Lots of good questions!"One study said that surgery showed a few % points better than radiation for life longevity but since the results were based on years 1995-2005 approx., then I wonder if the improved targeting capabilities of IMRT in the past 3-5 years would make those survival rates equal or possibly better for IMRT and seed combo?"
You are right to discount such studies. There was a sea change in the way radiation was delivered - dose escalation, and improved technology that greatly reduced dose to organs at risk.Still combo therapy with brachy and
IMRT has proven to give better results than modern-day IMRT alone. (see link below)Is the pc treatment research foundation accurate in their claims: http://www.pctrf.org/comparing-treatments/ Its hard to tell. They seems to be trying to guide potential patients to the doctor/hospital where the "research" was done. This concerns me, especially since ROs are printing out and using these "results" to advise patients.
I'm suspicious too. They seem to be cherry-picking the studies - brachy especially- that gave good results. I want to say that brachy does
give good results in the hands of expert practioners. All this means is if you want brachy - go to an expert.One study I read said that second cancers caused by radiation treatment, amounts to only about an additional 2% after 30 years.
It's actually much less than that - about
3-5 per thousand maybe. MSKCC found no excess primary cancers after 10 years. Second primary radiation-induced cancers show up between 5 to 15 years - after that they are less likely. Here's a good reference:Risk for radiation-induced second primary cancer (RTSPC) is low and may differ by radiation techniqueIs adjuvant radiation therapy following surgery any safer, with less side effects than salvage radiation after surgery?More
side effects. Fow why, read this link:Why salvage radiation is bad. Is the dosage of adjuvant or salvation radiation following surgery, the same amount or less than the amount for primary radiation treatment (no surgery)
It's less - 70 Gy vs 80 Gy but dose is only one small part of the toxicity story.Is the failure rate of IMRT and seed combo the same as for surgery for someone with my statistics shown above?
They've never been tested head to head in a randomized comparison trial. Using monadic testing, the recurrence-free survival seems to be much higher with the radiation combo therapy. In the recent ASCENDE-RT study, men with intermediate risk PC, like yourself, had 94% progression-free survival after 7-yrs of follow-up. Levels reported for HDR brachy boost are equally impressive. These are far higher than for surgery, given your GS 4+3 and ECE.EBRT + LDRBT boost provides superior cancer control compared to EBRT aloneIs hormone use a good idea to use with IMRT then seeds? Or. should I forego the hormones? According to pctrc.org the outcomes success levels are about the same,
There have been some new studies that demonstrated a benefit to short-term (6 month) ADT with escalated doses for intermediate risk PC. Here's some info. Interestingly, the benefit may be less clear with extreme hypofractionated radiation - HDR brachy and SBRT.Androgen deprivation therapy and escalated dosing in radiation therapyso why not hold off on hormones until a later date when you might need them for sure? I read an article that showed anecdotel evidence that hormones might actual increase the chances of cancer to surface at other places in the body down the road (recurrence).
This is a misunderstanding about
the various uses of hormone therapy. When used as an adjuvant to radiation, it seems to sensitize the tumor to radiation, and it seeks out and kills off any micrometastases - the rest, hopefully, killed off by the abscopal (immune) effect. ADT is given for different reasons when the cancer is no longer curable. Eventually - over a period of years usually - castrate resistance eventually sets in and the ADT becomes less effective. The short-term use as adjuvant to radiation doesn't much affect the lifelong use after curative options are exhausted.