In this study, researchers found surgery plus radiation vs radiation pus ADT to have survival advantage. They mention an advantage of real world results vs "clinical" study results.
Interesting.....
" Another interesting finding from the research was that slightly more than half of men diagnosed with the disease did not receive combination therapies for their prostate cancer. “Two modes of treatment are recommended by both United States and European guidelines for cancer treatment. It was surprising to see only 29 percent of patients received the recommended combination therapies, and as many as 20 percent are not getting any treatment six months after their diagnosis,” said Dr. Lu-Yao. “Our data can’t tell us the reason for this deviation from guidelines and further studies are needed.”
They found that 10 years after treatment, 89 percent of the prostate removal plus radiation group was still alive. That compared with the 74 percent survival at ten years in the group that received only radiation plus hormone therapy, amounting to a 15 percent survival advantage in the group that was treated with prostate removal.
“For high-risk prostate patients we started the use of aggressive radiation therapy after surgery 20 years ago,” said Adam Dicker, Senior Vice President and Chair of the Department of Enterprise Radiation Oncology at Jefferson Health, who was not involved in the study. “We recognized that it may have curative potential.”
“However, the proportion of men undergoing prostatectomy plus radiation therapy decreased significantly over time and there were trade-offs for the survival advantages,” said Dr. Lu-Yao. Men who received the combination of surgery and radiotherapy had higher rates of erectile dysfunction (28 percent vs 20 percent) and higher rates of urinary incontinence (49 percent vs 19 percent).
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maley2711
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TA, why is Brachytherapy, a viable approach to a curable treatment for localized Prostate Cancer non metastatic findings is such a rare recommendation?
Yes, sadly that's true. It gets down to economics. Brachy is a highly specialized discipline. It takes a lot of education, and there is a steep learning curve. Unlike external beam treatment, which is reimbursed per treatment, brachy is often one and done, so reimbursement is low compared to external beam or surgery. So the brachytherapist's costs are high and his revenue is low=disincentive to specialize in it. There rae just few good one's around.
if brachy is absolutely known to be superior, then aren't these Docs breaking any sort of code of ethics? surely they could convince the powers to be to properly compensate? if superior, costs downstream will also be lower, which insurers would love?
It depends on the initial doctor, so for example, if your doc is an urology surgeon, given the advanced prostate findings, it will be surgery, cut out the prostate gland!
You have to be able to find a specialist, which is what DarkEnergy is saying. That can be difficult in many parts of the country. Even ROs who specialize in external beam won't necessarily know much about it. Many of the top institutions offer it for prostate cancer patients, but some (like Mayo or JH) have weak RO departments.
what is LT ADT? is this actually 3 treatments...brachy + "LT" (?) + ADT? yes, seems often the more diagnostic tests that are done, the more treatments that are done, the better the survival results..but with additioanl risks of negative SEs/consequences? I was struck that 20% of men had not treatment!! and 30% passed on 2nd treatment!
Sorry for the abbreviations. LT=long term. The standard duration of adjuvant ADT for brachy boost is 18 months. Yes, there are side effects of the powerful treatment. It has an 85% cure rate, but 17% experience late-term urinary side effects (mostly urinary retention).
I had a prostatectomy 7 years ago this June by Da Vinci robotic procedure with excellent results and no other therapy. I had the surgery at John Hopkins and had a fast recovery. My sex life has changed but my quality of life is fine. I definitely recommend this course of treatment, my cancer was caught early which made a big difference. I was tested annually since family members had prostate cancer.
This was posted elsewhere, and I took the time to read the paper. I question the conclusions on a number of points:
- It was a retrospective study based on data from the SEER database. I have read a number of times criticism of using the SEER database due to it not being complete. Lots of records apparently have incomplete information, making it difficult to sort the records to a uniform standard for each branch of the study.
- It mentioned but really didn't address - that generally men taking radiation/ADT are generally older, and have more comorbidities than men taking RP. The endpoint was how many of each branch were alive (I believe after 10 years) - not how many died from PCa or complications from PCa treatment. In this case - it seems even if no treatment was done to either branch, considering the demographics - the older group is logically going to have more deaths.
- They mentioned the records selected were of men treated from 1999-2007 (I think that's right, if not it's very close - this is from memory) - 1999 is the dark ages of radiation treatment compared to what's available now. Even 2007 was prior to many of the precision targeting techniques now used. And in that era - a normal dose of radiation usually totaled something under 60Gy. Now,>80Gy is common for high-risk treatments.
Perhaps I've misunderstood the paper entirely - if so - I'll blame my MD's - they showed me how to really look critically at papers, and especially to look critically at any based on old data. Things have changed for the better... especially in the RT world.
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