I stumbled across this prostate treatment comparison tool which seems to be a pretty reasonable method based on a lot of data that could help those of us struggling to know what treatment to have.
I listed the high-risk chart (Gleason 8-10) and compared EBRT & Seeds (purple) alongside RP (Red). I'm not really certain what the left-hand scale actually means but if I am reading this chart correctly, it appears as though EBRT/Seeds has a better outcome. I was surprised to note that if you add ADT to the EBRT/Seeds, - the outcomes were less favorable. Perhaps I am reading this chart incorrectly.
Has anyone got any thoughts on this comparison tool and also what am I meant to understand by the left-hand scale that ranges from 20 - 120?
Thanks and all the best to you all.
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Mike58
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It was a project of Peter Green's, an eminent LDR brachytherapist while he was alive. After he died, his widow kept it going for a few years. I don't think she has kept it current, and it was always biased/cherry-picked towards LDR brachy, IMO.
Thanks, T-A. I suppose this will always be a concern when discussing treatments, as each specialist tends to advocate for their own expertise, which is perfectly natural. However, I had hoped that the comparison chart available on their website, which they claim is regularly updated, would rely on objective data rather than being biased. In any case, I've shared these findings with my RO for his input, so we'll await their response. By the way, can you clarify whether brachytherapy is typically performed by an RO, a Urologist, or a combination of both? It seems a bit confusing as both specialists seem to be involved to some extent.
Thanks T_A, It will be interesting what my RO has to say about HDR Brachytherapy without HT. That treatment seems less invasive with less side effects but maybe some others on this forum may have differing views, especially if they have actually had this course of treatment.
Thanks for raising this. I found this also very helpful and kept hoping to see it updated, but i guess that may not be likely based on what's being said. I hadn't realized there was some cherry-picking of studies, which is disappointing. RP definitely emerged as a less appealing option in my mind in part due to these tables and that may be over-stated.
If you’ve ever heard of Dr. Mark Scholz, he believes the data presented to be accurate. He presents it to readers in his book.
The data is now maintained by a foundation. There are xx experts from around the world that include both surgeons, radiologists, and oncologists who meet periodically to insure that the data is up to date and accurately reflects the current state of the art.
The founder, the late Dr. Grimm, started these comparison charts because he realized there was/is a great information void here. It was intended to empower patients tasked with the heavy burden of choosing their own fate.
When I was in the thick of this and was pulling/reading research papers, when I came across a paper that did any comparisons, it followed the same trend as the charts. Sometimes the surgery/radiation comparison was even more stark.
The Prostate Industry has had decades to commission studies doing this very thing, monitor the effectiveness of the various treatment paths. They commission studies on all kinds of things except this. Also, if you show these charts to your docs, don’t be surprised if they have never seen them before. It seems as if information like this is not included in med school training.
Surgery: This is what i read about surgery. They have hit an effectiveness wall. Taking out a prostate is difficult and can be messy. Thats why you pick a guy that has done a ton of these procedures.
The distance between the prostate and surrounding organs/tissues is only millimeters. So they can’t remove all kinds of margin tissue for safety.
Then the problem of micro-mets. After a time PCa cells will migrate out around the capsule edge. The prostate capsule is more of a porous membrane than it is a thick impenetrable barrier. The micro mets can be around the capsule.
When the robotic assist machines came out, they did what they promised. They made removal much more precise and cleaner. But.. the hoped for leap in curative effectiveness did not occur. This is believed to be because of the tiny invisible micro-mets.
Brachytherapy (seeds): This is what I’ve read about brachy. When they do external beam radiation, the object is to blast the cancer cells. But, with external beam, the radiation also hits other tissues/organs. They have to draw the line and stop dosage due to the healthy tissues.
With brachy, the radiation emanates from the seeds, inside the prostate. Because of this they have less restrictions on surrounding tissue dosage. They can dose higher and blast the PCa a little more. This is the explanation of why the chart curves with brachy are a little higher.
Hey, - thanks for your great input. I was hoping that this comparison tool was accurate and although no treatment that works well on one person is necessarily going to work well on another, nevertheless, this data of the results of nearly 130,000 men can't possibly be dismissed. I'll certainly be using it to formulate a treatment moving forward but will also pass it by my RO who may have some input as well.
In the meantime, has anyone heard of or even used Retzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP). It appears to be the new and best method of removing the Prostate with minimal collateral damage.
Although I wish I wasn't on this forum, I must say that it is really great to tap into the wealth of knowledge that is evidently present.
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Summary of my journey to a treatment decision
Positive Margins -- Will I need additional treatment?
Treatment options?
27 months post 39 sessions of EBRT and completion of 3 years of ADT my PSA remains at <=0.08
