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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2004Combining Radiation Modalities Increases Prostate Cancer Cure Rates
High-risk prostate cancer patients who undergo a combination of hormonal therapy, radioactive seed implant (also called brachytherapy) and external beam radiation therapy are shown to have an increased chance of cancer cure, according to a new study by researchers at Mount Sinai School of Medicine published in the August 1, 2004, issue of the International Journal of Radiation Oncology*Biology*Physics. Historically, high-risk prostate cancer has been a therapeutic challenge for physicians, despite their efforts to cure patients by aggressively treating them with either surgery, brachytherapy or external beam radiation. Previous studies have shown the 5-year freedom from recurrence rates for high-risk patients treated with just one of these treatments to be between 0 and 50 percent, with up to half of these failures occurring where the original tumor was found. To see if combining therapies would decrease recurrence rates for men with high-risk prostate cancer, 132 patients with high Gleason scores, high prostate-specific antigen (PSA) scores or who were at an advanced clinical stage of prostate cancer were studied. A three-pronged approach that included brachytherapy, external beam radiation therapy and hormonal therapy produced an 86 percent rate of freedom from recurrence after five years. In addition, 47 of the original 132 patients in the study had a prostate biopsy performed two years after the end of treatment and 100 percent of them showed no evidence of the cancer recurring. "This is a very exciting study because it shows that this new approach of combining brachytherapy, external beam irradiation and hormonal therapy to cure prostate cancer can be very effective for men with aggressive forms of the disease," said Richard G. Stock, M.D., lead author of the study and Chairman of the Department of Radiation Oncology at Mount Sinai School of Medicine. "The data also supports the theory that enhanced local control can improve overall disease control." 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." > High-risk prostate cancer patients who undergo a combination of hormonal > therapy, radioactive seed implant (also called brachytherapy) and > external beam radiation therapy are shown to have an increased chance of > cancer cure, according to a new study by researchers at Mount Sinai > School of Medicine published in the August 1, 2004, issue of the > International Journal of Radiation Oncology*Biology*Physics. This subject is dear to my heart (or my prostate anyway) since it's the treatment I had. I looked it up in PubMed. The abstract for the study is available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15275720 What is particularly exciting to me about it is that "high risk" patients did very well with this therapy. The numbers they report in the "Results" section of the abstract are: "The actuarial overall freedom from PSA failure rate was 86% at 5 years. The freedom from PSA failure rate at 5 years was 97% for those with a Gleason score of < or =6 (35 of 36), 85% for a Gleason score of 7 (50 of 59), and 76% for a Gleason score of 8-10 (28 of 37; p = 0.03). A trend was noted toward worse outcomes in seminal vesicle biopsy-positive patients, with a 5-year freedom from PSA failure rate of 74% vs. 89% for all other patients (p = 0.06). Posttreatment prostate biopsies were performed in 47 patients and were negative in 96% at the first biopsy and 100% at the last biopsy." These numbers seem to me to be very good for all categories of patient. My own case, Gleason 4+3, looks like 85% chance of success - which is about the best I hoped for. However I admit to being confused by the last sentence. Does it mean perhaps that 4% of patients showed some cancer cells in the first biopsy after treatment but these cells all died by the time of the second biopsy? That might make sense if, as is normally claimed, radiation doesn't do all its work immediately. Alan > > High-risk prostate cancer patients who undergo a combination of > hormonal [quoted text clipped - 9 lines] > it's the treatment I had. I looked it up in PubMed. The abstract > for the study is available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15275720 > What is particularly exciting to me about it is that "high risk" > patients [quoted text clipped - 23 lines] > make sense if, as is normally claimed, radiation doesn't do > all its work immediately. Hi Alan..... Ron and I went for his 6 months checkup on Thursday, but won't have the PSA level till next week......long round trip drive, so we do both at the same time. Physical exam and blood tests. Anyway.....we had a different doctor and she explained exactly what you are questioning. The radiation works for a long while in the prostate and then your body keeps on working to get rid of the dead cancer cells for much longer after that. That would account for that 4% you mentioned. Ron had his HDR treatments one year ago and he gets a bit fatigued at times, and I also asked about this. He was fine in England, but this mild fatigue comes and goes. As she said......a lot of radiation patients have this *fatigue* but there is no direct correlation with the radiation.....if you follow that statement. IOW, it is reported by a large majority of their patients, but no *direct* cause and effect link. She told me of some really interesting studies being done at Sunnybrook and one was on a new drug to combat hot flashes for the HT patients.....seems it is an older anti-psychotic drug (no name mentioned), but like lots of drugs, they noticed that it helped those patients who were also on HT. They are also comparing the combination of HT and radiation or surgery, but the jury is still out on that one. It is not done as much up here as in the US. Night.....Heather > ... > Ron and I went for his 6 months checkup on Thursday, but won't have the PSA > level till next week......long round trip drive, so we do both at the same > time. Physical exam and blood tests. Hi Heather, Please keep us posted when you get the results back. > ... > Ron had his HDR treatments one year ago and he gets a bit fatigued at times, [quoted text clipped - 4 lines] > patients, but no *direct* cause and effect link. > ... Is Ron getting enough exercise and enough rest? My energy level seems a bit lower than it was before treatment, but I can't say whether the difference is accounted for by treatment or just advancing age. I tried before, during, and after treatment to keep as fit as possible. I had been running for years. My running capacity declined dramatically during treatment but I was able to build it back up again afterwards - though I never got back to the speed I was at before. Still, by exercising hard, I've built a reserve capacity that keeps my energy level fine during the day and even allows me to do some decent running or bicycling, even if it's not as fast as it used to be. Alan Hi Heather, I too get very tired from time-to-time and feel emotionally drained - yesterday for example. I feel much better today though and am planning to get in a good workout at the health club I belong to. I do both cardio and strength and try to work each muscle group at least once a week. I would rather get in a hike in the mountains but can't work it in. I am nowhere near the level I was at prior to my treatments but I'm working at it. Larry > Hi Alan..... > [quoted text clipped - 6 lines] > > Night.....Heather Thanks Alan and Larry...... I was kind of concerned at his off and on again fatigue......yet I knew it was because of the radiation. Plus I forget that he is 72 as well, grin. He only looks about 60, btw. He did fine in England, as I said. 3 weeks of intense *touristing*. Climbing castle stairs and so on. But I have to admit that when at home, we are not all that active. I will work on that. One thing I have realized is that he may be a bit hypoglycemic.....and we are seeing the family doctor on Wed and will get that checked out. Our daughter told me that she gets the same *shakes and dizziness* when she hasn't eaten, so that was a clue. Hoping that there will be a drop in the PSA.....and have to admit to some apprehension. Normal I know....but I swore I wouldn't allow it to get to me, lol. He dropped from 10+ to 3.6 in 3 months and stayed there 3 months later.....but I know it is slower. My brother-in-law went from 4.6 to 0.46 in 6 months after 42 EBRT, so everyone is different, I guess. His was really early when it was caught during a bladder stone removal operation. Cheers.....Heather > Hi Heather, > [quoted text clipped - 20 lines] > > > > Night.....Heather > ... > Hoping that there will be a drop in the PSA.....and have to admit to some > apprehension. Normal I know....but I swore I wouldn't allow it to get to > me, lol. He dropped from 10+ to 3.6 in 3 months and stayed there 3 months > later.....but I know it is slower. > ... Heather, I know how concerned the two of you must be. We're all rooting for you on this. If it turns out that the cancer is still there and Ron needs HT, you might try to find a medical oncologist with prostate cancer experience who can help. I am increasingly thinking that HT is a specialty like surgery or radiation and the specialists know more about it than the surgeons and the radiation oncologists. Best of luck to you. Alan > I am increasingly thinking that HT is a specialty like surgery or > radiation and the specialists know more about it than the surgeons and the radiation oncologists. > > Best of luck to you. > > Alan Alan...You've touched upon an important point. When someone dealing with PCa is looking for an oncologist, it's advantageous to find one who specializes in PCa. A (partial) listing of such oncologists can be found on Don Cooley's website at http://www.prostate-help.org/camedon.htm No doubt many of the people in this discussion group will recognize some of the names on Don's list from their publications or their participation in other PCa discussion groups. Amongst this collection of standouts is Dr. Charles "Snuffy" Myers. A medical oncologist who has PCa himself...Best wishes and good health, Ron > That might make sense if, as is normally claimed, radiation doesn't do > all its work immediately. Hi Alan...I thought you might be interested in this recent data to support that claim...Best wishes and good health, Ron International Journal of Radiation Oncology*Biology*Physics Volume 59, Issue 3 , 1 July 2004, Pages 665-673 Time to metabolic atrophy after permanent prostate seed implantation based on magnetic resonance spectroscopic imaging*1 Barby Pickett M.S., , *, Randall K. Ten Haken Ph.D., , John Kurhanewicz Ph.D., Aliya Qayyum M.D., Katsuto Shinohara M.D.§, Beverly Fein R.N. and Mack Roach, III M.D.*, § * Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA, USA Department of Radiology, University of California, San Francisco, School of Medicine, San Francisco, CA, USA § Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, CA, USA University of Michigan, Ann Arbor, MI, USA Received 20 August 2003; Revised 11 November 2003; accepted 12 November 2003. Available online 7 June 2004. Abstract Purpose: To characterize the time to metabolic atrophy (TMA) after permanent prostate implantation (PPI) using combined MRI and magnetic resonance spectroscopic imaging (MRSI) compared with the time to prostate-specific antigen (PSA) nadir. Methods and materials: This study was based on a posttreatment analysis comparing the MRI/MRSI findings with the PSA levels of 65 patients treated with PPI alone or combined with external beam radiotherapy and/or HT. The fraction of interpretable voxels demonstrating metabolic atrophy was used to compare the TMA with the time to PSA nadir. Results: The fraction of patients with metabolic atrophy in >95% of usable voxels after PPI increased from ~46% to 100% at 6 and 48 months, respectively. The mean time for PSA nadir vs. TMA was 42.5 vs. 28.9 months (PPI), 32.8 vs. 25.6 months (external beam radiotherapy + PPI), and 25.3 vs. 28.0 months (external beam radiotherapy + hormonal therapy + PPI). Conclusion: Magnetic resonance spectroscopic imaging may provide an early tool for evaluating the treatment response for patients treated with PPI. If supported by longer follow-up, TMA may be a useful adjunct to PSA measurement for assessing local control after PPI and could be useful in evaluating the complex relationships between the quality of the implant and the time to indication of successful therapy. Hi Curtis, More evidence that confirms what I was shown by my oncologist, Dr. Blasko prior to deciding on my treatment choices. There has been a lot of discussion on the objectivity of studies showing the success of certain treatments or combination of treatments based on the notion that radiation oncologists (or whoever) have a vested interest in promoting their area of expertise. One argument against it is that it is relatively new and doesn't have a reliable track record. I tended to favor this combination treatment option because it is new not in spite of it. I have a predisposition toward believing all this science is leading us in a positive direction and providing a level of optimism that wasn't possible before. Also, thanks Alan for your comments on this and other threads. Larry |
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