Future of Treatment for Low-Risk Prostate Cancer: For All, for Some, or for None?

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 4/12/2011 4:33 PM (GMT -6)   
Interesting write up from Dana Farbers Anthony D'Amico.

jco.ascopubs.org/content/early/2011/04/04/JCO.2010.34.2006.full.pdf+html

The point is that yes there are more men that can choose active surveillance but the problem is that it is not easy to discern who they are. D'Amico writes that we needs better tools to make better recommendations. Low PSA and G6 alone is not a reliable tool...This article talks about the use of stereotactic body radiation as a precaution...

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 ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/12/2011 4:45 PM (GMT -6)   
I just saw two interesting videos, might link them here later. One a Sloan Kettering panel in which they discuss genetics, race, environement as factors to consider, another a video with a prominent surgeon who mentions that age is an important factor in that old men (the example was 75) with low scores would be ideal candidates for AS.

Individuals personality must also play a prominent role in understanding who an ideal candidate is.

On my way to play soccer, but will read it tonight.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/12/2011 5:23 PM (GMT -6)   
tony,

its' always been about having better tools at the point of diagnosis, if there was something accurate as to the aggressivenes and type of PC variant, could makes worlds or diference in treatment, if needed.
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 2/11 1.24
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 9/10,

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/13/2011 10:03 AM (GMT -6)   

Thanks for providing the article, Tony.

It appears to me that the main point of the article was this (in my words):  The “overtreatment” of low-risk PC is now well recognized in the medical community.  While Active Surveillance is appropriate for the lowest risk patients, we need to further develop & improve some of the newer focal targeted therapies which might be more appropriate for treating some of the cases on the other lower-risk localized patients, because radical prostatectomy or radiation is largely overkill for those cases.  Stereotactic body radiation therapy (SBRT, a 3-dimensional image-guided focal radiation) is one of the promising treatment options for the future.

 

Anyone else who read this article have a similar or different interpretation?

 

It’s a common theme which is being recognized by the leading experts in prostate cancer treatment…they recognize the current epidemic of PC overtreatment, they advocate AS where appropriate, and they support development of focal therapies for the non-AS low-risk cases.  D’Amico (an RT expert) has made his statement here.  I’ve also seen a presentation by Dr Peter Scardino (surgeon) where he outlines the appropriate treatments for low- and intermediate-risk PC patients in this way (I’ll just copy his presentation slide):

LOW RISK PC

-          Restage with MRI, repeat biopsy to rule out higher risk cancer

-          Active Surveillance

-          Future:  chemosuppression for diffuse cancers, and focal therapy for selected, localized cancers.

ALL OTHER CANCERS [intermediate-risk cancers] IN MEN WITH LIFE EXPECTANCY >10 YEARS LIFE EXPECTANCY

-          RP or Radiotherapy

 

Scardino's message is similar to D-Amico's...the surgeon and the radiologist agree!

thanks again, Tony 

 

 

edit:  fixed typo

 


Post Edited (Casey59) : 4/13/2011 10:07:18 AM (GMT-6)


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 4/13/2011 10:11 AM (GMT -6)   
Does this make me with my TFT a man of the future?

I know I'm not a time traveler. Maybe ala Fringe I crossed over from another universe?
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy

2/16/10 12 of 12 Negative Biopsy

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/13/2011 10:15 AM (GMT -6)   
U da man! A real, modern pioneer!
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