What’s difficult to determine are his references to “intermediate” prostate cancer - is he referring to 7(3+4) or 7(4+3)?
Also, the data for this retrospective study is as from treatments during 2004-2007. It’s always challenging applying 20-year old data to modern technology. (But, that’s the nature of research.)
...a follow up comment in the very recent PCRI.org video is telling. (In regards to Kaiser data for intermediate stage disease) External beam radiation [ (EBRT) IMRT, SBRT 'Cyberknife' ] is by its very physics a suboptimal dosage. Interstitial radiotherapy ( permanent seeds ) being intra glandular can be much higher and last longer. Europe has increased the use of this form of brachytherapy because it is optimal dosing. The EBERT guidelines even gives a nod to the lower tech lower remunerative permanent seeders by post EBRT 'boost' brachytherapy. Might the reverse seem more reasonable to use the optimal dosage tech first and
maybe boost it later with suboptimal EBRT? There even was a mention of a hybrid approach of 2/3 optimal permanent seed dose followed with a spray of 1/3 EBRT for good measure.
@scottbeammeup If by “intermediate” Gleason score he means 7(3+4), then I would expect no difference. (NCCN guidelines don’t recommend hormone therapy for 3+4.)
However, if by “intermediate” Gleason score they meant 7(4+3), then that would be inconsistent with other studies and with NCCN guidelines.
He never mentions what “intermediate” he’s referring to - favorable or unfavorable. So, there’s no way to know……
That was discouraging to watch. My oncologist said the 5 year remission rate from SBRT+ADT was only 10%. There's a HUGE difference between 10 and 50 percent.
@scottbeammeup I was also initially discouraged when I saw the PCRI video. However, after thinking about it, I realized the PCa radiation patients in this study had their radiation treatments a long time (nearly 20 years) ago.
I think today's PCa radiation technology and the corresponding patient outcomes will be significantly better.
Having completed my SBRT treatment for Gleason 4+3 PCa less than four months ago, improved outcomes are what I'm expecting.
@brianjarvis
As you know there are many types of cancer than prostate. Almost every medical institution that I am familiar with these days will refer those with cancer that are children, have eye cancer, brain cancer, etc. to proton facilities. This include Mayo Jacksonville which does not have proton radiation just photon. Mayo Jacksonville is building a new cancer center which will have proton radiation.
I don't think Mayo and all the research they do would spend the hundreds of millions of dollars to build a new cancer center with proton radiation if proton was not beneficial addition to treating cancer.
Not one of my medical providers told me anything different than this. There is no difference in success rate of radiation treatments from proton and photon. They both have the same success rates. The main difference is photon comes in, hits target, can continues out through body. Proton enters a low dose, releases it's full dose strength at progammed target, and stops.
The below was copied directly from American Cancer Society.
Particle beam radiation therapy. A common type of particle beam radiation therapy is proton therapy. Proton therapy focuses beams of protons on the cancer.
The beams used in proton therapy only travel a certain distance. The radiation beam stops at the tumor and doesn’t go beyond it, so the tissues behind the tumor are exposed to very little radiation.
This is different than the photons (x-rays) used in photon beam radiation therapy, which go through the body and expose tissues to radiation both before and after they hit the tumor.
This echoes what was told to me by my Mayo urologist, Mayo R/O, Mayo PCP, and UFHPTI R/O.
Proton has only been around since about 2006 and very few long ranges studies done comparing both. Many short term studies have been done. What my UFHPTI told me his research (UFHPTI is the institution that got 25 million dollar grant to do a long term study of proton and radiation treatments) was showing the same conclusions that proton and photon success rates are identical.
Where the differ is the side affects and damage to other organs and tissues. The reason (again my UFHPTI R/O when I commented on so many children here) proton is used so much on children is they life span is so much longer than and adult and thus secondary cancers caused by radiation can occur during their life span.
My UFHPTI also told me (he has been doing proton for 20 years) he does not like the high dose radiation as he is seeing sooner and additional side affects. My Mayo PCP who says he stays atop of recent studies stated the information is showing increased issues with side affects of the high dose limited number of days treatments.
My Mayo PCP was the one who stated why years ago he wanted me to continue getting PSA test even though past reocmmendation were for it to be optional. He said Mayo was seeing an increase in stage 4 prostate cancer. They did a study to see what may be causing such an increase and saw that when they changed making PSA optional they could see the shart increase of patient coming is with stage 4. Thus they changed their protocol. This is the real time information and studies I was referring to.
The radiation treatments have greatly changed and improved. Even in the 2.5 years on MCC I have seen new treatments.
I get monthly newsletters from Mayo. They are citing studies now showing great promise for using a type of protein type chemical which only attach to specific prostate cancer cells and keeps them from multiplying and growing, and eventually dying. That will be great news if pans out in clinical trial as it will drastically change prostate cancer treatments.
I won't probably be around when that is offered but hopefully those of us in the future that will get prostate cancer wil not even have to deal with radiation damage.
@jc76 Off topic, but how do you get those monthly newsletters, and are the mailed, or electronic. I"m a Mayo PC patient (proton beam finished 4 months ago), and don't get them.
I wonder what cure rates the institutions in that time period were touting to patients. I am pretty confident in saying that they weren’t even close to suggesting cure rates of only 50%.
I wonder if they will retroactively downgrade current quoted cure rates in a few years too!
For me at least, what was the most disappointing was that PCRI didn’t take enough time explaining that this was from around 2005 and explaining to viewers that current radiation cure rates are in fact likely much better. Also, as they had quite rigorously promoted radiation as a much better alternative to surgery for a number of years now, I thought they may have been a bit more sensitive to the reaction of their many viewers.
@jc76 Off topic, but how do you get those monthly newsletters, and are the mailed, or electronic. I"m a Mayo PC patient (proton beam finished 4 months ago), and don't get them.
@rotate
I am a member of the Legacy Program at Mayo Jacksonville. By being a member you get them free. I really like them as cover many different topics every month. Read a lot about new prostate treatments being developed at Mayo. And a lot of my replies will mention Mayo and that is the source I mention.
I think you have to sign up for them and the process to do that I don't know as have always got them free as became a Legacy member way back in 2006. I am on an upcoming article about heart failure and have a contact for that. I will asked how you get the newsletters without being a Legacy program or featured in a highlight and get back to you.
I think a moderator or Colleen who reads this may know also but will get back to you when I get that information from my newsletter contact. I have a telephone number for her as she interviewed me over the phone. It is 7:00 a.m. here in Jacskonville Forida so will call her when I get back from exercising this morning.
Do you want to post that on this forum or sent you a private message?
@scottbeammeup I was also initially discouraged when I saw the PCRI video. However, after thinking about it, I realized the PCa radiation patients in this study had their radiation treatments a long time (nearly 20 years) ago.
I think today's PCa radiation technology and the corresponding patient outcomes will be significantly better.
Having completed my SBRT treatment for Gleason 4+3 PCa less than four months ago, improved outcomes are what I'm expecting.
@kenk1962 I finished the same treatment as you 18 months ago and finished six months of ADT a year ago. So far, my PSA is at .04 and holding so I feel I'm doing OK. I was just moved from 3 to 6 month PSA testing. It does seem like today's radiation treatments are much more targeted and stronger. At the very least, I'll be helping to provide data about the effectiveness of SBRT over time since there isn't that much yet.
@kenk1962 I finished the same treatment as you 18 months ago and finished six months of ADT a year ago. So far, my PSA is at .04 and holding so I feel I'm doing OK. I was just moved from 3 to 6 month PSA testing. It does seem like today's radiation treatments are much more targeted and stronger. At the very least, I'll be helping to provide data about the effectiveness of SBRT over time since there isn't that much yet.
@scottbeammeup Six month duration of ADT for me too. And congratulations too on a PSA of 0.04 at the 18-month mark - so excellent!
As a side note, I inquired into the amount of radiation (measured in units of Gy) I received from my SBRT. They told me I received 37.5 Gy.
When I met with my Mayo radiation oncologist I inquired into whether SBRT plus a brachytherapy boost would be beneficial. She replied "no", although she was open to doing brachy on me. I passed because there was a 45 day extra wait for brachy and I needed to complete the treatment and get back to work. The radiation oncologist also asserted her belief that SBRT and brachy typically had the same level of favorable results for my Gleason 4+3 situation
Finally, I should probably add that as soon as the six-month ADT period (Mayo only recommended a four month period, but I decided on six because seemed a bit safer) was over I re-started my TRT. I had reached a PSA of 0.1 one month after completing my five SBRT fractions (i.e., at the four-month ADT point). I needed to restart my TRT because I'm unable to work when I'm at castrate level testosterone. I don't know if this will be a mistake for me, but I take a degree of comfort in the generally promising, encouraging results from Harvard-trained urologist Dr. Abraham Morgantaler's three-decade of work where he's seen many patients on TRT after prostate cancer treatment do well.
@rotate
I am a member of the Legacy Program at Mayo Jacksonville. By being a member you get them free. I really like them as cover many different topics every month. Read a lot about new prostate treatments being developed at Mayo. And a lot of my replies will mention Mayo and that is the source I mention.
I think you have to sign up for them and the process to do that I don't know as have always got them free as became a Legacy member way back in 2006. I am on an upcoming article about heart failure and have a contact for that. I will asked how you get the newsletters without being a Legacy program or featured in a highlight and get back to you.
I think a moderator or Colleen who reads this may know also but will get back to you when I get that information from my newsletter contact. I have a telephone number for her as she interviewed me over the phone. It is 7:00 a.m. here in Jacskonville Forida so will call her when I get back from exercising this morning.
Do you want to post that on this forum or sent you a private message?
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@brianjarvis Am I reading the first study correctly that six months of ADT was a waste of time and caused unnecessary side effects for no benefit?
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1 Reaction...a follow up comment in the very recent PCRI.org video is telling. (In regards to Kaiser data for intermediate stage disease) External beam radiation [ (EBRT) IMRT, SBRT 'Cyberknife' ] is by its very physics a suboptimal dosage. Interstitial radiotherapy ( permanent seeds ) being intra glandular can be much higher and last longer. Europe has increased the use of this form of brachytherapy because it is optimal dosing. The EBERT guidelines even gives a nod to the lower tech lower remunerative permanent seeders by post EBRT 'boost' brachytherapy. Might the reverse seem more reasonable to use the optimal dosage tech first and
maybe boost it later with suboptimal EBRT? There even was a mention of a hybrid approach of 2/3 optimal permanent seed dose followed with a spray of 1/3 EBRT for good measure.
@scottbeammeup If by “intermediate” Gleason score he means 7(3+4), then I would expect no difference. (NCCN guidelines don’t recommend hormone therapy for 3+4.)
However, if by “intermediate” Gleason score they meant 7(4+3), then that would be inconsistent with other studies and with NCCN guidelines.
He never mentions what “intermediate” he’s referring to - favorable or unfavorable. So, there’s no way to know……
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2 Reactions@scottbeammeup I was also initially discouraged when I saw the PCRI video. However, after thinking about it, I realized the PCa radiation patients in this study had their radiation treatments a long time (nearly 20 years) ago.
I think today's PCa radiation technology and the corresponding patient outcomes will be significantly better.
Having completed my SBRT treatment for Gleason 4+3 PCa less than four months ago, improved outcomes are what I'm expecting.
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Like -
Helpful -
Hug
1 Reaction@jc76 Off topic, but how do you get those monthly newsletters, and are the mailed, or electronic. I"m a Mayo PC patient (proton beam finished 4 months ago), and don't get them.
I wonder what cure rates the institutions in that time period were touting to patients. I am pretty confident in saying that they weren’t even close to suggesting cure rates of only 50%.
I wonder if they will retroactively downgrade current quoted cure rates in a few years too!
For me at least, what was the most disappointing was that PCRI didn’t take enough time explaining that this was from around 2005 and explaining to viewers that current radiation cure rates are in fact likely much better. Also, as they had quite rigorously promoted radiation as a much better alternative to surgery for a number of years now, I thought they may have been a bit more sensitive to the reaction of their many viewers.
-
Like -
Helpful -
Hug
5 Reactions@rotate
I am a member of the Legacy Program at Mayo Jacksonville. By being a member you get them free. I really like them as cover many different topics every month. Read a lot about new prostate treatments being developed at Mayo. And a lot of my replies will mention Mayo and that is the source I mention.
I think you have to sign up for them and the process to do that I don't know as have always got them free as became a Legacy member way back in 2006. I am on an upcoming article about heart failure and have a contact for that. I will asked how you get the newsletters without being a Legacy program or featured in a highlight and get back to you.
I think a moderator or Colleen who reads this may know also but will get back to you when I get that information from my newsletter contact. I have a telephone number for her as she interviewed me over the phone. It is 7:00 a.m. here in Jacskonville Forida so will call her when I get back from exercising this morning.
Do you want to post that on this forum or sent you a private message?
-
Like -
Helpful -
Hug
2 Reactions@kenk1962 I finished the same treatment as you 18 months ago and finished six months of ADT a year ago. So far, my PSA is at .04 and holding so I feel I'm doing OK. I was just moved from 3 to 6 month PSA testing. It does seem like today's radiation treatments are much more targeted and stronger. At the very least, I'll be helping to provide data about the effectiveness of SBRT over time since there isn't that much yet.
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Like -
Helpful -
Hug
4 Reactions@scottbeammeup Six month duration of ADT for me too. And congratulations too on a PSA of 0.04 at the 18-month mark - so excellent!
As a side note, I inquired into the amount of radiation (measured in units of Gy) I received from my SBRT. They told me I received 37.5 Gy.
When I met with my Mayo radiation oncologist I inquired into whether SBRT plus a brachytherapy boost would be beneficial. She replied "no", although she was open to doing brachy on me. I passed because there was a 45 day extra wait for brachy and I needed to complete the treatment and get back to work. The radiation oncologist also asserted her belief that SBRT and brachy typically had the same level of favorable results for my Gleason 4+3 situation
Finally, I should probably add that as soon as the six-month ADT period (Mayo only recommended a four month period, but I decided on six because seemed a bit safer) was over I re-started my TRT. I had reached a PSA of 0.1 one month after completing my five SBRT fractions (i.e., at the four-month ADT point). I needed to restart my TRT because I'm unable to work when I'm at castrate level testosterone. I don't know if this will be a mistake for me, but I take a degree of comfort in the generally promising, encouraging results from Harvard-trained urologist Dr. Abraham Morgantaler's three-decade of work where he's seen many patients on TRT after prostate cancer treatment do well.
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1 Reaction@jc76 Thanks! Pls post it if that's okay with here - others may also care.