Gold Standard Study?

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K2
Regular Member


Date Joined Feb 2011
Total Posts : 51
   Posted 2/15/2011 7:37 AM (GMT -6)   
The copy-and-past text belows refers to a new "gold standard" study that says "precision radiation with hormone therapy is just as successful as surgery"
 
What study is being referred to?
 
Does anyon believe it? Any thoughts?
 
"Within the prostate “world” there is what is talked about as the “old standard” treatment as a must to get all the cancer they can out of your body. Recently, a new “gold standard” study came out that says precision radiation with hormone therapy is just as successful as surgery, and maybe more so. Surgery alone has many problems and can cause many problems that you will live with the rest of your life and impacts quality of life for the rest of your life. Most men with a Gleason score below 7, should consider active survillance with your doctor. Doctors that make their living doing surgery do not readily accept the new “gold standard”. In some cases surgery may be the best treatment."
 
 

 

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/15/2011 8:46 AM (GMT -6)   
Don't believe "Gold Standards" that are hawked by those individuals or companies that are in it for the money. What works for some won't work for others. Radiation has improved tremedously and maybe the best choice depending on the nature of the disease with or without the addition of hormone therapy.

Maybe you could quote your source of the copy and paste and give readers a better understanding where this was taken from and who the author is.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months
Clinical Trial - SRT begins 2/21/11

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 2/15/2011 8:52 AM (GMT -6)   
the source is a paid motivational speaker - Jerry Hampton -'nuff said

I would recommend continuing your research - don't self-diagnose when you do not have all the information - keep breathing and don't panic..
- divine sources are good for support - but cool the miracle route.... the "f" word is downplayed here on HW - has lead to heated debates.
sincere hugs,
BRONSON

Post Edited (tatt2man) : 2/15/2011 6:59:50 AM (GMT-7)


John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 2/15/2011 12:45 PM (GMT -6)   
There has been much debate over the recent years as to what is the gold standard. Unquestionably surgery was the gold standard 10 or 15 years ago, because radiation had not developed to the point where its toxicity at the higher doses needed to effect a total kill was acceptable.
Today's radiation, both external and brachytherapy is able to delive much higher doses with much better accurracy. These high doses have significantly increased the cure rates with radiation and at the same time have reduced the side affects. Todays radiation has cure rates across all risk catagories that are equivelant to surgery with much less long and short term side affects.
Active survielence for low risk PC has developed to the point that PC can be safely monitored with no side affects and if treatment is necessary in the future results are similar to immediate treatment.
Newer treatments such as cyberknife are showing promise and may be the future's new gold standard.
So basically there is no "gold standard" as some would have you believe. The true "gold standard" is is to match your individual PC to the best treatment for your particular PC's biology and your overall health risks. Chosing the absolute best doctor for what ever treatment you choose is the best "gold standard" as the doctor's skill and experience has much more effect on the outcome than the treatment type.
JohnT
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.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/15/2011 1:25 PM (GMT -6)   
K2,
There are no studies that compare the efficacy of front line local prostate cancer therapies that have usable results. There are many studies that are run by various centers that claim that they have "proven" that other therapies are equal to surgery ~ and most compare to surgery ~ but there are many factors that can be at play. Study flaws, Bias, and comparisons that do not include the most critical data ~ prostate cancer specific mortality usually riddle such studies.

I was diagnosed at the age of 44. What I found about studies is nearly 95% of them lack maturity enough to give us needed information. Ten year studies are useless when comparing death rates and PSA biochemical failures is not a strong tool just as the PSA test is not a strong tool.. I have been banging that drum since my diagnosis and working extensively with advocacy groups to raise awareness to this fact. We are seeing more and more "conclusions" in studies indicating that "more follow up is need" and I applaud the study team when I see it.

But once again, there are no studies that meet the "proof criteria" of a Level 1 multi-institutional randomized study comparing treatment modalities and while some are starting, we are probably 20 years away from seeing such a study that provides us prostate cancer specific mortality. Treatments that have been around for ten to fifteen years will be completely unable to show 15 years of median data even in lower tier studies. When you read studies and see a median of say 11 years, you know that 50% were treated after 11 years, and 50% before 11 years. This can really skew data as virtual no one dies from localized or locally advanced prostate cancer in the first ten years.

I caution anyone to not "piece part" various studies available on the internet as this is not a good way of arriving at facts. In fact it can be a dangerous way of doing things. Use common sense and try to set your goals. For example I was 44 at Dx and I would sure like to live until 80. The best I can hope to find for what treatments will get me there are anecdotal single case profile studies.

Ugh...

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

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 2/15/2011 3:59 PM (GMT -6)   
TC-LasVegas said...
K2,

But once again, there are no studies that meet the "proof criteria" of a Level 1 multi-institutional randomized study comparing treatment modalities and while some are starting, we are probably 20 years away from seeing such a study that provides us prostate cancer specific mortality. Treatments that have been around for ten to fifteen years will be completely unable to show 15 years of median data even in lower tier studies. When you read studies and see a median of say 11 years, you know that 50% were treated after 11 years, and 50% before 11 years. This can really skew data as virtual no one dies from localized or locally advanced prostate cancer in the first ten years.


Tony


And by the time we have studies 20 years from now that meet the proof criteria of a Level 1 multi-institutional randomized study comparing treatment modalities that show cancer specific mortality the treatments themselves will most likely have become totally antiquated.

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2009 + ADT3 (Lupron + Casodex+Avodart) + IMRT on Novalis, 45 gy, 3/2010.

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06
11/2010 -- 0.013

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/15/2011 4:23 PM (GMT -6)   
Sancarlos,
That is quite possible. In fact it is quite possibly why prostate cancer studies are seldom long enough to prove mortality rates.

It certainly is frustrating that such data is not available. But perhaps a vaccine or an immune therapy will render much of this mute before we get 20 years comparisons. Until that time, we, and the medical community, have to reserve judgement based on studies that compare biochemical failure, that use different standards for determining biochemical failure, and understand that bias is industry wide. We have a whole slew of newer localized therapies ~ and little data for which to compare them with. I am certain that we will continue to be inundated with claims. And as we see more and more costs for treatment skyrocketing, I am certain that we will see that groups will attempt to show that they are worth it...by whatever means available.

Tony

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 2/15/2011 4:45 PM (GMT -6)   
TC-LasVegas said...
Sancarlos,
Until that time, we, and the medical community, have to reserve judgement based on studies that compare biochemical failure, that use different standards for determining biochemical failure, and understand that bias is industry wide. We have a whole slew of newer localized therapies ~ and little data for which to compare them with. I am certain that we will continue to be inundated with claims. And as we see more and more costs for treatment skyrocketing, I am certain that we will see that groups will attempt to show that they are worth it...by whatever means available.

Tony


Tony,

I agree completely, but since we live now, and have to be treated in this time period, our choices are, 1) be guided by Level 1 randomized studies that were begun 15-20 years ago, or 2) wade through the claims made by the various centers based on less complete studies. And we must do this with the knowledge that there are few totally unbiased studies of any kind since all of the centers, regardless of what type of treatment they provide, are in the business to make money. Caveat Emptor!

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2009 + ADT3 (Lupron + Casodex+Avodart) + IMRT on Novalis, 45 gy, 3/2010.

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06
11/2010 -- 0.013

tvwohio
Regular Member


Date Joined Sep 2010
Total Posts : 175
   Posted 2/15/2011 7:08 PM (GMT -6)   
Gold Standard - I agree with John T.
Your PC treatment has to based not only on immediate cure but long term options if PC reappears.
Family History and your biology shoud play a part in your treatment options.
 

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 2/15/2011 10:08 PM (GMT -6)   
Tony, your post of 11:25 a.m. today (at least that's what it shows on my date/time stamp) is truly a "gold standard" and I congratulate you on again banging this all important drum.

One thing that occured to me as I read your post, and this thread, is that while there are new surgical techniques that may well improve long term statistics, generally a RP is a RP. With radiation (as John T pointed out earlier) things have improved so much results from 10/15 years ago are hardly relevant today. (I know I am extrapolating from what he said, but I hope John T agrees this would be his thinking too.)

Other new treatments, as you so correctly say, really don't have a long enough track record to be labeled "gold."

Doesn't that by elmination, and definition, leave surgery as still the "gold standard?"

I don't mean to sound as if I'm promoting it as the "gold standard" just curious on your's and other's thoughts.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 2/16/2011 12:00 AM (GMT -6)   
Everybody is right here, because we haven't defined the meaning of the term "gold standard" as it relates to PCa.

If it means "generally accepted as the best treatment for most", then surgery has certainly had the title in the past, and I think still has. It takes a while for new treatments to be generally accepted and having a track record going back many years sure does help.

Modern, closely targeted radiation with HT shows promise. But does it kill all prostate cells? I don't think it does, since I haven't read of PSAs dropping to undetectable after treatment, as often happens with surgery. What happens if the prostate cells that survive later turn cancerous? Can we have do-overs? How good is it in avoiding collateral damage? Those are questions I would have.

Undoubtedly radiation with HT is the best treatment now for some men, but by my definition above, it is not yet the gold standard. If you want to define the "gold standard" some other way, then I'm sure you could make a definition that gives the title to radiation/HT, or indeed any other treatment. :-)
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.4, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...
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