 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / September 2006What about Dr. Myers opinion?
As I am trying to choose between RT and RP, I realized that I have heard of several MD's with PC that chose RT. I'm not saying that no MD has ever chosen RP, I've just not read anything about it. The one I remembered that really struck me was Dr. Charles "Snuffy" Myers. For those who don't know, he is a medical oncologist who has been involved with PC for years. I went back to his web site and read his story. It is remarkably similar to mine. He was diagnosed in 1999 at 55, I was 57 when diagnosed. His PSA was 20.4, mine started at 20.3 and dropped to 13.8. His Gleason was 3+4, same as mine. He had a palpable lump on his gland where I have none. So, his situation was a little worse than mine, but not much. You can read his story "The Physician Becomes the Patient" at http://www.prostateforum.com/sample.htm. In it he said he chose RT because the Partin tables show "80-90% chance that the cancer had penetrated the prostate capsule and spread to the fatty tissue surrounding the prostate gland. There was a 9-14% chance that the cancer had spread to the lymph nodes that drain the prostate gland." He went on to say "I would have been pleased if radical prostatectomy had been a reasonable option. Unfortunately, if you study the Partin tables or other publications on radical prostatectomy, surgery does not do a very good job of curing men with cancers like mine. " That's pretty powerful. This was written in 1999. So, I purchased several back issues of his newsletters where he updated his progress. In Volume 7, Number 7 in 2003 he said: "For men with a Gleason 6 or lower and a PSA under 10 ng/ml, the results reported for temporary seed implants plus 3-D conformal or IMRT radiation are equal to or better than the best results reported for radical prostatectomy. For men with more aggressive cancers associated with a poor Gleason-related prognosis, a PSA over 10 ng/ml, a more extensive cancer in the prostate gland, or the presence of capsular penetration, 3-D conformal or IMRT combined with radioactive seed implantation currently offers results that are clearly superior to the best surgical approaches." Can anyone refute this logic? Thanks, John ... > That's pretty powerful. This was written in 1999. So, I purchased > several back issues of his newsletters where he updated his progress. [quoted text clipped - 13 lines] > > Can anyone refute this logic? Here's two cents worth of opinion (or maybe that price is a bit high) from a guy who can't really claim to know what he's talking about, but isn't 100% sure that the experts can make any stronger claims to certainty about their opinions. After arguing against a number of folks who said that surgery was better than radiation, I'm now going to go the other way and argue against the view that radiation is better than surgery. The logic that says that radiation is more effective against extra- prostatic extensions seems reasonable to me, and is supported by some prominent surgeons (Drs. Partin and Scardino for example). However I'm not sure that the data is comprehensive or conclusive enough to point to a clear decision one way or the other. The problem, as far as I can see, is that there are a myriad of studies with conclusions that contradict each other. My sense is that the best studies - the ones with the largest sample sizes, most valid study designs, and most reasonable selection of patients to include - show fairly comparable outcomes for well done surgery vs. well done (no pun intended) radiation. My personal decision was to go with radiation because I thought it offered good chances for success and fewer side effects. I too also thought that my Gleason 4+3 might be better treated with it. But I'd be kidding myself if I said my decision was based on highly objective factors. To tell the truth, knives scare me a little more than xrays - though I've found that some men here with extensive experience with xrays (I'm thinking of Curtis Palmer, who taught courses on the subject) felt exactly the opposite. And I liked the rad oncs I met more than the surgeon I met. You seem to be leaning towards radiation. I personally think that's a good choice if you can be treated at an advanced, experienced center - which you seem to be able to do. But you may want to give up the belief that your choice can be clearly justified by science as better than the alternatives. Alan The only thing I can say is my husband's PSA was 5.1 and then 4.8. His Gleason was a 6 (3+3) and his fPSA was 8%. We banked his life on brachytherapy with Iodine 125 seeds after 5 weeks of EBRT on IMRT. For men with higher PSA and Gleason scores it seems that they do recommend RT but for some reason our rad-onc (Massey Cancer Center) doesn't do brachytherapy on scores higher than a Gleason 6 and a PSA over 10. Yet I've read that they are seeing very successful outcomes with many men with high Gleasons and PSA's using this combined RT. I think I'm referring to RCOG's stats on the subject. I'll assume there is some controversy about these higher risk men. Bev > As I am trying to choose between RT and RP, I realized that I have > heard of several MD's with PC that chose RT. I'm not saying that no MD [quoted text clipped - 42 lines] > > John > The only thing I can say is my husband's PSA was 5.1 and then 4.8. His > Gleason was a 6 (3+3) and his fPSA was 8%. We banked his life on [quoted text clipped - 8 lines] > higher risk men. > Bev My dad had aggressive PCa and his urologist suspected it had penetrated the capsule therefore his urologist suggested a combination of radiation and seeds. Unfortuantely, the combination didn't work, or it was too late and the cancer had already spread. Hi John...I have a lot of respect for Dr. Myers, he has helped countless men. His background in cancer research and then his own personal dealings with PCa only add to his ability to make keen observations and correct decisions. That said, I'd sure like to know what articles or data he is basing the following comment upon. I don't disagree with what he says, I'd just like to know where it comes from. > For men with more aggressive cancers associated with a poor > Gleason-related prognosis, a PSA over 10 ng/ml, a more extensive cancer > in the prostate gland, or the presence of capsular penetration, 3-D > conformal or IMRT combined with radioactive seed implantation currently > offers results that are clearly superior to the best surgical > approaches." RCOG and Hopkins are, IMO, centers of excellence for [seeds + RT] and RP respectively. Both centers have published their long-term results stratified by risk group. RCOG SI+EBRT study (F. Critz, W. Williams, A. Levinson, J. Benton, F. Schnell, C. Holladay, and P. Shrake; Poster Abstract 692 at the 2003 AUA meeting; NOTE, this is a poster, NOT a peer-reviewed publication) Hopkins study (M. Han, A. W. Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169, 517-523, 2003; the paper can be found at http://www.prostate-help.org/download/jhnomo.pdf) The nice thing about these two techniques is that they both used a common definition of failure (PSA>0.2 ng/ml is a failre; note: RCOG has recently made a slight change to their method of calling a failure) so direct apples to apples comparisons are possible without having to make too many assumptions. When I compared the data, I found their success rates were too close to call for low risk men, but as you moved to higher risk men, RP started showing an advantage. This surprised me as I thought RT would show an advantage in these cases since it irradiates somewhat beyond the capsule. Further reading on the subject suggested that high-grade PCa may show signs of being radiation resistant for two reasons. First, dense tumors lack oxygen in their interior. Radiation does not interact with and destroy PCa cells directly, rather the radiation ionizes oxygen which then interacts with the cancerous cell in a process whereby the cell winds up damaged. Second, advanced PCa cells often contain mutated forms of proteins that are required to kill the now damaged cancerous cells. The mutated forms of these proteins are not as effective in bringing about apoptosis as the non-mutated versions. A number of studies have begun to appear that examine the efficacy of surgery and radiation with advanced PCa, Zincke's paper is a good one (BJU Int. 2005 Apr;95(6):751-6; Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome; Ward JF, Slezak JM, Blute ML, Bergstralh EJ, Zincke H.). A synopsis or review of this paper can be found at http://www.mayoclinic.org/news2005-rst/2745.html My honest opinion is that at this point in time there is no clear, undeniable signal that suggests one modality (RP or SI+RT) is better than the other. It's a plain, old-fashion crap shoot and not only does it depend upon the doctor's skill, but it also depends on things like your DNA. If you're psychologically more comfortable with SI+EBRT go for it, if you feel the better doc is the surgeon, go with him. You will make the right choice for you...Best wishes and good health, ron Ron, I appreciate your posts. They're always insightful. But there is one point I'd like to learn more about. When you say: > Further reading on the subject > suggested that high-grade PCa may show signs of being radiation [quoted text clipped - 6 lines] > forms of these proteins are not as effective in bringing about > apoptosis as the non-mutated versions. What you say makes perfect sense if we're talking about only XBRT, especially if it were the older 3D conformal beam. There were a lot of failures with that because it was difficult to get the dose over 70 Gy. Now with IMRT, doses over 80 Gy are more common. But, I'm considering SI+IMRT. With the combination, doses inside the gland can be over 200 Gy. I think most any living tissue will succumb to a dose of that level. > A number of studies have begun to appear that examine the efficacy of > surgery and radiation with advanced PCa, Zincke's paper is a good one I looked at this paper, but, again, they don't deliniate the type of RT used for comparison. One thing we know, in a study of 15 year survival, we're looking at technology used 15 years ago. If I had to choose between surgery and 15 year old radiation technology, I'd go for the surgery. But RT today is a completely different ballgame. I think a form of wide excision surgery could cure me now, but I believe it could take both nerve bundles and I'm not sure I want to live that way. I think that SI+IMRT can treat as large, or larger, area and leave the nerves intact. As you say > It's a plain, old-fashion crap shoot in the game of "You Bet Your Life". Thanks, John Again, I will repost my earlier response: Quotations from Dr Meyers website: > Dr. Myers believes that the available evidence indicates that many men > diagnosed today have cancers that are not going to be cured by surgery > or radiation therapy. All too often, men undergo these procedures only > to experience a relapse after a period ranging from several months to > several years. And > The patients most likely to be cured of prostate cancer by radiation > therapy or surgery have Gleason scores of 6 or lower and a PSA of 10 > or less. And > I ruled out watchful waiting for a number of reasons. My life > expectancy is longer than ten years. I have no other significant [quoted text clipped - 4 lines] > radiation therapy. If I let the cancer progress at all, this option > would disappear. I don't know, maybe I'm dense or whatever. Is he not contradicting himself? If Dr. Myers believes that if most men are incurable that are diagnosed today, then why bother at all? Should pts with GS scores greater than >6 just go on HT without first trying either RP or RT since he indicates that they are incurable in the first place? (I do understand the Partin Tables here in his case). Dr. Myers has a GS of 7, clinically I may add, and it could be even higher at pathology. But since he chose RT, he will not know for sure to which he does admit to. But if he had "let the cancer progress", then he goes on to state, "what can be successfully treated with surgery or radiation therapy" may be lost. I'm having a tough time deciphering to just what he is saying. I'm under the assumption that Pca that is found today in most of men are indeed curable due to earlier detection and better treatments. B.A. Bob, I don't see a contradiction. > > Dr. Myers believes that the available evidence indicates that many > men > diagnosed today have cancers that are not going to be cured by > surgery > or radiation therapy. He didn't say "most" men, he just said "many" men. So, I don't think he's saying treatment should not be undertaken. > > The patients most likely to be cured of prostate cancer by radiation > > therapy or surgery have Gleason scores of 6 or lower and a PSA of 10 > > or less. Again, he's saying "most likely". I don't think he's saying men in a higher risk group can't be cured, just that men in a lower risk group have a better probability of cure. I'm going to have a treatment. I'm just trying to figure if it's going to be RT or RP. Thanks for responding. John Hi John: I told you that I was dense ;) I just get a bit befuddled, perhaps unnecessarily, when he says "many" men diagnosed today are not going to be cured by surgery or radiation and those "most" likely to be cured have a GS of 6 or less and psa's of < 10 because the message sounds muddled and so much more pessimistic. Looking at other doctor's opinions and nomograms by comparison, I found what he was saying to be somewhat of a contradiction as well as depressing. Just my take on it. If you look at the SK nomogram for instance, you find only a 3% difference at the 7 year outcomes for recurrence between GS 6 and GS 7 cancers. I believe with the newer and more precise treatments that are available today, that number may even be better, hopefully. Good luck on your treatment of choice and wishing you all the best for a great outcome! B.A. Bob Anthony wrote...snip... "many" men diagnosed today are not going to be cured by surgery or radiation and those "most" likely to be cured have a GS of 6 or less and psa's of < 10 Bob...Kinda sounds like what Dr. Willet Whitmore, the father of urologic oncology, said some time ago, "For a patient with prostate cancer, if treatment for cure is necessary, is it possible? If possible, is it necessary?"...Best wishes and good health, ron Dr. Myers' thinking makes perfect sense to me. * RP only eliminates all of the disease if all of the disease is located within the gland and other tissues removed. * If there is a likelihood that that all of the disease is NOT located within the gland or other tissues removed [but not systemic] then it stands to reason that RT to the gland, seminal vesicles, local nodes, and prostate bed offers a better chance of cure than RP. It may be the equivalent of RP + SRT in one course of Tx. Bill Denton RP 2/12/02 PSA .06 Memphis > Dr. Myers' thinking makes perfect sense to me. > * RP only eliminates all of the disease if all of the disease is [quoted text clipped - 4 lines] > and prostate bed offers a better chance of cure than RP. It may be the > equivalent of RP + SRT in one course of Tx. I think this reasoning is generally accepted by those who treat prostate cancer. But the crucial point is that you should have some strong reason for believing the cancer, while still local, has extended beyond what surgery might reach. > Bill Denton > RP 2/12/02 > PSA .06 > Memphis > I think this reasoning is generally accepted by those who treat prostate > cancer. But the crucial point is that you should have some strong > reason for believing the cancer, while still local, has extended beyond > what surgery might reach. Leonard, I guess that is a good reason, if not THE reason for the Partin tables. Dr. Partin gives me 63% probability of extra-capsular penetration. On the other hand, even if I don't have extra-capsular penetration, the SI+IMRT looks like a good option. The radiation doses now are high enough to anihilate the prostate, the internal sphincter remains intact, the nerves are spared, and the primary cause of any ED is usually due to blood vessel damage. It turns out that this type of ED responds well to Viagra. If I come away from this with nothing more than a Viagra habit, I'm a happy guy. John >>I think this reasoning is generally accepted by those who treat prostate >>cancer. But the crucial point is that you should have some strong [quoted text clipped - 16 lines] > > John If I understand correctly, your diagnosis is T1c, Gleason 7=3+4 and PSA greater than 10. The probability that your cancer is not in the seminal vesicles or lymph nodes would appear to be about 80 percent. While that doesn't guarantee the cancer hasn't spread, it is the only evidence you have available on which to base a decision. So the question is the utility of surgery or radiation in killing the cancer in the case it has penetrated the capusule but is still local, which seems about as likely as its still being contained in the prostate. I buy the argument for radiation, but it is not clear to me from what I've read that adding seeds to the mix would help. 3D conformal radiation with IMRT seems capable of delivering very high doses with minimal damage to surrounding tissues. Scardino, in particular recommends against combination approaches instead of straight external beam therapy of the above kind. You should at least read what he has to say and compare it to your other sources of information. Of course, what may trump everything else is what type of high quality treatment is available to you. If the best practitioners you have access to use the combination therapy, you should go with it. Leonard Evens wrote...snip... > Scardino, in particular recommends against > combination approaches instead of straight external beam therapy of the > above kind. Leonard...Does Scardino give a reference or rationale for his position?..ron > Leonard Evens wrote...snip... > [quoted text clipped - 4 lines] > Leonard...Does Scardino give a reference or rationale for his > position?..ron The discussion is on pp 324-325 of his book. He gives a reference only to a paper reporting efficacy of such therapy, but he doesn't give any references to studies which directly compare the two methods head to head in a single study. But if you read the entire chapter, you see that he goes into great detail about the various modes of radiation therapy, including work done at Sloan Kettering with brachytherapy, and that there are many references to specific issues. It was my impression that he didn't find the cure rates claimed for combined approaches adequate to cure a higher risk cancer any better than 3D conformal with IMRT. Hence, he thought there was no point in taking on what he sees as additional risks from the combined approach. But go read it for yourself. I got the paperback edition of his book at Borders for $16. It is well worth the price for anyone interested in prostate cancer. First let me say that I really appreciate everyone's input on this particular thread. I started this thread because I'm trying to decide between RP and RT. As I'm now leaning heavily toward RT, if anyone has a good reason why someone in my situation would be making a mistake, I'd rather find out now than later. I also realized that each time someone made a point, I seem to make a counterpoint. I'm not trying to act like a know-it-all, it's just that most of these points I have gone over in my mind many times before in trying to make sense of this situation. Never the less, I really appreciate what everyone has to say. Now for my next counterpoint: >I buy the > argument for radiation, but it is not clear to me from what I've read [quoted text clipped - 4 lines] > above kind. You should at least read what he has to say and compare it > to your other sources of information. Leonard, I've read most all of the books mention around here and quite a few others. Of all the books, I think Scardino's is my favorite. He seems to give a fairly even handed assesment of RT in general. He points out that "conventional" XBRT was crude and not very precise and approximately one third suffered side effects like rectal damage. He goes on to say that 3D-CRT reduced the problem down to 17%. Then he says that IMRT reduces it to 2 to 3 percent. His diagram on page 303 clearly shows the differences in these procedures. So far, so good. But, then when he talks about combining external beam with seeds, he's talking about "conventional" external beam. He calls it a "low-tech, riskier substitute" and that the error rate and resultant side effects may be multiplied. Well, I would agree. I would not want to have seeds with "conventional" external beam radiation. But, he never addressed SI+IMRT. He devoted 17 pages discussing XBRT, 11 pages regarding seeds, and only one page to combined therapy. I think he really short-changed this important subject. He says, "There is no evidence that cancers are cured more effectively with combined approaches." Critz at RCoG (over 10,000 patients) and Dattoli (over 8,000) have published a number of papers to show there is evidence. I think Scardino dropped the ball on this one. But, I appreciate your mentioning it. John > But, he never addressed > SI+IMRT. He devoted 17 pages discussing XBRT, 11 pages regarding seeds, > and only one page to combined therapy. I think he really short-changed > this important subject. But in the next paragraph Scardino did state "Given the wide availability of effective, high-dose, modern 3-D conformal radiation and IMRT, I see little justification for the risks involved in the combination approach". Although it the message appears to be muddled. I would assume this does include SI+IMRT. He also goes on to state that combining hormones and IMRT is not worth the effort as well because combining hormones with radiation (IMRT) is comparable to adding 5Gy to the dose. Then, why not just add the 5Gy? I seem to get the impression that by using combined initial therapies, Scardino considers them to be riskier overall. There is a website where you can ask such a question. I'd be curious as to what they would have to say as well. www.theprostatebook.com B.A. Just Google something like combined radiation seeds prostate. There are many data and opinions and studies out there shedding some light on the issue. I.P. >> But, he never addressed SI+IMRT. He devoted 17 pages discussing XBRT, 11 pages regarding seeds, >> and only one page to combined therapy. I think he really short-changed [quoted text clipped - 16 lines] > > B.A. I had an RRP in March of '05. PSA about 7...Gleason 3+4 (which after pathology turned out to be 3+3=6) Confined to capsule, no SV or lymph node involvement. Before the surgery, and I was as scared as could be... Dr. Catalona said... You have to be prepared to buy the 'whole package'...meaning...the surgery and possible RT. He said that because if you were told later that you needed RT AFTER the surgery...you wouldn't be shocked or disappointed. (Right. :-) It didn't make me feel any better...but it's the truth. I didn't need the RT...so I feel very grateful. I just tell this tale to help John and maybe help with some of his thoughts. I gotta say that I am VERY impressed by the expertise shown by the group on this topic. That's why I'm here. Best of health to all, Ron B. Chicago > First let me say that I really appreciate everyone's input on this > particular thread. I started this thread because I'm trying to decide [quoted text clipped - 42 lines] > Dattoli (over 8,000) have published a number of papers to show there is > evidence. I think Scardino dropped the ball on this one. Walsh in his 2001 book, specifically discusses the RCOG results as of that date. I don't know if they have modified their approach since then. He claims that their comparison between results for surgery and their approach is comparing apples and oranges. I'm not qualified to evaluate whether he is right or not. I've looked at the RCOG website, and I am not clear about exactly what they do. I doubt it it is simply seeds plus 3D conformal radiation with IMRT. Presumably their studies are not based on some recent change in their procedures. My guess is that Scardino is well aware of what they do there, but what do I know. Anyway, in making a choice, since none of us is really qualified to evaluate competing claims, we just have to make the best guess we can. You seem to have thought it all out, and I am certainly in no position to question the validity of your choice. Good luck whatever you finally decide to do. > But, I appreciate your mentioning it. > > John > I've looked at the RCOG website, and I am not clear about exactly what > they do. I doubt it it is simply seeds plus 3D conformal radiation with > IMRT. Presumably their studies are not based on some recent change in > their procedures. My guess is that Scardino is well aware of what they > do there, but what do I know. Let me add that I checked the Sloan Kettering site, and the seeds expert ther, Zelefsky, who Cardino refers to in his book, is now useing a combined approach. > Anyway, in making a choice, since none of us is really qualified to > evaluate competing claims, we just have to make the best guess we can. > You seem to have thought it all out, and I am certainly in no position > to question the validity of your choice. > > Good luck whatever you finally decide to do. > if anyone has a good reason why someone in my situation would be making a mistake, > I'd rather find out now than later. I don't know what your "situation" is, but mine, not even counting my coexisting unrelated abdominal cancer, ultimately narrowed my options down to one choice. Factors included PSA level and dynamics, Gleason grade, age and health, urinary and bowel and sexual performance before and maybe after tx, lifestyle, potential impacts on that lifestyle, and extensive examination of my short and long term personal priorities. As an engineer, controlled radiation didn't scare me. Having had several surgeries, surgery didn't scare me. Cost was not a factor once I learned that there are some cutting edge VA facilities out there, two within a reasonable commute. But ever so slowly, my research painted out one more portion of the floor I was standing on. Each little piece of my puzzle -- G8 here, rapidly rising PSA there, exceptional health there, rejection of one likely SE or acceptance of another -- slanted me towards one tx or away from another until one day or week the picture became pretty clear, so I confidently selected a procedure and a facility and a doctor, and acted. Two "mistakes"" would be 1) deciding and acting before you've seen and weighed all the available facts, statistics, professional opinions, and personal priorities available within a rational search or 2) paralysis by analysis. Personally, I defined my rational research limit as the point my literature searches led me "back to my own tracks", i.e., nothing new and useful was turning up. If you're at that point and leaning strongly towards any tx and this group's not calling you an idiot and backing it up, what the hell . . . do it. If, OTOH, you have lingering doubts because of incomplete reading or introspection, you've got time to read or think more. Your cancer has taken many years -- decades, some oncs believe -- to surface; a few more weeks or even months won't matter unless your "situation" is unusual. i.e., a little paralysis is OK if you recognize it and put that time to good use. I.P. ... > I buy the argument for radiation, but it is not clear to me from what I've read that > adding seeds to the mix would help. 3D conformal radiation with IMRT seems capable of > delivering very high doses with minimal damage to surrounding tissues. Scardino, in > particular recommends against combination approaches instead of straight external beam > therapy of the above kind. You should at least read what he has to say and compare it > to your other sources of information. It's never been exactly clear to me what the relative risks of brachytherapy and external beam are. Brachytherapy adds some surgical risk. There is anaesthesia, puncturing of the perineum with the treatment catheters, insertion of foreign bodies, and some consequent risk of infection - though the radiation itself probably kills any bacteria that might be around the seeds. There is also the possibility of one or more seeds wandering into other parts of the body. Are those the risks we are talking about? From what I've read, they aren't too risky, though definitely more risky than not having them. On the other hand, I have no idea what the relative radiation risks of EBRT vs Brachytherapy are. EBRT sends xrays through parts of the body that are not part of the prostate. Presumably, seed implant does much less of that. With combined therapy, the dose of EBRT given is significantly lower than with plain EBRT. So I don't know (and don't know if anyone knows) whether the pure radiation risks are lower with combined therapy than with EBRT alone. Then there is the dosage issue. My understanding is that the total dose delivered by combined therapy is greater than for EBRT alone. But I don't know whether that translates into benefit for the patient. Another issue to be considered is whether the seed implant will make the EBRT aiming more effective. The treatment offered to John consisted of planting seeds first, then imaging the seeds each day during EBRT to get exact placement of the prostate. Again, I don't know and don't know if anyone knows, how much of an improvement that makes in EBRT aiming. I wonder if the primary issues in aiming have more to do with the time and care taken by the techs than with the specific procedure used. > Of course, what may trump everything else is what type of high quality treatment is > available to you. If the best practitioners you have access to use the combination > therapy, you should go with it. I agree. If there were a very clear case for monotherapy vs. combined therapy, one might choose based on that. But there doesn't appear to be a very clear case for one or the other. So picking the practitioner seems like a reasonable way to go. Alan Dr. Myers' thinking makes perfect sense to me. * RP only eliminates all of the disease if all of the disease is located within the gland and other tissues removed. * If there is a likelihood that that all of the disease is NOT located within the gland or other tissues removed [but not systemic] then it stands to reason that RT to the gland, seminal vesicles, local nodes, and prostate bed offers a better chance of cure than RP. It may be the equivalent of RP + SRT in one course of Tx. Bill Denton RP 2/12/02 PSA .96 Memphis > Dr. Myers' thinking makes perfect sense to me. > * RP only eliminates all of the disease if all of the disease is [quoted text clipped - 9 lines] > PSA .96 > Memphis Bill...I agree that it sounds reasonable that RT should outperform RP if disease has escaoped the prostate, but remains local. Are you aware of any comparative data that supports that view?..Best wishes and good health, ron However if RRP fails, you can get a second chance doing RT to the prostate area.. > However if RRP fails, you can get a second chance doing RT to the > prostate area.. Which was an important factor in my decision to get an RP. > However if RRP fails, you can get a second chance doing RT to the > prostate area. Dick, I felt the same way and that alone had me initially leaning towards surgery. But, then I thought about side effects. Surgery has one set, and RT has another. If it takes both to cure, you may end up with both. Also, as I mentioned in another thread, one rad onc showed me a diagram. The prostate forms a spacer between the bladder and rectum. It can be hit with high doses of radiation while mostly sparing the other organs. Once the prostate is removed by surgery, the bladder drops down to almost touch the rectum. It is then difficult to radiate the area without substantial radiation hitting those organs, and more profound side effects. Since Partin says I only have a 37% probability of an organ confined cancer, I really don't like the idea that I would likely need both treatments. Thanks, John > However if RRP fails, you can get a second chance doing RT to the > prostate area.. One theory about this, expressed to me by a radiation oncologist, is that if RP fails and salvage RT works, then RT would have worked originally too without the RP. If RT fails after RP, then the RT wouldn't have worked as a primary therapy either. But, as Ron says, all of this is theory. In practice, there is a lot dependent on the skill of the practitioner and the specific characteristics of the patient's disease, and on dumb luck. Alan I agree with Alan's comments. But the bottom line is if the cancer has escaped the area then it has escaped and no amount of surgery +RT or RT or combo RT's can do anything about it. To me it's a little like lost luggage,;it gets packed in the belly of the plane and what happens to it after that is anyone's guess. Most of the time it is right where you expect it to be when you get off the plane. Sometimes they get lucky and find it for you a few days later. And then there is the mystery of the totally lost luggage................... Bev > > However if RRP fails, you can get a second chance doing RT to the > > prostate area.. [quoted text clipped - 11 lines] > > Alan If primary treatment fails, then all primary treatments would have also failed. This is from my Medical Oncologist. The reason has to do with microfibers escaping and floating around for a place to dwell. GD >> However if RRP fails, you can get a second chance doing RT to the >> prostate area.. [quoted text clipped - 11 lines] > > Alan > As I am trying to choose between RT and RP, I realized that I have > heard of several MD's with PC that chose RT. I'm not saying that no MD > has ever chosen RP, I've just not read anything about it. There is a MD who has posted here from time to time. He does radiology of some sort and he is involved with diagnosis of prostate cancer but does not treat it, if I remember correctly. He was relatively young when diagnosed with prostate cancer and after consulting various experts, he chose surgery. A radiation oncology even recommended it to him over surgery. One argument was that radiation leaves some prostate tissue behind which in a relatively long life span could yield another cancer. > The one I remembered that really struck me was Dr. Charles "Snuffy" > Myers. For those who don't know, he is a medical oncologist who has [quoted text clipped - 25 lines] > radiation are equal to or better than the best results reported for > radical prostatectomy. I think other experts would disagree strongly with that. In particular, Peter Scardino, in his book "The Prostate" recommends against bracytherapy for any man with any additional risk factor such as one of the Gleason compoents 4 or greater, a PSA greater than 10, etc. For such men, he thinks surgery or external radiation is a better choice. Scardino is a surgeon, so you might feel he is biased, but he is also one of the world's leading prostate cancer researchers. He works with others such as radiation oncologists and has been an author of hundreds of papers on the subject. I only found two possible references to C. Myers and prostate cancer in Medline/Pubmed. > For men with more aggressive cancers associated with a poor > Gleason-related prognosis, a PSA over 10 ng/ml, a more extensive cancer > in the prostate gland, or the presence of capsular penetration, 3-D > conformal or IMRT combined with radioactive seed implantation currently > offers results that are clearly superior to the best surgical > approaches." You have a case of dueling experts here, but I think Scardino's qualifications clearly beat Myers's. > Can anyone refute this logic? > > Thanks, > > John > You have a case of dueling experts here, but I think Scardino's > qualifications clearly beat Myers's. I don't think there is any contradiction between the two. What I read is that Scardino said surgery or XBRT is better for high risk then seeds alone. This makes sense. Seeds alone will not handle extra-capsular penetration. But SI+IMRT will handle that problem. And that is what Myers is saying. In fact, he feels SI+IMRT is superior to surgery. Even Scardino says on p. 306, "For a small, aggressive tumor that may have extended outside the prostate in a way that can be included in the treatment field, radiation may offer a better chance for local cure than surgery." I think both experts agree. Thanks, John >> You have a case of dueling experts here, but I think Scardino's >> qualifications clearly beat Myers's. [quoted text clipped - 6 lines] > But SI+IMRT will handle that problem. And that is what Myers is saying. > In fact, he feels SI+IMRT is superior to surgery. I haven't the time or, presently, the motivation to look it up, but I'm 99% sure I read recently in one of our vaunted sources that combination internal/external RT offers no advantage over single-mode RT. People considering RT might want to research that one. I.P. IP what the heck freaks you out over RT? It works! For someone who is so pro RP you've been nailed with one of the worst side effects of RP. Which is exactly why my husband wouldn't even consider RP. To him quality of life was not peeing in diapers for the next 30 years. He was not about to chance it. Since you've put in your years and are living off of retirement maybe that doesn't mean that much to you but it does to my husband who still goes to work everyday. You are not supporting people. You plow in here and scare the crap out of every newbie. You make half the men facing additional therapy fearful of ADT/HT or RT. Do you enjoy doing that? Yes, there are side effects but a few side effects is a small price to pay for what may be years of a quality living. It's cancer! You've got it; they've got it, get over it! And just in case you haven't noticed the RT/brachy guys have it done and we never see them again because they go back to living their normal life. They have erections, they are not incontinent, and to them this was just a speed bump in their life. Personally I think having a RP is nuts but I'm not saying that to every person. Why would anyone want to subject himself to that surgery unless that was the only thing available? But I do understand that personal choices do matter. Some men just want the cancer out of their bodies as quickly as possible and they are willing to risk everything for it. Have you ever heard me actually condemn anyone for choosing RP? No, And you won't. Everybody needs to make their own decision. It's obvious that I'm pro combo RT's. I stay out here to give brachy a voice. I don't need to be here, my husband as an undetectable PSA, he has no problems with his bowels, and everything else he does have problems with is taken care of with a couple of pills. Not a bad trade off! We have normal sex once and sometimes twice a week. You know that we disagree and I do not want to start a war. I can't take this off the newsgroup because you have hid your true identity and email addy. And I'm sure you don't like me because I am a woman, and an outspoken one at that. I wish you no harm. But yes, most rad-onc will tell you that brachy with EBRT is the platinum treatment with much fewer side effects and offers a better chance of a "cure" for many men. Just try to be a little kinder and look over the fence with greater compassion. There's a half dozen men on this NG that would probably be dead or dying if they weren't on ADT. They are still enjoying their lives and playing with grandchildren. Yes, their sex drive is shot but they don't care, they are too busy smelling the roses or playing with the grandchildren to worry about their sex drive. I meant it when I said I was pleased you had a good PSA test as I do not wish anyone any harm. Just, please, be a little more sensitive to other people. Sometimes it is not what you say but how you say it. You are articulate and could contribute much more to this newsgroup if you would just think before you type! The men who supported my husband on this NG when he chose brachy were all RP'ers, and they are the same guys with whom I still converse and feel deeply indebted. They were the ones that keep me sane though the whole process. That is what a support group is supposed to be. Yes, we exchange knowledge and information as it becomes available. It's a BTDT group! We are not here to trash every treatment except for the one we chose. Don't expect me to respond because I probably won't. I don't have the time right now and I have no intentions continuing this conversation. It is perfectly okay to disagree but you don't need to throw grenades! Bev > I haven't the time or, presently, the motivation to look it up, but I'm > 99% sure I read recently in one of our vaunted sources that combination > internal/external RT offers no advantage over single-mode RT. People > considering RT might want to research that one. > > I.P. > IP what the heck freaks you out over RT? It works! For someone who is so pro > RP you've been nailed with one of the worst side effects of RP. Which is [quoted text clipped - 5 lines] > > Beverley- Well done! -Gordy > Just try to be a little kinder and look over the fence with greater > compassion. There's a half dozen men on this NG that would probably be [quoted text clipped - 10 lines] > articulate and could contribute much more to this newsgroup if you would > just think before you type! Beverly Very well said, thank you Dan  SignaturePSA = 2.2 , 03/05/2003 PSA = 7.92, 09/30/2004, @ 54 Biopsy, 11/10/2004, G9(5+4) (multiple cores) (6 of 8 cores positive), T1C EBRT, 01-03/2005 @55 Casodex (daily), begin. 11/16/2004 Zoladex, 12/23/2004, 03/10/2005, 06/14/2005, 09/14/2005, 12/14/2005, 03/14/2006, 06/14/2006 PSA, 0.1, <0.1, <0.1, <0.1, <0.1, <0.1 Bev: In all fairness to I.P., Dr. Scardino did mention in his book, The Prostate, on pages 323, and 324 "There is no evidence that cancers are cured more effectively with combined approaches. (Combination External Beam and Brachytherapy) I believe he referred to it as a "belt and suspenders" approach. Now do not kill the messenger, (me). I think that is what I.P. was referring to. B.A. > Bev: > [quoted text clipped - 5 lines] > Now do not kill the messenger, (me). I think that is what I.P. was > referring to. Thanks. That was one of several sources in the books and medical literature. I.P. > IP what the heck freaks you out over RT? It works! For someone who is so pro > RP you've been nailed with one of the worst side effects of RP. One? IP has two. He is impotent and incontinent. I didn't quite understand his and others enthusiasm for RP. Sometimes I wonder if cognitive dissonance is at play. Their advocacy for their treatment justifies their decision. The thought that there was another choice, equally effective, with significantly fewer side effects, is too much to endure, so they take the only path left to them, they embrace their fears and become it. That's a little pop-psych but that's what it looks like. I can't imagine choosing a treatment that has that high a risk of impotence and incontinence. -kh tchtic@yahoo.com wrote...snip... > I didn't quite understand his and others enthusiasm for RP. Sometimes > I wonder if cognitive dissonance is at play. Their advocacy for their > treatment justifies their decision. > > The thought that there was another choice, equally effective, kh...What is equally effective, SI+XBRT or XBRT? If it's the former that you are referring to, I'd agree; if it's the latter, please point me to some data. > with significantly fewer side effects, The data I'm aware of suggests SEs are more or less comparable, can you point me to some data that shows RT has fewer SEs? Let's keep in mind that RT doesn't fully ablate the prostate until you're (give or take) 24 months out from treatment, so the data needs to be collected at some meaningful time beyond that...Best wishes and good health, ron > is too much to endure, so they take > the only path left to them, they embrace their fears and become it. kh... > kh...What is equally effective, SI+XBRT or XBRT? If it's the former > that you are referring to, I'd agree; if it's the latter, please point > me to some data. I formed my opinion from the "dummies" book, Walsh's book, and a couple others, as well as the various websites and 1st person reports, like Andy Groves and the stories on seedpods. None of these will say outright that one approach is better or worse or equal. I was asymptomatic going in, no pain, pee'd like a firehose, no bumps to the gloved finger, PSA 10. They found 5% of 7 (4+3) in one of 12 needles after 2 biopsies. Inova gave me the full court press, 8 months of Lupron, 25 sessions with their IMRT robot, and Pd-103 seeds, the skewering handled by their "name-doc". This is "probably" as good as the best RP or Da Vinci. But, who knows. > The data I'm aware of suggests SEs are more or less comparable, can you > point me to some data that shows RT has fewer SEs? Let's keep in mind > that RT doesn't fully ablate the prostate until you're (give or take) > 24 months out from treatment, so the data needs to be collected at some > meaningful time beyond that...Best wishes and good health, ron Again, the books, papers, and websites skate around the side effects. I think the question is one of gradations of quality, not, oh, 50% of rad-grads experience some ED, or whatever the numbers are. I certainly have some ED. The point is the how much is some. Without a prostate full of seminal fluid nagging me to "take care of this", there just aren't the urges that were there a couple years ago. When I'm with a woman and things are warming up, my guy works without chemical assists. He takes more to get going and definitely doesn't work as well as before so some might call it "ED". I've tried Vitamin-V and Cialis and both help but I can go, er, bare too. I can drink 20 ounces of water and sleep for 8 hours. When I get up in the morning, I *really* have to go. The 20 steps to the bathroom is almost impossible and the last couple feet, drops are starting to ooze out. You might call it stress incontinence. If so, then yes, rad gave me both side effects but the quality isn't the same as looking for sales of bulk diapers or pads, reading up on valve or rod implants, or mainlining erection drugs. I'm not saying that side effects should be the primary concern. I agree that a cure is more important. I won't know if I am cured for another year or two or longer. That's the nature of Rad. However, I drive the highways around here everyday with nut-cases who floor their SUVs and weave in and out of traffic, just like the commercials taught them to. I call that life-threatening. So you take some risks in life. There are no guarentees and we do the best we can. A couple times, I have had second thoughts about the treatment. The softer erection even with Vitamin-V, just isn't the same. It might not be all-important to the gals but a guy can miss being really hard and really "up there". Ditto orgasms. Dribbling a small amount of semen is not the same experience as a full roaring delivery. We do the best we can with what we have. -kh >> IP what the heck freaks you out over RT? It works! For someone who is so >> pro [quoted text clipped - 16 lines] > > -kh It's presumptuous to declare that another guy's choice of treatment is wrong, much less to ascribe to some psychological weakness the reasons for his choice. There is no treatment that is "right" for all men. If there were, there wouldn't be the wide diversity of opinions among expert physicians and researchers, much less the wide range of options offered to us as patients. Age, physical condition, perception of risk (death versus side effects, "cutting it out" versus lack of pathology report with RT), anxiety about surgery, etc., all play into the decision. If the outcome is good -- few SEs, no mets, low PSA -- it's natural to feel good about the choice. It's also helpful to share that with other men facing a similar decision, because those of us who are newly diagnosed want to hear from those who have gone down all of these paths before us. And if it turns out not so well, we want to know that too. KH can't imagine a guy choosing RP, with its "high risk" of impotence and incontinence. Others might have a hard time imagining a guy choosing RT, with its risks of radiation-induced impotence over time, rectal burning, fecal incontinence, elimination of the option for salvage surgery, and so on. Yet clearly RT was the right choice for KH. Unfortunately, with this disease we all study like hell, figure the odds that seem best to us, and then roll the dice, knowing that no choice we make offers any real certainty. That sucks, but that's PCa. Alex > It's presumptuous to declare that another guy's choice of treatment is > wrong, much less to ascribe to some psychological weakness the reasons for > his choice. Not that. I'm not talking about the reasons for "the choice". It's the reasons for the advocacy after the fact. It sure looks like, "those ladies doth protest too much". > If the outcome is good -- few SEs, no mets, low PSA -- it's natural to feel > good about the choice. It's also helpful to share that with other men facing > a similar decision, because those of us who are newly diagnosed want to hear > from those who have gone down all of these paths before us. The strange part of RP-advocacy is in stating that RP's ED and incontenence are minor bothers but the SE of Rad or ADT are to be avoided at all costs. > And if it turns out not so well, we want to know that too. > KH can't imagine a guy choosing RP, with its "high risk" of impotence and > incontinence. Others might have a hard time imagining a guy choosing RT, > with its risks of radiation-induced impotence over time, rectal burning, > fecal incontinence, elimination of the option for salvage surgery, and so > on. It's a matter of degree. My radiation-induced impotence is what some guys might call being over 40, 50, or 55. I can "do it"; I just can't "do it" two and three times a day for 20 or 30 minutes like when I was younger, 30, 40. But then I can't run two miles either. According to the Rad-doc at Inova, rectal side effects were a real concern, hitting a small precentage of the early EBRT patients. Since Inova upgraded to 3DCRT and now IMRT and they adopted their anti-radiation diet program with the carefully scripted stool softeners, they haven't had a single serious rectal injury. Believe me, I followed their diet and instructions strictly. > Yet clearly RT was the right choice for KH. I don't know that. With rad, you don't really know for years. Of course, there're enough reports of RP treatment failure and mets that RP'ers don't really know either. -kh > I didn't quite understand his and others enthusiasm for RP. > Their advocacy for their treatment justifies their decision. I don't advocate, have enthusiasm for, recommend, or advise against ANY PC tx. I just present and provide links to facts I found during my own literature searches. > The thought that there was another choice, equally effective, with > significantly fewer side effects Please inform the medical field of that choice. It fails to appear in any of the literature. > I can't imagine choosing a treatment that has that high a risk of > impotence and incontinence. All PC treatments have a significant risk of i and i; it's just a matter of when and how dramatically the i's may strike -- quickly with RP, more slowly with RT, and DRAMATICALLY if and when WW fails. Realize also that many people rate those i's way down their QOL priority list. My RP has had virtually no impact on my life beyond switching from boxers to briefs. I.P. >>> You are not supporting people. You plow in here and scare the crap >>> out of every newbie. You make half the men facing additional therapy [quoted text clipped - 3 lines] >>> they've got it, get over it! Just try to be a little kinder and look >>> over the fence with greater compassion. There's a half dozen men on this NG that would probably be dead or dying if they weren't on ADT. They are still enjoying their lives and playing with grandchildren. Yes, their sex drive is shot but they don't care, they are too busy smelling the roses or playing with the grandchildren to worry about their sex drive.<<<< ------------------------------------------------------------------------- Very well said, Beverley. That is what I have been trying to get across to him for a long time. My Ron has no choice in the matter of ADT with a soaring PSA, so IP's rants on that (or any) subject are totally ignored in this house. As for not having a sex life, frankly I don't give one sweet damn!! I have a husband of 45 years who is ALIVE & WELL.....that is all that matters. And we take each day as it comes.....we don't dwell on the negatives. Thanks.....Heather > Personally I think having a RP is nuts Ouch. > It's obvious that I'm pro combo RT's. I stay out here to give brachy a > voice. I don't need to be here, my husband as an undetectable PSA, he has [quoted text clipped - 3 lines] > taken care of with a couple of pills. Not a bad trade off! We have normal > sex once and sometimes twice a week. And, to me, this is exactly the strength of anecdotal input. Brachy has possible SEs. Direct and indirect SEs can lead to short term and/or long term loss of function of organs, nerves and other body parts. It can lead to death. But, George is a shining example that it can cure, or at least significantly arrest, prostate cancer. And, it can do so, apparently, without significant lasting SEs. Surgery has possible SEs. Direct and indirect SEs can lead to short term and/or long term loss of function of organs, nerves and other body parts. It can lead to death. But, most here regained functions they lost in the short term and some have been here for more than a decade without rising PSA. Hormone Therapy has possible SEs. Direct and indirect SEs can lead to short term and/or long term fatique, loss of short term memory, organ damage, and loss of sexual function or desire. Personally, IP's SEs are important. He is an example of what might happen, even if it usually does not. His RP experience is important, but only anecdotally. My anecdotal example is as one who had T3/Gleason 7/PSA 16 cancer, RRP, EBRT and ADT. This morning, I walked 5 miles in 1 hour and 15 minutes, up and down Grade 3 hills. Thiry minutes agao, I ran up 15 steps from my lower level to get the door bell. I think I can have sex; I just don't want to. And, more than likely, my PSA is back below 0.1. Mine is an example of what might happen, even if it is better than average. That is the strength of the NG. That is it's purpose. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum ... > Brachy has possible SEs. Direct and indirect SEs can lead to short term > and/or long term loss of function of organs, nerves and other body parts. [quoted text clipped - 11 lines] > term and/or long term fatique, loss of short term memory, organ damage, and > loss of sexual function or desire. ... Steve, the above is a disservice. You've homogenized the side effects until they are meaningless and equal. While what you say is "true", it's not TRUE. The side effects from seeds and IMRT are *generally* mild compared to the side effects from surgery. There are certainly cases of IMRT and seeds gone bad where a guy can't pee, has to be TURPed, has major problems with erections, etc. Those cases are not common. My *opinion* is that the major problem with seeds and IMRT is that there are no long term statistics. The RCOG folks seem to have the most data and their stats look good, although they might be cherry picking their patients. I *think* the side effects from IMRT and seeds are generally much less than RP, fewer and milder problems with incontinence and ED. That's certainly my experience and my experience matches what I've read in the books. No one gets off scott free but rad is close to a cake-walk as it gets. The problem with rad isn't the business about "I need to see the path report" or "I want to know what my margins were". That's a stalking horse that some surgeon invented and we sheeple are echoing it. If *knowing* were a concern, guys would be hollaring for Prostascint, bone scans, and color doppler ultrascans before they started treatment. Heck, if it really were a concern, someone would invent the retropubic or robotic biopsy. The problem with rad is you know up front that you won't know how you did for 3 years or so. You hope you're in the roughly 90% that ends up cancer free. With RP, you're pretty sure in a few months that you're OK, unless it turns out that you're not. You hope you're not in the roughly 10% that has a recurrance. Exactly why this is different, well, I can't explain that. Then with RP there's the percentage where they wake you up and tell you that the cancer was more extensive than orginally thought and they had to take the nerves. That would be incredibly disheartening. I might be a little off on this but while I was on Lupron and in the 6 months or so after, I had to face the issue of impotence. It was very difficult. I hoped that things would perk up as the Lupron faded and my T increased but I didn't know if they would. What if the ED was due to radiation damage to the nerves, valves, or blood veins? What if I couldn't have or maintain an erection? Those first seconds as you slide into a woman, the blood pounding in your ears drowns out her quick gasp for breath. What if I could never experience that again? As for hormones/ADT, that's a deal with the devil. That's hardly a choice. -kh > Steve, the above is a disservice. You've homogenized the side > effects until they are meaningless and equal. Yeah. That was my intent. I find the bickering between treatments to be a disservice and the claims of one over the other to be untrue. Over time, the potential and usual SEs probably do even out. > While what you say is "true", it's not TRUE. The side effects from > seeds and IMRT are *generally* mild compared to the side effects from > surgery. There are certainly cases of IMRT and seeds gone bad where a > guy can't pee, has to be TURPed, has major problems with erections, > etc. Those cases are not common. I had RRP. The side effects are as I described. I had EBRT. The side effects are as I described. I have no further to fear from RRP. However, I can expect the deterioration from EBRT to continue. > No one gets off scott free but rad is close to a cake-walk as it gets. In the short term, I have to agree. > As for hormones/ADT, that's a deal with the devil. That's hardly a > choice. Been there too. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum > IP what the heck freaks you out over RT? Why do so many people attribute emotion (freaking out?) to facts? I just don't get it. > It works! Never said, implied, or felt it doesn't. > For someone who is so pro RP I'm not pro or con RP or RT, don't recommend one over the other. They're comparable cures, as best as I can tell. > you've been nailed with one of the worst side effects of RP. That's your opinion; it's not mine. Some SEs are personal judgment calls. > Which is exactly why my husband wouldn't even consider RP. To him quality > of life was not peeing in diapers for the next 30 years. He was not about to chance it. > Since you've put in your years and are living off of retirement maybe that > doesn't mean that much to you but it does to my husband who still goes to > work everyday. So? No one knows I wear pads if I don't tell them. Did you find pads a big QOL issue for the 40-some years you wore them? Did you walk around the office on big days in fear that someone might realize that -- GASP! -- you were WEARING ABSORBENT ITEMS? > You are not supporting people. I'll let people making tx choices be the judge of that. They need all the facts they can get, and as you and your husband have said, SEs are a huge part -- potentially life-affecting in his case because they drove his tx choice -- of that decision. The literature states and this forum demonstrates almost daily that SEs are glossed over or altogether ignored -- often until it's too late to go back -- by our oncologists. > You plow in here and scare the crap out of every newbie. So we should just let them choose treatments based on . . . what? Cost? Convenience? Cure rates based on 15-year-old statistics? Whether our cancer returns or not, what's its primary impact on our daily lives for the next year or decade? SEs! What drove your husband's choice? SEs! What drove the tx my rad onc prescribed for me? SEs! > You make half the men facing additional therapy fearful of ADT/HT or RT. No, FACTS make (rational) people fearful of cancer and its treatments. I just quote 'em so interested pts can add them to their decision data bases. We've all seen far too many cases right here in our minuscule sample of what lack of SE knowledge can do to uninformed pts. I hope EVERY pt and partner have a reasonable fear of ALL cancer treatments; what else would motivate them to take it seriously, take the time to investigate their options, choose an exceptional oncologist, and choose their tx with the whole picture (cure rates and SEs) in mind. > Yes, there are side effects but a few side effects is a small price > to pay for what may be years of a quality living. This contradicts your statement that your husband pinned his whole future on his aversion to urinary incontinence. > It's cancer! You've got it; they've got it, get over it! And just in > case you haven't noticed the RT/brachy guys have it done and we never see > them again because they go back to living their normal life. They have > erections, they are not incontinent, and to them this was just a speed bump > in their life. Unless, of course, you actually count the ones who DIDN'T enjoy the perfect picture you paint. Do you think surgery would still exist if your statement were accurate? > Personally I think having a RP is nuts And you call ME biased? I don't think ANY mainstream tx is nuts. They're OPTIONS, with choices to be made based on medical and personal facts and opinions and preferences. > but I'm not saying that to every person. You just did. > Why would anyone want to subject himself to that surgery unless that > was the only thing available? Your bias is showing again. > But I do understand that personal choices do matter. So why do you thus speak out so stridently against RP? You don't see me recommending for RP or against RT or ADT. > Have you ever heard me actually condemn anyone for choosing RP? Nor I for RT or ADT? > Everybody needs to make their own decision. Exactly my entire point and my reason for being here. What good's a cancer tx choice made without considering ALL the facts and substantiated opinions available? > And I'm sure you don't like me because I am a woman, and an outspoken > one at that. I'm sick and tired of people playing race or gender or ethnic cards every time they run out of facts. My wife is a woman who built a career out of waging entrenched battles with colonels and generals in the Pentagon, about as chauvinist a place as exists in this country outside a mosque, and I admire her for that and for the things she accomplished there, including saving taxpayers many billions of dollars and converting many of those chauvinist pigs to believers that women can be their equals. i.e., Keep your BS personal attacks to to yourself. > But yes, most rad-onc will tell you that > brachy with EBRT is the platinum treatment with much fewer side effects and > offers a better chance of a "cure" for many men. The ASTRO disagrees with you. See http://www.newswise.com/articles/view/502645/ . > Just try to be a little kinder and look over the fence with greater > compassion. There's a half dozen men on this NG that would probably be dead > or dying if they weren't on ADT. They are still enjoying their lives and > playing with grandchildren. Yes, their sex drive is shot but they don't > care, they are too busy smelling the roses or playing with the grandchildren > to worry about their sex drive. So? That doesn't change any facts. > Just, please, be a little more sensitive to other people. If "being sensitive" means dispensing bogus information or hiding real information so pts make decisions based on BS and/or just "feel better" until reality sets in, no thanks. That's not "sensitive, it's cowardly. One makes end-stage terminal cancer pts "feel better", 'cause that's all we can do for them. Pts with a chance of cure or substantial relief deserve better than that. > Sometimes it is not what you say but how you say it. Of course. We all have our own unique interpretations of and emotional reactions to life's experiences. That's exactly why I just lay the facts out there bare naked and let each person use it -- or not -- as they wish; how on earth could anyone word a fact in such a way that every unique PC pt would react to it in the same pleasant manner? > You . . . could contribute much more to this newsgroup if you would > just think before you type! That presumes that I could think in the same manner as each reader, word each fact so it would upset no reader, and sugar-coat all the bad stuff associated with PC and its treatments . . . impossible on all counts. Here's proof that doesn't work: I DO think, and often reread and edit, before I hit SEND. The fallacy in your statement is that my objectives are not the same as yours. Yours is to sugarcoat everything, make people feel good, and push your favored treatments; mine are a) to provide and reference facts which help people make sounder treatment choices and b) to AVOID recommending any particular tx. You want people to choose RT and/or ADT; I don't give a damn what tx they choose but want their choice to be based on every fact and personal consideration they can muster. > They were the ones that keep me sane though the whole process. > That is what a support group is supposed to be. This has been discussed ad nauseum in this forum, without consensus. Many, maybe most, of us want more than strokes from this group; they want facts and opinions on which to base tx decisions, not "Oh, you'll be fine. Just pursue this or that panacea and you'll still be playing tennis at 120, your gas mileage will double, and your toilet will never need to be flushed twice." Look at the thread topics; how many of them say, "Please tell me my cancer will go away."? > We are not here to trash every treatment except for the one we chose. In my nearly two years here I have seen only one or two people trash any tx other than drinking one's own urine; I certainly have never done so. But what you do -- make up feel-good homilies about RT and ADT and represent them as fact -- is at least as harmful because it leads to way too many surprises, some reversible but some devastating. > you don't need to throw grenades! I feel SO sorry for people who equate facts with grenades. It may make some of life's choices simple in the short term, but it all too often blows up in our faces a short ways down the road. Feel free to keep fabricating and dispensing your palliative touchy-feely homilies, but don't expect the more responsible people here to let them pass without a dose of reality. It's just not fair to people who still have a chance at cure or long-term palliation. We WANT you holding our hands in our deathbeds, but your homespun tx advice interferes with those of us still trying to treat and defeat the bastard. I.P. > I haven't the time or, presently, the motivation to look it up, but I'm > 99% sure I read recently in one of our vaunted sources that combination > internal/external RT offers no advantage over single-mode RT. People > considering RT might want to research that one. I'm no expert myself, but a radiation oncologist whom I respect told me this same thing. He said that there is no proven difference in outcomes for men receiving EBRT alone vs. EBRT combined with brachytherapy. When I pressed him as to which he recommended, he told me that, although he couldn't justify one over the other based on published outcomes, when his father-in-law developed prostate cancer he treated him with EBRT + SI. Alan >> I haven't the time or, presently, the motivation to look it up, but I'm >> 99% sure I read recently in one of our vaunted sources that combination [quoted text clipped - 10 lines] > published outcomes, when his father-in-law developed prostate > cancer he treated him with EBRT + SI. Well, since I wrote that, it took only a few clicks to verify that ASTRO sez all mainstream PC cures -- surgery, external rad, seeds, and combination external/seeds - have virtually indistinguishable survival records. The implication, if they're right? That just as the PCRI sez about adjuvant tx, curable pts may as well choose their initial tx by SEs rather than life span prognoses. Sorta places emphasis on accurate, thorough, prior understanding of SEs and their treatment, doesn't it? I.P. ... > Well, since I wrote that, it took only a few clicks to verify that ASTRO > sez all mainstream PC cures -- surgery, external rad, seeds, and [quoted text clipped - 5 lines] > > I.P. With a few caveats, I agree with that. One caveat is that brachytherapy, when used alone without EBRT, is NOT as effective for intermediate or high risk patients as EBRT or EBRT + brachytherapy. Also, I'm not sure that the treatments really are exactly equal. For example, it is conceivable to me that well done radiation has a higher probability of a cure than well done surgery if the cancer has penetrated the capsule. And conversely, it is conceivable to me that well done surgery has a higher probability of a cure than well done radiation if the cancer is completely organ confined. But this is just speculation on my part, and even if it were true, I don't know what the difference in probabilities amount to, or to what extent a patient can determine whether his cancer is completely organ confined prior to actual surgery, or how he can balance the chance that radiation might not kill some cancer cells inside the prostate vs. surgery not killing some outside. Given all the uncertainties, it may well be that you might as well try to avoid the side effects you fear most as do anything else. But also pick the best doctors you can find because that really will influence your probability of a cure. Alan The problem I have with all this is the comparison of results based upon questionable studies. The results from confined cancer by surgery is probably close to 100% if done properly. But radiation studies will use surgeries that include marginal and questionable stages that probably shouldn't have been done in the first place that skews the surgery results to some lower percentage for cures. By doing that they can claim similar results. The problem is that there still isn't any long term studies on radiation that extend out at least ten years or more. The studies they us are speculative and flawed. If seeds or any other type of radiation was as effective as surgery on confined cancer, they wouldn't have to keep coming up with so-called better treatment options. Usually they end up using a variety of hormone and radiation treatments in hopes that throwing everything at it will kill all the cells. Unforunately they get a lot of the good ones in the process. They never want there studies to go much over five years as there resuults wouldn't look so good. Ron S. > The problem I have with all this is the comparison of results based upon > questionable studies. The results from confined cancer by surgery is [quoted text clipped - 13 lines] > > Ron S. This seems like a wildly overbroad statement. According to you, all or a large portion of radiation studies are "questionable" and wrongly compare radiation to surgeries that "probably should not have been done in the first place." But you don't say where you get that information, which if true undermines the ethics and scientific credibility of a whole lot of doctors, hospitals and professional journals. You also say that if radiation or seeds had results as good as surgery, "they wouldn't have to keep coming up with so-called better treatment options." Huh? When has medical science declared, "hey, we got it right, so there's no need to try to improve"? If that were the case, we'd still be subjected to radical prostatectomies that didn't try to save nerves, or that use robotic keyhole surgery for less blood loss and faster recovery. Alex Alex, With all due respect, reference one long term study of any radiation treatment that supports the claim that the treatment is as good or better than surgery. I believe that most people that research the internet don't really appreciate how much they are exposed to marketing and that goes especially true from the medical comunity. You want to believe it so therefore it must be true. I believe that the best course for CONFINED prostate cancer is open RP. The only other possible option would be Robotic LRP however due to it's recent development there isn't any long term data to determine it's effectiveness. I had what you call Keyhole surgery or LRP and wouldn't recommend it for anyone. Yes, my case may have been unique but the leaning curve is extremely difficult for surgeons especially for prostate surgery and there is a big difference between perception and reality. Nerve spareing can be done just as well if not more easily with open RP. What's usually best for a patient is spending the least time under anesthesia and open surgery will usually accomplish that over the LRP and RLRP. LRP being the longist in most cases. What disturbs me most is members telling newbies that they have many options for treatment and all they have to do is researh and read and make a decision and don't look back. I believe people come here for a reality check. They know they can do the research. They are wanting to cut through all the crapola. One needs to do a better job of defining the terms we use when we communicate. Surgical removal of the prostate does NOT treat the cancer, therefore it should not be included in the term treatment options. A successful surgery will in now way compromise any cancer cells. Another problem is calling the removal of the prostate a cure for prostate cancer. Obviously if the cancer is removed along with the prostate then one should not have anymore issues with prostate cancer. I don't call that a cure in the medical sense. On the other hand, all other options available attempt to treat the cancer cells by altering the DNA, freezing them, burning them or starving them to death. These treatment options are used to manage the cancer with the hope of buying a patient more time although there isn't any convincing evidence that it does that very well. Remember, we are talking about early localize prostate cancer that at our best guess is still confined to the prostate. The prostate is one of the few organs that we can live without. Bottom line: Why would a person that is still relative young and healthy pass up removal of the prostate with the cancer confined when there is NO CURE for prostate cancer. Or are you telling me there is a cure for prostate cancer and if so let everyone know because we can end the debate now. Ron S. > reference one long term study of any radiation > treatment that supports the claim that the treatment is as good or better > than surgery. Once again, see http://www.newswise.com/articles/view/502645/ Excerpts include: Cure rates are just about equal for prostate cancer patients treated with surgery, radiation, permanent seed implants and permanent seed implants combined with radiation therapy, according to a new study in the January 2004 issue of the International Journal of Radiation Oncology·Biology·Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology. The study included 2,991 consecutively treated patients “This study represents the largest published series comparing the most frequently used therapies for patients with clinically localized prostate |
Enable EMail Alerts
Start New Thread
Reply to this Message