Comparison of Prostate Cancer Treatments (an excellent graphic representation of the clinical research on all combinations of therapy.

[cesanon]

Comparison of Prostate Cancer Treatments (an excellent graphic representation of the clinical research on all combinations of therapy. Any comments or thoughts?

prostatecancerfree.org/comp...

[Data-nerd]

Great post, cesanon.

I just saw it today( 1/12/19) and it resonate# with my own experience and my own review of the literature.

It took me a few minutes to wrap my head around the visual format used to summarize the data and a bit longer to digest their implications.

A prostatectomy is administered with curative intent. That means that the available evidence indicates that the cancer has not escaped the prostate capsule and that if the prostate is removed then the cancer should not recur.

If these assumptions were true, then surgery should have the greatest success in producing the longest PSA free post treatment interval, since there is no cancer remaining to release PSA into the blood stream. It is well known by now that other organs produce minuscule amounts of PSA but these do not grow exponentially and affect patients in all categories.

The fact that surgery produces such poor outcomes using this metric to quantify success means that these assumptions are not reasonable.

Prostate cancer is not typically confined to the prostate cancer and removing the gland does not produce a durable cure.

Some form of radiation plus ADT produces more durable results but it is not clear what the proper sequence or combination should be.

This supports the notion that prostate cancer is from the very start a systemic disease that should be addressed by long term management strategies that are sequenced according to the unique circumstances of each patient.

This is what is meant by “ personalized oncology” or “ patient- centered treatment”.

Large, placebo controlled research designs cannot answer this question.

Each patient must serve as his own control with treatment results monitored sequentially until a combination is found tha5 works for that particular patient.

After enough results are accumulated, certain regularities will become apparent that can lead to hypotheses which can be tested by these so-called “ gold standard” designs.

Not the other way around, where the group designs are conducted first and then validated for particular patients according to a standard protocol.

That way doesn’t serve the patient’s best interests although it is preferred by big pharma and the insurance companies who are held hostage by the FDA approval process.

Oncologists who can think outside of the box can find a way around these limitations although sometimes we as patients must take the initiative to strongly request that we have an opportunity to try a particular approach that is supported by the available literature and which can be evaluated by a rigorous single subject research design.

Thanks for sharing this study with us.

[cesanon in reply to Data-nerd]

Sure, thanks for the kind words.