RP/Chemo vs RT/ADT - 43% difference in recurrence for high-risk PCa patients.

[Don_1213]

The video is short enough:

medpagetoday.com/meetingcov...

It's entitled: Is Radiation Better Than Surgery for High-Risk Prostate Cancer?

Hopefully, you can view it. If not - let me know.

This is a huge hole blown in the urologist's claim of better long-term control of PCa with the surgery standard of care vs radiation standard of care. It's not even close.

Worth a listen for anyone debating that choice. It doesn't cover less-serious cases, so they may be different (but I'm betting they aren't...)

[MrProstate]

A real comparison of surgery to radiation should be just that.

This business of adding chemo or ADT or grandma’s favourite potion may be interesting for those that want to go all out from the start.

So as far as blowing holes out of urologists claims I doubt it very much.

The other thing to be mindful of is that BCR versus metastatic spread in the context of clinical trials are seperate measures.

In my humble opinion chemo and radio both offer some control but both select for more aggressive clones.

At least with surgery if the cancer is truly contained in the prostate no matter it’s definition you would very likely be cured.

[Don_1213 in reply to MrProstate]

You said: "This business of adding chemo or ADT or grandma’s favourite potion may be interesting for those that want to go all out from the start" - and I said "standard of care" for HIGH RISK PCa patients.

I don't think you'll find any oncologist (medical, urologic, radiation) who would suggest a man with G9 or G10 PCa is going to do well without the additional treatment.

Both surgery/chemo and radiation/ADT are standards of care for G9-G10.

Even with cancer fully prostate contained - surgery gives a nice opening for millions of cancer cells (think seeds) to enter the bloodstream during the surgery. Radiation not so much, but radiation is more effective for high-risk patients if ADT is combined with it - in preventing spread/recurrence.

From your bio you had a prostatectomy 2 years ago and based on your PSA results are doing well 2 years after. Good for you - but that still doesn't change the numbers from the study referred to.

[MrProstate in reply to Don_1213]

All I am saying is that an apples to apples comparison is the only appropriate way to draw a conclusion.

If you use surgery plus adt versus radio plus adt then you might have a valid comparison.

Alternatively surgery with chemo versus radiation with chemo would probably be equally valid.

Anything other than an apples to apples in your treatment arms introduces biases that preclude valid conclusions about surgery versus radiation.

It may facilitate other conclusions but it provides negligible evidence about a strict surgery versus radiation comparison.

I mean did they compare surgery with ADT and the arm that received Radiation with ADT?

[London441]

Definitive data on this probably isn’t happening soon, and I agree that there are enough confounders besides just the markedly different treatment combinations.

But this:

‘I don't think you'll find any oncologist (medical, urologic, radiation) who would suggest a man with G9 or G10 PCa is going to do well without the additional treatment.’

Urologic surgeons perform RP on G9 patients all the time. Many sending them home with a rosy ‘we got it all’. Far too often they did not.

[Don_1213 in reply to London441]

That is the unfortunate truth. The honest ones usually plan for follow-up radiation depending on what they find.

[ron_bucher]

Why wouldn’t the main conclusion be that it was ADT that made the difference?

[Don_1213 in reply to ron_bucher]

Because the difference in results was still there (a bit less - about 12% I believe) when no followup treatment was done. ADT makes a difference, but not all the difference.

[j-o-h-n]

They're now talking about prostate transplants....(women first)....

Good Luck, Good Health and Good Humor.

j-o-h-n

[ron_bucher]

Seems to me like a very confusing/convoluted presentation of data from two different studies, neither of which compared RP with radiation.

[MrProstate in reply to ron_bucher]

Exactly