Surgery Found Effective for Patients With Aggressive Prostate Cancer, Study Suggests

mrspjd said:

here's the critical info that was left out
Here's the critical info that was left out of the thread posters article entitled "Surgery Found Effective for Patients With Aggressive Prostate Cancer, Study Suggests"
ScienceDaily (Sep. 27, 2010)

1) the reason the % was higher for RP in advanced stage PCa, was that many in that group required (due to postive margins and rising PSA post RP) & went on to have adjuvant & salvage RT, some w/HT, others, without, thereby increasing the %, but not significantly;

2) by needing both RP AND RT, the toxicity of their side effects from all tx modalities were increased;

3) toxicity of side effect compounded by the RP (especially incontinence & ED) AND RT AND hormones, affected quality of life issues for most who needed the adjuvant tx;

4) that is why Dr Boorjian states "Further studies evaluating the differing impacts of treatments on quality of life and non-cancer mortality are necessary BEFORE we can determine the best approach for patients with aggressive prostate cancer."

If you're going to post studies, please include all the so called "facts." BTW, is this some sort of marathon posting binge of any & all "studies" that seems to hint at supporting RP surgery as best tx for any & all stages of PCa...give me a break...the CSN site was down this am from overload...might it be from obsessive lengthy postings from one very determined poster?

mrspjd said:

# 5 (continued)
I had read the actual study that is summarized in the science magazine article posted in the first/initial thread quite a while ago. Forgot to mention one other reason for RP APPEARING to have better % in tx of advanced PCa (unclear if defined by volume & capsular containment or ECE & locally advanced--assuming non-mets???):
5) the methods used for RT as PCa tx between 1988-2004 were not as effective in treating PCa as are the IMRT/IGRT (Intensity Modulated/Image Guided) & SBRT modalities used today. External beam (EBRT), used in the original study was, at the time, hit or miss, with high side effect toxicity common. Today EBRT has evolved and is evolving into equipment that is better able to accurately distribute rad dosing to critical areas. In addition to the prostate, prostate bed, seminal vesicles and nodes can be targeted by imaging systems used today to tx most T3 locally advanced PCa. These newer guidance/tracking and dosing systems have made RT, especially when combined with HT, an effective and successful tx for intermediate risk locally advanced PCa, without the add'l potential side effects of RP, and with comparable life expectancy and PCa free survival as RP alone.

Kongo said:

Good Points
mrspjd:

Good points. In addition to the advances in radiation treatment after the timeframe of this study, surgery has also seen technological improvements in the form of robotic assist in the removal of the prostate. Given the time frame, the study obviously does not address the difference between robotic and open, but if I were to chose surgery for an advanced prostate cancer diagnosis I think I would go the open route because there is probably a good chance that the surgeon would also need to remove the nerves and perhaps the seminal vesicles as well.

My personal opinion is that a T3 or later diagnosis is strongly indicative that there are tumors outside the prostate, at least in the margins, and perhaps elsewhere as well. In such a situation I don't understand the reasoning behind removing the prostate. Sure, you will get the source but the strong possibility is that the surgeon is going to be cutting across margins and may well end up taking your nerves and who knows how much around the bladder connections...so the risk of adverse side effects goes up. Since prostate cancer grows much faster outside the prostate than within the prostate, it seems to me that the area of concern would be addressing the cancer that has moved out, not what may still be inside the prostate.

Even the surgeons I consulted with were all in agreement that if there was evidence that the cancer had moved outside the prostate, surgery was not a good option.

Early in my research when I was considering surgery I read about a procedure where nerves from the ankle are removed and grafted to replace those damaged or removed during RP. I haven't seen any posts by anyone who had that done. Since the nerve sparing procedures we all hear about involve trying to save nerves that are about the size of a human hair, I can easily understand how easily they could be damaged in the surgical process and perhaps if they were transplanted from another source it would be easier since the "nerve sparing" techniques that Dr. Walsh pioneered is difficult to perform and has varying degrees of success.