Treatment Options And Percentages

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Fairwind
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   Posted 2/3/2011 11:18 PM (GMT -6)   
Does anyone know on a percentage basis the order in which the following primary treatments are chosen after a diagnosis of prostate cancer and are these percentages radically different in foreign countries..

Active Surveillance
Surgery
External beam radiation
Hormone therapy (ADT)
Brachytherapy
High dose brachytherapy
Cryotherapy
HIFU

I suspect the first four choices account for 85% of the PC treatment performed but I could be wrong...Does anyone know the actual numbers?
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

Casey59
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Date Joined Sep 2009
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   Posted 2/4/2011 12:17 AM (GMT -6)   

Here ya go...this chart presented at the AUA Annual Meeting in October 2010.   I'll leave the percentage calculations to you.

CHART


Arnie
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Date Joined Aug 2009
Total Posts : 372
   Posted 2/4/2011 8:05 AM (GMT -6)   
That's an interesting chart, Casey. Thanks for posting it......
 
Arnie in DE

Fairwind
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   Posted 2/4/2011 9:32 AM (GMT -6)   
Casey, thank You! That chart is EXACTLY what I was looking for! Very interesting...It looks like Robotic Surgery and advanced beam radiation are pulling away from the pack...

Casey59
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   Posted 2/4/2011 10:44 AM (GMT -6)   
I think that it's important to remember that there is not a one-size-fits-all answer to the question of "which treatment is best for me?" (I know that you aren't suggesting otherwise, but I'm feeling inspired to make additional comments.   smilewinkgrin  )   The biology of each case can be so different, each patient's personal situation can be so different (age, health, personality, etc)...there simply will never be a single solution for treating PC.

Some (not all) cases have a real choice in primary treatments, and in those cases it's both a blessing and a curseā€”a blessing to actually have options with similar outcomes to choose from, but a curse to have to choose one.

Looking a little further down the road than this chart projects (2012), my crystal ball has a continued increase in use of targetted focal therapies (TFT) and Cyberknife...again, these are not options for all cases, but as these solutions continue to mature from both a process and equipment perspective, I think these will increasing be seen as excellent alternatives. Over time, we will continue to be less freaked-out by the "big-C" word with prostate cancer and for the guys who continue to be increasingly accurately defined as low risk, we will treat PC more as a chronic disease.

If you'd like me to read your palm, I can do that too... 
cool  
 
 
----------------------------------------------------------------------
 
Added later:  It was interesting that one comment accompanying this chart was that the increase in IMRT/IGRT was projected to be largely driven by economic factors.  More doctors are installing the (very expensive) equipment right in their offices, so that they can steer you conveniently right into the treatment room...one-stop shopping can be popular.

Post Edited (Casey59) : 2/4/2011 9:51:14 AM (GMT-7)


April6th
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Date Joined May 2010
Total Posts : 264
   Posted 2/4/2011 10:49 AM (GMT -6)   
Thanks for posting.

I wonder what is included in "other" since it makes up a significant percentage? Hormone maybe?

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean
PSA tested on 7/15/10: Zero Club membership card issued (trial membership with 90 day renewal)

wigged-out
Regular Member


Date Joined Dec 2009
Total Posts : 130
   Posted 2/4/2011 11:07 AM (GMT -6)   
Maybe Active Surveillance is one of the things they think of as "treatment".
Age: 55- good health. Exercise regularly.
DRE 11/08- no lumps, just enlarged prostate
1st PSA, total- 11/08= 6.1
2nd PSA, total- 8/09= 6.6
Needle Biopsy 11/09- 12 samples. 11 OK. Right Lateral Mid- Adenocarcinoma Gleason score 3+3=6 9 involving 5% of specimen.
PSA rising from 7.0 to 8.0 thru 2010.
2nd biopsy- 2 positive cores, one a 3+3=6, 3% and the other a 3+4=7, 20%
Treatment needed.
Feb. 2011

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/4/2011 11:12 AM (GMT -6)   
Found the chart accurate to the area where I live.

Two comments. In 2008, the chart shows open as still king, and makes sense, since that is when I had my open, and at the time, only 15 robotic prostate surgeries had been done in a metro area of over 600k people.

2nd, surprised to see "seeding" falling away on the chart. I was under the impression that it was becoming more popular the past few years, unless I read the chart wrong.

david
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Fairwind
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Date Joined Jul 2010
Total Posts : 3748
   Posted 2/4/2011 12:23 PM (GMT -6)   
here is what is going on in Denver. Until now, surgery and treatment on the new Linac's (linear accelerators) had to be performed in the big hospitals because that's where the equipment was..most of the hospitals in Denver are now owned by the big health-care corporations..The cancer doctors, the specialists fought very hard to maintain their "private contractor" status, there bill was separate from the hospital..

In the hospital where I am being treated, management laid down the ultimatum to the specialists, including the radiation oncologists, come work for us as employees or lose access to the equipment you need to practice your profession....

Result. Many of the specialists are abandoning the hospitals and building their own "Treatment Centers" outside the hospital system. Most of these centers try to be "one stop shops" equipped to handle all but the most complex procedures..They make deals with the insurance companies and can undercut the hospitals while maintaining the income levels they have become accustomed to..That's their plan anyway...

The underlying question is this..The average Radiation Oncologist makes $500,000 a year...Many medical specialists feel this is an appropriate income range and they are fighting to maintain it..The people who are paying the bills are moving in the opposite direction, trying to reduce costs and make the practice of medicine more affordable..A major collision is underway..In Denver, this has resulted in twice as many Linac's as can be supported..Treatment centers advertise on the radio, put up bill-boards..Treating cancer is big, big, business..Hospitals are struggling as their highest profit services are being siphoned away from them..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

JNF
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Date Joined Dec 2010
Total Posts : 3758
   Posted 2/4/2011 12:49 PM (GMT -6)   
Similar thing happening in Atlanta. The most prominent permanent seed brachytherapy practice here, and perhaps in the country, was just purchased by the largest for-profit hospital.

My wife was having breast radiation done when it occured and they moved her treatment from a state of the art center that wasn't 5 years old to the hospital over a weekend. She completed her last two weeks at the hospital and cared for by the same rad-onc and staff. Thankfully the linac equippment was the same.

While the radiation practice was always advertising it has now gone big time with large billboards all over Atlanta and numerous tv and radio ads. I have not heard the purchase price but it had to be many millions.

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 2/4/2011 12:51 PM (GMT -6)   
Fairwind said...
here is what is going on in Denver...
 

 

Inter-metropolitan variation in PC treatment modes (between, for example, Denver and similarly sized Seattle) is less significant than (i) the intra-regional, but geographically disadvantaged differences (rural hospitals versus Comprehensive Cancer Centers, at the two extremes), and (ii) socio-economic backgrounds (most specifically, whether you have private health insurance or not).  Perhaps more significantly, these two factors were significant in mortality rate differences.  Our current system of care is...er, uh, uneven.

 


JNF
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Date Joined Dec 2010
Total Posts : 3758
   Posted 2/4/2011 12:56 PM (GMT -6)   
Additionally, you often have to go to the practioners themselves for their statistics. A case in point is HDR brachytherapy. It does not seem to be widely reported, however if you look at Dr. Jeffrey Demanes website www.cetmc.net you can see his results over long periods of time. He started doing HDR for prostate cvancer in 1981 and has treated many thousands nof men and reports on the success. He now is inside the UCLA Medical Center. Not sure whether statistics like nhis show up in all of these studies. Another example would be the reporting that Dr. Frank Critz provides on the 30 years and over 10,000 permanent seed treatmernts his practice has provided. John T often refers to the Prostate Study Group statistics that show radiation and surgery to be about even for low risk men and radiation being better for high risk men.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/4/2011 1:05 PM (GMT -6)   
Casey,
Is there any supporting information on this chart. Such as is this US only? What might be included in "other".

Tony
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:
Da Vinci Surgery ~ 2/17/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 2/4/2011 1:42 PM (GMT -6)   
I can't say with 10000% certainty, but this looks, smells and tastes like (I'm a Renaissance scientist/statistician) it's US only data. Number of new PC cases in the US is around 225K...same ballpark as the add-up shown here. Further, it wouldn't make sense to mix different countries (even "western" countries) with significantly different national healthcare systems. Also, no further info from the report on "other", but the big "other" modes I can think of are HT as a primary treatment mode (not very many) and AS; other "others", not so big. I also believe that this is just a chart of primary (initial) treatments only...so an SRT wouldn't show up, nor would HT after primary treatment. Like I said, not 10000% certain, but this is what makes sense. This gives a decent high-level perspective.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/4/2011 3:06 PM (GMT -6)   
Casey then I have ask the $64,000.00 question...Where did you get this chart?

Tony
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:
Da Vinci Surgery ~ 2/17/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 2/4/2011 3:35 PM (GMT -6)   
Is that the most challenging question you can come up with?!?

You gave me the UroToday link last summer. (remember? I'm also tracking renal cancer publications; and thank you again for that link.) The AUA Meeting presentations were posted there. Here's the direct link to the presentation:
http://www.urotoday.com/images/conferences/aua_ny_2010/8.30%20gejerman.pdf

I like the cartoon.
 
 
Please deposit $64K to Cayman Islands acct #2435465768

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/4/2011 3:42 PM (GMT -6)   
No My challenging questions came from Terry Herbert on my UsTOO Facebook page...

www.facebook.com/pages/UsTOO-Las-Vegas-Chapter/206932628271

And anyone is welcome to join us.

Tony
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:
Da Vinci Surgery ~ 2/17/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/4/2011 3:45 PM (GMT -6)   

I don't do Facebook... nono

 

When my daughter sees me on HW, she calls it my "Cancer Facebook"

 

So, what was the question that I can't see?


Tim G
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Date Joined Jul 2006
Total Posts : 2301
   Posted 2/4/2011 3:50 PM (GMT -6)   
Casey,

What is a Renaissance scientist/statistician?

Tim
PSA quadrupled in one year (0.6 to 2.6)
DRE negative Retested at 3 months
1 of 12 biopsies positive (< 5%) G6
RP open surgery June 2006 at age 57
Bilateral nerve-sparing
Organ-confined to one minuscule area, downgraded to G5
Prostate weight 34 grams
PSAs < 0.1

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 2/4/2011 3:51 PM (GMT -6)   
Some of my members at UsTOO won't do Facebook either. But when I explain that you can still be 100% anonymous and join the page ~ they breakdown and do it. Usually then they become Facebook users too... :-).

The Urotoday link comes back as invalid...

Tony

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/4/2011 4:03 PM (GMT -6)   
It's not the issue of anonymity...it's more one of "overhead", "bandwidth", "BTUs"...

Not really knowingly doing anything different, but try this:
http://www.urotoday.com/images/conferences/aua_ny_2010/8.30%20gejerman.pdf



Tim, the scientists from the past always used taste (well, maybe not always) to help complete their fullest understanding of whatever they were studying. Marie Curie (first woman Nobel Prize winner) basically poisoned herself to death in the lab...
 
 
-----------------------------------------------------
added later as an edit:  Sorry, I also get an error when using the link as posted here.  Not sure what I'm doing wrong, because I'm copying it directly from the file I have open in another window.  I'll keep fiddling with it, but the presentation was by Dr Glen Gejerman from The John Theuer Cancer Center at Hackensack (NJ) University Medical Center.
 
Try this:  LINK
 
Or try this:  LINK2     <<<-------   this one seems to work

Post Edited (Casey59) : 2/4/2011 3:17:03 PM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/4/2011 4:18 PM (GMT -6)   
It's ok I got there. Thanks. I did not see that presentation when I was at the conference. Probably because I was with Mike Scott at the Bostwick Labs booth promoting the New Prostate Cancer infoLink and PCai most of the time.

Tony
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:
Da Vinci Surgery ~ 2/17/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/4/2011 4:21 PM (GMT -6)   
and now the $64K...?

billye
Regular Member


Date Joined Nov 2009
Total Posts : 24
   Posted 2/5/2011 3:27 PM (GMT -6)   
the chart remains a global view---the patient's profile determines the trteatment. read Walsh's book. the best doctor you'll ever have
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