My husband has been diagnosed with locally advanced prostate cancer. Pet scan showed its spread in to both L & R and spread upwards in the seminal vesicles.
We have been given 2 choices of treatment and desperate to find out from any one who has had the treatments to enable us to make the right choice.
Option 1 Surgery, followed by radiotherapy beam.
Option 2 Brachytherapy beam and hormone and radiotherapy
thank you so much,
Option #2 has the best track record of success. Here's an article comparing brachy boost treatment to surgery for high risk patients. Brachy boost had a 10-year rate of distant metastases only about a quarter as high as surgery, and 10-year prostate cancer-specific survival that was twice as high as surgery. This was true even though many surgery patients had salvage radiation afterwards.
pcnrv.blogspot.com/2018/03/...
From what you wrote, he does not have "locally advanced" prostate cancer. If it has only spread to the seminal vesicles and nowhere else outside of the prostate, it is staged T3b, and is in the "high risk" category. (The other risk factors for "high risk" are a Gleason score between 8-10, or a PSA over 20). This should come as a relief to you because "high risk" PC is highly curable. With brachy boost therapy, 70% have no evidence of recurrence within 10 years of treatment (only 16% have no evidence of recurrence 10 years after surgery, even if they had salvage radiation afterwards).
Thank you for your reply, it has been helpful,
Allen, this is a great link. Does the 2nd described study temper your enthusiasm about the 1st study?
No. I wrote that to explain why "overall survival" differences don't show up. Distant metastasis-free survival is probably a better surrogate endpoint if the study can't run for 15-20 years. This surrogate endpoint is particularly important for intermediate and high-risk survival, who will likely survive a long time. While there is often not enough deaths to see a difference in a shorter time frame, there were enough metastatic events to see a difference. An analysis last year by the blue-ribbon panel ICECaP Working Group of 12,712 patients in 19 clinical trials of radiation in localized prostate cancer showed that 5-YEAR metastasis-free survival was almost perfectly correlated with overall survival.
ascopubs.org/doi/full/10.12...
Thanks, good. What do you make of the decline in the use of brachy boost therapy (last paragraph of article)?
Devil's advocate -- Do you think there might be a suggestion here that brachy boost, while dealing with the PCa better, contributes more than RP to other deaths among those treated, like maybe other cancer deaths?
The decline in brachy therapy is attributed to economics - reimbursement rates are low for BT and much higher for IMRT. Also the learning curve is steeper for BT. Why would anyone go into it?
No. I'm sure if they were followed for 15-20 years, the differences would emerge. It is the early deaths that may have been caused primarily by uncaptured variables discussed in the article. Secondary cancers associated with prostate radiation are very low:
pcnrv.blogspot.com/2016/08/...
Allen you're a fount of good, pertinent, persuasive knowledge. & reasoning! Thanks for sharing it.
Allen, sorry to persist, but this comes right to the crux of the big dilemma. (1) The 70% versus 16% figures (evidence of recurrence) -- that's amazing -- how did you come by those figures? (2) I'm still trying to get my head around reconciling differences like that with the similar 10-year OS rates, in multiple trials. You mention there not being enough deaths (10 years) for accurate figures. It does seem clear that if we were talking about more years, a notable difference would show up. But, there's the coincidence of multiple studies. It feels like some piece of the puzzle is missing -- not brachy-caused cancers, but something else.
I neglected to put the link to the published study is in the article. Here it is:
jamanetwork.com/journals/ja...
Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. By 10 years, 91 RP (14%), 186 EBRT (40%), and 90 (21%) EBRT+BT patients had died. Patients who received radiation were about 10 years older and had more comorbidities than patients who received RP. After adjustment for those factors there was no difference, However, no therapy had reached a median (50%) death rate, which is what we'd like to see.
You might check into HIFU. Not sure if it is useful when there is seminal vesicle involvement.
Check out my profile and posts sounds like a similar story to mine. You didn’t mention Gleason score or PSA both of these criteria help determine the aggressiveness of the disease. Both criteria PSA and Gleason score will help you decide on a course of treatment. I chose surgery 2.5 years later followed up with radiotherapy. Good luck on your decision. Prayers sent your way.
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