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Medical Forum / Diseases and Disorders / Prostate Cancer / July 2005Results of RP vs RT at 5 and 9 years out
Saw this in the July 2005 Journal of Urology: INTERMEDIATE TERM BIOCHEMICAL PROGRESSION RATES AFTER RADICAL PROSTATECTOMY AND RADIOTHERAPY IN PATIENTS WITH SCREEN DETECTED PROSTATE CANCER. Journal of Urology. 174(1):126-130, July 2005. KRYGIEL, JULIE M. *+++; SMITH, DEBORAH S. ++; HOMAN, SHARON M. ++; SUMNER, WALTON II ++; NEASE, ROBERT F. JR ++; BROWNSON, ROSS C. ++; CATALONA, WILLIAM J. [S] Abstract: Purpose: We compared biochemical progression rates measured by increasing prostate specific antigen (PSA) levels using a standard definition of biochemical recurrence among patients with screen detected prostate cancer treated with radical prostatectomy (RP) or radiotherapy (RT). Materials and Methods: A total of 1,939 patients diagnosed with clinically localized prostate cancer in a community based screening study from 1989 to 1998, followed through 2001, were treated with RP or RT and agreed to enroll in a followup study. This prospective cohort study (median followup 62 months, range 0.2 to 141) used adjusted Cox proportional hazards models to examine time to progression. Selection bias was addressed with propensity scores. Biochemical evidence of cancer progression was defined as PSA greater than 0.2 ng/ml in patients who underwent RP and 3 consecutive PSA increases as recommended by the American Society for Therapeutic Radiology and Oncology criteria for radiotherapy. Results: Of the patients 17% had evidence of cancer progression. The percentage with progression-free survival at 5 and 9 years for RP was 84% and 76%, respectively, and for RT 80% and 70%, respectively. Cox proportional hazards models produced a hazard ratio of 1.63 (95% CI, 1.12, 2.38) for RT compared with RP, adjusting for clinical stage, Gleason grade, preoperative PSA, biopsy age, treatment year and propensity for treatment type. Conclusions: With intermediate term followup, patients treated with RT were more likely to have cancer progression than with RP adjusting for demographics, clinical factors, selection bias and treatment year. Copyright (C) 2005 by American Urological Association, Inc. Steve U Steve U wrote...snip... Biochemical evidence of cancer progression was defined as PSA greater than 0.2 ng/ml in patients who underwent RP and 3 consecutive PSA increases as recommended by the American Society for Therapeutic Radiology and Oncology criteria for radiotherapy. ------------------------------------------------------------------------- Conclusions based on studies using different definitions of failure to compare arms of the study are meaningless at best and misleading at worst. Is 32C the same as 32F, then why should failure rates based on PSA>.2 mean anything in comparison to failure rates based on ASTRO? It has been shown in a large number of studies that ASTRO is 8-40% (depending upon length of time of study and cohort makeup) more forgiving in defining biochemical recurrence than PSA>0.2...Ron Ron, If ASTRO is more"forgiving", then doesn't that just further support the articles conclusions? Steve U > Ron, > If ASTRO is more"forgiving", then doesn't that just further support the > articles conclusions? > Steve U Steve...Yes, it does. Nonetheless, I worry about studies that use erroneous methodologies (in this case making comparisons using two different definitions of failure) to draw their conclusions. In addition to this issue, the abstract states, "patients treated with RT were more likely to have cancer progression than with RP." This statement surprised me too. What do the authors mean by "RT"; seeds, EBRT, or seeds + EBRT? Other published data suggests that RRP (Hopkins) and SI+EBRT (RCOG) have comparable freedom from biochemical recurrence. Using "RT" just seems like a sloppy way to present things in the abstract. Dr. Catalona is a noted researcher, I suspect this point (and perhaps use of the different DOFs, as well) is discussed in the full paper. My original post reflected my concern with the author's methodology based on the abstract. Their conclusions (depending upon what they mean by "RT") may, in fact, be correct...Best wishes and good health, Ron >>Ron, >>If ASTRO is more"forgiving", then doesn't that just further support the [quoted text clipped - 15 lines] > point (and perhaps use of the different DOFs, as well) is discussed in > the full paper. Actually, it isn't adequately discussed. There is a brief discussion in which it is noted that it might have been interesting to stratify the study by comparing external radiation to seeds, but that only a few men were treated by seeds (51) because it was just starting at their institution. They also note that they had no information on whether hormone therapy was used as a supplement for any of the RT cases. All told, it seems to me that the questions you raise were not answered in the original paper. At best this can be taken as a rough comparison of treatment methods as they were actually used in a community setting. Sometimes, authorities argue that it is appropriate to proceed that way beause it is actually what gets done in real life that counts, not what theoretically could have been done under ideal circumstances. Myself, I don't buy that argument. To compare two treatment methods scientifically, you would want to choose the best practitioners of each and compare them head to head. > My original post reflected my concern with the author's methodology > based on the abstract. Their conclusions (depending upon what they > mean by "RT") may, in fact, be correct...Best wishes and good health, > Ron Leonard wrote...snip... At best this can be taken as a rough comparison of treatment methods But Leonard, how can it even be considered a "rough" comparison. If we're talking and I tell you the temperature at my place is 32C (southern India, I guess), and then you add that the temperature at your place is 32F, would I be correct to say, "Oh, we're experiencing the same temperature, we're both at 32 degrees"? That assertion is no more correct than saying that since the biochemical failure rate on the RT population is X% using ASTRO, and since the biochemical failure rate on the RP population is X% using PSA>.2, the two modalities have the same biochemical failure rate...Ron > Leonard wrote...snip... > At best this can be taken as a rough comparison of treatment methods [quoted text clipped - 8 lines] > on the RP population is X% using PSA>.2, the two modalities have the > same biochemical failure rate...Ron I guess one answer is that if you are an "average" man going to an "average" therpaist using "average" procedures and "average" criteria for recursion, then in the end you are on the average a bit better off after RP than after RT. Unfortunately, that doesn't tell you much about how any particular man with a particular therapist will do. Presumably the criteria for recurrence in either case are related to clinical symptoms of recurrence at a later date and something is known about that from other studies. It seems reasonable that the criteria for PSA recurrence in each case were derived with such studies in mind, and the ultimate consequences are at least roughly the same. But your point is well taken, and some prostate cancer experts have raised it. > ... > I guess one answer is that if you are an "average" man going to an "average" therpaist > using "average" procedures and "average" criteria for recursion, then in the end you are > on the average a bit better off after RP than after RT. Unfortunately, that doesn't > tell you much about how any particular man with a particular therapist will do. > ... Your point about the skill of the practitioner seems very cogent to me. Patrick Walsh reports higher success rates than just about anyone else, and it may have to do with his being one of the highest skilled surgeons in the world for RRP. After going through radiation, I'm convinced that skill is also highly important for RT also. Getting the exact position right, the right dose, placing the seeds correctly for brachytherapy, etc. are all high skill, high knowledge, high precision operations. I notice that one of the authors of the study is William Catalona, a renowned surgeon. I wonder if a high percentage of the surgery patients were treated by him. Alan <snip> >Conclusions: With intermediate term followup, patients treated with RT >were more likely to have cancer progression than with RP adjusting for >demographics, clinical factors, selection bias and treatment year. > >Copyright (C) 2005 by American Urological Association, Inc. You know what's wrong with you Yanks who tend to research and post all this stuff? You tend to believe it as final and true. Tomorrow, someone else will authoritively post something totally 180 Degrees juxtapositioned, and then where will you be? You all read books on PCa and do you wake up in the morning cured? NO! You all talk Doctors' jargon, but for why? IMHO, just get on with your lot whatever it is, and survive in hope for a longer life with some degree of quality. -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC Clarence...Why does something have to be "wrong with you" to discuss medical information that is relevant to a condition you have? And in some of the other PCa groups I look in on, it is not just the Yanks who do such posting. There from every continent. I understand and accept that it is not everyone's cup of tea, but for those who choose to participate, it's an acceptable method to try and discover the truth accept and come to grips with your illness help and support others in their process prepare yourself for a range of possible future eventuallities decompress, have fun by working on puzzles etc., etc. I don't think that there is much about PCa that has changed 180 degrees in the few years I've been on board. Just cut others a bit more slack. If people get some satisfaction posting / discussing this kind of stuff, then they probably derive some benefit from it, and that's great for them...Ron <snip> >I don't think that there is much about PCa that has changed 180 degrees >in the few years I've been on board. Just cut others a bit more slack. > If people get some satisfaction posting / discussing this kind of >stuff, then they probably derive some benefit from it, and that's great >for them...Ron Ron This week I'm a little stressed out. -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC |
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