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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[COLOR="DarkGreen"]Hi ronnald,

Welcome to the Board! :wave:

Baptista has covered many important points. I'll add a few thoughts in green.[/COLOR]

[QUOTE=ronnald;4824232]A close friend of mine was diagnoses with prostate cancer a month ago. He is 45 and his PSA at time of diagnosis was 3.0 and his GS was 3+4.[/QUOTE]

[COLOR="darkgreen"]The Gleason score is critical for good decision making. If the original score was done by a general pathologist who does not specialize in prostate cancer, the pathology samples need to be reviewed by an expert. Also, it would be important to know how many biopsy cores were taken, how many were posititive, the extent of cancer in each positive core, and the percentage of Gleason grade 4 cancer found.[/COLOR]

[QUOTE] He is considering proton beam treatment, but has not excluded other treatments either. His treatment center of choice would be Loma Linda. He's in good shape and overall healthy. Obviously his first priority is longevity with the fewest side effects as possible. Doing some research for him, what are the stats for proton beam regarding "cure" rate? How about the other therapy such as brachy? He has told me that he will eliminate photon radiation due to the reasoning that if he was to be treated with radiation he might as well go with proton. Surgery, he has indicated to me is lower on his list due to the numerous side effects.[/QUOTE]

[COLOR="darkgreen"]A group of experts in prostate cancer known as the Prostate Cancer Results Study Group (PCRSG) created a database of results studies of various treatments that met important criteria they set up. Among other requirements, surgery studies had to be based on the initial Gleason scoring so they could not look better by getting rid of patients whose Gleason scores post-op turned out to be higher, and they set a minimum dose for radiation, thereby eliminating old radiation studies where the dose was much too low. The results are now published informally by the Prostate Cancer Treatment Center. That center in Seattle is known for its expertise in brachytherapy, but I don't see how they could be skewing the results in the database to favor their specialty. However, brachytherapy at centers of excellence does look like the best approach, in general. As Baptista notes, "in general" needs to be tailored to the needs and circumstances of each particular patient. Results are also available in a recent issue of PCRI Insights, the newsletter of the Prostate Cancer Research Institute, a non-profit organization.

Proton alone for an intermediate risk case (the Gleason 3+4=7) does not look that promising compared to other approaches, as you can see from the chart for intermediate risk patients in the PCRSG review. There is some quite long term evidence (at about the fourteen year point for average follow-up) of a seeds plus external beam approach with results in the 80% range (two results, about 89% and about 82%). Studies with shorter follow up also mostly favor the combined seeds plus external beam approach with results in the 90s, with a couple of brachytherapy only studies with results near 100%, and several impressive but shorter term high dose rate brachytherapy studies. These days, hormonal therapy might be added in the mix for a period of time.

As you can see from the charts, results for surgery are simply not competitive with radiation for intermediate risk patients. That said, such patients who really want surgery have a fairly good chance for cure, just not nearly as good as the chances they would have had with well-done radiation.

However, if you look at some of the individual studies (you can see abstracts at www.pubmed.gov, a site we can use on this board because it is Government sponsored; complete papers are sometimes available for free, or they can be obtained at libraries or for a fee), you see something interesting in their results tables. As the years go by, the success lines for surgery patients in studies with high levels of success gradually continue to curve downward, meaning that more patients have cancer recurrence and the recurrences do not stop as the years go by. In sharp contrast, the lines for the radiation studies with high levels of success flat line; in other words, after about five years, there are very few recurrences. Here's a note of hope for the surgery patients: while the recurrences do continue, many of them are mild; some are so mild that no further treatment is needed. Researchers at Johns Hopkins have had papers published about that.[/COLOR]

[QUOTE]He's not very computer literate so I volunteered to so online research for him. I will admit, I'm having a tough time finding studies for proton. 5 year studies don't have much value for a 45 year old patient, I'm looking for 10 years or longer. MSK prostate calculate indicates a high level of confidence that surgery will erraticate the tumor and recurrence, a little lower for photon radiation. But how true are those figures?[/QUOTE]

[COLOR="darkgreen"]Take a look at the PCRSG results. Personally, I would steer away from surgery if I had a Gleason 7 cancer.[/COLOR]

[QUOTE]Can someone help me out here with the information needed for proton and brachy therapy, it is much appreciated. Any personal experience from those treatments would be wonderful too.

:wave:[/QUOTE]

[COLOR="darkgreen"]I hope you get other responses from board participants who have had proton and brachy. An excellent recent book that gives information about those and other options, including great tips on decision making, is "Invasion of the Prostate Snatchers" by Ralph Blum and Dr. Mark Scholz, MD. Another older book, "A Primer on Prostate Cancer - The Empowered Patient's Guide," is still outstanding on staging the cancer and decision making.

Take care,

Jim :wave:[/COLOR]





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