AUA 2009 Conference Highlight

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KeyWestPirate
Regular Member


Date Joined May 2009
Total Posts : 60
   Posted 5/6/2009 9:40 PM (GMT -7)   
I pulled this off URO Today:

Wednesday, 29 April 2009
CHICAGO, IL, USA (UroToday.com) - This study compared the overall survival outcomes of radical prostatectomy (RP) and radiotherapy (RT) while controlling for co-morbidities and the definition of biochemical failure. The researchers retrospectively reviewed the data of all 6,460 patients diagnosed with prostate cancer at their institution from 1995 to 2007. Analysis was restricted to patients with localized disease, who had no other medical problems, and who underwent RP or RT with curative intent. Patient specific variables investigated included age and race, while the tumor specific variables included clinical stage, Gleason score, and initial PSA. Univariate analysis was performed to determine which variables predicted risk of death and then variables with p values less than 0.05 were incorporated in a Cox regression multivariate model. Propensity analysis was also performed to confirm results.

Of the 6,460 men initially reviewed, 2,552 received local therapy with curative intent and had no medical problems. 2,157 (84.5%) patients were treated with RP while 395 (15.5%) patients were treated with RT . Radiation therapy was associated with a worse overall survival with a HR of 1.69 (95% CI 1.14-2.50). Survival analysis controlling for age, ethnicity, grade, PSA demonstrated that surgery was associated with an improved survival (p=0.008). The survival advantage for RP was confirmed with propensity analysis.


Presented by Adam S. Kibel, MD, et al. at the Annual Meeting of the American Urological Association (AUA) - April 25 - 30, 2009 - McCormick Place Convention Center - Chicago, Illinois, USA.

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/6/2009 11:16 PM (GMT -7)   
Although I was treated by surgery those figures may not reflect the situation today. They date back to include patients treated by radiation 14 years ago. While surgery is basically the same (excluding nerve saving) there have been substantial improvements in the accuracy of delivery of radiation since that time so I would expect to see the radiation figures show an improvement over the coming years. Additionally, once the surgery patient is opened up, any that have some local spread will be eliminated from the statistics( the study says only patients gauged to have local disease are counted) while radiation guys with that same extent of spread may well slip through as being judged to have had local disease. With better pre-treatment scanning the figures may well even up. Only time will tell.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/7/2009 12:09 AM (GMT -7)   
Reference to RT patients 14 years ago is valid. RTOG 9413 is a continuing ongoing study on Radiation, Radiation after RP and with or without ADT and is starting to show interesting results similar to Key's post.

I have been an advocate for continuing these studies to year twenty. Five to ten year studies in prostate cancer have minimal value on mortality in prostate cancer. When I was diagnosed at 44 I had 39 years of life expectancy in the US. Being advanced in my cancer, I find little relief in the short term results of other therapies. In fact I find little usable information in ten year studies of any treatment. RP has been performed for decades and has real data. And it too has been improved.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


KeyWestPirate
Regular Member


Date Joined May 2009
Total Posts : 60
   Posted 5/7/2009 7:44 AM (GMT -7)   
I agree with Tony. There are on-going improvements in every treatment option. But, does every treatment provider implement these in his practice? Or does he just do the tried and true he learned 20 years ago in medical school?

I continue to puzzle out the big differences in erectile and continence outcomes across RP patients who have what should be the same surgery, on very similar anatomical structures. There is a piece of the puzzle missing. I suspect that "nerve sparing" and "bladder neck re-attachment" mean vastly different things to different surgeons.

The same is probably true of the other PC treatment options. Until surgeons (and other treatment providers) are required to publish their results, it remains incumbent on the PCa patient to seek out the best treatment provider, who employs the latest information and techniques. This person may or may not be his current urologist.

There are a number of interesting, newly-published articles here:

http://www.urotoday.com/browse_categories/prostate_cancer/1014/

This is another interesting concept:

Is Seminal Vesiculectomy Necessary in All Patients with Biopsy Gleason Score 6? - Abstract

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 5/7/2009 7:48 AM (GMT -7)   
Be great if it were that easy, not so great if you were one of the 4.6% that tested positive.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


KeyWestPirate
Regular Member


Date Joined May 2009
Total Posts : 60
   Posted 5/7/2009 10:15 AM (GMT -7)   

Yes, especially the 4 out of 636 with Gleason < or = 6  (0.6%)   It would be a huge shame to be that early stage and still miss a bit.  This interest and empahsis on the importance of erectile function is a good thing, though.

There is no free lunch.  Pay now, or pay later.  The story of life.

The big reason for going RP is to find and get ALL the cancer.  I'd hate to be faced with making this decision.

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