Radiation studies

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John T
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   Posted 10/13/2010 10:49 AM (GMT -6)   
In answer to Postop's request from Tudpuck to provide radiation studies that show superior results to surgery:

EFFECTIVENESS OF BRACHYTHERAPY

 

The following are published studies supporting the effectiveness of Brachytherapy in achieving cure rates higher than or equal to surgery.

 

11 year follow up, Prostate Cancer Foundation of Chicago, 2009: 9137 patients:

Low risk, 96%; Intermediate risk, 84%; High risk 75%

 

Cleveland Clinic, 11 years: 96% low; 84% intermediate; 71% high. “Brachy more successful than surgery in low risk cases”

 

MSK, 1819 patients, 5 year follow up; “Reoccurrence rates similar with surgery, Brachytherapy, and External beam.”

 

Journal of Urology, 173, 2005

12 year follow up: 1449 patients; 93% disease free survival. Biochemical reoccurrence:

89% low; 78% intermediate, 63% high.

 

Seattle Prostate Institute: 10 year follow up: metastic free survival 97%; local control 97%.

 

ICER, Dec, 2008: “Brachytherapy is the most cost effective method of treating prostate ca.”

 

The largest study was the just released Prostate Cancer Study Group Results which showed Brachy superior to surgery in all risk catagories.

 

Data from the Dattoli Cancer Center shows similar results.

 All of these are retrospective studies, but the data comes from well respected organizations and are published and peer reviewed.

JohnT


JohnK11
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Date Joined Jan 2010
Total Posts : 25
   Posted 10/13/2010 12:51 PM (GMT -6)   
Please post the surgery survival rates, along with Seeds. How significantly different are the results ?? Also, I wonder whether there are any biases. I can think of at least one--since seeds are usually give to older people, and surgery to younger people, the chance that they will die from other sources would be much higher for seeds patients, and thus the chance of dying from prostate cancer could be reduced by this strong bias.
I'm sure that I can think of others.
Interesting statistics, though.

F8
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   Posted 10/13/2010 2:27 PM (GMT -6)   
>>since seeds are usually give to older people<<
 
 i got my seeds @ 55.  my buddy had his at a younger age.
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

John T
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   Posted 10/13/2010 3:41 PM (GMT -6)   
These stats have nothing to do with survival rate. The numbers reflect biochemical free reoccurrances; They also have nothing to do with age.
Numbers published by Dr Walsh in 2007 in the Journal or Urology had cure rates for surgery for low, intermediate and high at 85%, 63% and 40%.
The Prostate Cancer Study Group averaging across 12 institutions came up with 85%, 70% and 40% for surgery, fairly close to Walsh's numbers.
A study by released by John Hopkins concluded that reoccurrances for surgery occurred an average of 5 years earlier than from seeds.
Studies for seed implants across 24 institutions averaged 95%, 85% and 75%.
The data is fairly consistant where ever you look.
I think the reaon for this is that with surgery the doctor will never get all of the prostate tissue and microscopic cells can be left at the margins, nerves or seminal vessicles or in the left behind tissue. Radiation will kill the cells in these hard to get at places.
In almost all cases of a local reoccurrance after surgery that requires salvage radiation, radiation would have done the job the first time. There is also a significant difference in incontinence rates and ED rates between surgery and seeds. Incontinence 8% to 0%,
and ED, 50% to 35%
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Jazzman1
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   Posted 10/13/2010 3:43 PM (GMT -6)   
The concern that I had about brachytherapy, and about radiation in general, is whether it can cause secondary cancers in adjacent organs 10 or 15 years down the line. It's a concern that was shared by my urologist and by a general oncologist I spoke with. It's a particular concern for relatively younger men.

I'm not sure if there are any long-term studies on this subject. Assuming there are, they're based on treatments that occured over a decade ago. I'm not sure that would mean much for today's treatments.

The efficacy of brachytherapy in curing cancer is pretty much undisputed, as far as I know. Long term effects are another issue. I've made my treatment decision, partly on the basis of these concerns. However, I'd be interested in hearing more about what's known regarding this issue.
Age 55

PSA:
8/09 2.69
7/10 4.00
8/10 4.11

Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C
Gleason 6

John T
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   Posted 10/13/2010 6:07 PM (GMT -6)   
Jazzman,
There is about a 1% risk of developing secondary cancers from external beam radiation 20 years later. Did your doctor also tell you there is a .5% chance of dieing IMMEDIATELY from surgery or that complications like septic infection, major blood loss, and piercing of bowels during surgery is a much greater risk than getting a very curable secondary cancer from radiation? There is virtually no risk of secondary cancers due to brachytherapy as it does not affect any other organs and radiation dose extends only 1mm. I have been reading posts on various radiation sites for over 2 years and have never run across one incidence of secondary cancers. You chance of getting another unrelated cancer, a heart attack or a reoccurrance of PC is much more likely.
I think that doctors do a patient a disservice by over emphasizing the risks of one treatment and not mentioning the risks of the treatment they are recommending. I believe a patient deserves ALL the information concerning the risks of all treatments and these should be presented fairly. The main risk of external radiation is a 2-4% chance of major bowel issues and this should be a major concern to anyone considering external beam.; fortunately this doesn't exist in Brachytherapy.
The basic decision is that would you rather accept a .5% chance of dieing immediately versus a 1% chance of getting a curable secondary cancer in 20 years.
I doubt if your doctor presented the option is this manner.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Jazzman1
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   Posted 10/13/2010 6:29 PM (GMT -6)   
Thanks for educating me. I wasn't aware of the secondary cancer statistic you cited.
Age 55

PSA:
8/09 2.69
7/10 4.00
8/10 4.11

Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C
Gleason 6

Postop
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Date Joined Feb 2010
Total Posts : 385
   Posted 10/13/2010 7:06 PM (GMT -6)   
Thanks! Do you have the citations?

John T
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   Posted 10/13/2010 8:33 PM (GMT -6)   
Postop,
There are no citations for secondary cancers from Brachy because it doesn't occur; just as there are no citations for secondary cancers from surgery, because they also don't exist. It is never mentioned in any of the articles I have ever read about Brachy.
10 to 15 years ago it was commonly thought that ERBT caused about 1% secondary cancers. It also had a wide beam that caused all sorts of other damage to surrounding organs. 10 years ago surgery was more effective as to both cure rates and side affects and these perceptions still exist today, even though we are now using a completely different technology that delivers a higher dose much more accurrately. These old problems have all but disapperated with the 2nd and 3rd generation IMRT in which the beams can be sculpured within a millimeter. Since secondary cancers take about 15 to 20 years to develop it will be another 10 years before we can see data on the newer radiation. It stands to reason that if adjacent organs are getting a much lower dose then the incidence of secondary cancers and side affects will be much lower. We have already seen this with the incidence of side affects.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

John T
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   Posted 10/13/2010 8:46 PM (GMT -6)   
In comparing the cure rates for surgery and radiation one has to be careful in using only the clinical pathology. Most of the studies relating to surgery use the actual pathology. If a patient is clasified as a low risk G6 and later found to be a G7 many institutions reclassify him as an intermediate risk in reporting their data. Since radiation only deals with clinical pathology from a biopsy, and this is the only information a person has in which to base a treatment decision one must compare apples to apples. Many surgical studies report 95%+ cure rates for a G6, but this is only for confirmed pathology after the prostate is removed and after any upgrades. When based on clinical pathology, the only information available on which to base a decision, the cure rate drops to 85%.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Postop
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Date Joined Feb 2010
Total Posts : 385
   Posted 10/13/2010 9:30 PM (GMT -6)   
John,

I'm asking for the citations for the articles for the statistics you give in the first post in the thread, so that your readers can look them up. If you put the Journal, volume, page numbers, year, (or the authors and title), you can find the article on pub med,

http://www.ncbi.nlm.nih.gov/sites/entrez/query.fcgi?myncbishare=uwonline

Also, every article has a unique ID number (PMID). If you list this number, anyone can search and find the article from that, also. You can see the abstract, at least, and a number of journals are now open access. Every reputable journal is indexed on pub med, and the trend is for more and more of the world's medical research to be open source.

ChrisR
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Date Joined Apr 2008
Total Posts : 825
   Posted 10/14/2010 5:09 AM (GMT -6)   
John,

I have suspected that brachytherapy might have been superior when I first started researching this. Only because you are correct about only being able to classify people based on their biopsy score and not post op. pathology. So you know some people have a higher Gleason score and are misclassified. My uro. does brachy and is affiliated with the Seattle Institute. He also get published on Urotoday quite a bit, so he is no slouch. He did a 50 point mapping biopsy on me to dx. me. He recommended that I go to Johns Hopkins and have RP. He said he would do brachy on me if I wanted. I felt I did not want the radiation and his stats. for young people only when out 5 years. J.H. had 15-20 year data for surgery. I have seen some studies that showed better BCR with brachy. Long term though I don't know. This cancer runs such a long course. 10 years is nothing to be clear in my opinion.
Dx 42
Gleason 6 (tertiary score 0)

open RP 10/08 Johns Hopkins

pT2 Organ confined Gleason 6

PSA
10/15/2009 <.1
10/15/2010 <0.03
10/15/2011 -

NY-Sooner
Regular Member


Date Joined Sep 2009
Total Posts : 463
   Posted 10/14/2010 6:15 AM (GMT -6)   
I was considering brachytherapy three years ago when I was diagnosed because I had a low risk gleason 6 cancer, but the one thing that scared me away was when I read that the chances of getting ED after two or three years was 50% because of the radiation damage to the nerves. Also the fact that you never really know if all the cancer was killed or not with brachytherapy made me a little nervous.   I decided to take my chances with surgery and I was lucky and had very good out come, no ED issues what so ever. 
 
I am just curious if there is anyone here, or if you know someone who has had brachytherapy three or more years ago. I am curious to know what, if any long term side effects such as ED has occured.
 
Age 56, Biopsy 6/2007 - PSA 4.5, 2 of 12 with  <5% cancer Gleason 6
Surgery 9/2007 Strong Memorial,  Rochester  NY with Dr. Jean Joseph (1300 plus surgeries)
 Path - Negative margins, cancer in 20% examined tissue, Gleason 6
 Post Op - No ED issues, full erections without drugs,  used 5-7 pads a day for 3 months. Now dry except for stress leaks now and then.
 All post op psa's <.04

Tudpock18
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Date Joined Sep 2008
Total Posts : 4156
   Posted 10/14/2010 7:05 AM (GMT -6)   
Dear NY Sooner:
 
I think I am the longest tenured brachy patient on this site that "regularly" posts and I am almost 2 years post procedure with no ED or any other side effects.  JustJulie was a regular poster when I arrived at HW and her husband's procedure was in April of 2006.  As i recall from her last post earlier this year he was still having no ED issues.
 
Personally I am acquainted with a dozen or so brachy patients and only a couple admit to mild ED that is treated with Viagra.  However, that is clearly anecdotal and not "evidence".  But, in general, I think the stats are pretty clear that some 35% or so of brachy patients experience ED...which is less than the surgery rates...and one of the reasons I chose brachytherapy.
 
Tudpock (Jim)
 
P.S.  Your comment about never really knowing if the cancer is killed off is no worse for brachy than for surgery.  Witness the legions of surgical patients on this site who anxiously await every PSA test to find out if they have a recurrance...
 
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643

John T
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Date Joined Nov 2008
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   Posted 10/14/2010 10:45 AM (GMT -6)   
Postop,
I'm not a researcher or a libarian so I'm not into entering every individual source. I read things and take notes or just remember.
Some sources if you are really interested, but I doubt any amount of data or studies will satisfy you.
www.chicagoprostatefoundation.org.
myclevelandclinic.org/services/radiation_oncology/outcomes.aspx
the others you can google.
Seattle Prostate Institute.
Prostate Cancer Study Group Results.
Dattoli Cancer Center.
Radio Therapy Centers or Georgia.
"Brachytherapy and IMRT" by Dr Michael Dattoli, book
"Seeds of Hope" Dr Michael Dorso, book
Predicting an optimal outcome after RP. James Eastham JOU june 2008
10 year biochemical control with brachytherapy, Peter Grim, International journal of Radiation Oncology biology Physics, April 2002
15 year biochemical free relapse in T1-T3, Seattle experience. International Journal of Radiation Oncology Biology Physics, Jan 2007
Invasion of the Prostate Snatchers, Mark Scholz Chapter 12.
ICER 2008, Effectiveness of Brachy, ERBT and Proton
If you google Peter Grimm or John Sylvester or Michael Dattolli you can find a lot of published articles on Brachy.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 10/14/2010 5:52 PM (GMT -6)   
Hi JT:
 
A belated thank your for a very comprehensive answer to a question that was posed to me on another thread.  Like you, I have read many of those studies but unlike you I didn't have the notes or recall to find them.  At this point you have hopefully provided enough information for the original questioner to complete his term paper.
 
Tudpock (Jim)

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 10/14/2010 6:36 PM (GMT -6)   
Thanks. I appreciate John T's response. I will try to find the articles and post them here when I find them. I have a lot of things to do in the next few days, but I will try.

I think the comment about "completing a term paper" is out of line.

I'm just trying to learn. I'm not trying to contest what has been said, but to verify it and understand it better.

We are all amateurs here. If anyone wants to play amateur medical scientist here, that's a big responsibility. This whole area is really murky. We've all had the experience of getting vague and conflicting opinions from our doctors. For better or worse, people actually look on this website to learn about prostate cancer and its treatment, and, for better or worse, their real world decisions about their treatment may be influenced by what they read.

While there is a natural human tendency for the people who post here to want to defend and advocate for the particular treatment path they they chose to undergo, this is balanced by the fact that there are many different viewpoints, and you can really get a feeling for different aspects of these decisions. That's what I like about the board.

Some posts go beyond giving personal feelings or opinions, and give specific statistics and data. If you are going to do that, you need to reference the source for what you are quoting, so it's possible to verify it, don't you think?

Purgatory
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Date Joined Oct 2008
Total Posts : 25380
   Posted 10/14/2010 6:49 PM (GMT -6)   
tud, that remark was out of hand, in my opinion

postop, i think your last post spoke a lot of truth. sometimes the line is crossed here between being helpful and pretending to be a doctor or med prof.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

F8
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   Posted 10/14/2010 6:54 PM (GMT -6)   

as i recall this thread was in answer to some unsubstantiated claims about radiation treatment, which occur all the time on this forum.  the sky is blue.  the burden of proof is on the guy who doesn't believe that.

ed


age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Post Edited (F8) : 10/14/2010 7:54:23 PM (GMT-6)


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 10/15/2010 1:25 AM (GMT -6)   
LOL,
F8, I just looked outside. It's midnight here in the desert and the sky is not blue.

I'm just saying. ;-) But great analogy... Fitting for this discussion.

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) : 10/15/2010 1:29:03 AM (GMT-6)


Postop
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Date Joined Feb 2010
Total Posts : 385
   Posted 10/15/2010 11:52 AM (GMT -6)   
I have found a lot of articles; some referenced by John T, others just by searching on Pubmed.gov, which is sort of a scientific google. I'm not reading any websites or books, only articles published in the medical literature. I probably won't have time to go through all this stuff and write my term paper for a while; I'm leaving on a trip soon and won't bring my computer or have much internet access for several weeks. When I get through these articles I'll start a thread (never started one before). What I want to talk about are these issues:

1. summarize studies that show that radiation is effective (i.e., that the sky is blue)
2. review the studies of the complications after radiation, and how that's been compared to surgery
3. review any studies that directly compare the effectiveness of radiation and surgery
4. summarize the articles that report rare late occurrence of bladder and rectal cancer after radiation.

I'm not doing this to advocate for or against any treatment. I just have heard or seen certain arguments from doctors and on this website to advocate for surgery or for radiation. It all seems rather unclear and soft. I don't believe that there is anything there that will severely challenge the conventional wisdom. I just wanted to summarize the evidence and give the references, for the different arguments that have been used, and put it out there for anyone to comment on or add to.

Casey59
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   Posted 10/15/2010 2:24 PM (GMT -6)   
Jazzman1 said...
The concern that I had about brachytherapy, and about radiation in general, is whether it can cause secondary cancers in adjacent organs 10 or 15 years down the line. It's a concern that was shared by my urologist and by a general oncologist I spoke with. It's a particular concern for relatively younger men.

 

 

Each patient’s goals and priorities in the treatment of their prostate cancer should individually be evaluated and considered to individualize treatment plans.  Due to the individual variation in the perception of quality of life—everyone sees this differently—objective evaluation of outcomes and side effects is difficult to generalize.

Brachytherapy has in recent years become a widely accepted mode of treatment for prostate cancer, and rates of BCR are outstanding for patients with a favorable risk profile; generally on par with the surgical results for patients.  [Generally, good candidates for seeds have PSA less than 10 ng/mL, Gleason score of 6 or less, negative DRE, no history of BPH, and prostate volume below 60cc.]  Adding in external beam radiation (in addition to seeds) yields the best BCR results.

The short-term side effects of brachytherapy are well documented.  However, the consequential late effects are less widely known and (therefore) less widely communicated.  For the young-ish patient, the concern over secondary cancers (raised by Jazzman 1) appears to be less significant than the other known consequential late effects of brachytherapy…but few new patients know to inquire deeply enough into these HRQoL (Health Related Quality of Life) issues and the time-scale of reported outcomes.

American society often celebrates immediate gratification, and doctors tend to describe the immediate effects of a particular therapy.  Most studies only examine short-term; however, long-term effects may result in serious and debilitating problems or negatively affect QoL.  The young-ish patient who chooses seeds in order to reduce risk of erectile dysfunction (ED) may find significant reduction 3-6 years later.  The trade-off for immediate gratification (retaining erectile function in the short-term after treatment) may or may not have been worth it in the long-term (permanent loss of functionality at an “early” age).  Dr Michael Zelefsky, MSK’s Chief of Brachytherapy Service, reports 53% of patients potent before brachytherapy developed ED within 5 years of therapy.  Radiation thickens the walls of blood vessels, limiting blood supply th the nerves responsible for erections.  On the upside, the PDE-5 inhibitors (Viagra, Cialis, Levitra) are a generally effective solution for most men, but they become a permanent solution (versus a generally temporary solution, for only the short-term, after surgery).

Urinary incontinence, rectal bleeding and frequency…also consequential late effects of brachytherapy.  Again, given that men have often been accused of thinking with our dxcks, the young-ish patient may be tempted to not think about blood-stains in the back of his pants 5- or 10-years down the road, but probably should.  Greater than 20% of brachytherapy patients required TURP or colonoscopy to manage chronic urinary retention or moderate to severe proctitis; the number shot up to over 40% for combined external beam radiation plus seeds.  These problems are not biochemical recurrences or secondary cancers treated by oncologists; rather, many patients rely on their primary care physician, gastroenterologist, or colorectal surgeon for the management of late complications after brachytherapy.

With these factors in mind, the site www.prostate-cancer.com issues this words of caution:

While brachytherapy is an effective prostate cancer treatment option, men who are much younger and in good health and who can reasonably expect to live another 20 years, may want to consider other treatments. Most of the conclusive data in LDR or HDR therapy does not extend past the twenty year mark. Most long-term studies do not extend past 10 to 15 years.  

Here’s some troubling quotes (with references):

·         There is a perception among many urologists that complications of brachytherapy may be underreported.     http://onlinelibrary.wiley.com/doi/10.1002/cncr.20446/pdf

·         Brachytherapy-induced erectile dysfunction is more common than previously reported.  http://www.psychiatrictimes.com/sexual-disorders/content/article/10165/105988?pageNumber=2

·         Although early proponents of prostate brachytherapy suggested that this treatment has a minimal effect on HRQoL (health-related quality of life), studies have found that it significantly affects HRQoL…    http://www.urotoday.com/prod/pdf/reviews/BJU1_sept2004.pdf

 

Enthusiasm for brachytherapy may be appropriately curbed with the inclusion of these longer term factors.

 

References (in addition to those cited above):

·         http://www.moffitt.org/CCJRoot/v8n6/pdf/540.pdf

·         http://www.urotoday.com/prod/pdf/reviews/BJU1_sept2004.pdf

·         http://www.nmanet.org/images/uploads/Publications/OC500_june.pdf

·         http://onlinelibrary.wiley.com/doi/10.1002/cncr.24223/pdf

·         http://onlinelibrary.wiley.com/doi/10.1002/cncr.20446/pdf

·         http://www.healthboards.com/boards/showpost.php?p=4300083&postcount=1

 


compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 10/15/2010 2:56 PM (GMT -6)   
Casey:
 
Excellent post. I miss your erudite comments!!!
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

Tony Crispino
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Date Joined Dec 2006
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   Posted 10/15/2010 3:21 PM (GMT -6)   
Casey, I concur with Mel,
Good to see you again...and good post...

Tony

Jazzman1
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Date Joined Sep 2010
Total Posts : 1160
   Posted 10/15/2010 5:42 PM (GMT -6)   
Just when I think I'm out, they pull me back in...

Thanks, Casey, for giving this little debate some perspective. Actually, when I spoke with my urologist, he emphasized the things you mentioned regarding the downsides of brachytherapy, not secondary cancers. Secondary cancers were more of a concern of mine, and I guess you could say that's my bias.

The prevalence of long-term side effects Casey mentions beg the question of how that radiation can cause all these nasty things to happen, but not do the kind of damage that radiation is perhaps best known for -- cause cancer.

Whether it's brachytherapy or x-rays or living next door to a nuke plant, I'm skeptical about what "they" claim to be "safe" levels of radiation. That's a key reason why I chose surgery as my treatment mode, despite all the undeniably nasty side effects of surgery. Others may disagree, and I certainly can't prove they're wrong.

Selecting a course of treatment is a god-awful hard thing to do. I wouldn't second-guess someone's choice (at least not a mainstream choice) for a minute. I wish all the best to everyone who chooses some form of radiation. It just ain't my choice. Thanks, Casey, for clarifying my concerns better than I could.
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