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I really don't understand the point of posting these two Abstracts of very small studies involving less than 10 men, but perhaps purelife52 can explain that.
If he, or any one else, wants to post Abstracts of studies, would they please
1. make sure that they are relevant – that is to say they advance the knowledge of men who read them or raise questions for discussion.
2. Edit them so that all extraneous matter is removed before posting
It is well known that salvage surgery is possible after other therapies have failed. What is also known that it may not be the best option for the patient - and these studies seem to reinforce that view. They put me in mind of my dear old Dad who always used to quote the apocryphal surgeon saying I am pleased to say that the operation was successful. Regrettably the patient died.
Just look at the results reported in the first study:
Long-term symptom-free survival was achieved in 2 patients following surgery at 26 and 56 months, respectively. Now for me, that’s an interesting definition of long term survival – a little over 2 years in one case and a little over 4 years in another!
and
One patient died of metastatic disease 3.5 months after surgery but he had been rendered free of local symptoms by surgery. Gee, he must have been happy to have 3.5 months symptom free after the rigours of surgery. I wondered how many of the reported side effects, like Wound infection, delirium and prolonged ileus occurred in 1 patient each. Otherwise surgery was well tolerated. he had to tolerate before he died
And finally:
The other 2 patients are currently free of local symptoms 5 and 7 months following surgery, respectively Gee whiz – 5 and 7 months survival! Getting towards long-term in this study’s definitions.
I'm fairly certain that radiation, a.d.t, and most other treatments for this disease and all others began with small studys. You act like no one dies getting ADt radiation or chemo. Perhaps as we age one tends to get narrow minded and set in there ways. The treatments have been mor or less the same for many many years. To say a different approach is n/g is lame. What if next week a camera dude invents a lens that see's thru scar tissue? Salvage robotic surgery would be easy.
You are quite correct when you say that the development of all forms of treatment – and the way in which they develop and improve – start with experiments on small numbers of people. I have always had admiration for the people who take part in such experiments (as long as they are fully aware of the risks involved) because without such bold volunteers, advancement would be impossible. Such experiments are written up in small studies and, if successful, encourage others to try similar experiments. The small studies you posted seemed to me to be demonstrating the lack of success in salvage surgery where the original treatment was surgery.
I have to confess being puzzled by your statement You act like no one dies getting ADt radiation or chemo. I don’t know if this is addressed to me personally or to others who have responded to your posts. If it is addressed to me, then your statement is absolutely incorrect. My personal belief is that very few men who die from prostate cancer have not been treated: that there is no guarantee of a cure from any treatment: that it is doubtful whether the majority of men gain any real benefit from being treated. I am not saying that there is no benefit from treatment. I am saying (and this is now supported by a number of studies) that the number of men who are treated unnecessarily vastly outweighs the number who benefit from treatment. One such study puts the ratio at about 25:1. But that is my personal belief. What I have tried to do with this website for 10 years now is to try not to let my personal beliefs get in the way of the stated aims of the site:
We want to provide comfort to any man diagnosed with prostate cancer, to offer thoughtful support to him and his family and to help them to decide how best to deal with the diagnosis by providing them with and guiding them to suitable information, being mindful at all times that it is the individual's ultimate choice that the path he decides to follow is his own and that of his family, based on his particular circumstances.
Then you make another puzzling statement:
Perhaps as we age one tends to get narrow minded and set in there ways. The treatments have been mor or less the same for many many years. To say a different approach is n/g is lame.
Again, I assume this is addressed to me. What I find puzzling is that it seems that you are ignorant of the treatments that have been developed over the years, like cryotherapy and focal cryotherapy, HIFU and the significant changes in radiation therapy including proton beam therapy. These newer treatments and variations in older treatments are all set out in the Choices page of the website and there are even references to experimental potential therapies – Photo Dynamic therapy being one, for example, and therapies which were stopped, like PC-Spes. Perhaps I’m not too narrow minded and set in my ways despite the ageing process.
Well said Terry as per usual. I firmly believe that salvage robotic surgery can easily be done on a patient with positive margins and high gleason scores. This should happen on younger otherwise healthy subjects BEFORE the P.S.A. moves up and is still undetectable. If the salvage surgery fails after a few months, and The PSA goes up they can quickly start radiation or hormones etc. as if there never was a 2nd surgery. I asked my surgeon about this and he said that he could do it but the morbidity rate would be to high. I said that I would take that chance. Would it still take 4 hours? But that was then and this is now. If a positive margin causes a rise in PSA after more than 6 months is it still "local" ? p.s. feel free to delete the other 2 posts of mine about the small study's on 4 men.
If a positive margin causes a rise in PSA after more than 6 months is it still "local" ?
This is my take
1. It is not the ‘positive margin’ that causes any PSA rise. Depending on the degree of the PSA increase, the continuity of the increase etc ( all the points covered in PSA 101 ) the PSA might be due to prostate cancer and this might be due the disease having escaped from the gland prior to the surgery.
2. It is simply not possible to put any accurate time frame on the relationship between a rise in PSA and the positive margin in a post-surgical pathology report. It seems that there might be some kind of relationship between positive margins and progression (not all positive margins are associated with progression of the disease) and there might be an association between an early increase in PSA levels and confirmed progression.
3. It is not possible to say whether a PCa associated PSA movement is due to a ‘local’ extension or a systemic condition or a metastasized disease.
It seems to me that you have not yet grasped the fact that there is simply no certainty in any aspect of this disease: not in diagnosis; not in treatment choice; not in treatment outcome: not in the definition of failure: not in the consequences of failure. So no one can answer your multiplicity of questions with any degree of certainty – all they can do is provide their interpretation of what is known.
