Which Treatment Is Best ?

The study linked below made big waves when it was first published. I don't think it's accuracy has ever been challenged.

www.prostatecancertreatmentcenter.com/ProstateCancer/ProstateCancerResultsStudyGroup.aspx

I think brachytherpay has the edge in terms of cancer control, recovery time (mine was less than 2-3 weeks) and side effects (it has less urinary issues and ED problems).

It is probably money. I think the robot costs like 50 zillion bucks and maybe a couple million a year to maintain. Hospitals push it.

I think in many cases surgery is pushed on men and the options are not being given to them.

My hospital didn't even mention brachytherapy and the guy who did HDR there only had 20 under his belt. Like yeah, I would have picked him. ;)

It wasn't my first treatment because I was more comfortable with surgery.

I spoke to the BT guy at Mount Sinai that my boss had used. My boss had done a combination of BT and hormone treatment and I really wanted to stay away from that if possible as an initial approach knowing full well it might be in my cards down the road.

I also wasn't comfortable with the lack of long term studies on BT vis-a-vis surgery.

I also wanted to get the prostate out and get a definitive pathology with the hopes of getting the answers I was looking/hoping for and being able to "start over" fresh.

I was also concerned about potential immediate SEs vis-a-vis potential long term SEs. I preferred having to deal with potential immediate ones while I was young and fit and theoretically better suited to rehab. Turns out I had none anyway so in that regard my choice was certainly validated.

I really liked the idea of taking care of things within a one week time frame including recovery. The notion of alternative forms of treatments and the longer time frames involved was definitely not something I was interested in on a strictly personal level. Remember, I had surgery, started workign again almost immediately and moved continents within 5 months!

And lastly it was an age issue for me. I thought surgery was clearly the best option for a guy at 40.

That said, I think BT is a wonderful option and would not hesitate for a second to suggest it for my dad.

Interesting Peter. How so?

I suppose a lot more guys could choose brachytherapy, but for some of us it was never an option.

My prostate was way too large (about 88g, as I recall) to consider brachy, and I think there are other guys here on HW who also found themselves in that situation.

Then, too, my wife and I were watching our 3-year-old twin grandchildren at that time, and I really didn't want to wear a lead apron or have to push them away from my radioactive nether regions.

So, brachy may be a great option for a lot of guys, but not for all.

 

When I was diagnosed at 41 my initial reaction was, given my age, surgery was the way forward. However, given my 'high risk' status, my urologist passed on it and my oncologist suggested RT combined with 3 years HT (standard treatment for T3's in the UK) as surgery would need to be followed by RT, in his opinion anyway. I sought a second and third opinion. Both agreed with the oncologist.

On reflection and based on my results thus far, it seems that the the right course of action has been chosen. However, I cut my HT course from 3 years to 14 months on the advice of a trusted party and also because I developed metabolic syndrome, which I am currently dealing with via diet and Metformin.

It seems, from my perception, that brachytherapy is often seen and pushed in the UK as the third option offering less than satisfactory results when, in fact, the opposite may be true. Very few, if any, men in my support have used brachytherapy although it does seem popular in certain hospitals. Maybe its a finance issue, but in the UK surgery and RT rein supreme.

Paul

Phenom it almost seems like that doesn't it? Just the way I was almost talked out of getting a PSA makes me angry.

before these studies existed one guy did his own study and came to the same conclusion.

http://www.phoenix5.org/articles/Fortune96Grove.html

so far it's worked for me, too.

ed

 

Hi davidg,

If it has escaped? Or if it hasn't?

I believe the reason that many of the robotic surgery studies were eliminated were primarily due to two factors that were in the study criteria, length of followup, and clinical risk classification. Most of the robotic studies published at the time used post op risk classification vs clinical risk classification, which means the patients were upgraded to higher risk class based on their post op pathology. For example the clinical risk class for low risk is 85%, but when based on post op it goes up to 95%+ because all patients with a G7, positive margins and SVI were reclassed into a higher risk class. Since the clinical risk class is the only information on which a patient has to make a decision it is the only one that should be used in any comparison of treatment options.
The panel of 25 PC experts from every field, oncologists, radiologists, surgeons and pathologists determined the criteria on which studies were included and 750 out of 17,000 met this criteria which included number of patients, peer review, clinical risk stratification according to DiAmico criteria and followup time. This is truly an apples to apples comparison.
There were more radiologists on the panel than surgeons, but Proton and Cryosurgery also faired poorly which would preclude any radiation bias as they are performed by radiologists.
The other criticism of the study is that it is retrospective, but since there will never be a realtime randomize study of treatment options it's the only data we have. Patients just will not consent to be randomized into treatment options and every study that has been attempted has produced too few patients to be statistically valid.
njs,
If you look at the scatter graph you can reference every individual study by clicking on the dot. Each study was peer reviewed, must have a minimum number of patients, have a certain follow up time, I believe 6 or 8 years, and be based on DiAmico risk classification and the DiAmico definition of failure for each option. The 750 studies included involved tens of thousands of patients, so the sample size is valid.

JohnT

John T said...

If you look at the scatter graph you can reference every individual study by clicking on the dot.

Doesn't work for me (neither in Chrome nor IE)

njs,
You have to go to the original study and not the summary. I think you can find it by googling "Dr Peter Grimm, Prostate Cancer Study Group"
davidg,
You are correct. The reason is that any positive margin that would be found in surgery would most likely be cured by a combo treatment in that it would hit up to 15 mm of the prostate bed. This is similar to SRT in which radiation is used to hit a positive margin after a failed surgery, except it is used as a primary treatment. Also in some cases bits of tissue are left around the nerves and if these contain PC cells you can have a reoccurrence. Radiation will kill these cells. Think of it this way: If salvage radiation will work because of positive margins then it would have worked better as a primary treatment, because it hits the same spots.
This is why I don't understand Doctor's telling their patients that surgery gives them a plan B of salvage radiation if the surgery doesn't work. I just heard your doctor say this on TV yesterday. If salvage radiation will work as a plan B then it stands to reason it would have worked as a plan A the first time. Either the doctors are being disingenuous or that phrase has been repeated so many times it is just accepted as fact without thinking it through. Having a plan B sounds good, but once you think it through it's telling you the exact opposite; if you are concerned about having a plan B then you should have radiation as it is both plan A and plan B and you avoid the SE's of Plan A.
JT