Prostate Cancer Study Results

John T

Veteran Member

Joined : Nov 2008

Posts : 4276

Posted 12/6/2009 6:33 PM (GMT -6)

The Prostate Cancer Results Study Group 2009 just released it's data after reviewing 15,000 studies on cure rates of different treatment options.

"By BRSF (biochemical reoccurrance) control creieria, Brachytherapy alone or Combo was superior in all risk groups."

There are eaisly read charts that indicate cure rates by risk factors and treatment option.

http://www.prostateseedinstitute.com/PCRSG_0409_Results.aspx

JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

Purgatory

Elite Member

Joined : Oct 2008

Posts : 25399

Posted 12/6/2009 7:00 PM (GMT -6)

Had a hard time reading some of those graphs in the format presented, but aren't we always being warned here about biased reports, this one says its from "The Prostate Seed Institute", which promotes seeding/ Where is the difference between this, and a study sponsered by RT groups or Surgical groups?

Or am I missing some obvious point here?

David in SC

Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin

Incontinence: 1 Month ED: Non issue at any point post surgery
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped 9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place

compiler

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Joined : Nov 2009

Posts : 7270

Posted 12/6/2009 8:34 PM (GMT -6)

John:

In looking on that site, they seem to require a G-6 or less to do the therapy. Yet, they did yours. Is that because they were assured the tumor was localized?

Mel

63 years old

PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.

History of BPH/prostatitis.

PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):

Biopsy on 11/30/09

Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.

goodlife

Veteran Member

Joined : May 2009

Posts : 2692

Posted 12/6/2009 8:52 PM (GMT -6)

Obviously, Brachy would appear to be the treatment of choice based on these graphs from the seed therapy group.

As I understand it, this is no new research, but a compilation of 600 articles that fit the criteria.

I would have seeded, but with a Gleason 9, did not fit the criteria. That is a positive for surgery in my own book, that it is applicable to all stages and conditions like EPE, etc. I think if we had better diagnostic tools to tell the oncologist everything they needed to know, Brachy is a great form of treatment for certain PC cases.

Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9

Da Vinci, Cleveland Clinic 4/14/09 Nerves spared, but carved up a little.

0/23 lymph nodes involved pT3a NO MX

Catheter and 2 stints in ureters for 2 weeks .

Neg Margins, bladder neck negative

Living the Good Life, cancer free 6 week PSA <.03

3 month PSA <.01 (different lab)

5 month PSA <.03 (undetectable)

6 Month PSA <.01

1 pad a day, no progress on ED. Trimix injections

John T

Veteran Member

Joined : Nov 2008

Posts : 4276

Posted 12/6/2009 9:36 PM (GMT -6)

Even though the report is published by Grimm, which would indicate a bias, just read the names of the Doctor's involved in the study, guys like Bostwich and Lee and other well know Doctors from all the major institutions that have nothing to do with Brachytherapy.
Mel, I don't know where you got the idea that A G6 is required for Brachy or Combo. It done all the time for high risk PC.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8128

Posted 12/6/2009 10:09 PM (GMT -6)

No doubt in my mind ~ total bias. This is not a controlled study by any means.

This is the kind of report that makes me question the ASTRO bFRS system (Nadir+2) and the criteria used to determine the candidates in this study. The conclusions spell it out best.

1> This is not a randomized study.
2> Comparisons are confounded particularly because there was no pre-treatment stratifications.
3> Few of the studies used conformed to reporting criteria.

In other words, we need better data than what is assembled here to draw any conclusions. The group willing to say it appears that seed/combination therapy is performing better, is not telling us much because of the other conclusions. And this is a seed radiation center selling seed radiation.

Tony

Prostate Cancer Forum Co-Moderator

compiler

Veteran Member

Joined : Nov 2009

Posts : 7270

Posted 12/6/2009 10:25 PM (GMT -6)

John:

I got the idea from the site, to quote:

"...necessary for a patient to be considered for seed implantation alone (monotherapy):

Prostate gland cannot be too large.
A PSA result of less than 10, depending on the patient’s specific case (see Testing for Prostate Cancer)
Gleason score of 6 or less, depending on the patient’s specific case (see Grading and Staging Prostate Cancer)
If it is likely that cancer has spread outside the prostate gland, external beam radiation may also be required.

Mel

63 years old

PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.

History of BPH/prostatitis.

PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):

Biopsy on 11/30/09

Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.

lifeguyd

Veteran Member

Joined : Jul 2006

Posts : 688

Posted 12/6/2009 11:32 PM (GMT -6)

I hate to say this, but this looks like a self promoting study. I get upset when a DaVinci surgery Mill or old time advocate of open RP assembles data to make themselves look better than a 'competing' treatment modality. The same goes for Proton 'factories' or brachytherpy proponents. They are just trying to sell their product.

I think most of us agree that there are several good ways to treat prostate cancer. A lot depends upon the exact diagnosis, we know that one size does not treat all. The data from this study appears to try to mislead the reader into thinking that brachytherapy is the best for everyone. It purposly excludes more advanced cancer diagnosis from it's conclusion. It also appears to have excluded DaVinci surgery, though I doubt that significantly changes their conclusions.

Brachytherapy is one of the best treatments for G6 results, but other studies seem to indicate that it should not be used for more agressive cancers. Just as some DaVinci assembly line surgeons overpromote their product and make claims that in some cases are just plain not true, this study needs to be read with a suspicious mind.

PSA up to 4.7 July 2006 , nodule noted during DRE

Biopsy 10/16/06 ,stageT2A

Very Aggressive Gleason 4+4=8 right side

DaVinci Surgery January 2007

Post op confirms gleason 4+4=8 with no extension or invasion

no long term continence problems

Post surgery PSA continues to be "undetectable"

One side nerves spared

Bi-Mix for ED

born in 1941

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8128

Posted 12/7/2009 12:01 AM (GMT -6)

It is also very subjective to compare combination therapies to "mono" therapies. I have always noted that Brachytherapy with combined external beam radiation shows promise when compared to surgery, but the same isn't true comparing that combination with surgery with external beam radiation as adjuvant therapy particularly in high risk cases like mine. We do need multi-center controlled studies when comparing treatment modalities. And we need the extra timeframes of 15 and 20 year data.

I am disappointed that the medical community does not have such data.

Tony

Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/6/2009 10:33:42 PM (GMT-7)

zufus

Veteran Member

Joined : Dec 2008

Posts : 3149

Posted 12/7/2009 6:14 AM (GMT -6)

Truly-truly TC, that sentence reasonates 'I am disappointed that the medical community does not have such data'. One of the reasons we all search our tails off and try to compare all data we can find and get those multiple opinions and treatments. Now should we suspect the medical community giving us the mushroom effect???? No doubt it works for them. I know that is half glass but it does run across my thoughts.

Seems like the clinical trials usually lack some parameters or are dropped sometimes for reasons that we don't understand, too. Frustating as heck, been watching the PCa world for 7-8 yrs. and not to much in the way of break throughs, some little bits maybe.

My brothers wife is a mulitple myleoma patient has looked into plenty of treatments even on a global basis to some degree, many mushrooms to look at with no real answers, makes PCa look alot more definable. He says that he read that the average cancer patient (generality and averages thing) is worth $500,000 to the medical community. I will leave my thoughts there on this...like Tom Hanks in Forest Gump...that's all I'm gonna say about that (Jenny...).

P.S. Radio Therapy Clinics of Georgia (RCOG) was going to sign me on as a patient with high risk stats, I did not want to travel and be there for all those weeks and later preferred Dattoli "if" I were to chose that proceedure and distance parameter...I did not trust the local expertise to do this.

Post Edited (zufus) : 12/7/2009 5:02:16 AM (GMT-7)

Tudpock18

Forum Moderator

Joined : Sep 2008

Posts : 4292

Posted 12/7/2009 9:14 AM (GMT -6)

Tony, I've gotta be honest and tell you that your first post on this thread was a little nonsensical and indicated that perhaps you didn't read John's post OR the report.

As goodlife pointed out, this was a report that summarized many studies...it was not intended to be nor advertised as a "controlled study". And, the report concluded with some of the same criticism you leveled about lack of randomized studies, stratifications and consistent reporting criteria...but I think we all probably agree that is needed in studying PCa.

With the limitations identified, this report identified the results of a review of publications with the criteria established by a pretty good panel of experts...nothing more and nothing less.

Yes, the fact that it was revealed on a brachytherapy web site should probably give us all a pause to be a little skeptical. However, please take the time to see what a post/report does or does not conclude rather than immediately jumping to the conclusion that it is "biased".

Tudpock

Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc

Brachytherapy December 9, 2008. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Regular activities resumed, everything continues to function normally as of 12/09. 6 month PSA 1.4 and now 1 year PSA at 1.0. My docs are "delighted"!

Tudpock's Brachytherapy Journey: http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Zen9

Regular Member

Joined : Oct 2009

Posts : 314

Posted 12/7/2009 10:27 AM (GMT -6)

Tony writes, "I am disappointed that the medical community does not have such data."

I am shocked that a generation after starting to use the PSA test, the medical community still doesn't have answers to a lot of key questions about prostate cancer.

And I share Zufus' suspicions as to why that is.

As for this new study, in the immortal words of John McEnroe, "You can not be serious!"

Zen9

No family history of PC. PSA reading in 2000 was around 3.0 . Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.

Urologist advised a repeat PSA reading in six months = 4.0 . Diagnosed May 2008 at age 56 as a result of 12 core biopsy. Biopsy report by Bostwick Laboratories = Gleason 3 + 3.

Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3.

Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist. Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.

Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008. Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear. Gleason = 4 + 3.

Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances.

PSA readings:

November 2008 = <0.1 ["undetectable"]

June 2009 = <0.1

Ziggy9

Veteran Member

Joined : Jul 2008

Posts : 981

Posted 12/7/2009 10:32 AM (GMT -6)

John T said...
Even though the report is published by Grimm, which would indicate a bias, just read the names of the Doctor's involved in the study, guys like Bostwich and Lee and other well know Doctors from all the major institutions that have nothing to do with Brachytherapy.

I'll attest to that for the one expert I know. Dr Crawford the head of Urologic Oncology at the University of Colorado has no connection to brachytherapy at all.

Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%

Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

7/30/08 - Psa: .32

11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to

complete clinical research study

April 2009 12 of 12 Negative biopsy

10/12/09 - Psa .30

Tony Crispino

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Joined : Dec 2006

Posts : 8128

Posted 12/7/2009 11:05 AM (GMT -6)

David Crawford is a board certified radiologist and he is director of the radiation oncology center at UC. He was also Director of surgery. I am not sure what he is doing now that a new director of the cancer center is in place.
www.cpdr.org/speakers/crawford.html

Tony

Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/7/2009 9:19:09 AM (GMT-7)

Ziggy9

Veteran Member

Joined : Jul 2008

Posts : 981

Posted 12/7/2009 12:14 PM (GMT -6)

TC-LasVegas said...
David Crawford is a board certified radiologist and he is director of the radiation oncology center at UC. He was also Director of surgery. I am not sure what he is doing now that a new director of the cancer center is in place.
www.cpdr.org/speakers/crawford.html

Tony

I didn't know that. It does maybe explain why my Doctor is now on a different floor. Oh well he was the head of Urologic Oncology in October.

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8128

Posted 12/7/2009 12:40 PM (GMT -6)

He might still be. He did at one time run that center. But over time I have noticed that most researchers don't like that role. My oncologist was the facility Medical Director at the Nevada Cancer Institute, but he didn't like it. He is now focused on Genitourinary cancer research.

Crawford is a gem of a doctor but I don't think any on the "Expert Panel" are endorsing brachytherapy as the best therapy unconditionally as this website clearly does. I have put some feelers out this morning on this web page. Awaiting word from my personal "Panel of Experts".

Tony

Prostate Cancer Forum Co-Moderator

John T

Veteran Member

Joined : Nov 2008

Posts : 4276

Posted 12/7/2009 1:38 PM (GMT -6)

Dr Grimm is associated with the Seattle Prostate Cancer Center and is widely acknowedged as one of the best Brachytherapists in the US. He has done many research project on Brachytherapy and it is no surprise that he would start a study of this type. All of his previous studies have been well documented and peer reviewed, and the Seattle Prostate Cancer Center has some of the oldest and best data on Brachytherapy.
I doubt that Dr Bostwich, the noted pathologist, and Dr Scholz, the Director of the Prostate Cancer Research Institute would have put their names on a biased study and neither are associated with Brachytherapy. These are two individuals noted for their unbiased research.
Are we only to believe studies that show that surgery is the best option and disregard all others? Maybe the gold standard isn't what is used to be.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8128

Posted 12/7/2009 2:01 PM (GMT -6)

Dr. Scholz is partnered with Duke Bahn, a radiologist, and it is the primary local therapy at his center. In any case, the role he played in this non-study is moot. Bostwick like you said is a pathologist. I show you his presence in many surgery non-studies as well.

These "Expert Panelists" did not endorse these findings into a study. I am not surprised. The study subjects include "Google-Study" Are you kidding me?

PCRI is Mark Scholz's institution. He is a co-founder of PCRI. It's interesting to note that the medical advisory board is mostly radiologists and only 2 Urologists ~ hardly prominent ones at that.

http://www.prostate-cancer.org/pcricms/node/30

I do respect these guys, but they are biased. I attended the PCRI summit this year and it was largely a lesson in radiology.

Tony

Prostate Cancer Forum Co-Moderator

Tudpock18

Forum Moderator

Joined : Sep 2008

Posts : 4292

Posted 12/7/2009 3:17 PM (GMT -6)

Tony, you seem so anxious to discredit the report and the panel and I still don't believe you are reading the link that John sent. You make fun of "Google-Study", when all the report said was that they used "Google Scholar" to help find the publications (along with Pub Med, Medline and Elsevier Search). In case you are not familiar with Google Scholar, here is what it is:

What is Google Scholar?
Google Scholar provides a simple way to broadly search for scholarly literature. From one place, you can search across many disciplines and sources: articles, theses, books, abstracts and court opinions, from academic publishers, professional societies, online repositories, universities and other web sites. Google Scholar helps you find relevant work across the world of scholarly research.

Features of Google Scholar

Search diverse sources from one convenient place
Find articles, theses, books, abstracts or court opinions
Locate the complete document through your library or on the web
Learn about key scholarly literature in any area of research

Tudpock

Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc

Brachytherapy December 9, 2008. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Regular activities resumed, everything continues to function normally as of 12/09. 6 month PSA 1.4 and now 1 year PSA at 1.0. My docs are "delighted"!

Tudpock's Brachytherapy Journey: http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8128

Posted 12/7/2009 4:04 PM (GMT -6)

Andrew,
1st, this is not a study. Period. It's selected data used as an Ad at a radiology center website. At best it is designed to get more patients to do brachytherapy.

2nd, I have been treated with surgery, external beam radiation, and hormonal therapy. So I have been around the block with Urologists, Urologic Oncologists, Radiologists, and medical oncologists/hematologists, not to mention working in the advocacy front and as President of a large UsTOO chapter. I fully recognize that other primary treatment modalities would have me in the same boat I am in today. My problem with this webpage is in my opinion about seeds and studies below.

3rd, your comments about what I don't believe in are in direct conflict with conversations you and I have had together on the phone. I will reprise my position on each since you mis-stated them:

ADT3 ~ As I just told you on the phone, I am on the fence with ADT3 when compared to ADT using an LHRH agonist combined with an anti-androgen. I am not aware of any study that has been completed giving us data that shows adding Finestaride or Dutasteride to ADT improves any patient mortality rate. As I said, if my PSA climbs, I am in agreement with my oncologist that we will add finesteride when returning to ADT for peace of mind. There is a new study comparing these options, but we are 10 to 15 years away from useful data. Anyone electing to proceed with ADT3 should do so with the full understanding they are adding SE's to an already tough regimen of homonal therapy without medical history of whether or not it will work for them. This is commonly accepted anyway in cases where the disease is metastatic and I don't fault anyone choosing to do so.

Combidex ~ I have stated before that the use of ferumoxtran-10 is a tool that can help identify the presence of metastatic cancer in the lymphatic system. But it is 25% inaccurate, and this is not my opinion. It can lead to bad decisions if it alone is used. This is why it is only available in limited locations world-wide. The overall usefulness is still being studied, along with research to find a contrast that is more precise. Today Combidex is still not an accepted protocol in ANY country. It is still in the research phases even in Europe. These is a Phase II study in the US involving certain cases of brain cancer but it is very early and there are no results. John T can tell you these points are true as I don't think he disputes these points.

CDI ~ Color Doppler. Again a useful tool but not for all. I have recommended that some guys get one because their cases are very much in a gray area in deciding treatment and the extra data may help them. But CDI does not detect micro-metastatic disease, and no imaging does. While the accuracy of CDI is not real strong, it can be useful in selected cases. One should look at CDI as only a piece of their information gathering, and not solely base decisions on it.

Seeds ~ Again, I have stated that brachytherapy alone should be compared only to other mono-therapies alone. Comparing brachytherapy combined with other treatments to several mono-therapies, like this website does, it stupid. It's what makes this page biased. If you are going to add ADT or EBRT, or both, when comparing modalities, then you must do the same in the other modality options as well. It's a definite way to make the treatment you do look better in a graph by failing to do so. And it was intentional here that Surgery with EBRT and HT were eliminated in the comparison. I have stated for my position on this that seeds are a great option for a large population of prostate cancer patients, but not for all. Particularly those who are in the younger age groups that will definitely realize long term side effects that are well publicized, and have longer life expectancies.

Dr.s Strum, Leibowitz, Myers and the et. al. you might be referring to. It's the Et Al, that I believe is being biased against in general when discussing prostate cancer in web forums. I have never met Dr. Strum, but his reputation is well known as is his contributions to the research of prostate cancer. Dr. Leibowitz and Dr. Myers are cut from different molds. Myers believes in surgery in both advanced and local cases. Leibowitz actually believes in treating local prostate cancer with ADT3. I find that one fascinating. You will get drastically different approaches from these two alone. On the plus side these are great doctors for prostate cancer.

To your question of how many researchers, scientists, studies, etc. are not biased ~ I don't have that data. But usually when a study is reported before confirmed in a controlled study, or it is done with one doctors patient pool ~ I would be willing to bet it is biased.

I have never mocked anybody having slides sent to a 2nd pathologist and you won't ever find that I did here at HealingWell. In fact, I have frequently made it one of my top pieces of advice for new guys. I have even posted instructions on how to do so...There is a short list of prostate cancer pathologists floating around here, but they are not the only choices to get a solid pathology reading. Mine was confirmed by Epstein, but he did not change the results of my original one done at the City of Hope. So that guy at the City of Hope certainly didn't miss anything in his report so I concluded.

Andrew, since you are going to quote me, please refer to this list of responses the next time you quote my opinions on the above items so that MY side comes out of it.

To quote Dr Myers: "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data".

Sadly. Very true...

Tony

Prostate Cancer Forum Co-Moderator

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8128

Posted 12/7/2009 4:12 PM (GMT -6)

Tud,
Google scholar is not a medical website at all and what pops up when you search it is up to the Google sitemasters. Thank goodness that no actual study is based on information found there...Except, seemingly, this one.

I admit being anxious to discredit the comparisons in this website as they leave much to be discredited. I do not mean to discredit brachytherapy. Just the webpage. Brachytherapy is not a bad choice for many men. But these graphs leave much to be desired.

Tony

Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/7/2009 2:23:59 PM (GMT-7)

John T

Veteran Member

Joined : Nov 2008

Posts : 4276

Posted 12/7/2009 5:53 PM (GMT -6)

Tony,
Your bias is affecting how you see things.
1st, this was a study supported by many noted doctors from just about every field and major institution, and just because the results were posted on a seed site does not make it an ad or biased any more than a study favoring surgery being posted on any institution's site doing surgery is. If I were running a seed institution I would also be touting this study.
2nd, To infer that Scholz is biased because he has Bahn as a partner. Bahn is a cryosurgeon and Scholz certaintly doesn't recommend cryosurgery. Frankly he's biased because he has treated hundreds of cases of failed surgery and is intimately familiar with the results and permanent side affects.
3rd. You are quick to support all posts indicating surgery as the most effective option and quick to discredit any that don't share this view. You infer that any doctor who does not support surgery like Bostwich or Sholtz are biased. Maybe they are biased because the evidence supports their bias.
4th, You can't really compare the combo of seeds and IMRT to a combo of surgery and anything else. Seeds and IMRT is an established protocol widely recommended as a 1st choice treatment. A combo of Surgery and anything else is rarely a recommeded 1st option, but in too many cases ends up that way. Very few people choose a surgery combination when offered as a 1st option. It is mainly touted as the best chance of a one shot cure.

I admit my bias. I started out as most everyone else, believing that surgery was by far the most effective option. As evidence mounted, I changed my opinion, and more and more evidence is being presented that surgery may not be the most effective option for the vast majority of PC patients.

Thanks for clearifying your other positions to Ohio State; I agree with them. PC has many conflicting opinions among all the specialists and we must avoid letting our bias keep us from accepting new evidence that may not support our preconceived positions.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

John T

Veteran Member

Joined : Nov 2008

Posts : 4276

Posted 12/7/2009 5:55 PM (GMT -6)

Tony,
Your bias is affecting how you see things.
1st, this was a study supported by many noted doctors from just about every field and major institution, and just because the results were posted on a seed site does not make it an ad or biased any more than a study favoring surgery being posted on any institution's site doing surgery is. If I were running a seed institution I would also be touting this study.
2nd, To infer that Scholz is biased because he has Bahn as a partner. Bahn is a cryosurgeon and Scholz certaintly doesn't recommend cryosurgery. Frankly he's biased because he has treated hundreds of cases of failed surgery and is intimately familiar with the results and permanent side affects.
3rd. You are quick to support all posts indicating surgery as the most effective option and quick to discredit any that don't share this view. You infer that any doctor who does not support surgery like Bostwich or Sholtz are biased. Maybe they are biased because the evidence supports their bias.
4th, You can't really compare the combo of seeds and IMRT to a combo of surgery and anything else. Seeds and IMRT is an established protocol widely recommended as a 1st choice treatment. A combo of Surgery and anything else is rarely a recommeded 1st option, but in too many cases ends up that way. Very few people choose a surgery combination when offered as a 1st option. It is mainly touted as the best chance of a one shot cure.

I admit my bias. I started out as most everyone else, believing that surgery was by far the most effective option. As evidence mounted, I changed my opinion, and more and more evidence is being presented that surgery may not be the most effective option for the vast majority of PC patients.

Thanks for clearifying your other positions to Ohio State; I agree with them. PC has many conflicting opinions among all the specialists and we must avoid letting our bias keep us from accepting new evidence that may not support our preconceived positions.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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