Chicago Prostate Center: 96% low, 84% intermediate, 75% high.
Cleveland Clinic: 95% low, 89% intermediate, 71% high.
I think these results for intermediate are higher than surgery.
The largest study, The Prostate Cancer Study Group 2009, found that Brachy had superior cure rates in all risk catagories.
There are some studies at Hopkins that show surgery to be more effective in the high risk cases.
I think as these studies and updated ones that will come out in the future they will continue to challange the old way of thinking that surgery is the best cure for intermediate and high risk cases in much the same way that Active Survielance is gaining confidence among doctors as more data becomes available. It takes a lot of time to change, and most of the old data definately favored surgery. There is now good 15 year data on Brachy and a lot of 10 year data where there was very little 4 or 5 years ago. The recent developments in both external radiation and Brachy have outstripped surgery which is basically the same as it was 20 years ago. Robotic has been able to reduce the immediate after affects of
open surgery, but has not improved QOL issues or cure rates over
There are a couple of situations in which surgery has an advantage: when a patient has urinary issues before treatment and for very young patients with high risk disease, and for overweight patients and those that have a very large prostate.
All of these studies are retrospecive studies and I don't ever see the time when we will have head to head studies with patients randomly assigned to various treatment options.
I think what we have seen this year is that the urological community is now beginning to realize that the side affects of surgery are much greater than most have been led to believe.
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.