5-50. The universal scheme (ie the tax payer) pays the balance. But this gives the administrator of the scheme (the government) great leverage and bargaining power when it comes to the cost of all things medical. Drug companies fight each other to get their products listed under the PBS. The end result is cheaper drugs. eg Here are the prices paid to drug companies for various Leuprolide Acetate Injections (Lupron aka Lucrin)
www.pbs.gov.au/medicine/item/8875D-8876E-8877F

Incidentally the overwhelming majority of doctors here are private practitioners and the government plays absolutely no part in any medical treatment decisions or what may be or not be appropriate so far as treatment is concerned. In essence the Scheme acts as a universal insurer with "premiums" paid within the individuals taxation regime.
Bill

Post Edited (BillyMac) : 2/1/2012 7:16:43 PM (GMT-7)

Posted 2/1/2012 11:43 PM (GMT 0)
Time will tell us real information. I am not surprised by this study. It's biased of course but then again all studies are in some way. But I want to comment about one point that Casey makes:

"..Expensive treatments for PC are a tremendous burden to our society, especially when you consider the gross PC overtreatment that is epidemic in this country..."

I know one sure way to increase those expenses ~ add AS to the equation. The costs of AS, which is viewed largely as delayed therapy, are in addition to when a patient decides to end the AS and start with active therapy. Sometimes the costs are pretty high depending on your preferences for AS.

You can't use costs alone for solving these issues. The costs for similar treatments in other countries are a fraction of what they are here. We can blame greed, but we have to add regulation and litigation to these costs. We are a litigious society and if we are going to fix anything that we have direct control over it would have to be a level of acceptance of risks to treatments. Kathy Meade recently posted a costs comparison of various treatments comparing the US against many other countries. These were for far more than prostate cancer therapies. Heart disease, breast mastectomies, gall bladder procedures...etc...etc. Prostate cancer is a very small pice of the problem when you compare the costs here. For example administering tylenol in a hospital here can exceed 100.00 per dose. It's 3 euros in France...Ugh...

Tony
Posted 2/2/2012 12:14 AM (GMT 0)
When you consider treatment costs, you have to consider side effects. My insurance company just paid $40k for sling surgery. They would have saved a bundle had they paid an extra $20K for a treatment that didn't make me incontinent.
Posted 2/2/2012 1:45 AM (GMT 0)

So just what do we need to do to avoid the horrors of "overtreatment"?

I can visualize a newcomer to this site reading recent threads and reaching the conclusion that: (1) no one should get PSA tested....ever, and that (2) surgery is a barbaric over-reaction to this disease that deprives us of our manhood and leaves us with no urinary control, no sexual powers and which, in addition to that, fails to ever offer an actual "cure," leaving us no better than if we had chosen no treatment at all, and (3) external beam radiation is just about as barbaric as open or robotic surgery with similar side effects, and which also can't claim to offer a "cure," so why go that route?, and (4) proton beam therapy likely has even worse results than photon radiation, and (5) HIFU is unproven and possibly dangerous, and (6) brachytherapy may be the best choice of the lot, but the patient must have a smallish prostate for it to be a practical choice.

So, maybe the answer is to simply go back 100 years and not treat the disease at all and let the cards fall as they may. Then we could finally stop wringing our hands about overtreatment.

I hope it's obvious that I'm not being serious here, but last night I learned that my dear sister-in-law has just been diagnosed with breast cancer. I'm heartbroken for her and for my brother, her husband. But it has brought home to me very vividly the degree to which we, ourselves prostate cancer survivors, seem to continually downplay our disease. Every aspect of breast cancer seems to be treated with greater respect than our disease, the male equivalent if you will. Thanks to mammogram screening, her invasive tumor was found early. Whether early enough remains to be seen, but I don't hear breast cancer survivors wringing their hands over too much mammogram screening or "overtreatment" of breast cancer. Some "experts" may do those things, but not the women who've been personally affected by the disease.

Yes, I know, they're different diseases and that they behave differently, but I'm absolutely dumbfounded sometimes at the way we critique the treatments available to us for our PCa. They're not perfect, but they're what we have available to us right now. Hopefully, they'll be even better in the near future.

Posted 2/2/2012 2:04 AM (GMT 0)
Clock:

You raise some good points, but don't forget that with PC we have this wonderful thing called a PSA test that let's us know how things are going. That's a lot of information but it also leads to a lot of angst and treatments. With BC, they don't know if it will return until...all of a sudden a lump appears. I don't think they have anything akin to a PSA

Mel

Posted 2/2/2012 2:09 AM (GMT 0)
Prostate cancer is, itself, many different diseases. There is not a one-size-fits-all treatment plan that works for everyone; this is one of the important realizations we "vets" need to be teaching newcomers. The variation is wide...from an aggressive, deadly version (albeit, effecting a small percentage of men), to those who will benefit from treatment, and then to those who probably should only conservatively manage their (often "incidental") finding of prostate cancer. I have no problem with aggressively treating those that need aggressive treatment; but I'm baffled that more here (at HW) aren't outraged at the epidemic of aggressive, life-altering treatment for those whom there is not scientific evidence that any benefit will be realized.
Posted 2/2/2012 2:12 AM (GMT 0)
Casey:

Good point.

Someone asked you on another thread about your own background regarding PC. How about sharing that information.

Mel

Posted 2/2/2012 2:16 AM (GMT 0)
I've shared pieces of my life as they are relevant to the message I am posting at the time. It's been relevant in other posts; it's not relevant in this post. End of reply.
Posted 2/2/2012 2:17 AM (GMT 0)
Casey I'm baffled as to why people are jumping to conclusions sight on scene regularly here. "Show me a five or ten year study and I have facts".

No you don't. Not with this disease.

I have a 41 YO man in our UsTOO group on AS with G8 because he now thinks that all doctors are trying to do are get his money. That's G8 as in Gleason 8. That's 41 as in "Are you crazy, you need therapy!!!"

We really need to be careful about our opinions about over treatment because we run the risks of under treatment. There needs to be a fair and balanced approach but we tend to swing all in in our opinions when in fact what we have today will see the repercussions of todays thinking some 15 years down the road...

Over treatment ~ yes. Over hype about over treatment ~ likely...

Tony

Post Edited (TC-LasVegas) : 2/1/2012 7:27:25 PM (GMT-7)

Posted 2/2/2012 2:38 AM (GMT 0)
Tony, maybe that guy is a little nuts.   I don’t know.   I don’t give recommendations for treatments; I’m not qualified.   But what I do encourage is to educate themselves about the big picture.   AS isn’t for everyone…which fits squarely into my comment that there is not a one-size-fits-all approach for all.   There are plenty of men, however, for whom AS would likely be appropriate who rush into aggressive treatments instead, and suffer consequences which they didn’t need to suffer.   I absolutely don't think, as your 41, G8 friend does, that all doctors are out to get his money; but in many cases there are disturbing undertones of ecomonic self-interest that are masked by the apparent compassion of our new best-friend...the guy who just told us we had cancer !  
Posted 2/2/2012 3:00 AM (GMT 0)
But the problem?
Everywhere i read in certain PCa groups and webpages (Including the comments sections) is insinuating that urologists are criminally in practice. The pendulum of public opinion has swung violently.

As a group leader I don't recommend doctors or therapy. I recommend a balanced education on prostate cancer and their therapies. For this guy I mentioned that there are guidelines for prostate cancer active surveillance. The guy isn't nuts just convinced by what he has been reading online. He understands the difference between low, intermediate, and high risk cases. But his situation is he doesn't have great insurance so he might be buying into the over treatment chatter to justify his inaction.

just today I read a few articles on the InfoLink. The comments section show us an equal amount of over treatment bias as treatment choice bias.

In my opinion this is the tip of the iceberg of online opinion side effects.

Tony

Post Edited (TC-LasVegas) : 2/1/2012 8:03:54 PM (GMT-7)

Posted 2/2/2012 3:05 AM (GMT 0)

Casey59 said...
I have no problem with aggressively treating those that need aggressive treatment;

...and your foolproof method of telling which is which and who to treat before it's too late - does not exist; As at least a few members have personally experienced. They sure wish they had "overtreated" when they had the chance, rather than undertreating when Elvis had already left the prostate. You can gamble with your life on a set of guidelines that have no assurance of being right, based on tests that are incomplete at best, and then decide to treat when it's too late. Or not. Evidently we'll be seeing what lots of undertreatment looks like in the USA in about 15 years. It won't be pretty.
Posted 2/2/2012 3:12 AM (GMT 0)
Tony, you will find that my message does not change with the wind. Nor am I prone to hyperbole.
Posted 2/2/2012 3:15 AM (GMT 0)
Casey, you are the most vocal, or certainly one of the most vocal, proponents of AS on this site. I think that's fair to say. Of course, most of us understand that AS can be the correct choice for some men, but AS and overtreatment are themes you return to again and again. Have you perhaps come to feel that you yourself, were overtreated?

I guess some would argue that I was "overtreated," but I would vehemently disagree.  And if I ever make even the slightest comment that might be interpreted as second-guessing myself, my wife sets me straight.  In truth, I regret nothing and would change nothing.  Personally, I would prefer to be over-treated rather than under-treated.

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