This is indeed interesting, and I appreciate others taking the effort to research and post information here. I do that to some extent too. There are countless studies out there, and every study is subject to inherent biases and limitations. Interpreting them can be a bit tricky. (That's one thing TA excelled at). Nonetheless, it is still useful to share what we find.
A few things to look for in studies: 1) Is it a retrospective study, or a randomized controlled trial?, 2) who sponsored it?, 3) what institution conducted it?. Depending on your level of cynicism, it might be worth considering the objectivity of those producing the study. Confirmation bias will cause anyone to see results they want to see; it's really hard to avoid doing that in any type of study. Surgeons like surgery, radiation oncologists like radiation, brachytherapists like brachytherapy. Manufacturers of, and institutions with, multi-million dollar investments in a machine/treatment/drug would tend to favor that machine/treatment/drug, or they wouldn't have invested in it. It's human nature, and just something to keep in mind. Unfortunately, it can really upset people if you question a study as being biased in such ways. I'm just suggesting it's something to consider.
The whack-a-mole concept has been discussed a lot, and preciously there has been limited evidence to support the idea's effectiveness. Detection of the first lesions meant that metastatic cells had been released long prior, and had doubled enough times in place to finally become detectable. Other "seeds" had blown through the system, and would eventually become detectable too. Eliminating the first lesions would have no impact on the others to come. By analogy, once dandelion seeds have blown throughout your lawn, digging up the first one to bloom doesn't stop any of the others.
The question has been whether or not the lesions themselves were sources of more metastatic cells, and whether subsequent lesions could be slowed or even prevented by clobbering the first ones. In effect, does the first dandelion actually shed more seeds into the lawn that could be problematic?
This study is the first I've seen suggesting that indeed there is benefit to zapping the initial lesions. That could be a game-changer, and very good to know. Some of us may indeed be facing this in our future, particularly for the high-risk folks. Having a relatively simple treatment like SBRT as an option is encouraging.
(Oh, and an observation regarding contributors here: a wise person wrote, "Better a dry crust with peace and quiet than a house full of feasting, with strife.". I'll leave it at that.)
55@Dx on 4/16/13. PSA 5.2, G9(5+4), PNI+, cT3a by MRI.
IGRT - 44 sessions (79.2 Gy, 50.4 Gy pelvic)
ADT2 - Lupron+Casodex (5/13-3/16)
8/13-5/16 <0.1 (ADT2)
5/16-3/17 recovering from ADT2
3/17-7/18 ~ 0.6 - 0.8 (no TX)
10/18 = 1.0My Story