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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2004Surgery versus Radiation
One often overlooked difference in comparing surgery to radiation is how successful are treatments for recurrence should the initial treatment fail. According to PCRI ( Prostate Cancer Research Institute), the advantage with surgery is that local recurrences are easier to treat than radiation recurrences. The disadvantage of radiation recurrences are that they are more difficult to treat and there is a higher risk of permanent side-effects. Considering that the new radiation techniques haven't been around long enough to know the recurrence rate, it would seem that one would be taking a greater gamble with the unknown. I see a lot of oncologist promoting a superior "Cure" rate and at least comparable to surgery. However, I see no real statistics to support there claims. The articles that make this claim are bias and have bumped up the definition of locally confined to lower the success rate of surgery and to inflate the success rate of radiation. I read an earlier post referencing such an article and it was stated that, Prostate cancers that clinically appear to be localized may nontheless respond poorly to curative treatments. It states that a man with Stage T1c, PSA 12, Gleason 8 to 10 in two biopsey cores has a relative poor prognosis. This is a high risk patient. The rest of the article compares RP with RT on this patient and suggest that RT has a superior outcome over RP. What they don't tell you is that Stage alone has never been the only parameter used in chosing a treatment option. The article seems to imply that they found a better predictor by including PSA, Gleason score and positive biopsy cores. Everything I have read has always included these parameters. A patient with the above stats would never be a candidate for RP. But also to assume that this patient would be "Cured" with brachytherapy and EBRT is highly speculative. However, even with a patient with better stats should there be a recurrence, radiation would be administered almost immediately as soon as the PSA started rising and there is a good chance that the patient could still be cured. However, with RT, it usually takes a couple a years for the PSA to bottom out and by then if there is a recurrence the chances of cure are almost impossible due to the spread. Ron S > One often overlooked difference in comparing surgery to radiation is how > successful are treatments for recurrence should the initial treatment > fail. According to PCRI ( Prostate Cancer Research Institute), the > advantage with surgery is that local recurrences are easier to treat than > radiation recurrences. ... > However, even with a patient with better stats should there be a > recurrence, radiation would be administered almost immediately as soon as [quoted text clipped - 4 lines] > > Ron S That's an interesting point. I had never thought about it that way. But it is certainly true that with RP you know about immediate failures immediately, whereas with RT you don't find out about them for a couple of years. A key question in my mind in all of this is, What causes the failure? I can think of 3 possible causes: 1. The cancer had already spread to the rest of the body. In that case, salvage radiation is of no use, whether the original treatment was surgery or radiation. 2. The cancer was in the prostate bed, but outside the prostate. In that case salvage radiation might very well work. However, if the patient received EBRT initially, this area should already have been radiated. If he received seeds only, it would not have been. If the EBRT had been done right, the patient would have essentially received his prostate treatment and his salvage radiation, all in the initial treatment. Hence this case should not happen with radiation. But of course it could because radiologists aren't perfect and they might botch the job. 3. The cancer was contained in the prostate, but either the surgeon failed to excise all of it, or the radiologist failed to sufficiently xray all of it. In that case salvage radiation would work. The original doctor didn't do his job right - and the patient was just plain unlucky. So, if I'm right, your point is well taken. But a concommitant point is that, whether you get surgery or radiation, you want to get the most skillfull doctor you can find and hope that the treatment you get ensures that cases 2 and 3 won't happen and the only way you'll get killed is by case 1. Alan And here's another thing to throw into the mix you can have salvage brachytherapy done after radiation alone should there appear to be a reoccurrence down the road. If RP and EBRT don't get it then chances are neither would brachytherapy with EBRT. That leaves hormone therapy, etc. And even after radiation it might take a couple of years to reach the nadir but a good doctor knows the benchmarks of the falling PSA so they have a real good idea very quickly how successful the treatment was. And someone with a higher Gleason score, etc. is not going to be a candidate for brachy anyway. So here we are discussing apples and oranges with someone who will not even post their name be it real or fictitious. Bev > > One often overlooked difference in comparing surgery to radiation > is how [quoted text clipped - 65 lines] > > Alan I had no decision to make, so my assessment is theoretical, I guess. But, if I had to make the decision, I think knowing more faster would have been way up there in criteria. All things being more or less relatively equal, I'd wanna see my PSA drop to < 0.1 on my first PSA. RT does not afford you that.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 > > One often overlooked difference in comparing surgery to radiation > is how [quoted text clipped - 65 lines] > > Alan I see a lot of oncologist promoting a superior "Cure" rate and at least comparable to surgery. However, I see no real statistics to support there claims. --------------------- hi ron - in all my many years of studying this disease, i have yet seen a clear cut winner as to treatment, but as i posted last week, an article from msnbc, the people in the cancer business are pushing their particular treatment because of the money that is at stake. and because of that, i have to sound a warning alarm. it is a crap shoot at best. here's just one example and i'm going to stay with surgery. i know of at least three men who had similar psa level and staging as i did. mine was 6.35, T1c, gleason 6. so far, here's what happening. one person has had a reoccurance and is in stage T3a, one man had some cancer on the resection tissue and after 5 years, his psa is starting to climb. his surgeon said that his case is the only one it has happened to. one person had a "web" around his prostate and they could not do nerve sparing. and this was the same surgeon who did the nerve sparing on me. so, what do we have here as a conclusion. simple - pca develops in a different pattern each time and men need to know this. this is why you do all your homework and after all the facts are in - then choose your treatment and don't look back. radiation treatments had similar results. but i don't see these people talking in terms like that. i've seen different results from the same type of treatment. it just seems to take longer to produce the results. you have seen ads for cars, yet they all do the same job - move people from one place to another. each saying theirs is the best. i'm sure we will keep hearing about the big debate of one type of treatment is better than the other for years to come. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." I want to appoligize to Bev for not listing my member ID(ronju99) as this was my first post of a topic and I must have overlooked it. I have replied to post in the past and ID is inserted automatically. I thought Alan and Curtis offered excellent responses to my observations. I myself am not an expert but do try to be informed and believe others that join our unfortunate group are looking for informed suggestions and feedback from our own experiences. Everyone has different levels of comprehension and research capabilities as is recoginized by the conclusions they come to after reading the same articles. I believe a person would be doing himself a disservice if he didn't go to the PCRI site and read it thoroughly. One should start out by reading the About link first. I like many others here have seen a lot of bias in studies and conclusions and this site seems to be as well written as any I have seen. I'm in no way affiliated with this site but came across it in my research. And finally, I would like to see a treatment that was foolproof, but the the evidence is still lacking on EBRT and Brachytherapy being the cure-all for localized PCA. There results havn't been that good in the past so far and it's too early to put all your eggs in one basket if you expect to live for many years. RP has been very successful and when necessary combined with EBRT to "cure" a high percentage of patients. I used the word cure lightly because there is no real cure, only removal or killing of cancer cells. Ron Spane PSA 6.7 Stage T2b Gleason 3+4=7 Perinerual Invasion-Positive LRP- 7/1/03 Post PSA - non-detectable My own layperson/patient view is that, in the main, any of the major methods will get the job done, which is to interdict the cancer. I doubt that one can make a big mistake by choosing one method versus the others. At the other end of the scale, I also doubt that any of the methods is absolutely foolproof. One needs to do the research and choose the method that makes the most sense to the patient & his physician. I may be oversimplifying things, but that's the way I see it. John Hanley Brachytherapy: October, 1999 98 I-125 Seeds Age at treatment: 62 Pretreatment PSA: 7.5 Gleason: 3+3 = 6 Most recent PSA: 0.3 ----------------------------- > I want to appoligize to Bev for not listing my member ID(ronju99) as this > was my first post of a topic and I must have overlooked it. I have replied [quoted text clipped - 31 lines] > LRP- 7/1/03 > Post PSA - non-detectable Congratulations John on your progress so far. Hope it continues. I can only relate a story about my cousin that died this January from prostate cancer. His Psa was 9 and is Stage was AB 11 years ago. He was given a Choice 11 yrs. ago between surgery and EBRT. Brachytherapy wasn't available then. He chose EBRT and the cancer went into remission for about 9 years. When it came back it was in his spine and brain. After further treatments without much success he finally became paralzed from the waist down. The pain and suffering became so great that he chose to stop any further treatments as he was told that he would never walk again. He died within two years. The reason I tell this story is because he truly thought he had an option too. I don't have any other facts pertaining to his gleason score etc, however they must have felt it was localized or they probably wouldn't have given him a choice. The EBRT was done at Methodist Hospital in Indianapolis, one of the top cancer centers in the nation. An at one time in the past, they thought seeds was the answer too an that failed miserably. Now they feel they have perfected it again with the same claims as before without convincing evidence. I do believe they will eventually perfect it to comparable "cure" rates as surgery but for the time being it seems that it is only feasible for older persons with a shorter life expectancy. Surgery for organ confined PCA is still the only option for younger men who expect to become great grandfathers. Understanding that it's difficult to determine whos cancer is organ confined but the majority seem to think a PSA <10 and Gleason <7 and Stage 1 or 2 is a high probability. As I've said before, removing the tumor while it is confined by a skilled surgeon pretty much guarantees no more problems with prostate cancer. My father had his removed at 65 and is now 95 and doing well. Ron Spane >Congratulations John on your progress so far. Hope it continues. > >As I've said before, removing the tumor while it is confined by a skilled >surgeon pretty much guarantees no more problems with prostate cancer. >My father had his removed at 65 and is now 95 and doing well. Well whoopty do. How in the name of all that is holy is this BS of any value to John? Sorry, but I for one am sick to death of reading your imperious, self important and biased diatribes in favor of RP and against all other treatments. Like all true believers and converts, you are firmly locked into one point of view and are incapable of understanding or even politely considering another. Your posts are repetitive, negative, predictable and obnoxious, and add nothing of value to a support group of newly diagnosed patients struggling to make decisions and survivors of this disease who are struggling to live their consequences. Another troll for the block sender list. I'm wondering if anyone who is not imperious uses the word "imperious". Come on, Doug. You show all the signs of living throug this nightmare. What's got you so pissed? SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 > >Congratulations John on your progress so far. Hope it continues. > > [quoted text clipped - 16 lines] > > Another troll for the block sender list. >Come on, Doug. You show all the signs of living throug this nightmare. >What's got you so pissed? This newsgroup is entitled alt.support.cancer.prostate, not alt.support.cancer.prostate.RP How is it supportive for some a-hole continuously to post messages which effectively assert that virtually every patient who chose radiation over RP made a mistake, is going to get recurrence of PCa and die? Sure makes ME (who chose IMRT at age 52) sleep better. What I really want to say is that it sound like some miserable limp dicked whiner grinding an axe, but I'm too polite and restrained to post flames. Am I making myself clear? Hey, if it is me that is out of line and not the other guy, by all means let me know and I'll find another group. From: dtaylor@dreamscape.com (Doug Taylor) On Sun, 16 May 2004 01:09:08 GMT, "Steve Kramer" <skramer@cinci.rr.com> wrote: Come on, Doug. You show all the signs of living through this nightmare. What's got you so pissed? This newsgroup is entitled alt.support.cancer.prostate, not alt.support.cancer.prostate.RP How is it supportive for some a-hole continuously to post messages which effectively assert that virtually every patient who chose radiation over RP made a mistake, is going to get recurrence of PCa and die? Sure makes ME (who chose IMRT at age 52) sleep better. What I really want to say is that it sound like some miserable limp dicked whiner grinding an axe, but I'm too polite and restrained to post flames. Am I making myself clear? Hey, if it is me that is out of line and not the other guy, by all means let me know and I'll find another group. ---------------------- hi doug - boy, it sures does sound like someone pissed in your post toasties. you are right about this newsgroup being for the support of prostate cancer regardless of the choice of treatment. and i see that in everyone here. i guess what i don't understand is that i have read the whole lists of posts on this thread at least 5 times and maybe i missed something but i didn't see anything the should have caused a response like this. having a background in radiation poisoning, i know what radiation can do - both good and bad. your choice of treatment is one that has proven to work as good as any of the other radiation treatments. you address the issue that you had prostate cancer and dealt with it, just like each of us. you should sleep good each night knowing you have done the right thing for you, just as anybody else would if they chose a different treatment. i mean what about cyrosurgery, these guys still have their prostate and i don't hear from them. the original poster, as i see it, was making a statement between the two main treatments - radiation/surgery. while it is true the effects/damage is immediate from surgery. the effects from radiation is slower in coming about. and because they are slower in coming about, i can see how it would play on the mind of the person who would chose that type of treatment, whether it is beam type radiation or seeding. the results takes time. i guess what we ALL are right now is pioneers. that's right - pioneers. we are the test rats for the different treatments that in 50 years, scientists will have complete longitudinal studies and be able to back up the treatment with numbers as to cure rate or a per cent as to slowing down the spread. hell, by that time - they may have a shot in the arm and your cancer is gone and everything we are going through is for naught. if you wish to leave the group - it is your choice. nothing i would say here would sway feelings one way or the other, nor am i trying to. maybe if some the folks would had IMRT would to chime in, it might balance the opinions - i don't know. i can say this and it is from the heart. when i was 52, even though my dad had pca at the time, i wasn't going to the doctor every year for my check ups because i always thought i was healthy as a horse. so it was almost 5 years when i did pull in and get my psa checked and got the bad news. i was lucky because i was still T1c. what i'm saying is where would i be and what choices of treatment would i have if i would have developed pca at the age of 52 and allowed it to grow until i got the psa ran. now that's scary, and it would have been my fault and boy, would i have beaten myself up for not doing the dr's appts. enjoy the group if you stay. peace be with you if you leave. the choice is yours. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." Hey, Doug, I've had that feeling at time, too, since deciding on seeding rather than surgery, but I hope you'll stick with the group. We need all the radiation guys we can get here to help keep things in balance. People have staked a lot on their treatment choice and want desperately to believe that they chose the right option. Sometimes, I think that makes them a little too passionate in their responses to the choices others make. And yeah, it doesn't help much when you're still glowing from your rad treatment and somebody posts something about how you're going to die of bladder cancer 3 years out. But in a weird way, even dire warnings like that have helped me gain confidence in my choice. And they also underline the important fact that we're all gambling here. At least, I know to be alert for signs of bladder cancer (and all the other terrible things that are supposed to happen as a result of choosing radiation). So don't go, okay? > >Come on, Doug. You show all the signs of living throug this nightmare. > >What's got you so pissed? [quoted text clipped - 15 lines] > Hey, if it is me that is out of line and not the other guy, by all > means let me know and I'll find another group. I've been reading/posting to this newsgroup for almost 4 years and I would assert that in that time I have enjoyed the impartiality of people who post here. I cannot remember (there may have been some I missed) reading one post where a person was rubbished, criticised or otherwise disparaged for the choice he and his family made. If you examine the posts over time you will see that there are waves of popularity. Sometimes RP will get a lot of cover, or RRP or LRP. Then there will be discussions that concentrate on nerve sparing or ED. Brachy, being relatively new and lacking the historical empirical records that go with RP, gets a good airing. And what about they different types of radiation? They all get their chances. Sure, we all lean more towards the treatment we chose, but that is natural. The important concept is CHOICE. We research. We ask questions. We become more knowledgeable. Then we each make a decision based on what we believe is the BEST treatment for us in our particular unique sets of circumstances. I know that I gained immeasurably from reading contrasting views about different treatments. I read posts that advised against the treatment I chose but NEVER AT ANY TIME DID ANYONE TRY TO MAKE ME CHANGE MY MIND. Other long time posters will recall Martin who decided on urine treatment. Many of us raised different viewpoints, but when Martin explained that he had made a choice with which he was happy, I think we all agreed that this was his right, and as far as possible supported him by reading and responding to his posts. I hope that different points of view will continue to be posted and that readers take the positives rather than the negatives from them. That is the strength of this news group. SignatureRay Walsh Armadale WA Australia http://www.jeelan.com.au jeelan@jeelan.com.au ABN: 12 892 867 982 > > >Come on, Doug. You show all the signs of living throug this nightmare. [quoted text clipped - 16 lines] > Hey, if it is me that is out of line and not the other guy, by all > means let me know and I'll find another group. >I hope that different points of view will continue to be posted and that >readers take the positives rather than the negatives from them. That is the >strength of this news group. Ray, You said it very well. This is one of the most civilized and informative groups I've seen on usenet and this particular subject is one that's caused us all a tremendous amount of anguish. I'm actually surprised there aren't more emotional outbursts. Sometimes I get so annoyed and bored with the constant disclaimers in most posts.... "I'm not a doctor, I believe,,, I think.... these are only my opinions, here's my advice but don't take it because I'm just li'l ol' me and if my advice is right for me it doesn't mean it's right for you, blah blahhhhh" However, having said that, I do understand that there are people in this world who will come into this group for the answer and simply follow it without question or research. so the disclaimer is necessary, and what's at stake is a life, and a future. Not quite the same as asking someone about the type of microphone they might use to record a cello. I understand Doug Taylor's reaction to Ron, although I think it was more of a reaction to Ron's post in another thread. But I also understand the passion of Ron's belief system. It's so strong that it doesn't occur to him to qualify it, aside from what he's read as facts, data, statistics. He believes his choice was the best. Lee Group, I got tired of all the posts stating that nobody has a l0 year study of brachytherapy. Dr. Blasko, et al at Seattle Prostate Institute just published such a study, so I wish you all would refrain from this crap. Dr. Blasko implanted seeds for me on 05/02 and my PSA is <0.2 after 2 years. Amen. John in Oregon What's it say? SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 > Group, > I got tired of all the posts stating that nobody has a l0 year study [quoted text clipped - 4 lines] > Amen. > John in Oregon > Sometimes I get so annoyed and bored with the constant disclaimers in > most posts.... "I'm not a doctor, I believe,,, I think.... these are > only my opinions, here's my advice but don't take it because I'm just > li'l ol' me and if my advice is right for me it doesn't mean it's > right for you, blah blahhhhh" "Bored", I understand. "Annoyed"? Surely you understand why you would want a newbie to understand those facts. SignatureProstate Cancer Survivor, not a doctor, only opinionated, what may be right for me may not be right foryou, blah blahhhhhhhh PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 Hey, Lee, As Red Skelton used to say "Rotsaruck". And I am not a soothsayer? or a doctor, either. Like the man driving a highway in Fla. saw a sign "ALL THE ORANGE JUICE YOU CAN DRINK FOR A DOLLAR" He gave the lady a dollar , drank a big glass and asked for somemore. She said you can't have anymore, you had all you can drink for a dollar. John in OR >> Sometimes I get so annoyed and bored with the constant disclaimers in >> most posts.... "I'm not a doctor, I believe,,, I think.... these are [quoted text clipped - 4 lines] >"Bored", I understand. "Annoyed"? Surely you understand why you would want >a newbie to understand those facts. Yup, thats exactly why I went on to say that I understand why it's necessary. Or responsible, I should say. > Hey, if it is me that is out of line and not the other guy, by all > means let me know and I'll find another group. I've been told twice, once now and once in private email, that he has basically told non-RPers that their choice was a poor one and they will die because if it. I never got that out of his posts. Maybe, I should have listened harder. Maybe, had I listened harder, I could have expressed myself as an example of a failed RP. I promise to do better in the future. However, I will not do so with a flame-thrower. So, I'd prefer you stayed here and merely muted your dialogue. But, if you feel like he is personally attacking you, defend yourself in whatever way you feel necessary. I ask for temperance, but I won't wet myself if I am not so obliged. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 AND OBVIOUSLY A FAILED ONE! PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 DIDN'T DO A HELL OF A LOT EITHER! PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 >I've been told twice, once now and once in private email, that he has >basically told non-RPers that their choice was a poor one and they will die >because if it. This is exactly what I'm talking about. This is not "support"; this is mean spirited provocation and has no place in a support group. >I never got that out of his posts. Maybe, I should have >listened harder. Maybe, had I listened harder, I could have expressed [quoted text clipped - 4 lines] >attacking you, defend yourself in whatever way you feel necessary. I ask >for temperance, but I won't wet myself if I am not so obliged. I hear you and agree. I think I'm generally temperate in this group. I have posted more than once subtly suggesting that the person in question back off, but got nowhere. So I figured I'd just tee it up and whack it with the driver for a change. I'm not new to usenet and know how to configure a "block sender." This has been done on my machine in regard to the person in question. I'm sure there are those that feel the same way about me, so do what ya gotta do. In the meantime, I believe that the vast majority of the people in this group agree: 1) that a man's choice as to treatment for PCa is between him, his doctor and his family, and is nobody else's business; 2) Once the choice has been made, it's over, done and completely off-limits for others to criticize or second guess. Surely newly diagnosed men can be counseled with our personal experience and as to what we know, think, and believe, but we are all just patients. It is not our place to diagnose, prescribe, direct, preach, or order. That is for medical professionals who are paid for their advice and services. We can only suggest, argue, and counsel, sometimes with vehemence - but there is a line which need and should not be crossed into the area which is personal and private. --dt > I'm not new to usenet and know how to configure a "block sender." > This has been done on my machine in regard to the person in question. > I'm sure there are those that feel the same way about me, so do what > ya gotta do. It was evident to me from the very beginning that you are not new to usenet. It is my sincere desire that this NG does not sink to the level of the rest of the usenet. > In the meantime, I believe that the vast majority of the people in > this group agree: 1) that a man's choice as to treatment for PCa is > between him, his doctor and his family, and is nobody else's business; > 2) Once the choice has been made, it's over, done and completely > off-limits for others to criticize or second guess. I think a preponderance would agree: 1) A man's choice as to treatment for any disease is his and his alone. 2) A man's choice as who where he seeks knowledge and advice in order to make the decisions is his and his alone. 3) 4) Once the treatment is implemented neither he or anyone else should dwell on the decision. I left #3 open. There is a point between a man's decision and the treatment where another who cares for the man might impose on him to change his decision. It is rare, but I have seen it and have not found it to be offensive. > Surely newly diagnosed men can be counseled with our personal > experience and as to what we know, think, and believe, but we are all > just patients. It is not our place to diagnose, prescribe, direct, > preach, or order. That is for medical professionals who are paid for > their advice and services. We can only suggest, argue, and counsel, > sometimes with vehemence Ordinarily, I agree. The best people there are to give advice for prostate cancer treatment is a medical professional daily involved with prostate cancer and up-to-date on prostate cancer research and information. Down from that is probably a medical professional daily involved with it. Down from that is probably a medical professional in general practice. At some point, I think you will agree, you will find a medical professional that does not know as much as you do. A psychiatrist, or plastic surgeon, or maybe even a heart specialist comes to mind. I know that Stan Chesley probably knows less than a cop about criminal law; a top COBOL programmer knows less than a 14-year-old geek about reprogramming a game; and Mr. Goodwrench couldn't possibly tune a 69 Ford Mustang Mach One with a 351 engine with all his Sun computers as fast as I can (if I can find my cross bar and 12" eye-bolts to get to that last spark plug). > but there is a line which need and should > not be crossed into the area which is personal and private. I think I agree with thought behind your assertions. I don't know if I would attribute to them the adjectives of "personal" and "private." Once you come to a NG, you leave those at the door. The best you can hope for is anonymity. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 hi doug - just an after thought. if you are upset with this group, there is another newsgroup called sci.med.prostate.cancer i don't know how many people go to it, but it is the only other prostate cancer support discussion group that i know of. have a happy. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." Hi Doug...... Yes, you made yourself clear. And I do understand where you are coming from even tho I don't have a prostate either, grin. Ron (at 71) chose HDR radiation and EBRT and he would never, ever have considered an RP, so I do understand strong feelings on the subject. It bothers me a tad at times when some of the pro-RP folks wax on about how it is the best treatment with the longest survival stats!! It is not the best treatment for everyone and there are a lot of reasons for going other routes. Age being one of them. HDR has been done up here at Sunnybrook Hospital in Toronto for 3 years, but our rad oncs know the survival rates in other countries as well. You don't seem to have this treatment done as often in the US because it costs a bloody fortune.....$50,000, I hear. So the US patients are not as *up* on the procedure as we are. No one wants to even entertain the thought that they made a wrong choice and no one here ever inferred Ron did. Not many commented on HDR before Alan Meyer had it done so I felt like we were flying solo. But I think that was more due to lack of knowledge on the procedure. We all have our bad days......I occasionally get a bit ticked or down when lurking on here, but not about to let that take over. Ron made his choice and he firmly believes it was the right one. That is all that matters. And one thing I have noticed up here is that a larger percentage of men opt for radiation than an RP......and even Ron's urologist and the non-radiation oncologist said it was the best route for him at his age. And his PSA was just over 10 btw. Not a low one. So cheer up......roll with the punches and know in your heart that you made the right choice for YOU!! That is the crux of the matter. Best....Heather (and Ron) > >Come on, Doug. You show all the signs of living throug this nightmare. > >What's got you so pissed? [quoted text clipped - 15 lines] > Hey, if it is me that is out of line and not the other guy, by all > means let me know and I'll find another group. Hi Doug...I'm feel bad that your upset. I honestly believe that no one here would knowingly do something to hurt someone else in the group. Sometimes people are in a rush or don't take time to consider the effect their remarks might have on others. Sometimes the recepient is just having a bad day. I find I appreciate posts more when people provide a basis for their remarks, especially something more that the anecdotal, " I know someone who...", but that's just me. In any case I hope you'll stick with us, the more points of view expressed the better. BTW, at Don Cooley's site, things have a bit more of an RT tilt, especially RCOG's SI+EBRT. You can go to http://www.phcagroups.org/grsubsc.htm and see what groups are available...Best wishes and good health, Ron > This newsgroup is entitled alt.support.cancer.prostate, not > alt.support.cancer.prostate.RP [quoted text clipped - 12 lines] > Hey, if it is me that is out of line and not the other guy, by all > means let me know and I'll find another group. Group, I might add that Dr. Blasko recommended SI alone since it was organ confined and EBRT would only serve to increase the side effects to the rectum and the bladder. If there is ever a recurrence, I can safely go with HDR since EBRT is not an issue. John in OR > My father had his removed at 65 and is now 95 and doing well. I can sure use a 30-years-out story every once in awhile. Thanks. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 Here's the problem. One no one likes to hear a treatment has failed but it happens. Eleven years ago brachytherapy was being done. It was being done 30 years ago just not as successfully because they used it on anybody including those with high PSA's, Gleason's and staging. PC caught early enough usually responds well to most treatments. My FIL also had EBRT many years ago and his cancer is back. They were not using the equipment they are using now. They just blasted the whole area. And they only gave him about 29 treatments not the 40 they do now. He also only had his a couple of times a week - not daily. Then they waited until his PSA began to really go up before they decided to start hormone therapy. The list goes on and on. But for every failed EBRT or brachytherapy story there are probably 10 times the failed RP stories mainly because there have been more RP's performed than other treatments. If the PC is organ confined the chance of survival is positive no matter what treatment. If it is not organ confined then it's a crap shoot that no one wants to face. There is no question in our minds that my husband did not do everything possible to rid his body of PC. He had EBRT followed by brachytherapy. If that hasn't killed everything then it wasn't confined in the prostate bed area and having a RP would not have been helpful at all. And at what age is it too young for brachytherapy (or any radiation)? I don't think the doctors know the answer to that question. Bev > Congratulations John on your progress so far. Hope it continues. > I can only relate a story about my cousin that died this January from [quoted text clipped - 31 lines] > > Ron Spane You are absolutely correct! Never really thought about it in these terms, but if there was a clear-cut solution, there wouldn't still be half a dozen from which to choose. > My own layperson/patient view is that, in the main, any of the major methods > will get the job done, which is to interdict the cancer. I doubt that one [quoted text clipped - 47 lines] > > LRP- 7/1/03 > > Post PSA - non-detectable "...because there is no real cure, only removal or killing > of cancer cells." Exactly. We've all known guys who had surgery and were told they had "clear margins," then saw their PSA start to rise in a year or two. And we've all seen cases of brachytherapy patients experience recurrence. And I've found studies showing brachytherapy to be as effective as RP and studies showing it to be less effective. So as I see it, it comes down to what you're willing to trade and what you're willing to risk. In my case, I was willing to trade the advantage of an immediate verdict on the margins and an immediate PSA drop for a much quicker recovery and fewer side effects. I was seeded a week ago yesterday and, aside from urinating a little more slowly and a little more often, haven't had any major problems yet. I spent one day on the catheter and one night in the hospital. I was able to trim the hedges today, and I've been walking a couple of miles for most of the past week. That's the plus side. On the negative side, yeah, once in awhile I worry about whether or not the more focused techniques being used today to implant seeds are going to make a big difference in "cure" rates. Also, it would be nice to see an immediate drop in my PSA. And I feel a little guilt about getting off so easy. Somehow, it seems like the price for beating this disease should be a little higher. Maybe it is. I won't know for a few years. I do agree that a key factor in any treatment is finding the right doctor. I have immense confidence in my radiation oncologist. > I want to appoligize to Bev for not listing my member ID(ronju99) as this > was my first post of a topic and I must have overlooked it. I have replied [quoted text clipped - 30 lines] > LRP- 7/1/03 > Post PSA - non-detectable Ai Guys Maybe we are all missing the point in these futile and angry discussions. The key question is whether any cancerous cells had left the prostate before whatever action you select, RP or radiation, is performed. There is solid evidence that the prostate sheds cells into the bloodstream whether it is diseased or not, and apparently at all adult ages. If you have prostate cancer some of these circulating cells are most likely going to be the seeds for future metastases. RP or radiation (brachytherapy with/without EBRT) can only get what is localized in the prostate bed. The treated survivors will see an immediate response in the PSA, but it seems to me to be only a matter of time before the PSA begins to rise again. Those guys with slow growing, low Gleason, cancers might never have a life-threatening problem before dying of something else, but the fast growing, high Gleason, survivors will see a return of the cancer, as metastases, eventually. The common wisdom is to wait until the PSA begins to rise again, and then begin to attack the problem with hormone therapy. A casual glance at the current chemotherapy data, suggests that previous hormone therapy, and steroids, makes it more difficult for chemotherapy to be successful. So, shouldn't we really be doing chemotherapy, NOT hormone therapy, immediately after the prostate bed has been treated? especially for high Gleason survivors? Another interesting thing is that it seems that metastases, particularly of aggressive cancers, grow faster when the "parent" cells have been destroyed. As if the primary focus regulates the growth of the metastases via chemical (hormonal) signaling. Somehow we have to get the medics to begin to see the wisdom of chemotherapy, immediately after the primary focus of cancer cells has been destroyed either by RP or radiation. Waiting just makes things worse. Vernon (Also a PCa survivor) Well, Vernon, assuming you are a survivor of prostate cancer and chemotherapy, why don't you give us a little bit of your history? My father was treated with RP and chemo and was so sick after chemo that I decided I would never go that route if I got it. But, I understand chemo is much less toxic now. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 > Ai Guys > [quoted text clipped - 38 lines] > Vernon > (Also a PCa survivor) Vernon, I'm in a trial that combines chemo (metaxantrone and prednizone) with Zoladex and Casodex. One of the parameters is that the patient must have had a failed (positive margins, or spread) within 120 days of registering for the trial. This is a phase III trial sponsored by CALG-B. My highest post-op PSA was .064, my most recent PSA was 0.006. My pre-op stats, PSA 5.81, Gleason 3+4 (post op GS was 3+3) So some are looking at early chemo intervention (although combined with HRT). DanR Hi Dan I'm glad to hear that you are going that route, rather than waiting until things get much worse. The FDA recently approved the use of taxotere, in combination with other synergists, for prostate cancer and that is a good beginning. Until we have good reliable ways to show that PCa is slow-growing, non-aggressive and non-life-threatening, I think that the best bet is to attack with chemo from the date of positive diagnosis. Best wishes. Vernon > Vernon, > I'm in a trial that combines chemo (metaxantrone and prednizone) with [quoted text clipped - 7 lines] > HRT). > DanR In article <97691ac7.0405151056.bc8320d@posting.google.com>, We've all known guys who had surgery and were told they had > "clear margins," then saw their PSA start to rise in a year or two. I for one do not know anyone who had clear margins and came up with the big C later on. Not to say it does not happen it's just that I have not come across anyone yet. Maybe I'll be the first, yikes!! I'm kind of a born pessimist, just my nature, but I try not to let it rub off on others. Dale J. SignatureEmail: dalej2@mac..com > In article <97691ac7.0405151056.bc8320d@posting.google.com>, > [quoted text clipped - 4 lines] > big C later on. Not to say it does not happen it's just that I have not > come across anyone yet. Maybe I'll be the first, yikes!! Let me introduce you to me. Clean margins and relapse x 2. However, I didn't have a clean seminal vesicle. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 > > In article <97691ac7.0405151056.bc8320d@posting.google.com>, > > [quoted text clipped - 7 lines] > Let me introduce you to me. Clean margins and relapse x 2. However, I > didn't have a clean seminal vesicle. Just when its safe to come out there's always one there lurking. In the above I never thought clear margins, but not clear seminal vesicles. I just read it for it's face value and commented regarding my own knowledge. Sorry about that outcome though and I hope the rad takes care of the rest. Dale from the land of a zillion bugs and a few lakes. SignatureEmail: dalej2@mac..com > > > In article <97691ac7.0405151056.bc8320d@posting.google.com>, > > > [quoted text clipped - 16 lines] > Sorry about that outcome though and I hope the rad takes care of the > rest. No apologies, please. I was just .... you know what? I don't know what I was doing. How on earth could I expect that it would help you to know that I had a relapse after clean margins? No, it is I who owe you an apology. >Subject: Re: Surgery versus Radiation >From: "dale.j. " nos.pamq@nospam.com [quoted text clipped - 10 lines] >big C later on. Not to say it does not happen it's just that I have not >come across anyone yet. Maybe I'll be the first, yikes!! You won't be the first, but I hope it doesn't happen. My margins were clear, but there were some isolated PCa cells in the seminal vesicles. I may be in good shape, after surgery, radiation, and six months each of two styles of chemotherapy. >I'm kind of a born pessimist, just my nature, but I try not to let it >rub off on others. > >Dale J. >Subject: Surgery versus Radiation >From: ">"" <> [quoted text clipped - 30 lines] > >A patient with the above stats would never be a candidate for RP. Oops- I was. Of course, they misread the biopsy and thought it was Gleason 7, turned out to be 9. I keep thinking of Jackie... >But also >to assume that this patient would be "Cured" with brachytherapy and EBRT [quoted text clipped - 8 lines] > >Ron S Doug, It was not my intent to critisize your choice or anyone elses for that matter. Your choice may well turn out to be the best choice for everyone in the long run. What I was attempting to do was point out the fact that surgery has a proven track record for most organ confined patients. Brachytherapy hasn't been out there long enough for a track record. Until that record exist, a young person will be taking quite a gamble with his choice. Because of all the literature out there with many biased, I just made a feeble attempted to quantify it. I truly appologize if I affended you. As for the website, my link is fron Talkaboutsupport.com and doesn't mention alternate support. Ron Spane > Doug, > It was not my intent to critisize your choice or anyone elses for that > matter. Well said. Ron, it's not surprising that you are upset and perhaps bitter after watching your brother die in spite of his treatment. Who can blame you? It's hard to watch a loved family member die. It's hard to watch other people recommend a treatment that you feel failed to save your loved one. It's hard to be completely "objective" in such a situation. Similarly, it's equally hard for Doug or anyone else who has chosen a particular treatment to listen to someone else tell him he's just killed himself. It's easy to see why Doug got upset. But in the final analysis, given the information we have now, I think we just can't be sure what the best treatment is. There are men who have had surgery who subsequently had a relapse of cancer - sometimes after years have passed. Other men who have had radiation had the same thing. Some of these cases might have been due to inadequate or failed treatment - the surgeon didn't find and excise all the cancerous tissue or the radiologist didn't radiate all the right tissue with the right amount of xrays. Some might have been caused by the wrong treatment - the surgery couldn't reach all the areas around the prostate that were cancerous and that radiation might have reached, or the radiation hit the tumor but just couldn't kill it where surgery would have taken it all out. Many cases might have simply been caused by the cancer having established itself outside the prostate before the treatment even began. There's just no way to know. So we go on the basis of statistics, on what people we trust recommend, on how we like a particular doctor, on what we read, on our perception of side effects, or on whether deep down we are more afraid of being cut or of being burned. Let's not be too hard on each other or too certain of anything. At this stage, we're all doing the best we can. Alan |
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