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    Old 07-29-2020, 08:42 PM   #16
    ASAdvocate
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    Re: Decisions

    I have yet to read any study that showed that surgery could match the non-recurrence rates of the two advanced types of radiation, SBRT/Cyberknife and proton beam therapy. Not even close.

    If you have not researched those options, I suggest that you should.

     
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    Old 07-29-2020, 09:12 PM   #17
    Southsider170
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    Re: Decisions

    Quote:
    Originally Posted by ASAdvocate View Post
    I have yet to read any study that showed that surgery could match the non-recurrence rates of the two advanced types of radiation, SBRT/Cyberknife and proton beam therapy. Not even close.

    If you have not researched those options, I suggest that you should.

    I was told years ago, that a course of radiation to the prostate increases the chances of colon/rectal cancer enough that screening colonoscopies are recommended every 5 years instead of 10 for the general public.

     
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    Old 07-30-2020, 12:43 AM   #18
    guitarhillbilly
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    Re: Decisions

    Why go thru the trauma of RP surgery and then have to go thru RT trauma at a later date? Skip the surgery and go straight to the radiation trauma.
    The PCa can return with either procedure so it made sense to me to bypass the RP surgery.
    I actually Briefly considered RP until UR told me the PCa could return after prostate removal and still would be faced with Radiation.
    There are risks and side effects with radiation just as there are risks and side effects with Surgery.I'm already on a 5 year schedule for colonoscopy due to polyps on the last one.
    Each individual has to choose which path and risks they are willing to accept.
    In physics we don't get something for nothing as there are always trade offs.

    Airshow pilots trade altitude for airspeed and airspeed for altitude.
    Always dealing with a trade off including prostate treatments.
    __________________
    T2a / Gleason Score 8 / PSA at Diagnosis 6.9 /
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    Old 07-30-2020, 01:37 AM   #19
    Prostatefree
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    Re: Decisions

    At 63, choosing surgery was an easy choice. If I had been 73, radiation would have been the easier choice. For me, that 10 years makes all the difference if I'm planning the next 25 years or 15.

    Its hard for me to argue against surgery when I had a successful experience. I'm sure I'd think differently if things had not gone well.

    On the point, why surgery if you are going to end up also with radiation? Early detection. If you miss early detection nothing is easy.

    ADT is what I'm working to avoid. It's the last defense.

     
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    Old 07-30-2020, 05:34 AM   #20
    Terry G
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    Re: Decisions

    @Southsider...When I was researching my options I too was cautioned that radiation can cause other cancers as well as reduce my options down the road if I had a recurrence. I found both had bits of truth; however, both were almost none significant. Every treatment including active surveillance carries the risk of side effects.

    I found it difficult quantifying the exact secondary cancer risk for RT. What I was able to determine was that risk was very small. Since those cancers can take many years to develop the numbers reflect older less sophisticated radiation technology. Even so the numbers were very small and no higher than a couple percent. Today’s treatments are most likely on the order of less than one percent. If someone has a reference that better quantifies this risk I would appreciate them sharing it.
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    TRUS 1/17
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    DOB 7/21/47; good health; age 69 @ Dx
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    Old 08-02-2020, 05:04 AM   #21
    IADT3since2000
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    Re: Decisions

    References for The Extremely Low Risk of Secondary Cancers Due to Radiation for Prostate Cancer

    Hi Terry,

    You wrote:
    Quote:
    Originally Posted by Terry G View Post
    @Southsider...When I was researching my options I too was cautioned that radiation can cause other cancers as well as reduce my options down the road if I had a recurrence. I found both had bits of truth; however, both were almost none significant. Every treatment including active surveillance carries the risk of side effects.

    I found it difficult quantifying the exact secondary cancer risk for RT. What I was able to determine was that risk was very small. Since those cancers can take many years to develop the numbers reflect older less sophisticated radiation technology. Even so the numbers were very small and no higher than a couple percent. Today’s treatments are most likely on the order of less than one percent. If someone has a reference that better quantifies this risk I would appreciate them sharing it.
    I suppose most of us wonder about the risk of secondary cancers if we choose radiation. I know I did. Based on what I see in patient forums, including this one, I believe that many men overestimate this risk; perhaps this is a main reason why some still think that radiation should be reserved for older men, which is counter to what research indicates for modern radiation: ages should not be a factor in the choice.

    Like you, I was told the risk of secondary cancer was very low, but I was unable to find specific direct references before I had radiation. I finally did find some.

    Here’s what Dr. Jeffrey Turner, MD, has to say about it. He is a medical oncologist practicing in partnership with Dr. Mark Scholz, MD, the primary author of “The Key to Prostate Cancer.” Dr. Turner writes in that book, in a section entitled “Risk of Secondary Malignancy from Radiation,” in Chapter 46, “Health Issues for Men with Prostate Cancer,” pp. 373-374: “The risk of secondary malignancy, in a worst case scenario, is about 1 in 300. However, many studies have reported that the risk is far lower, probably negligible. The risk is probably higher with older radiation techniques such as 3D conformal radiation. Patients who have had seed implants probably have the lowest risk.” He goes on to mention monitoring methods. (I was advised to have occasional rectal exams, which I get when I have colonoscopies, approximately every five years, and stool samples are also useful. Dr. Turner notes that blood in urine and stool, though it can indicate a cancer, can be a side effect of radiation that does not stem from cancer. He suspects that too much attention is given to blood in the stool or urine as an indicator of secondary cancer.)

    Dr. Turner provides a reference for only one of the studies to which he alludes: F. Suriano, “Bladder cancer after radiotherapy for prostate cancer”. An abstract and link to a free copy of the complete study is available at https://pubmed.ncbi.nlm.nih.gov/24223022/ . However, if you go to that site, you will see a short list of “Similar Articles.” If you click on the link to ”See all similar articles”, you get a list of 63 other papers, some of which look highly relevant, and all with hypertext links to abstracts, and likely some with free links to the complete papers.

    I wish I had known of this research when I was deciding to have radiation. It would have eliminated one small but nagging concern.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured. (Current T 99 6/5/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    Old 08-02-2020, 07:11 AM   #22
    Terry G
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    Re: Decisions

    Jim, Thanks for the ‘risk’ information. Numbers that low are hard to quantify. Sort of like the < on PSA.

     
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    Old 08-02-2020, 09:19 AM   #23
    Southsider170
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    Re: Decisions

    Quote:
    Originally Posted by Terry G View Post
    @Southsider...When I was researching my options I too was cautioned that radiation can cause other cancers as well as reduce my options down the road if I had a recurrence. I found both had bits of truth; however, both were almost none significant. Every treatment including active surveillance carries the risk of side effects.

    I found it difficult quantifying the exact secondary cancer risk for RT. What I was able to determine was that risk was very small. Since those cancers can take many years to develop the numbers reflect older less sophisticated radiation technology. Even so the numbers were very small and no higher than a couple percent. Today’s treatments are most likely on the order of less than one percent. If someone has a reference that better quantifies this risk I would appreciate them sharing it.

    So after you received your radiation, your primary care doctors haven't recommended ramping up screening for colon/rectal cancer? Very good, as I had heard otherwise, although that was a number of years ago.

     
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    Old 08-02-2020, 09:24 AM   #24
    Southsider170
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    Re: Decisions

    Quote:
    Originally Posted by Prostatefree View Post
    At 63, choosing surgery was an easy choice. If I had been 73, radiation would have been the easier choice. For me, that 10 years makes all the difference if I'm planning the next 25 years or 15.

    Its hard for me to argue against surgery when I had a successful experience. I'm sure I'd think differently if things had not gone well.

    On the point, why surgery if you are going to end up also with radiation? Early detection. If you miss early detection nothing is easy.

    ADT is what I'm working to avoid. It's the last defense.

    Hormone therapy isn't the last defense at all. New kinds of chemotherapy and immunotherapy are being used too, you know.

    I'm glad that prostatectomy worked out well for you. However, everyone has a different disease profile, as well as a different set of co-morbidities and other circumstances. Its an individual decision, and one without the same answer for everyone.

     
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    Old 08-02-2020, 02:10 PM   #25
    Terry G
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    Re: Decisions

    @Southsider...Right now my PCP and the GI Dr. who did my last colonoscopy have me in the middle of a ten year pattern for colonoscopy. You make a good point and I’ll ask Tendulcar what he recommends on my 6 Mo. follow up in month or so. We have UPMC For Life as our insurance and they have my wife an I on the Cologuard Screening schedule as well. Thanks...Terry.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3

     
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    Old 08-03-2020, 05:30 AM   #26
    Prostatefree
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    Re: Decisions

    Quote:
    Originally Posted by ASAdvocate View Post
    I have yet to read any study that showed that surgery could match the non-recurrence rates of the two advanced types of radiation, SBRT/Cyberknife and proton beam therapy. Not even close.

    If you have not researched those options, I suggest that you should.
    What do studies say about the highest effective "cure" rate? My understanding is the combination of surgery and follow up radiation is the most effective of the treatment strategies.

     
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    Old 08-03-2020, 05:59 AM   #27
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    Re: Decisions

    Quote:
    Originally Posted by Prostatefree View Post
    What do studies say about the highest effective "cure" rate? My understanding is the combination of surgery and follow up radiation is the most effective of the treatment strategies.
    I was referring to monotherapies. The recurrence rate for a Gleason(3+4) is about 17 percent after surgery; but 8 percent or less for both SBRT and Protons. Recurrence with Gleason(4+3) is about 35 percent for surgery; and half of that for SBRT and PBT.

    Adjuvant and salvage therapies are another dimension, and cumulative side effects become more important. Since I generally respond to threads from newly diagnosed men, I haven't really researched salvage treatment statistics. Others can add their knowledge here. I do know that both SBRT and also PBT are now being used for radio-recurrent salvage treatment. Don't know how those will compare with RP and SRT.
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    Old 08-04-2020, 02:18 AM   #28
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    Re: Decisions

    Quote:
    Originally Posted by ASAdvocate View Post
    I was referring to monotherapies. The recurrence rate for a Gleason(3+4) is about 17 percent after surgery; but 8 percent or less for both SBRT and Protons. Recurrence with Gleason(4+3) is about 35 percent for surgery; and half of that for SBRT and PBT.

    Adjuvant and salvage therapies are another dimension, and cumulative side effects become more important. Since I generally respond to threads from newly diagnosed men, I haven't really researched salvage treatment statistics. Others can add their knowledge here. I do know that both SBRT and also PBT are now being used for radio-recurrent salvage treatment. Don't know how those will compare with RP and SRT.
    Are the studies you refer to for radiation 5 year studies? History shows us recurrence after surgery can often occur after 5 years. What do we know about recurrence for radiation after 5 years?

    I thought side effects after radiation also take longer to develop, and may put them outside the range of a 5 year study. I'm not talking about the risk of secondary cancer, but the more common side effects of incontinence and sexual function.

    It may be important to young men to consider long term strategies. And, side effects in younger men are less severe in the treatment considerations for both surgery and radiation. Maybe more so with surgery.

    Never hurts to repeat, the best outcomes regardless of the treatment choice begin with early detection.

     
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    Old 08-04-2020, 04:59 AM   #29
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    Re: Decisions

    Quote:
    Originally Posted by Southsider170 View Post
    Hormone therapy isn't the last defense at all. New kinds of chemotherapy and immunotherapy are being used too, you know.

    I'm glad that prostatectomy worked out well for you. However, everyone has a different disease profile, as well as a different set of co-morbidities and other circumstances. Its an individual decision, and one without the same answer for everyone.
    It is my understanding chemotherapy is a last effort for cancer, and not as effective against prostate cancer as other cancers. At best, it buys some final time with very harsh side effects. Immunotherapy is in its infancy.

    You are an example of long term survival on ADT. There is no comparison to your experience with ADT and those for whom ADT is failing and their only recourse is chemotherapy.

    Declaring to young newbies chemotherapy and immunotherapy are effective long term treatment strategies comparable to surgery, radiation, and ADT is misleading, imo.

     
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    Old 08-04-2020, 07:24 AM   #30
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    Re: Decisions

    Quote:
    Originally Posted by Prostatefree View Post
    Are the studies you refer to for radiation 5 year studies? History shows us recurrence after surgery can often occur after 5 years. What do we know about recurrence for radiation after 5 years?

    I thought side effects after radiation also take longer to develop, and may put them outside the range of a 5 year study. I'm not talking about the risk of secondary cancer, but the more common side effects of incontinence and sexual function.

    It may be important to young men to consider long term strategies. And, side effects in younger men are less severe in the treatment considerations for both surgery and radiation. Maybe more so with surgery.

    Never hurts to repeat, the best outcomes regardless of the treatment choice begin with early detection.
    SBRT has really only been available since about 2005. PBT, outside of Loma Linda, only had a handful of prostate cancer cases until the huge increase in building new centers in the past few years. So, there are a few ten year statistics on both therapies, mostly from a small number of institutions. They look very good for non-recurrence, with what I cited previously.

    The problems with ED seem to be the same for RP and RT after 3-5 years. But, I never hear of RT guys doing injections or having implants. Maybe pills are all they need? Incontinence is not significant with RT.

    As always, I totally agree with your position on detection.
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