Brachytherapy 12 year follow up data

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 7/28/2010 8:47 PM (GMT -6)   
Posted on the New Prostate Cancer Infolink July 28.
The long-term data on outcomes after first-line treatment with brachytherapy for localized prostate cancer are becoming increasingly compelling, and studies have also suggested strongly that quality of life data are better after brachytherapy than after other forms of treatment.

A recent article by Taira et al. report on 12-year follow-up from 1,656 patients treated in a single series between 1995 and 2006. This is believed to be the largest single series of brachytherapy patients treated using modern brachytherapy techniques. The patients were categorized by risk group (low-, intermediate-, and high-risk) using the Mt. Sinai risk criteria, and all patients were treated with permanent interstitial seed implantation.

The results of this analysis show the following:

  • Median follow-up was 7.0 years.
  • The median minimum dose covering at least 90 percent of the target volume of the prostate at Day 0 was 118.8 percent of the dose initially prescribed.
  • Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) for the entire patient cohort at 12 years were 95.6, 98.2, and 72.6 percent, respectively.
  • For low-, intermediate-, and high-risk patients
    • bPFS was 98.6, 96.5, and 90.5 percent, respectively.
    • CSS was 99.8, 99.3, and 95.2 percent, respectively,
    • OS was 77.5, 71.1, and 69.2 percent, respectively

 


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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/28/2010 9:24 PM (GMT -6)   
Compelling findings and hopefully patients will realize more about their choices and weigh all factors, especially side effects and quality of life, when making their own personal decisions for treatment type(s). Brachy with IMRT is also another choice and worth looking into, sources like Dattoli and RCOG and well known about on a national level.
Youth is wasted on the Young-(W.C. Fields)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/28/2010 10:24 PM (GMT -6)   
These are great numbers. But...

I think we are seeing more and more compelling evidence on combined therapies not just brachytherapy, but neo-adjuvant ADT with ANY localized therapy. Please don't take this the wrong way John, but this study is based on retrospective view on brachytherapy largely combined with ADT in the attack against prostate cancer from a radiologist group.

Mike goes on in his assessment in the InfoLink that many of the low risk patients endured unnecessary COMBINED treatment, and most endured ADT for a 6 month period, which results in 9-12 months of some pretty big side effects that will shut down sexual function for that term. I argued that point again today in a followup article because I think that 6 months of ADT prior the localized therapy is going to skew numbers dramatically, and there is little information on how that affects later ADT usage. And I also noted that the hidden factor still is in the road ahead. This study is based at a median year 7. I still want to see years 15 and 20.

That stated, I am starting to believe more in brachytherapy in combination with ADT as a great approach for the ages of 63 and above...still challenge the cohort to prove that it is even a good selection for a 44 year old like me when I started out.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 7/28/2010 11:16 PM (GMT -6)   
Tony,
I hear you, but considering the other options Brachy even with 3-6 mos of HT has pretty minor side affects. If you only take Casodex the side affects are pretty minor, you have some hot flashes that are very tolorable, have a loss of libido, but can still get an errection and all side affects disappear in 2-3 months. Taking Lupron to shrink the prostate like most doctors recommend is unnessary. The risk of permanent complications such as ED and incontinance are rare. Compare this to the recovery time for a surgery and the time it takes to be continent or get an errection.
Most Brach doesn't require HT only those with large prostates or high risk stats.
I just don't buy long tem results as that important. In just about every study done with every treatment option the rate of reoccurrance the curve levels out at 5 years and flatlines at 10 years. Your chance of a reoccurrance after 10 years with any treatment is very rare, but it does happen with surgery as well as with radiation. I don't think it has anything to do with the treatment, but much more with the biology of the cancer. The Seattle Prostate Institute as well as Dattolli has very good 15 year data that is similar to the above study. When Brachy get 20 years of data you will be asking for 30 years.
As long as the prostate is completely ablated with radiation it is extremely unlikely that something will grow in the future.
The study and posts concerning Brachy and HT were about another study posted at the same time. I read that and your and Mike's posts. That study also showed superior result for Brachy as compared to surgery. The differences were statictically signifacnt.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/29/2010 9:22 AM (GMT -6)   
Interesting percentages, but I would feel better if it were based on 16,000 patients, or 160,000 patients, not 1,600. Guess over time, larger pools of brachy patients will make up future stats
Age: 58, 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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/29/2010 10:15 AM (GMT -6)   
John,
The studies showed COMBINED therapy is better than surgery as a mono-therapy in a biased study by a group that has never done surgery on a patient. That's it. There is little doubt in my mind that adding a stint of ADT to the surgery side would reap the same results if not better. I have never mentioned a 30 year study result so please leave it where I stated it. My point is valid that in the PSA testing era, except in extreme cases, almost no one dies in ten years regardless of treatment modality. But we are absolutely seeing a shift in data after ten years. This was just noted in the 9 year European study that was included in the New England Journal of Medicine just three years ago that had guys here saying that screening only saved one life in 48 men diagnosed through screening. Data in just three years later changed dramatically in that same study, which now says 1 in 15 men diagnosed are saved by screening. That was a 300% change in just three years, and the group stated that they needed to follow the data for 20 years to get a more accurate accrual of data.

We need independent studies to make these comparisons on treatment modalities. If you go to MSK and use the nomograms, combined brachytherapy NEVER outperforms surgical intervention with adjuvant or salvage therapy using a database of over 20,000 cases. MSK is a multi-faceted center that does both treatment modalities and the radiation oncology center is run by world renowned RO Michael Zelefsky, one of the first to do todays methods of brachytherapy and the editor in cheif of Brachytherapy magazine. I find it less than amazing that independent radiology centers combine therapies and compare to mono-therapies and they use the data to prove what they do is better yet the MSK nomograms don't align with their data. Here try it:

www.mskcc.org/applications/nomograms/prostate/PreTreatment.aspx

Key in intermediate or high risk cases for both surgery and brachytherapy and compare for yourself.

I think for a median aged man at 63 with low risk disease, brachytherapy is a good option. I also think that data beyond ten years is ultra important to any man under that age group... I don't understand with compelling data that things change dramatically in year ten and beyond, you don't agree with that...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 7/29/2010 12:25 PM (GMT -6)   
Tony,
Long tem data in screening is very different than long tem data after treatment. The rate of detection from screening increases as time progresses. The rate of reoccurrance decreases as time progresses after any form of treatment. You just can't compare apples to oranges.
The longer you go without a reoccurrance the less chance you have of having a reoccurrance; the data just isn't there to show reoccurrance increases after 15 years with any treatment option. A particular treatment doesn't have a time expiration in which after 15 years you have a higher chance of reoccurrance. The vast majority of reoccurrances occur with 5 years and tail off significantly and keep tailing off as time progresses.
Combined therapy of anything works better than a mono therapy; surgery and SRT, Surgery and HT, radiation and HT. The issue is the combination of side affects. The combination of Brachy and 3 months of HT are certaintly much less than any other combination therapy and all studies show similar or superior results to other mono or combination therapies with better QOL issues.
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


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/29/2010 12:55 PM (GMT -6)   
Also note ~ The median follow up is 7 years in this study not 12. You can have a median of 7 years by combining a 12 year patient with a 2 year patient. The term of this study is over a 12 year period with the patients averaging 7 years after treatment.

Your statement that prostate cancer recurs mostly in the first 5 years is true. But the statement that prostate cancer recurs less with each year is not true for all patients. In fact, relapse increases with higher risk and time just as the mortality rate does. In breast cancer, they say get past 5 years and you're odds improve dramatically. This is completely untrue in prostate cancer. Which is why in the 5 and 10 year data tables shows significantly differing results.

Also, relapse is not the only measuring stick and is less significant tool than prostate cancer specific mortality...Which is why we need longer term studies...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 7/29/2010 1:01 PM (GMT -6)   
Same old argument...JohnT provides interesting and postive data about radiation based treatments and Tony finds a way to disparage it. 
 
Personally I remain convinced that there is a compelling case for brachytherpy and combo radiation therapy.  It breaks my heart to see guys continuing to march off to surgery and the consequences thereof...but, hey, that's just me.
 
Tudpock (Jim)
Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 7/29/2010 1:16 PM (GMT -6)   
This debate -- and the article that began it -- is very interesting. To me, it shows (at least) two things. The first, is the value of the multi-disciplinary panels that exist at some hospitals -- particularly large teaching hospitals -- where docs from different specialties get together and make a combined recommendation to a patient. The second is the value for a newly diagnosed patient, who is unsure what treatment he wants, of consulting with a medical oncologist, who may have less bias becuase he does not do surgery or radiation. Becuase the choice is not really surgery versus radiation. It is brachy versus brachy plus IMRT/IGRT, versus either or both with ADT (and then which form of ADT), versus surgery (which one?), versus surgery plus ADT, versus surgery plus ART (versus cryo, cyberknife, proton, etc.). So, good, unbiased advice is key.


Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

Post Edited (medved) : 7/29/2010 12:24:06 PM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 7/29/2010 2:26 PM (GMT -6)   
The median time of the study was 7 years, but here is the 12 year data from the study and it is pretty good.
bPFS was most closely related to the percentage of positive biopsy specimens and the patient’s risk group.
The patient’s Gleason score was the strongest predictor of CSS.
OS was best predicted by patient age, hypertension, diabetes, and tobacco use.
At 12 years, biochemical failure and prostate cancer-specific mortality were
1.8 and 0.2 percent, respectively, for patients with a Gleason score of 5 or 6
5.1 and 2.1 percent, respectively, for patients with a Gleason score of 7
10.4 and 7.1 percent, respectively, for patients with a Gleason score of ≥8.

Tony, no matter how much data is provided on any treatment other than surgery, you will always discount it. Any treament that has 12 year cure rates of 1.8%, 5.1% and 10.4% for low, medium and high risk PC with relatively few side affects can't be brushed off. Scardino in his book admits that of all the surgeries done at MSK 40% are clasified as unsuccessful, defined as no cure, permanent side affects or major complications, and this is one of the top surgical center is the US.
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


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/29/2010 5:02 PM (GMT -6)   
Guys until I see a major multifaceted facility, like Mayo, MD Anderson, MSK, Harvard, Stanford, etc. until I see facilities like them switch their m.o. of recommending brachytherapy first, then you are correct, you won't win me with a study abstract like this one...

I asked earlier why the MSK nomograms, with data provided by both the urologic and radiation oncology groups at MSK, absolutely contradicts both this study and John's claim that brachytherapy is better against all prostate cancer risk groups ~ but no one answered that. Anybody care to take a swing at it, I'd appreciate it. I think I'll try to contact Zelefsky and get his response (while of course inviting him to speak at our UsTOO group ;-))

If my father decides on treating prostate cancer, I would tell him to go the seed rout. I'm not as closed minded as you both just said. He is almost 76 and he is on active surveillance, which I am also fine with. Treatment for him can be quite less aggressive because of his age and life expectancy.

My guest speaker for September is a radiation oncologist who told me point blank that they would encourage a 44 year old high risk case like mine to look at surgery first. When I went to their facility at their invitation to look at the Calypso and brachytherapy program, I was impressed by the technology. But I was most impressed when they said that to me. They also acknowledged that more time is needed with studies to determine the efficacy of the latest RO technologies on mortality.

So yes. I am likely to offer counterpoint to statements that say that brachytherapy is absolutely more effective than surgery (one should note that this study does not make that claim)

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 7/29/2010 6:29 PM (GMT -6)   
Wow, wonderful info, articulately and intelligently discussed by two very informed individuals. This IS the reason that I come here. Gentlemen I hope that the two of you keep this activity up.
Hero
Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09 Non-Nerve Sparing on Rt.
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate involving 20% of the Gland. Surgical Margins Free of Tumor,
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. Extracapsular extension is absent Perineural Invasion is Identified, Vascular Invasion is not identified.
Post-op PSA 12/10/2009, Undetectable  <0.01
Post-op PSA 05/03/2010, Undetectable  <0.01
I hate this crap
Moved by individuals like Living1963

 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/29/2010 7:16 PM (GMT -6)   
Hero, medved,
I am a very serious fan of everybody at this site. If I had it my way, everybody will do very well here, with minimal side effects ~ regardless of treatment modality, or that we would stamp out prostate cancer all together. Until then, I hope that John keeps posting studies. And everybody who was treated in other ways keep posting them. I'll keep commenting on what I see in the study.

It's important to note that 85% of released abstracts in PubMed are not accepted by any general medical organizations. They are just pieces of information that can be used or discarded when comparing cases. How they are compiled can be through a single doctor, an institution that specializes certain illnesses - sometimes in certain ways, or by multi-center corroboration. Personally I weight the multi-center ones the highest, but not always.

If I had it to do over again with the numbers I had, and I could not go with surgery for some reason, I can say I likely would go with brachytherapy with adjuvant EBRT and HT for two years. But in the back of my mind I would be questioning every study I see on it. I would be happy to see studies like this one, but I would keep asking questions about it. Zufus' best advice here is question everything.

What I would really like to see is a controlled trial with random inclusion from many centers comparing treatment modalities. Probably won't ever happen. There's way too much money at stake with the arguments being as they are...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 7/29/2010 6:27:42 PM (GMT-6)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/29/2010 8:57 PM (GMT -6)   
Brachytherapy is a great treatment option.

Surgery is a great treatment option.

Why can't these two statements co-exist ? I really do get tired of the debate that one is better than the other, when statisticlaly they are in a dead heat. Ironically, it is usually the treatment that the person had that is superior.

I think that we need to work more on getting men to recognize that they need to be treated, than to keep beating up each other's treatment options.

I am not saying that any poster on this thread has done any of the above, but it can appear that way at times tho.

Academic debates and discussions are good, until they start to get personal.
Goodlife
 
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 injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01


An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 7/29/2010 9:57 PM (GMT -6)   
I actually think it is fabulous that these discussions happen.
This is why this site is so powerful, knowledgeable people like Tony, John and Jim can have this discussion and we can watch them have it. I love the fact that John put up this study and I also love the fact that Tony challenge’s the study’s assumptions.

This disease is confusing, there are many right answers and the right answer for one individual may be the wrong answer for another. Specialists in the field do not agree on a universal approach so there is little chance that people in this forum will. However if there is a new input into the discussion (e.g. 12 year Brachy studies) then it is certainly a good opportunity to revisit the discussion again – it is possible that after reading all this the pendulum would shift a little towards Brachy and someone may make the decision that Brachy makes more sense to them than surgery.

This is what makes this site great.
Husband's age: 52
 
In 2007 my husbands PSA levels was 2.5.
In Feb 2008 it was 1.7
In Oct 2009 it was 3.67 with a free PSA ratio of 27
In Feb 2010 it was 4.03 with a free PSA ratio of 31.
In June 2010 it was 2.69
 
Referred to urologist. DRE normal.
Biopsy 28/4/2010: results, negative for a diagnosis of PC however 3 focal ASAPs on left side of prostate at base, apex and at transition resulting in the conclusion  "...small acinar proliferation is suspicious but not diagnostic for prostatic adenocarcinoma."
 
Review of biopsy by experienced pathologist, results,
1 out of 12 core diagnosed with 10% of Gleason score 3+3 cancer (left transitional) 
1 out of 12 cores with ASAP (left apex), suspicious but not diagnostic of cancer
 
My husband's maternal grandfather died  of prostate cancer at 72. His maternal uncle died of prostate cancer at 60. Because he is the third generation to be diagnosed he has hereditary PC.

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