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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2004Sloan Study
As always, very brief abstract, but.... Jan. 7, 2004 -- The major treatments for localized prostate cancer all work -- and none works better than the others, new research shows. The findings are reassuring to men who've already undergone treatment. But they don't offer much guidance to a man trying to decide which treatment is best for him. It doesn't matter whether a man's prostate tumor has, as doctors say, "favorable" or "unfavorable" characteristics. The chances of cure are the same whether he chooses surgery (radical prostatectomy), high-dose external beam radiation, implantation of radioactive "seeds," or a combination of seeds and external beam radiation. The only treatment that doesn't work as well as the others is low-dose external beam radiation alone. The findings come from a study of nearly 3,000 men treated for prostate cancer between 1990 and 1998 at The Cleveland Clinic or at Memorial Sloan-Kettering at Mercy Medical Center. The treatment was considered to have failed if a patient had three consecutive tests showing rising PSA levels. The study, led by Patrick A. Kupelian, MD, of MD Anderson Cancer Center Orlando, did not look at patient survival. "This study represents the largest published series comparing the most frequently used therapies for clinically localized prostate cancer in the PSA era," Kupelian says in a news release. "The results suggest that except for [low-dose external beam radiation], biological failure at seven years is determined more by the intrinsic tumor characteristics at the time of therapy rather than a specific [kind of] treatment." How, then, does a man with prostate cancer choose the best treatment? It's not an easy process. A man must consult with one or more doctors and consider which side effects he's most comfortable risking. The "right" choice differs according to the individual.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 > A new Study just hit the presses from the Seattle Prostate Institute, a much recognized and accomplished center of excellence. My Sloan Kettering trained radiation onclolgist gave me a hard copy last week. The title is: "Ten-Year Biochemical Relapse-Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience" John Sylvester M.D., John Blasko M.D., Peter Giimm D.O., Robert Meier M.D., and Judith Malmgren, (PhD) Copies may be requested to: John E. Sylvester, M.D., Seattle Prostate Institute, 1101 Madison, Suite 1101, Seattle, Wash 98115. Tel 206-215-2480. Fax 215-2481. E-mail: JohnSylvester@seattleprostateInst.com. You might be able to locate it in the Int. J. Radiation Oncol/Biol. Phys., Vol 57, No.4 pp. 944-952 2003 The bottom line as I read it: This is the first 10-year study done by a large and recognized center of excellence on the efficacy of IMRT AND seeds. And, as we had hoped, the 10-yr biochemical relapse-free survival (BRFS) is a little better than earlier literature and studies had reported. Sailor Jack > Prostate Cancer Patient, not a doctor > PSA: 4.3 11/15/2003 @ 62 [quoted text clipped - 3 lines] > Erection: Still there @62 but fading a bit > Continence: Ok for now. Here is a copy of the abstract. A key question is what was the median follow-up time? Maybe he followed them out to 10 years, but he does mention Kaplan-Meier statistics which may suggest a shorter follow-up. If median follow-up is 5 years of less, then even this tightened up version of ASTR0 failure can be pretty forgiving (for example, if somebody's PSA bounces at around 3 years and then nadirs, and if PSA is measured yearly, then there is really little or no time left to fail). In any case, here are the comparable 10 year biochemical relapse free rates from the Hopkins' RRP nomograms (M. Han, A. W. Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169, 517-523, 2003) for men that would fall into Dr. Blasko's low-risk group. T1c psa=4-10 GS=5: 97% T1c psa=4-10 GS=6: 95% T2a psa=4-10 GS=5: 96% T2a psa=4-10 GS=6: 93% T2b/c psa=4-10 GS=5: 95% T2b/c psa=4-10 GS=6: 91% Note that this last group from Hopkins contains T2c men. which the Blasko team would have placed into their intermediate risk group. Also, the study is on the small side (232 patients), but it is informational. It becomes difficult to compare the Hopkins' nomograms to the intermediate- and high-risk groups, but I suspect that RT gains an edge here...Ron International Journal of Radiation Oncology*Biology*Physics Volume 57, Issue 4 , 15 November 2003, Paes 944-952 doi:10.1016/S0360-3016(03)00739-9 Copyright © 2003 Elsevier Inc. All rights reserved. Clinical investigation: prostate Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prost ate cancer: the Seattle experience John E. Sylvester M.D. , , *, , John C. Blasko M.D.*, Peter D. Grimm D.O.*, Robert Meier M.D.* and Judith A. Malmgren Ph.D. , § * Seattle Prostate Institute at Swedish Hospital, Seattle, WA, USA Swedish Cancer Center at Stevens Hospital, Edmonds, WA, USA HealthStat Consulting, Inc., Seattle, WA, USA § Department of Epidemiology, University of Washington, Seattle, WA, USA Received 21 January 2003; revised 27 May 2003; accepted 4 June 2003. ; Available online 17 October 2003. Abstract Purpose The role of external beam radiation therapy in addition to brachytherapy continues to be scrutinized for long term control of PSA levels after prostate cancer diagnosis. Methods and materials We report 10-year biochemical relapse-free survival (BRFS) on 232 patients presenting with localized prostate cancer and consecutively treated with iodine125 (I125) or palladium103 (Pd103) brachytherapy and neoadjuvant external beam radiation therapy. Multivariate regression analysis was used to create a pretreatment clinical prognostic risk model using a modified ASTRO consensus definition (two consecutive rises in serum PSA) as the outcome. Gleason scoring was performed by pathologists at a small community hospital. Derived risk categories are the following: LOW = PSA =< 10 ng/mL, Gleason sum score <7, and stage <T2c; INTERMEDIATE = PSA >10 ng/mL or Gleason Score >= 7 or stage >= T2c (1 intermediate risk factor); and HIGH = 2 or more intermediate risk factors. Time to PSA failure (local, distant, or biochemical) was calculated and compared using Kaplan-Meier plots. Results Ten-year BRFS for the entire treatment group was 70%. Biochemical control rates by risk cohort analysis (95% confidence interval): low risk, 85% (83.390.7%); intermediate risk, 77% (73.084.5%); and high risk, 45% (45.457.2%). Using a risk grouping proposed by the Mt. Sinai group, the BRFS was: low risk, 84%; intermediate risk, 93%; and high risk, 57%. Grouping by the risk classification used by D'Amico, the BRFS was: low risk, 86%; intermediate risk, 90%; and high risk, 48%. Conclusions I125 or Pd103 brachytherapy, as a boost combined with EBRT, continues to result in high rates of biochemical control at 10 years. Different risk group classification schemes lead to different BRFS results. Author Keywords: Prostatic neoplasms; Radiotherapy; Brachytherapy; Prostate Corresponding author. Reprint requests to: John E. Sylvester, M.D., Seattle Prostate Institute, 1101 Madison, Suite 1101, , Seattle, WA 98115, , USA. Tel: (206) 215-2480; Fax: (206) 215-2481; > > A new Study just hit the presses from the Seattle Prostate Institute, a much recognized and accomplished center of excellence. My Sloan Kettering trained radiation onclolgist gave me a hard copy last week. The title is: > "Ten-Year Biochemical Relapse-Free Survival After External Beam [quoted text clipped - 23 lines] > > Erection: Still there @62 but fading a bit > > Continence: Ok for now. |
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