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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2004How Do the New Treatments Get Accepted?
I've been lurking and posting on this group ever since I discovered I had PCa several months ago, and many of you have seen my reports on IMRT and why I chose it. There have been several posts here lately-- and possibly some I've not seen-- from some new members of this "fraternity" who don't want to try the newer treatment options because of the lack of long-term data on the results. For good reason: What a quandary! How are new procedures to be proven unless someone tries them? Trials for new procedures and medicines are, for good reason, most used by those who have more advanced cancers, with less to lose (and more to gain) by trying new things. Nobody in their right mind would try a new procedure if he had a pretty good chance at a cure by using the established ones. So how does prostate cancer treatment science advance? Any thoughts from the rest of you? Jim Thomas > ... > What a quandary! How are new procedures to be proven unless someone [quoted text clipped - 6 lines] > So how does prostate cancer treatment science advance? > ... Jim, You've put your finger on a very serious problem. Many trials of new therapies for all types of cancer and many other diseases as well are undersubscribed. Research is indeed significantly slowed by lack of patients willing to enter trials. I chose to enter a trial even though my cancer was treatable for several reasons. First, the trial itself was a refinement of a proven set of techniques (HDR brachytherapy + EBRT), so I wasn't doing anything radical. But second, the care I got from the trial physicians (at the National Cancer Institute) struck me as better than the care available to me through my HMO. They gave me many more tests, had more doctors examine me, and took a lot of time in handling my treatment and follow up care than I expected from my HMO. Finally, I liked the idea of contributing to medical science, even though it was a pretty small contribution. Care at NCI trials is 100% free. I have even been told I can have free Viagra for the rest of my life through NCI. And yet, in spite of the reasonably conservative nature of the trial, the high quality of care, and the zero cost, the trial has not succeeded in recruiting the 18 patients it aimed at in the course of one year. NCI is in the Washington DC, metropolitan area, where I'm sure there are hundreds of thousands of uninsured people. Yet they are all either ignorant of, or afraid of, enrolling in clinical trials. I only met two other people in the trial. One was a doctor and the other a college professor. I'm sure either of them could have gotten other care, but they chose to enter the NCI trial - perhaps for the same reasons I did. So the answer to your question: "how does the science advance?" is, very slowly. Alan My theory is that we know that surgery is pretty successful and has a long-term history of being pretty successful. Once that is known, I think I can rely on different methods for surgery, especially if it can be shown they are more or as accurate. Similarly, if EBRT and Brachy works, it can be assumed that IMRT is going to work. How they conned someone into taking out the first few prostates is beyond me.  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 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (3 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non illegitimi carborundum > I've been lurking and posting on this group ever since I discovered I > had PCa several months ago, and many of you have seen my reports on [quoted text clipped - 15 lines] > > Jim Thomas > My theory is that we know that surgery is pretty successful and has a > long-term history of being pretty successful. Once that is known, I think I > can rely on different methods for surgery, especially if it can be shown > they are more or as accurate. Similarly, if EBRT and Brachy works, it can > be assumed that IMRT is going to work. I think that's a good approach. Refinements to known effective techniques don't look nearly so risky as totally new treatments. However, we do have animal studies of totally new techniques. So sometimes, if the results on mice have been dramatically better than results of standard therapies on mice, that gives you some reason to take a chance. > How they conned someone into taking out the first few prostates is beyond > me. Of course in that case, little conning would have been needed: "Mr. Jones, I don't know if this operation will cure you, but I can promise you certain death if you don't get it." It's pretty persuasive. > non illegitimi carborundum Steve, I have to confess my ignorance of Latin and ask, what does that mean? I've read it in your signatures for the last year and always wanted to know. Alan > > non illegitimi carborundum > [quoted text clipped - 5 lines] > > Alan Roughly, "don't let the bastard beat you." >non illegitimi carborundum >I have to confess my ignorance of Latin what does that mean? >Roughly, "don't let the bastard beat you." Well, grin, it's a bastardised Latin {if you can even call it that} Steve. But also interpreted as..."Don't let the bastards grind you down" hence the reference to grinding and carborundum, grin... Canada Bob, {one who's never been ground down}, grin... "Don't let the bastards (illigitimate) grind (carborundum grinding wheel compounds) you down". It is, of course, tongue in cheek "Latin". I.P. >> > non illegitimi carborundum >> [quoted text clipped - 7 lines] >> > Roughly, "don't let the bastard beat you." Steve, Ran across this sig in another newsgroup: "Nil Carborundum Illegitemi" looking kind of familiar. SignatureJerryW jweindel at flash dot net >> > non illegitimi carborundum >> [quoted text clipped - 7 lines] >> > Roughly, "don't let the bastard beat you." I first ran across it in a BBS Forum many, many years ago it seems. There was a Deep Diver on what then was called OneNet and another called Fido net. He used it as his signature for all the years I was BBSing. BBSes died out when the WEB began. I started using it less than a year ago when I decided I was, after all, in a position to fight the bastard and maybe win. > Steve, > [quoted text clipped - 12 lines] > >> > > Roughly, "don't let the bastard beat you." Ah! THE Bastard! Maybe "Illigitimus." Capitalized and singular. Jerry >I first ran across it in a BBS Forum many, many years ago it seems. There > was a Deep Diver on what then was called OneNet and another called Fido [quoted text clipped - 23 lines] >> >> >> > Roughly, "don't let the bastard beat you." Done! 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 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (3 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > Ah! THE Bastard! Maybe "Illigitimus." Capitalized and singular. > [quoted text clipped - 27 lines] > >> >> > >> > Roughly, "don't let the bastard beat you." >Subject: Re: How Do the New Treatments Get Accepted? >From: "Steve Kramer" skramer@cinci.rr.com >Date: 11/21/2004 12:40 PM Central Standard Time >Message-id: <Ri5od.6607$182.6114@fe1.columbus.rr.com> I think the clinical trials should concentrate on end-stage disease. Once treatment is developed that turns the management of cancer into something similar to the management of diabetes, research on early stage treatments that reduce the side effects we all love so much should proceed. >My theory is that we know that surgery is pretty successful and has a >long-term history of being pretty successful. Once that is known, I think I [quoted text clipped - 24 lines] >> >> Jim Thomas > >Subject: Re: How Do the New Treatments Get Accepted? > >From: "Steve Kramer" skramer@cinci.rr.com [quoted text clipped - 5 lines] > similar to the management of diabetes, research on early stage treatments that > reduce the side effects we all love so much should proceed. I'm not an expert on this, but it seems to me that the clinical trials process has many weaknesses. One is the one you've pointed out - that resources are not always being allocated in the order of most serious to least serious. Another problem is that it's not always clear that we're getting the maximum of information from each trial. Another is that recruitment for trials is haphazard. Many important trials never succeed in attracting the number of participants needed for statistically significant measurements. But the one thing that disturbs me the most is the slow pace at which trials seem to proceed. It occasionally happens that someone discovers a potential cure for a horrible disease like cancer or Alzheimer's Disease and years pass before the first Phase I trial begins, more years for a Phase II, more still for a Phase III. So over the course of time, even though the treatment may be a big improvement with life-saving results, 15 years can pass between the discovery of the new therapy and its approval for regular use. This conservative approach makes sense to me for non-life threatening diseases. You don't want to rush a new diet drug into production without assurance of safety and effectiveness. But there are a lot of people dying of terminal illness who would willingly take a chance on a drug that isn't 100% tested, knowing that the worst outcome of taking the drug won't be much worse than the outcome of not taking it. Alan Interesting question. Does anyone know when they started doing radical prostatectomy? Was that the first treatment alternative for prostate cancer? When was prostate cancer recognized as a major cause of death for men, i.e., did most die of something else by age 50 up until 50 or 60 years ago? Thank you. David S. > How they conned someone into taking out the first few prostates is beyond > me. >Subject: Re: How Do the New Treatments Get Accepted? >From: "David S." nospamplease@hatecomputers.com [quoted text clipped - 9 lines] > Thank you. >David S. The male life expectancy in the United States in 1900 was 47 years. However, my grandfather was born in 1892 and died at age 85, of stroke. I dunno when. I suspect I did know at one time. I do not know that my dad first complained about Age 40 of pain during sex. After a couple of years of ignoring him and sending him to a shrink ("because at Age 40 it just couldn't be Prostate Cancer"), he was finally diagnosed with a DRE. You can imagine how long the cancer had to get out of the capsule, but they did an RRP and radiation (cobalt). Almost 5 years later, they found "a spot" on his pelvis. That was the beginning of the end. They had no way of treating systemic bone cancer. But, he still lasted another 3 years. He went through HT (I think estrogen) and more cobalt and finally chemotherapy, but it was nothing like what they have today. 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 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (3 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non illegitimi carborundum > Interesting question. Does anyone know when they started doing radical > prostatectomy? Was that the first treatment alternative for prostate [quoted text clipped - 7 lines] > > How they conned someone into taking out the first few prostates is beyond > > me. |
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