Tools like mpMRI, advanced PET scans and biopsies have changed how quickly we can assess effectiveness. You don't seem to understand the process, so let me take you through what would happen in a typical case of a 70 yo man with a suspected recurrence after IMRT 4 years ago:
1. PSA rises over nadir +2 and remains elevated or increases.
2. An Axumin scan shows a site of recurrence within the prostate, and no detectable distant metastases
3. An mpMRI-targeted biopsy confirms the cancer
4. An HDR brachytherapist determines that based on
location, time since last radiation, and amount of last radiation, that the recurrence can be safely treated. His plan includes that data and shows the radiation exposure to organs at risk. He sets dose constraints and finds they can be achieved.
5. Patient fills out baseline questionnaire on urinary, sexual, rectal function, and health status. other than needing ED meds, all functions are good.
6. After treatment, patient reported outcomes are tracked every 3 months along with PSA
7. After, say 18 months, patient receives another Axumin scan - no metabolically active sites
8. They do a follow-up biopsy and find no cancer
9. Tracking of patient reported outcomes shows an initial deterioration in urinary and rectal function with a return to baseline within a year.
10. Erectile function continues to deteriorate.
11. PSA falls within 2 years to below 0.5 ng/ml
This is a successful case, as about
50-70% are. I expect that number will go up after PSMA PET scans get approved. High grade urinary and rectal SEs are rare, in spite of what you call "reason."
Statistics are our best guess at what will occur in the individual case. If you have the emotional expectation that results will be different for you, that is unarguable, but recognize it for what it is - an emotional guess. For most people, I'd hope that what you call "logic" would give way to empirical information. Who needs all these expensive clinical trials when we have your "logic" to rely on?
I have no idea what you mean by "fact."
David Hume in the 18th century pointed out a flaw in all scientific reasoning - that it is all based on inductive reasoning. Thus, having observed an apple fall from apple trees to the ground hundreds of times, Newton induced that there is a force of attraction that we call gravity, and that it will pull all
objects with mass towards all
other objects with mass. But that requires a belief
that it will always
be observed. It was a grand leap of faith on Newton's part (Newton was a man of faith, after all), that has proved useful. All of what we believe to be true about
the "laws" of the universe are just beliefs. So you can adopt Hume's skepticism, and believe none of it is objectively true, or you can adopt the POV that probability of truth is good enough.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog
Post Edited (Tall Allen) : 4/9/2018 11:54:13 AM (GMT-6)