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The relevant entries about surgery, clearly make the point that surgery was at one time regarded – erroneously - as the best method of dealing with prostate cancer, but with failure rates up to 80% and surgery commonly leaving cells behind causing spread to the bloodstream it seems to be pretty poor choice. Here are the extracts from the page for ease of reference.
Surgery: The old “Gold Standard." Previously perceived as best method to eradicate any cancer. Misconception of guarantee that all cancer is gone. Many, however 40 – 80% of cases found to have more cancer after surgery is completed, requiring additional treatment. Pierorazio PM, et al, "Long-term Survival After [RP]...", Urology 2010 Mar 27, shows an 80% failure rate with high risk patients
Radical Prostatectomy: Surgical removal of bulk of the gland by incisions either retropubic or perineal. Physically removes the tumor from the body. (A psychological benefit.) Most aggressive surgery to be performed on the patient’s body but least aggressive treatment to the cancer. Commonly leaves microscopic tumor cells behind, may spread cancer cells to blood stream. Results have been reported for many years, as this was the only treatment for decades. Moul, J Urol,Vol 163, 2000 “30,000 men per year will develop recurrence after radical prostatectomy.”
Robotic “da Vinci” Laparoscopic: Uses “sophisticated” robotic equipment to remove gland tissue through small openings in the abdomen. Possibly easier to tolerate than major open surgery. Still surgery with similar outcome and side effects of open surgical procedure. Success very dependent on operator’s level of experience. Recent studies report a 3-fold failure rate at only 6 months, with increased complications compared with standard prostatectomy. Blute, J Clin Onc, (Mayo Clinic, Rochester MN) Vol 28, No 14, 2008 “patients have been led to believe ..outcomes are better, but is not the case.” Just another way to extract the prostate.
What about radiation therapies then, or the newer ones like Cryotherapy or HIFU (High Intensity Focused Ultrasound). Not so good – here are some extracts:
Cryotherapy: Cryosurgery: Cryoablation: As primary treatment, uses the process of freezing and thawing to destroy cancer cells. No cutting; performed on outpatient basis. Recent methods reduce risk of rectal injury. Can be repeated. Highest risk of permanent erectile dysfunction; some risk of incontinence, rectal fistula, and urethral sloughing. Cancers return and are frequently more aggressive after recurrence. Not recommended for cases where cancer is known or suspected to have spread beyond the prostate. Very few studies. Despite dating back to the 80s, there is still a lack of long-term data on cryosurgery. Long JP, Bahn D, Lee F "Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cyrosurgical ablation of the prostate." Urol 57:518-523, 2001
Proton Therapy: Uses Proton beams to kill cancer cells. Non-invasive, excellent treatment for tiny tumors of the eyes/brain. However advantages become disadvantages when treating large areas, i.e. prostate plus margins and lymph nodes. Risks of radiation “scatter,” not effective for targeting large areas (such as the prostate), a likely risk of secondary tumors from proton by-product – neutrons. Unable to adjust targeting to account for organ motion; unproven, expensive, limited availability No studies longer than 10 years and most are devoted to protons combined with photons. Hall, IJ, et al "Intensity modulated radiation therapy, protons, and the risk of second cancers," IJ Rad Onc Biol Physics, Vol 65 No 1, 2006 "When compared to photons, a 10-fold increased total body dose is delivered to the patients by neutrons."
Cyberknife® : Fancy name, actually a method of external radiation therapy. This involves what is known as “hypo-fractionated” dose delivery (fewer sessions but higher doses of radiation). Treatment usually delivered in only 5 fractions (treatment sessions). All extreme radiation hypofractionated studies to date reveal a high risk of significant complications including high incidence of urethral/rectal fistula, bladder damage, ulcerations, bone necrosis. No long-term results published (should be reserved for non-curative cases; patients who will not live long enough to suffer harsh complications). King CR, et al Stanford Univ.Sch of Med, "Stereotactic body radiotherapy for localized prostate cancer: interim results of a prospective phase II clinical trial," Int J Rad Onc Biol & Physics, 2009 Mar 15; 73(4): 1043-1048.
And on and the page goes dismissing therapy after therapy, so what’s a man do do?
Why! Buy New Improved DART!! DART now with 4D IG-IMRT. True Dynamic Adaptive Radiation Therapy made possible only by numerous components of 4D image-guided intensity modulated radiotherapy (4D IG-IMRT)
New improved DART provides the most exquisite control of photon beams through SonArray, respiratory gating, cone beam helical tomography, on-board imaging and the "exact couch" functions.
Where can I get New Improved DART? This new level of technology in its most advanced "true" state is currently available at only one center - Dattoli Cancer Center.
Where can I see the long term results of New Improved DART? Evolutionary – in process, since 2008 (yet already “time-tested” since this is a dramatic improvement upon previous successful technology). There is a study, authored by our very own Dr Dattoli and Nurse Practitioner Cash, published in the prestigious Journal of Radiology Nursing – see Cash, J; Dattoli, M et al Radiology Nursing, vol 28, # 3; 87-95; Combined Modality Treatment for Prostate Cancer with Dynamic Adaptive Radiation Therapy. 2009
Are the options fairly presented to help a newly diagnosed man to decide what his best option might be? Or is this a marketing ploy focussing on the negatives for all but one therapy, a therapy that apparently does not have a long history or any independently published studies in peer reviewed journals? Is it fair that medical people who we should trust advertise like this?
I am told that I am naive and that's the way it is. I think it is a sad indictment of how the system works.
Re: Marketing of prostate cancer therapies – what is fair comment?
Terry,
It's a sad state of affairs when doctors are 'marketing' treatments to build their business rather than focusing on treating patients. I drive by a big billboard every day showing cyberknife as a miraculous treatment for prostate cancer. There's so much misrepresentation of prostate cancer and it's treatments - sometime for profit motives and other times just due to ignorance.
Re: Marketing of prostate cancer therapies – what is fair comment?
Check out online free reading of the Paact Newsletters (tab newsletters, June edition..pdf file)
Article written by Dr. Dattoli name URORAD...lovely story of how some urologists circumvent the Stark Laws and corner the market on patients, by owning their own self referred radiological enterprise, happening alot he claims. A company in Texas he mentions, sells prospective uro-docs the equipment and marketing things, and legally all you need is an assigned radiologist (generalist type), don't have to be board certified in this marketing.
Smell that going on, I pity the guys whom get a lousy radiation job or damaged from such, but making those dollars is paramount. Enjoy marketing in all aspects of PCa, it is not pretty.
Re: Marketing of prostate cancer therapies – what is fair comment?
Guess who does Dr Dattoli's path work? Why....."We have a comprehensive laboratory in our clinic...
Talk about the pot calling the kettle black!
It is also Dr Dattoli's Marketing Director who says:
Studies indicate that the younger a man is when diagnosed, the higher the chances are of his cancer being aggressive.
but who cannot supply references to these studies when asked - studies that cannot be found by anyone else, apparently and which contradict all other data that show that this statement is simply wrong.
It may be that the therapy being marketed vigorously by Dr Dattoli and his Marketing Director, which is labelled DART (Dynamic Adaptive RadioTherapy) is, as he claims, the best therapy for prostate cancer. I do not have the technical ability to make a judgement call on that. But then, neither can anyone else because there is no pubished data for this therapy - just the assurances that it is 'the best'.
All the best
Terry in Australia
PS - Did you look through the rest of that publication, Bob? Fame at last for me - but I'm not selling anything - just trying to give away knowledge:-)That's the PAACT JUNE 2011 NEWSLETTER - a large pdf file.
