Quality of life: Treatment Comparisons

Trew

Interesting document from the U of Mich school of urology on quality of life issues after the 3 types of major treatments (note- proton therapy is not included in the study):

http://www.med.umich.edu/urology/events/Other/PCNews.pdf

The chapter you want is on Quality of Life- that starts on page 6 of the document.

Strong evidence supporting surgery for overall Quality of life after treatment.

From page 6:

"It was found that each of the three common primary prostate cancer treatments (prostatectomy, brachytherapy, or external-beam radiotherapy) were associated with distinct patterns of change in quality-of-life domains related to urinary symptoms, sexual and bowel function, and vitality or hormonal function. These changes in quality of life were found to be significantly associated with the degree of outcome satisfaction among patients and their spouses or partners.
"Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. For all groups, urinary incontinence was at its worst by 2 months after surgery and then improved in most patients. Eighteen percent of patients in the brachytherapy group, 11% of those in the radiotherapy group, and 7% of those in the prostatectomy group reported having moderate or worse distress from overall urinary symptoms at 1 year. After prostatectomy, mean scores on urinary irritation and obstruction improved, particularly in patients with large prostates.
"Brachytherapy and radiotherapy were both associated with a reduced quality of life related to bowel function early after treatment, and the change lasted for a year or more. In contrast, no substantive change in bowel symptoms was detected after prostatectomy."

DanKCMO

Thanks for the link. Overall
Thanks for the link. Overall that newsletter was interesting.

For the quality of life article, I wish they would have broken out robotic vs open surgery.

After reading many of the posts here, it seems like everybody who has chosen surgery is getting robotic.

Does anybody get open surgery any more? I have studied both types of surgery and even though I chose robotic, I may have chosen open if my choice was between a robotic surgeon with 300 or less surgeries or an open surgeon with 15 years/1000s of open surgeries with an excellent reputation among his patients.

In other words, I think my decision came down to the skill of the surgeon instead of open vs robotic. The statistics I have seen seem to bear this out (but I am always open to more facts and other opinions),

Dan

lewvino

DanKCMO said:

Thanks for the link. Overall
Thanks for the link. Overall that newsletter was interesting.

For the quality of life article, I wish they would have broken out robotic vs open surgery.

After reading many of the posts here, it seems like everybody who has chosen surgery is getting robotic.

Does anybody get open surgery any more? I have studied both types of surgery and even though I chose robotic, I may have chosen open if my choice was between a robotic surgeon with 300 or less surgeries or an open surgeon with 15 years/1000s of open surgeries with an excellent reputation among his patients.

In other words, I think my decision came down to the skill of the surgeon instead of open vs robotic. The statistics I have seen seem to bear this out (but I am always open to more facts and other opinions),

Dan

My local Urologist performs
My local Urologist performs open and I know of one man at church that chose open with this Doctor rather then Robotic. He is doing great at 2 years post treatment. This same urologist made the appt for me with Vanderbilt where I had the Robotic and he still provides me with my follow up PSA testing.

At Vanderbilt they will perform Open or Robotic depending on the case and patients wishes. I even had to sign a 'form' that if needed the doctor at his decision could switch from Robotic to Open. I asked about this and he said that for some very obese patients the Open is better or if they encounter to much 'scar' tissue from previous surgeries sometimes they have to switch but again they stated it is 'rare' to have to switch.

I'm still thankful that I went robotic with a very exprerienced Surgeon and attribute that to my overall success.

Larry

Trew

lewvino said:

My local Urologist performs
My local Urologist performs open and I know of one man at church that chose open with this Doctor rather then Robotic. He is doing great at 2 years post treatment. This same urologist made the appt for me with Vanderbilt where I had the Robotic and he still provides me with my follow up PSA testing.

At Vanderbilt they will perform Open or Robotic depending on the case and patients wishes. I even had to sign a 'form' that if needed the doctor at his decision could switch from Robotic to Open. I asked about this and he said that for some very obese patients the Open is better or if they encounter to much 'scar' tissue from previous surgeries sometimes they have to switch but again they stated it is 'rare' to have to switch.

I'm still thankful that I went robotic with a very exprerienced Surgeon and attribute that to my overall success.

Larry

Larry, then this article
Larry, then this article reinforces your sense of confidence in your decision for surgery. I am always dhappy for those who have positive outcomes. If I could go back and do this whole process over, and IF surgery was a must, I now believe I would choose U of Mich.

mrspjd

glaring omission
Did anyone else notice one glaring omission from this article/study? Namely that it seemed to compare apples, oranges and bananas, rather than like fruit. I'm not talking about the treatment (tx) options, but rather the patient's clinical staging prior to treatment. In other words they make no mention of the clinical PCa stage of the patients prior to the tx that they received and that they are comparing for the results. It makes all the difference in tx outcome whether you are T1, T2, or T3 so if the study had isolated those clinical staging catagories and compared the outcomes of tx based on initial staging for those patients in the same clinical stage, then perhaps the outcome stats would be more meaningful. We (pjd & I) have found just how important it is to learn as much as you can about your clinical staging prior to making tx decisions and weighing the outcomes, side effects, etc. Those with lower risk PCa will many times have better outcomes with their tx decisions (whatever the tx is)than those with higher risk PCa. And some tx options just may not be well-suited for higher risk PCa. sorry to sound like the nag that I am, but please, do your homework!
mrs pjd

Trew

mrspjd said:

glaring omission
Did anyone else notice one glaring omission from this article/study? Namely that it seemed to compare apples, oranges and bananas, rather than like fruit. I'm not talking about the treatment (tx) options, but rather the patient's clinical staging prior to treatment. In other words they make no mention of the clinical PCa stage of the patients prior to the tx that they received and that they are comparing for the results. It makes all the difference in tx outcome whether you are T1, T2, or T3 so if the study had isolated those clinical staging catagories and compared the outcomes of tx based on initial staging for those patients in the same clinical stage, then perhaps the outcome stats would be more meaningful. We (pjd & I) have found just how important it is to learn as much as you can about your clinical staging prior to making tx decisions and weighing the outcomes, side effects, etc. Those with lower risk PCa will many times have better outcomes with their tx decisions (whatever the tx is)than those with higher risk PCa. And some tx options just may not be well-suited for higher risk PCa. sorry to sound like the nag that I am, but please, do your homework!
mrs pjd

Good point, Mrspjd. I was a
Good point, Mrspjd. I was a T4- main cancer was up close to the bladerneck and spread. No chance important nerves on one side could be saved. A guy with a T2 or even a T3 might very well get out of surgery with all important nerves saved. So for me, quality of life is going to be deminished compared to someone with a lower T rating.

I don't care, I keep thinking maybe if I had used a "better" doctor....

However, the new doctor yesterday indicated in our discussion that those nerves on one side could not have been saved. Too much cancer involvement on that one side.

I need to read more of the article. I may very well have U of Mich do the AUS if I chose to go that way.

Kongo

mrspjd said:

glaring omission
Did anyone else notice one glaring omission from this article/study? Namely that it seemed to compare apples, oranges and bananas, rather than like fruit. I'm not talking about the treatment (tx) options, but rather the patient's clinical staging prior to treatment. In other words they make no mention of the clinical PCa stage of the patients prior to the tx that they received and that they are comparing for the results. It makes all the difference in tx outcome whether you are T1, T2, or T3 so if the study had isolated those clinical staging catagories and compared the outcomes of tx based on initial staging for those patients in the same clinical stage, then perhaps the outcome stats would be more meaningful. We (pjd & I) have found just how important it is to learn as much as you can about your clinical staging prior to making tx decisions and weighing the outcomes, side effects, etc. Those with lower risk PCa will many times have better outcomes with their tx decisions (whatever the tx is)than those with higher risk PCa. And some tx options just may not be well-suited for higher risk PCa. sorry to sound like the nag that I am, but please, do your homework!
mrs pjd

Right On
Mrs. PJ's post spotlights the difficulty in sorting through the information available about PCa and comparative treatment options. For early stage prostate, (Gleason 6 or less, PSA <10, and stage T1) virtually every treatment has similar curative outcomes.

It would be great if you could take 1000 men, all at the same age, stage, PSA range, and Gleason score, and compare them head-to-head for the major treatment options and follow them over a 20-year period. Unless someone sorts through the data and does a paper study on that we'll never know for sure.

mrspjd

Trew said:

Good point, Mrspjd. I was a
Good point, Mrspjd. I was a T4- main cancer was up close to the bladerneck and spread. No chance important nerves on one side could be saved. A guy with a T2 or even a T3 might very well get out of surgery with all important nerves saved. So for me, quality of life is going to be deminished compared to someone with a lower T rating.

I don't care, I keep thinking maybe if I had used a "better" doctor....

However, the new doctor yesterday indicated in our discussion that those nerves on one side could not have been saved. Too much cancer involvement on that one side.

I need to read more of the article. I may very well have U of Mich do the AUS if I chose to go that way.

have read many of your posts
Trew,
Thanks. Have read many of your posts and it sounds like you have really been through the "mill." I'm glad you have a new dr who will be better able to help you. Think positively, know that what is done, is done, and you can't go back, only forward (so stop beating yourself up about the past). Take a deep breath & clear your mind when the thoughts about your previous decisions "get to you." You made the best decisions you could then, and are making better ones now. It makes all the difference if you research your doctor(s) & tx options, find a dr that is experienced and skilled, & have confidence in him/her. That seems to be the case for you now. All the best.
Sincerely,
mrs pjd

lewvino

mrspjd said:

glaring omission
Did anyone else notice one glaring omission from this article/study? Namely that it seemed to compare apples, oranges and bananas, rather than like fruit. I'm not talking about the treatment (tx) options, but rather the patient's clinical staging prior to treatment. In other words they make no mention of the clinical PCa stage of the patients prior to the tx that they received and that they are comparing for the results. It makes all the difference in tx outcome whether you are T1, T2, or T3 so if the study had isolated those clinical staging catagories and compared the outcomes of tx based on initial staging for those patients in the same clinical stage, then perhaps the outcome stats would be more meaningful. We (pjd & I) have found just how important it is to learn as much as you can about your clinical staging prior to making tx decisions and weighing the outcomes, side effects, etc. Those with lower risk PCa will many times have better outcomes with their tx decisions (whatever the tx is)than those with higher risk PCa. And some tx options just may not be well-suited for higher risk PCa. sorry to sound like the nag that I am, but please, do your homework!
mrs pjd

You make very good points.
You make very good points. So many just hear the 'c' word and then do not perform the research and go with what a doc might tell them. I'm not sure if there are other cancers where the patient can decide their options! Then all those choices! That is why I READ, READ, READ and did my homework! My doc told me I was borderline aggressive. Since I had about a 3 month wait to get into Vanderbilt I spent that time wisely. That way I knew I had covered all my bases and could not go back and think 'boy I wonder if I should have done that one'. Yes I have a positive margin and the cancer may return but right now I'm pulling 0's on my PSA, using 0 pads and having fun in the bedroom with the wife and a little pill called Levitra.

For me as others I had the prostate removed and know right where I stand. A gleason 7 at 3+4 post pathology. Also they saw some 'type 5 cell's' in the path report so Glad those BEASTS Are gone.

PLEASE CONTINUE TO NAG away!!!!

Larry

mrspjd

lewvino said:

You make very good points.
You make very good points. So many just hear the 'c' word and then do not perform the research and go with what a doc might tell them. I'm not sure if there are other cancers where the patient can decide their options! Then all those choices! That is why I READ, READ, READ and did my homework! My doc told me I was borderline aggressive. Since I had about a 3 month wait to get into Vanderbilt I spent that time wisely. That way I knew I had covered all my bases and could not go back and think 'boy I wonder if I should have done that one'. Yes I have a positive margin and the cancer may return but right now I'm pulling 0's on my PSA, using 0 pads and having fun in the bedroom with the wife and a little pill called Levitra.

For me as others I had the prostate removed and know right where I stand. A gleason 7 at 3+4 post pathology. Also they saw some 'type 5 cell's' in the path report so Glad those BEASTS Are gone.

PLEASE CONTINUE TO NAG away!!!!

Larry

constructive nagging?
wow, now I think I have some official permission to nag...how nice!! thank you, however not so sure pjd will go along with all that nagging, so guess some of you guys are willing to tolerate it from me, but in doing so, hope you know you are helping out pjd!! we both thank you!

bdhilton

lewvino said:

You make very good points.
You make very good points. So many just hear the 'c' word and then do not perform the research and go with what a doc might tell them. I'm not sure if there are other cancers where the patient can decide their options! Then all those choices! That is why I READ, READ, READ and did my homework! My doc told me I was borderline aggressive. Since I had about a 3 month wait to get into Vanderbilt I spent that time wisely. That way I knew I had covered all my bases and could not go back and think 'boy I wonder if I should have done that one'. Yes I have a positive margin and the cancer may return but right now I'm pulling 0's on my PSA, using 0 pads and having fun in the bedroom with the wife and a little pill called Levitra.

For me as others I had the prostate removed and know right where I stand. A gleason 7 at 3+4 post pathology. Also they saw some 'type 5 cell's' in the path report so Glad those BEASTS Are gone.

PLEASE CONTINUE TO NAG away!!!!

Larry

As you Larry, I know exactly
As you Larry, I know exactly where I stand from surgery from the pathology report (pre surgery clinical I was “golden”). ... My pathology report says I have a right positive margin and had right seminal vesicle invasion, 4+3=7 pattern but all of this has been cut out…My PSA readings say ZERO 8 weeks post surgery…

I have been dry from day one and have been able to have sex with full erections 12 days after surgery (injection therapy+ daily Cialis 5mg)…I am happy to take it where I can and enjoy each day…

griff 1

Trew said:

Larry, then this article
Larry, then this article reinforces your sense of confidence in your decision for surgery. I am always dhappy for those who have positive outcomes. If I could go back and do this whole process over, and IF surgery was a must, I now believe I would choose U of Mich.

surgery
i am new to the board, i am to have surgery on the 23rd of june to have my prostate taken out. i choose the da vinci procedure as the best route for me from everything i,ve read. it has good stats if you have a good doctor, any comments. thanks griff 1

griff 1

Trew said:

Good point, Mrspjd. I was a
Good point, Mrspjd. I was a T4- main cancer was up close to the bladerneck and spread. No chance important nerves on one side could be saved. A guy with a T2 or even a T3 might very well get out of surgery with all important nerves saved. So for me, quality of life is going to be deminished compared to someone with a lower T rating.

I don't care, I keep thinking maybe if I had used a "better" doctor....

However, the new doctor yesterday indicated in our discussion that those nerves on one side could not have been saved. Too much cancer involvement on that one side.

I need to read more of the article. I may very well have U of Mich do the AUS if I chose to go that way.

good point
trew, dod you not like your doctor?