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A new study . . .

Swingshiftworker
Posts: 1013
Joined: Mar 2010

A new 10 year study conducted in England reports that 99% of the men who were randomly assigned surgery, radiation and active survellience in order to "treat" their early stage prostate cancer survived a mediam (not average) of 10 years beyond diagnosis.

However, it is also noted that men who were assigned AS experienced a greater risk of the cancer speading, those where were assigned surgery had a greater risk of incontinence and those assigned radiation had a greater risk of bowel probems. It's also said that both surgery and radiation caused ED but I suspect that given the duration of the study that a more earlier form of radiation was used (pre-CK).  Had CK been used I doubt that few if any of the men in the study who received radiation would have experienced any side effects whatsoever.

 

See:

https://www.washingtonpost.com/news/to-your-health/wp/2016/09/14/almost-all-men-with-early-prostate-cancer-survive-10-years-regardless-of-treatment/#comments

https://consumer.healthday.com/cancer-information-5/prostate-cancer-news-106/prostate-cancer-treatments-the-good-and-the-bad-714863.html

 

While interesting, I think the study misses the point in focusing on survivability because I think we (as patients) have long known based on our own research that there is very little difference in the mortality or survivability statistics between these methods AND that the important decision for most men at this time is really the question of which method will provide a cure with the best possible quality of life. 

Speaking only of early stage PCa (Gleason 6), I think there is no doubt based on the current technology that radiation (specifically, CK) offers the best possibiliity of a cure without any debilitating side effects.  Surgery remains the most risky in terms of ED and incontience.  AS is just a crap shoot and, while you can go many years w/o the cancer ever growing/spreading, you have to remain ever vigilant (as H&O has been) and have to always be ready to make an ultimate choice between surgery of radiation to treat the cancer if it starts to grow larger.

 

 

 

hopeful and opt...
Posts: 2224
Joined: Apr 2009

http://www.cancernetwork.com/prostate-cancer/sbrt-prostate-cancer-may-result-more-complications

...................

AS a "crap shoot" ?

Studies have shown that men who are monitored with AS can seek the same treatment that they might have when they were diagnosed, if the cancer progresses. Additionally other studies have shown that  a very  large number of men die with the disease, not because of it.

Additionally, during the last 10 years , not only has technology improved for radiation, as you mentioned, but also for other main stream methods of treatment to include, but not limited to Active Surveillance,

 

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

Hopeful,

I have not yet read your link, but I was reading about two months ago somewhere (and I apologize, but I cannot recall where) that a major,  multidecade review had begun to determine whether SBRT very long term (i.e., more than ten years out) engenders more subsequent cancers than does EBRT.  The thesis was that because the radiation in SBRT is delivered so fast, in such heavy Gray, that it should intuitively cause greater tissue damage.  The abstract conceded that short term (within the first decade or more following SBRT) this greater risk is NOT yet established, and in fact might not exist.

If anyone here is familiar with this proposed study, I would appreciate the link. I apologize before hand if your link  (Hopeful) is in fact what I am looking for !

I am not a "proponent" or "opponent" of any form of PCa treatment myself, but enjoy studying oncology journals generally.  There are some cases where the treatment chosen by a writer does not, to an outsider, seem clinically reasonable, with no, or poor, prognosis for success.  But we are not oncologists, and in even the most well-related test results, seldom or never do we have every piece of information that is guiding a patient's doctors. 

I have a friend whom I have discussed with Hopeful via e-mail. About ten years since his diagnosis at about 62 years iof age, his tumors have spontaneously shrunk, and his PSA has reduced, while in A/S. It has been wonderful for him, even if his history is rare or peculiar.

Good health to all,

max

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

I laughed on the exchanged Crap Shooting affair. I pair Hopeful in his answer to Swing's comment. In any case I agree with Swing that we all should look for the best method that provides a cure with the best possible quality of life. The problem is that cure does not depend only on the Gleason grade found in each case but on the extent of the disease. Stage IV patients may see it ambiguous and if one prioritizes the quality of life over cure then even low risk patients would chose to do nothing. All treatments have risks and attached side effects that one should consider before any engagement. In this respect, AS may be the best balanced approach to deal with PCa.
Overall, this is what the study (subject of this thread) manages to figure out; In early stage prostate cancer cases, patients lived a medium of 10 years. Most probably, the ones from RP and those from RT had lesser quality of life than those on AS in terms of incontinence, bowel problems and ED.

Regarding the modalities in radiation treatment pointed out by Max, in my view, SBRT seems to provide higher probability in killing cancer because it damages cells DNA at once. IMRT also assures the kill but it depends on the time RT is delivered in regards to cell's life cycle (duplication), so that the section is repeated to try catching the best timing of cell's division. Both ways may engender subsequent cancers (damaged cells that managed to survive and duplicate) but low doses of Gy (IMRT type) assure faster recovery (repair of side effects) because of lesser number of damaged cells in the line of the rays. These will continue to duplicate and assume its fuctions providing recovery of affected parts.

This may be the link you requested: http://www.tucc.com/SBRT-Cyberknife-for-prostate-cancer-may-result-in-more-complications.29.564.html

Still laughing.

VG 

 

GI Joe's picture
GI Joe
Posts: 4
Joined: Oct 2016

I just stumbled across this study last night, and am surprised there hasn't been more discussion of radiation vs surgery side effects. So far, it seems like most of the discussion on most websites has focused on the survivability for treatment vs active surveillance.  I agree that is of interest, and may even have been the main concern of the study.  However, I have been surprised at how few surgery advocates have tried to criticize the study's quality of life findings.  It "seems" to me that mainstream medicine (if there is such a thing) really gravitates to surgery as a treatment for prostate cancer, and really wants to downplay the side effects.  However, an awful lot of anectdotal evidence seems to point to the study's QoL findings, specifically that surgery generally has more side effects than radiation.  I guess what the study did not address is surgery-advocates' assertion that people with a life expectancy much beyond 10yrs will "surely" eventually face trouble from the radiation, even if it takes decades to manifest.

I'd be curious to hear more about this forum's reactions to the QoL findings.  Are the pro-surgery medical professionals just declining to comment, conceding a (small) victory for radiotherapy?  

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

Joe,

My impression is that "quality of life" has no consistent, exact meaning.  For some, it means a post-surgical pathology report that with great precision says exactly what the status of the disease was, something not currently attainable with as much certitude from any form of scanning.  This certitude is of high value to some.  For others, it means no pain or recovery from surgery; for others still, it can mean remaining "natural" (unaltered by surgery or radiation) for as long as possible (essentially, A/S).   Each man has his definition of quality of life.  It can be physical symptoms, emotional, or whatever.

I have had more than one type of cancer, and watched a lot of people die from a variety of cancer types (in the last few years: Two from prostate, one from breast, one from colorectal, and a cousin last week from liver). 

Often, the option is life or death:  Get the one form of treatment available, or die. With leukemia or lymphoma, for instance, the only treatemtnt (past Stage 2) is chemotherapy; there is no radiation or surgical option.  And when the doc says start chemo, he adds "soon."   PCa is unique in having a plethera of treatment choices, many similiar in curative liklihood. 

Few other cancers have these options, such that there is not a "quality of life" discussion to engage in.  You get whatever "quality" is left over, or die.  Combination chemos (numerous chemo drugs mixed together) routinely leave patients with lifelong neuropathy (numb hands and feet), forgetfulness, extreme fatigue, loss of sense of taste, and many other possibilities.  I marvel when I read 70 year old men arguing about ED. What 70 year olds DON'T have ED ?  Aging has lots of "side-effects."

Specifically to your point, that surgical survivors don't seem to "push back" regarding the benefits of surgery. I had DaVinci robotic RP two years ago, but I am not a "surgery guy." I did extensive research, and know that the treatments have pros and cons, and I am not interested in persuading anyone toward anything.  But two years after surgery, I have no ED and no incontinence.  And I have no PSA "bounce" to agonize over.  I have known two men in my area who have been diagnosed since I was, and both chose surgery. Both are doing well.   I actually recommend against surgery with any writer who likely has aggressive or metastatic disease, or any man who is older than around 68-70.  But exceptions to every rule are written about here every day. Bless each man in his choice.

Overall I have consistently had two thoughts that I retain regarding cancer, since first being diagnosed with advanced lymphoma in 2009:

1.  I'd rather have side-effects than have cancer.

2.  What is the 'quality of life' if you are dead ?

 max

 

GI Joe's picture
GI Joe
Posts: 4
Joined: Oct 2016

Max,

Great response, thanks.  In particular, you are right to note how painful and--literally--deadly all cancer has the potential to be, and how deadly most are.  As you noted, there are a number of treatment options that are all similar in their ability to either "cure" prostate cancer or at least offer a person the likelihood of survival well beyond the 10 year mark.  That's not something to be taken lightly.

My interest in this study--and in feedback from people more knowledgeable and experienced than myself--comes from lots of frustration.  I'm frustrated that asking medical professionals what works seems like walking into a Chevy dealer and asking what truck is best: no way you will get an "honest" answer.  You might accidently get a "good" answer, and we can argue about what makes the best truck, but at the end of the day it's unlikely a Chevy dealer will recommend a Ford.  LIkewise, surgeons recommend surgery, etc.  My further frustration comes from what seems a pure reflexive answer from some doctors "surgery."  "Why?" I ask.  "Becuase." They say.  I even discussed reports like the one we are discussing here with my PCP, or the charts on the Prostate Cancer Treatment Research Foundation that suggest (not prove!) that brachytherapy, EBRT, or the two combined are superior to surgery.  He (PCP) shrugs his shoulder and just says "surgery."  No kidding, that was our exchange.  Thus, a non-medical professional like me is left with "internet research" and anecdotal evidence.  The latter--so far in my limited polling--suggests surgery (often) has more, and more significant side effects.  I am glad to hear from people like yourself who have not had such problems, as I still--despite my frustration--lean towards the surgery just becuase so many doctors seem in favor of it.  Further, the surgeon and two urologists I consulted suggested that usually people don't really have any lasting side effects, and if they do, there's a fix.  I know this is true, but many will say that ED meds, shots, etc did not restore erections, and slings and other incontence aids do work--sometimes.  Not always, sometimes.  So, it's hard to trust doctors--in theory, professionals with patient well-being in mind--when it's hard not to feel like you are being fed a line.  

Ok, I'm switching off the rant, now.

At any rate, I find this recent study very interesting, and I'm surprised they haven't sparked more discussion (at least that I can find).  

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

I detected the frustration in your post, but no "rant." Everything you wrote was very reasonable.

I too tend to enjoy reading and researching. It will assist you in this walk.

Keep looking,

max

xNTP
Posts: 34
Joined: Oct 2016

...You might accidently get a "good" answer, and we can argue about what makes the best truck, but at the end of the day it's unlikely a Chevy dealer will recommend a Ford.  LIkewise, surgeons recommend surgery, etc.  My further frustration comes from what seems a pure reflexive answer from some doctors "surgery."

My sentiments, too.   One surgeon I knew growing up, died recently after some years of mental impairment and drifting around a retirement home, following his surgery.  Instant conversion, with apparently a major loss of blood and brain oxygenation during the surgery. 

Old Salt
Posts: 720
Joined: Aug 2014

It was pointed out on another forum (!) that the Active Surveillance (AS) protocol for the study wasn't anything like the current AS protocols used in the USA. Hence, the results with respect to metastasis are useless for current patients.

xNTP
Posts: 34
Joined: Oct 2016

Is there a summary of what you call current AS protocols?  

I'm thinking more about off label chemistry of the mild forms, like metformin.

DanaGB's picture
DanaGB
Posts: 2
Joined: Nov 2016

I highly recommend that all cancer patients do some extensive research. As in most things, "Follow the money" can be enlightening as well as very disturbing.
Big Pharma and the AMA run the game.

At the turn-of-the-century, there were literally hundreds of different methods to deal with illness. Many of them that were "nature-based" involving things like naturopathy, osteopathy, homeopathy, chiropractic, veganism etc. While many of these are still around, they are significantly reduced and marginalized by the conventional medical community. Why you ask? It's all about the money! You cannot patent plants or lifestyles. If you cannot patent it, you cannot prevent other people from using it and thereby lose the ability to control and monopolize their use for your own profit.

Around the 1920s, billionaires like Carnegie and others, owners of huge pharmaceutical companies that dispensed patent medicine like candy and made huge profits, realized that the way to profit from the situation was to demonize anything that they couldn't control. They began this process by "funding" medical schools. Along with that funding came control. You know, the Golden rule? "He with the gold makes the rules." Within a few years, dozens of medical schools and hundreds of alternative medical practices closed their doors or were driven out of business. Mission accomplished... Big Pharma now rules the game. In combination, big Pharma, the AMA and the Insurance companies totally control the delivery of medical care available in the United States and around the world.

If you want proof, just ask your Oncologist about "alternative" treatments to surgery, radiation and chemo. They will usually give you a blank stare because they have no idea what you are talking about and will very quickly parrot the party line taught them in medical school and enforced by the insurance companies and the AMA that alternative treatments, ANY alternative treatment, is pure quackery.

Don't just believe me, try it yourself next time you visit your doctor. Be prepared to be floored and totally incredulous that a highly skilled professional is so totally blind to alternatives. Medical schools DO NOT teach nutrition or any other alternative therapy. If they cannot charge you for a clearly poisonous drug provided by their mentors big Pharma they don't want to hear about it.

And you do know that they are killing you don't you? The radiation destroys your body and the chemo destroys your immune system. You are already deathly ill from the cancer and they give you flipping poison! How intelligent and enlightened is that? Wake up people, do your research. There is hope and it DOES NOT lie in conventional medical treatment. You will rarely hear a doctor mention the word "cure" because it is a dirty word in the medical community. Curing things means the end of cash flow. Treating things can be unending and an amazing source of continuing income.

shipjim's picture
shipjim
Posts: 137
Joined: Apr 2006

Whether the treatment causes ED or not, you're on the green side of the grass.  I've seen so many men bemoan the ED or potential as ruining their life.

Really?  I sex is the prime measurement of your lfe I hope you're like Johhny Wad Holmes otherwise the rest of us probably will be just fine standing on the green.

daytona19
Posts: 54
Joined: Sep 2014

does anyone have experience handling the side effects of taxotere? I have had 2 sessions the side effects are so far:

1) loss of most of my hair.

2) tingling in my toes on both feet. Hopefully that will not go further but it just started with foot 3 days ago and have spread to other one yesterday.

3)sores on both arms and a few on the legs.

4) bloody nose left side only.

5) Dry patches on face.

6) Sore tongue and mouth and food taste funny.

7) tired.

I hope that is it as I have at least 4 more session if it works.

daytona19 

Old Salt
Posts: 720
Joined: Aug 2014

Please start an independent thread; this will bring more eyes to your post. In the meantime, let me state that I am sorry for your problems. I do believe that the nasy side effects you are experiencing are not untypical for taxotere chemotherapy. 

 

PS: If you put 'taxotere' in the search box, you will find other threads. One link is

csn.cancer.org/node/250222

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