9th February 2008
[COLOR="DarkGreen"]I'm making some comments in green for the last two posts. While some of the statements may look authoritative, I'm echoing what I've read and heard from real authorities, and I myself have had no enrolled medical eduction (unless the School of Hard Knocks has been accredited ;)). I can provide references if anyone is interested in them.
[QUOTE=lenapeter;3433607]Quote: "adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50% over radical prostatectomy alone" unquote.
From postings I rather gathered that radical prostatectomy was THE complete cure, so what does 50% treatment failure quantify to?
[COLOR="darkgreen"]Captain Bob's statement below is correct. Regarding "THE complete cure," radical prostatectomy is now viewed as highly effective in very low risk cases, and also highly effective in a clear majority of somewhat riskier cases, but with a degree of failure that increases as risk increases. While RPs are successful in nearly 100% of very low risk cases, overall, the success rate for all comers appears to be about 70%. However, even where there is a recurrence, and therefore a "failure" to cure, many recurrences will be so mild that they are the equivalent of success. Including these equivalents of a cure would boost the overall success rate to well over 70%.
It appears to me, based on research study results that have been published in substantial clinical trials and clinical series by respected researchers, that radiation is equivalent to surgery in effectiveness. :) This was not clear at all in early 2000, shortly after I was diagnosed, but has been fairly well established since then. Some of the cryo experts are also arguing that their approach is as also as good as surgery and radiation. That may prove true, but I don't believe there is a long enough track record at this time to support that view with high confidence.
When I was first diagnosed with PC I researched and was not attracted to radical prostatectomy (because of side effects), as it turned out I was not eligible for it anyway but postings by its enthusistic proponents have caused me a few concerns about my chances, despite 15 year survival rates being comparable for Brachytherapy (even though Brachy started later then radical prostatectomy.
[COLOR="darkgreen"]I have run across groups of veterans of brachytherapy, and they have displayed similar enthusiasm. There are experts in brachytherapy and/or external beam radiation who are thoroughly familiar with research into effectiveness and who are also enthusiastic about this therapy. If you look into what they have written and spoken, you will probably gain confidence. Several that come to mind include Dr. Michael Dattoli from Sarasota, Florida, Dr. Critz from the Radiation Clinics of Georgia in Atlanta, Dr. Anthony D'Amico from Boston, Dr. Patrick Kupelian from Cleveland, and Drs. Grimm, Sylvester and Blasko from Seattle. One place you can find there formal papers is the Government medical research website [url]www.pubmed.gov[/url]. All of these doctors are very actively involved in research on treatment effectiveness.
Good luck to everyone, peter
and Captain Bob 2/9/2008 12:46 #4
"The way I read it, there was a 50% better result in those where there was already spread beyond the capsule, into the surrounding tissue, not 50% better in the entire population of those with a RP.
[COLOR="darkgreen"]Right!
To a degree one could get the impression reading these boards that the failure rate for RP is far higher than it is, and that the other treatments are far more successful partly because a larger segment of prostate cancer patients "cured" by RP don't frequent the boards as those engaged in other therapies, particularly watchful waiting and hormone therapy who are far more actively involved day-to-day than the RP population by necessity.
[COLOR="darkgreen"]I think you're right about some of us being more actively involved by necessity, especially for those of us with cancer that is considered incurable with current technology. As for watchful waiting, which in its pure form means doing little until you have symptoms characteristic of well-advanced disease, that makes no sense to me unless the patient is very old, has life threatening illnesses, or both. Active surveillance is a far different approach and makes abundant sense to me. But I agree that both hormonal therapy, particularly as the sole and primary therapy, and active surveillance are much more "hands on" than hopefully definitive therapies like surgery, radiation, and cryo. With luck, the latter allow the patient to more or less turn on the automatic pilot and relax, with very occasional testing. The former usually involve more frequent testing and hopefully active use of lifestyle tactics to foil any cancer (nutrition/supplements/diet, exercise, stress reduction, and, for active surveillance, perhaps low-key medications like finasteride, Avodart, and a statin).
At times I envy those who can put this disease on the automatic pilot. On the other hand, patients practicing active surveillance are free from treatment side effects and gain years of unimpaired quality of life; meanwhile treatments and supportive technology steadily improve, and a simple cure may emerge while they wait. There is some risk that deferring treatment that becomes necessary at an older age will make side effects at that time harder to bear. It's a balancing act and a gamble, and each of us gets to place our own bet.
I do concur with many here though, who advocate a healthier anti-PC lifestyle even for those apparently "cured" by RP, because I suspect it's similar to alcoholism where one is never truly cured, but "in" recovery for life."
[COLOR="darkgreen"]You and I are in the same choir. :) Some of us will actually be completely cured, but there is no way to have absolute assurance. Besides, those lifestyle changes are worthwhile for other major health issues, especially cardiovascular disease and diabetes. :angel:
Jim
[QUOTE=lenapeter;3433607]Quote: "adjuvant radiation reduces the risk of biochemical (prostate-specific antigen [PSA]) treatment failure by 50% over radical prostatectomy alone" unquote.
From postings I rather gathered that radical prostatectomy was THE complete cure, so what does 50% treatment failure quantify to?
[COLOR="darkgreen"]Captain Bob's statement below is correct. Regarding "THE complete cure," radical prostatectomy is now viewed as highly effective in very low risk cases, and also highly effective in a clear majority of somewhat riskier cases, but with a degree of failure that increases as risk increases. While RPs are successful in nearly 100% of very low risk cases, overall, the success rate for all comers appears to be about 70%. However, even where there is a recurrence, and therefore a "failure" to cure, many recurrences will be so mild that they are the equivalent of success. Including these equivalents of a cure would boost the overall success rate to well over 70%.
It appears to me, based on research study results that have been published in substantial clinical trials and clinical series by respected researchers, that radiation is equivalent to surgery in effectiveness. :) This was not clear at all in early 2000, shortly after I was diagnosed, but has been fairly well established since then. Some of the cryo experts are also arguing that their approach is as also as good as surgery and radiation. That may prove true, but I don't believe there is a long enough track record at this time to support that view with high confidence.
When I was first diagnosed with PC I researched and was not attracted to radical prostatectomy (because of side effects), as it turned out I was not eligible for it anyway but postings by its enthusistic proponents have caused me a few concerns about my chances, despite 15 year survival rates being comparable for Brachytherapy (even though Brachy started later then radical prostatectomy.
[COLOR="darkgreen"]I have run across groups of veterans of brachytherapy, and they have displayed similar enthusiasm. There are experts in brachytherapy and/or external beam radiation who are thoroughly familiar with research into effectiveness and who are also enthusiastic about this therapy. If you look into what they have written and spoken, you will probably gain confidence. Several that come to mind include Dr. Michael Dattoli from Sarasota, Florida, Dr. Critz from the Radiation Clinics of Georgia in Atlanta, Dr. Anthony D'Amico from Boston, Dr. Patrick Kupelian from Cleveland, and Drs. Grimm, Sylvester and Blasko from Seattle. One place you can find there formal papers is the Government medical research website [url]www.pubmed.gov[/url]. All of these doctors are very actively involved in research on treatment effectiveness.
Good luck to everyone, peter
and Captain Bob 2/9/2008 12:46 #4
"The way I read it, there was a 50% better result in those where there was already spread beyond the capsule, into the surrounding tissue, not 50% better in the entire population of those with a RP.
[COLOR="darkgreen"]Right!
To a degree one could get the impression reading these boards that the failure rate for RP is far higher than it is, and that the other treatments are far more successful partly because a larger segment of prostate cancer patients "cured" by RP don't frequent the boards as those engaged in other therapies, particularly watchful waiting and hormone therapy who are far more actively involved day-to-day than the RP population by necessity.
[COLOR="darkgreen"]I think you're right about some of us being more actively involved by necessity, especially for those of us with cancer that is considered incurable with current technology. As for watchful waiting, which in its pure form means doing little until you have symptoms characteristic of well-advanced disease, that makes no sense to me unless the patient is very old, has life threatening illnesses, or both. Active surveillance is a far different approach and makes abundant sense to me. But I agree that both hormonal therapy, particularly as the sole and primary therapy, and active surveillance are much more "hands on" than hopefully definitive therapies like surgery, radiation, and cryo. With luck, the latter allow the patient to more or less turn on the automatic pilot and relax, with very occasional testing. The former usually involve more frequent testing and hopefully active use of lifestyle tactics to foil any cancer (nutrition/supplements/diet, exercise, stress reduction, and, for active surveillance, perhaps low-key medications like finasteride, Avodart, and a statin).
At times I envy those who can put this disease on the automatic pilot. On the other hand, patients practicing active surveillance are free from treatment side effects and gain years of unimpaired quality of life; meanwhile treatments and supportive technology steadily improve, and a simple cure may emerge while they wait. There is some risk that deferring treatment that becomes necessary at an older age will make side effects at that time harder to bear. It's a balancing act and a gamble, and each of us gets to place our own bet.
I do concur with many here though, who advocate a healthier anti-PC lifestyle even for those apparently "cured" by RP, because I suspect it's similar to alcoholism where one is never truly cured, but "in" recovery for life."
[COLOR="darkgreen"]You and I are in the same choir. :) Some of us will actually be completely cured, but there is no way to have absolute assurance. Besides, those lifestyle changes are worthwhile for other major health issues, especially cardiovascular disease and diabetes. :angel:
Jim