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With all due respect, since a fellow YANA member by the name of R Scott had this to say about your January 20th, 2012 post on the subject of proton versus photon: "I feel I must respectfully challenge some of the misinformation that your post on the subject contains", frankly I don't know whether to believe my urologist and my friend’s medical oncologist, or you. So, I will do my own research on the subject, although I have to say that I am in no hurry since I am on AS. Still, I invite you to provide supporting evidence for your claims and I would be perfectly happy to find out that you are right and that the doctors are wrong (particularly since it would expand my options if and when that time comes).
Perhaps you could start by addressing this October 30th, 2010 article on brachytherapy 15 year follow up data which can be found on the following website: prostatecancerinfolink.net/.../15-year-outcomes-after-brachytherapy-...
You said: "There are also options for treatment should Brachy fail, WHICH IS VERY RARE." However, the study figures appear to be in conflict with your statement. Is it because there have been significant improvements in brachytherapy since 1992?
The 15-year biochemical relapse-free survival (BRFS) when broken down by D’Amico risk group classification cohort analysis is
o 85.9 percent for low-risk patients
o 79.9 percent for intermediate-risk patients
o 62.2 percent for high-risk patient
Median time to biochemical failure (in those who failed) was 5.1 years
Note: The above percentages are based upon 215 patients with localized PCa treated between 1988 and 1992 with brachytherapy alone. BRFS was assessed based on use of the Phoenix (nadir + 2 ng/ml) definition.
It goes on to say:
"There is little doubt that the long-term outcomes of patients with localized PCa treated with brachytherapy alone in the modern era are closely comparable (and arguably superior) to the long-term outcomes of similar patients treated with radical prostatectomy. However, in the absence of a carefully controlled trial designed specifically to compare these outcomes, the newly diagnosed patient needs to come to his own decisions about therapy preference — preferably without being subjected to an overdue emphasis on the personal views of advocates for one or the other form of therapy".
"It is the case that in the only prospective trial designed to assess quality of life and satisfaction with outcome after treatment, patients treated with brachytherapy certainly expressed higher satisfaction levels than patients treated surgically in some areas."
Note: It is well worth your time to read this trial. If you would like to do so, go to the webpage and click on the link. Here's a sample of some of the things that you will read:
"Sexual quality of life scores were affected by all forms of therapy, with an average sexual quality of life score of 45 to 55 out of a possible 100 at 2 years after treatment for those who received nerve-sparing surgery, external beam radiotherapy alone, or any form of brachytherapy".
"Brachytherapy patients reported long-lasting urinary, bowel, and sexual symptoms, as well as transient problems with vitality or hormonal function".
This is a much later study of all Brachy published results that shows Brachy for low risk PC is in the mid 90%. It is the Prostate Cancer Study Group that reviewed over 700 published studies on all treatment options and is classified by DiAmico risk class.
I was also referring to local reocurrances as systemic reoccurrances are not elibible for any salvage therapy. There is also a published study by Dattoli on 1400 patients that showed all reoccurrances after seeds/IMRT to be systemic and not local.
Local failures are rare for low risk PC when done by an experienced Brachytherapist. There has been significant improvements in imaging to place the seeds and also the seed templets since 1992.
I attended a prostate group meeting last year at which a local radiologist spoke. After listening to him about the recent advances in Brachy I would now personally go with Brachy vs radical if I had my choice to do at this time. Being in my late 50's I chose radical 4.5 years ago as it had the best long term survival rate at that time. Now apparently the two procedures cure at about the same rate.
I was 46 when I had seed implants. My urologist of course wanted to rip out the prostate, but I balked. After a while he advised that brachy should be fine for my condition. My family doctor just wanted me to do something, and was fine with brachy. I saw 2 radiation oncologists, and both were fine with performing brachy on a 46 year old. I chose the doctor who has performed in excess of 10,000 seed implants, and so far so good, but I am only 8 months post seeding. You can read more here if interested: http://www.yananow.org/display_story.php?id=924
Good luck to you, and take your time making a decision.
The most objective recent series of papers I have found addressing the difficult issue of comparing prostate cancer treatments are those from the Prostate Cancer Results Study Group. A summary of the group's rather rigorous evaluation criteria and results is available at:
It is perhaps unfortunate that the lead on papers from this group has been by Dr. Peter Grimm (Prostate Cancer Treatment Center, Seattle), as too often critics assume a bias towards brachytherapy, Dr. Grimm's specialty. However, the doctors in the study group include nationally recognized surgeons, oncologists, radiologists, and pathologists.
If anyone wants more details than in the web site above, I have PDF files of a 2011 slide presentation (which includes links to over 50 reference studies) and a 2012 paper in the British Journal of Urology, International.
Cheers!
Jon in Nevada
PS- Studies on treatment outcomes are confounded by the fact that any analysis of 10 or 15-year results mean that the technology used now is 10 to 15 years old. We never will be able to get past this limitation in using long-term studies to try and justify a particular 'gold standard' for prostate cancer treatment....
