Re: Protons and treatment choices

[Guest guest]

Hi Tom,

I would bet a lot of money that the doctor who told you

that was a surgeon who makes his living doing radical

prostatectomies.

I have friends who had proton beam therapy shortly

after I had my stupid radical prostatectomy in 1992. They

are still doing well with less unpleasant side effects than

I have.

I wish I had known about proton beam.

I wish you all the bestAubrey Pilgrim, DC (Ret.) Author ofA Revolutionary Approach to Prostate Cancer-Read the original book for FREE at: http://www.prostatepointers.org/prostate/lay/apilgrim/Read new edition for FREE at http://www.cancer.prostate-help.org/capilgr.htmDr. E. Crawford is co-author of the revision

I'm still curious about getting a straightforward answer to the observation offered by my urologist the other day when I asked him about proton beam therapy.

When I mentioned that I'd seen some discussion about proton beam therapy that others had gone through and that the former patients were upbeat in their assessment of the therapy, his first question was "How long has it been since they went through proton beam therapy?"

When I said I thought the former patients had been out of proton beam therapy for maybe a year or two (sorry, I hadn't made it a point to focus on that particular question), his response was along the lines of "That's not long enough since treatment date to be meaningful. With that therapy you will find that some of the patients will show a low PSA level for several years and then five to seven years after treatment the PSA level can start ratcheting up again."

The clear inference of his observation was that proton beam therapy didn't eradicate the cancerous cells in a man with prostate cancer and that while proton beam therapy might be an attractive stopgap measure, it certainly wasn't a cure.

So the question I have is this: Is it the case that there's a significant percentage of men who undergo proton beam therapy who five to seven years or so after treatment find themselves dealing with a gradually increasing PSA level and, ultimately, a recurrence of prostate cancer?

The facility at Loma has been treating men with prostate cancer for more than 7 years, however, I don't really feel like traveling 3,000 miles to get an answer to this question if one's available more readily.

TIA.

Tom

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[Guest guest]

I'm still curious about getting a straightforward answer to the observation offered by my urologist the other day when I asked him about proton beam therapy. When I mentioned that I'd seen some discussion about proton beam therapy that others had gone through and that the former patients were upbeat in their assessment of the therapy, his first question was "How long has it been since they went through proton beam therapy?" When I said I thought the former patients had been out of proton beam therapy for maybe a year or two (sorry, I hadn't made it a point to focus on that particular question), his response was along the lines of "That's not long enough since treatment date to be meaningful. With that therapy you will find that some of the patients will show a low PSA level for several years and then five to seven years after treatment the PSA level can start ratcheting up again." The clear inference of his observation was that proton beam therapy didn't eradicate the cancerous cells in a man with prostate cancer and that while proton beam therapy might be an attractive stopgap measure, it certainly wasn't a cure. So the question I have is this: Is it the case that there's a significant percentage of men who undergo proton beam therapy who five to seven years or so after treatment find themselves dealing with a gradually increasing PSA level and, ultimately, a recurrence of prostate cancer? The facility at Loma has been treating men with prostate cancer for more than 7 years, however, I don't really feel like traveling 3,000 miles to get an answer to this question if one's available more readily. TIA. Tom Fuller wrote: Protons and the Yahoo ForumI think that what Mick says has some merit, and in posting about protons I certainly do not want to offend the members of this forum that have already made their choice and had something other than proton treatments, be it surgery, seeds, cryo, or whatever. I will admit that I myself have a bias against surgery even though I know that there are many success stories. In my posts I mean no criticism of any that have chosen a different treatment, and try to get across that we are all different and must make our own choice.I do NOT think

that the newly diagnosed members and others who have questions and do not know of protons should be ignored-- Perhaps we could preface our proton comments with "For the newly diagnosed" or for "Those trying to decide on a treatment—" But this seems a bit cumbersome to me. Why not let each member decide if a post is applicable to his or her situation? I am certainly open to suggestions on this.I think that what those of us that have "discovered" proton therapy are really trying to do is to make the availability of the proton option known to those newly diagnosed with any form of cancer, and on this forum the prostate cancer that we are all living with. This is so that they can do their own due diligence, and see if it is an appropriate option for them. My own viewpoint is that I consider myself extremely fortunate that I did "discover" protons, and was able to avail myself of it. No doctors told me about it, and I

had six that I consulted while trying to decide on a treatment method, two of whom were well known specialists.My point is that proton beam therapy is a viable treatment for prostate cancer (and many other cancers), with comparable results, and generally fewer side effects. But the majority of the medical community, including urologists, surgeons, and radiologists, do NOT make patients aware that the option even exists!I think that this is beginning to change, and over the next ten years or so as the new centers come on-line, the medical community at large will have to acknowledge the treatment. I predict that surgery will start to fade as the generally recommended option, as new treatment methods and medicines become available. As with most things in the world of prostate cancer, "Time Will Tell!" For my part, I am a "Proton Beam Advocate" and will attempt to spread the word whenever possible. For any

who want to contact me directly off-forum for proton information, I invite your e-mails (cnsjones then add @yahoo.com; or call me directly at (Florida) between 3 pm and 5 pm EST. Leave a call back number if you don't get me. I will be most happy to answer your questions to the best of my ability.Fuller>>" ... What you fail to see Laurel is that in your attempt to bring helpful information to the table which this group needs, you often times offend 90% of the members at the same time."

[Guest guest]

I'm not sure if this is exactly what you are asking, but here is an overview of

disease free

survival rates for proton therapy (though some were treated with both protons

and

photons) at Loma :

http://www.communityoncology.net/journal/articles/0404235.pdf

Bob

> >

>

> > " ... What you fail to see Laurel is that in your attempt to bring

> helpful information to the table which this group needs, you often

> times offend 90% of the members at the same time. "

>

[Guest guest]

>

> I'm still curious about getting a straightforward answer to the

observation offered by my urologist the other day when I asked him

about proton beam therapy....

>

To the group, I apologize for the length of this post, and it is

primarily addressed to Tom, so those not interested should take a

pass.

Hey Tom:

Here is the answer, as I have come to understand it, and as clear as

I can make it in this unclear thing called prostate cancer. And I am

not shouting with the caps, they are just for emphasis.

There are no guarantees for ANY treatment for prostate cancer. The

fact is that cancer cells are microscopic, and MAY have deposited

themselves elsewhere in your body BEFORE your treatment – and that is

ANY treatment, either surgery, brachytherapy, protons or whatever.

This means that once you have been diagnosed, your life has changed.

You will need to have your PSA checked at periodic intervals for the

rest of your life to watch for a recurrence of the disease, EVEN

AFTER surgery or whatever option that you choose is done to you. In

essence, there really is no ABSOLUTE " cure " as such. At least not at

the present state of medical science that I am aware of.

You quoted your doctor as saying: " With that [Proton] therapy you

will find that some of the patients will show a low PSA level for

several years and then five to seven years after treatment the PSA

level can start ratcheting up again. " Tom, what he said is true for

ANY treatment!

What your doctor said is most assuredly NOT an absolute truth for

proton therapy. It is what MAY happen after ANY treatment for

prostate cancer. That is what was telling you in post# 15167,

and what I meant in post # 15168 when I said:

" There is no history to my knowledge that the " rising trend " he

indicates is any more prevalent with proton therapy than with ANY

other treatment for prostate cancer. The results for all modalities

are similar. It is the side effects that are entirely dissimilar. "

I have become very cynical regarding the medical profession, and it

probably shows in my posts, but what your doctor said is somewhat

self serving in that he was trying to raise doubts about a particular

treatment that he was unable to provide. I suggest to you again, that

you visit www.protonbob.com and check out the names, professions, and

results of over one-hundred former proton beam patients, and what

they have experienced. Several of these were treated more than seven

or eight years ago.

So my answer to your question...:

" So the question I have is this: Is it the case that there's a

SIGNIFICANT PERCENTAGE [your words] of men who undergo proton beam

therapy who five to seven years or so after treatment find themselves

dealing with a gradually increasing PSA level and, ultimately, a

recurrence of prostate cancer? "

....Is an unequivocal NO!!!! There are some, but the percentage that

have experienced recurrence is approximately the same as in any other

prostate cancer treatment.

And lastly, it is the post-treatment lack of significant side effects

that distinguishes proton beam therapy for cancer treatment.

Potential side effects should be a full discussion with your doctor.

Fuller

[Guest guest]

Thanks Fuller- You said it very well-

Aubrey

>> I'm still curious about getting a straightforward answer to the observation offered by my urologist the other day when I asked him about proton beam therapy....> To the group, I apologize for the length of this post, and it is primarily addressed to Tom, so those not interested should take a pass.Hey Tom:Here is the answer, as I have come to understand it, and as clear as I can make it in this unclear thing called prostate cancer. And I am not shouting with the caps, they are just for emphasis.There are no guarantees for ANY treatment for prostate cancer. The fact is that cancer cells are microscopic, and MAY have deposited themselves elsewhere in your body BEFORE your treatment – and that is ANY treatment, either surgery, brachytherapy, protons or whatever. This means that once you have been diagnosed, your life has changed. You will need to have your PSA checked at periodic intervals for the rest of your life to watch for a recurrence of the disease, EVEN AFTER surgery or whatever option that you choose is done to you. In essence, there really is no ABSOLUTE "cure" as such. At least not at the present state of medical science that I am aware of. You quoted your doctor as saying: "With that [Proton] therapy you will find that some of the patients will show a low PSA level for several years and then five to seven years after treatment the PSA level can start ratcheting up again." Tom, what he said is true for ANY treatment!What your doctor said is most assuredly NOT an absolute truth for proton therapy. It is what MAY happen after ANY treatment for prostate cancer. That is what was telling you in post# 15167, and what I meant in post # 15168 when I said: "There is no history to my knowledge that the "rising trend" he indicates is any more prevalent with proton therapy than with ANY other treatment for prostate cancer. The results for all modalities are similar. It is the side effects that are entirely dissimilar."I have become very cynical regarding the medical profession, and it probably shows in my posts, but what your doctor said is somewhat self serving in that he was trying to raise doubts about a particular treatment that he was unable to provide. I suggest to you again, that you visit www.protonbob.com and check out the names, professions, and results of over one-hundred former proton beam patients, and what they have experienced. Several of these were treated more than seven or eight years ago.So my answer to your question...: "So the question I have is this: Is it the case that there's a SIGNIFICANT PERCENTAGE [your words] of men who undergo proton beam therapy who five to seven years or so after treatment find themselves dealing with a gradually increasing PSA level and, ultimately, a recurrence of prostate cancer?"...Is an unequivocal NO!!!! There are some, but the percentage that have experienced recurrence is approximately the same as in any other prostate cancer treatment.And lastly, it is the post-treatment lack of significant side effects that distinguishes proton beam therapy for cancer treatment. Potential side effects should be a full discussion with your doctor.Fuller

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[Guest guest]

Tom, My husband Gregg's proton treatment ended a little over 6 months

ago. We will be holding our breath just like everybody else for,

hopefully years to come. I have never claimed that Gregg is a success

story. We simply don't know yet.

To piggy back on what Fuller wrote, we went with proton, not because

we believed it to be a sure fire cure. We readily admit that the cure

rate is probably no better with protons than surgery or IMRT,

brachytherapy or the others I have not mentioned. Kaiser was only

offering Gregg 3D conformal which is a pretty archaic form of

radiation in this day and age. Our biggest concern was with the

minimal side effects that every proton veteran we have spoken to has

confirmed. We tried to find men as far out from treatment as possible.

You all must do your own research. There are lots and lots of

articles and studies about protons from all over the world. Between

us Gregg and I filled a bankers box with printed research.

We did not take the opinions of a handful of men as our deciding

factor. I read five books on prostate cancer in the 3 weeks we had

before our consult with Gregg's urologist. I took all 5 of the books

and some of the studies with me so that he would know we were

informed.

We believe that Gregg has a good a chance at a cure as he would have

with any treatment, but that we have minimized the potential for side

effects for reasons I have stated many times.

For the record, Loma began treating PCa patients in 1991. In

the beginning they used photon radiation with a proton boost. I have

read hundreds of studies. I do not recall any of them showing a

higher success rate for any one treatment over another. Our Kaiser

urologist confirmed this and when asked what he would do, replied

that he does not know.

Laurel

[Guest guest]

Fuller and , First, thanks for the clarification. It makes a lot more sense to me now, in light of what you just shared with me (and the group) about proton beam therapy compared to other treatment regimens. Are you aware of any statistics addressing the following question: Among the universe of patients who have had prostate cancer and who have elected to undergo proton beam treatment, what percentage eventually (5 - 7 years post-treatment or later) have to undergo additional treatment for prostate cancer of one sort or another? And I guess I'd ask the same question about having a prostatectomy performed. In other words, if you have a prostatectomy performed, what percentage of those men, by comparison, have to undergo some future treatment for prostate cancer again? I can understand, though I have some

questions about, the insights derived from saying that once you've been diagnosed with prostate cancer you're at higher risk for developing other forms of cancer later on. Take the hypothetical case, for example, of a guy who's been diagnosed with prostate cancer and who also smokes three packs of cigarettes a day. He elects to have a prostatectomy, has the lymph nodes removed, and the biopsies of the lymph nodes and the prostate both confirm the results of the various scans he had performed before the operation -- namely that the cancer was confined to the prostate and had not spread. Five years go by and he develops lung cancer. Does that statistic show up somewhere as being somehow correlated with the prostate cancer that preceded it? I'm guessing it does, though it seems a stretch to me, just as a layman, that you could infer any cause and effect relationship there as seems to be implied by some of the

medical literature. Again, thanks for the insights. Best, Tom APilgrm@... wrote: Thanks Fuller- You said it very well- Aubrey In a message dated 9/29/2007 12:22:08 P.M. Pacific Daylight Time, cnsjones writes: >> I'm still curious about getting a straightforward answer to the observation offered by my urologist the other day when I asked him about proton beam therapy....> To the group, I apologize for the length of this post, and it is primarily addressed to Tom, so those not interested should take a pass.Hey Tom:Here is the answer, as I have come to understand it, and as clear as I can make it in this unclear thing called prostate cancer. And I am not shouting with the caps, they are just for emphasis.There are no guarantees for ANY treatment for prostate cancer. The fact is that cancer cells are

microscopic, and MAY have deposited themselves elsewhere in your body BEFORE your treatment – and that is ANY treatment, either surgery, brachytherapy, protons or whatever. This means that once you have been diagnosed, your life has changed. You will need to have your PSA checked at periodic intervals for the rest of your life to watch for a recurrence of the disease, EVEN AFTER surgery or whatever option that you choose is done to you. In essence, there really is no ABSOLUTE "cure" as such. At least not at the present state of medical science that I am aware of. You quoted your doctor as saying: "With that [Proton] therapy you will find that some of the patients will show a low PSA level for several years and then five to seven years after treatment the PSA level can start ratcheting up again." Tom, what he said is true for ANY treatment!What your doctor said is most assuredly NOT an absolute truth for

proton therapy. It is what MAY happen after ANY treatment for prostate cancer. That is what was telling you in post# 15167, and what I meant in post # 15168 when I said: "There is no history to my knowledge that the "rising trend" he indicates is any more prevalent with proton therapy than with ANY other treatment for prostate cancer. The results for all modalities are similar. It is the side effects that are entirely dissimilar."I have become very cynical regarding the medical profession, and it probably shows in my posts, but what your doctor said is somewhat self serving in that he was trying to raise doubts about a particular treatment that he was unable to provide. I suggest to you again, that you visit www.protonbob.com and check out the names, professions, and results of over one-hundred former proton beam patients, and what they have experienced. Several of these were treated more than seven

or eight years ago.So my answer to your question...: "So the question I have is this: Is it the case that there's a SIGNIFICANT PERCENTAGE [your words] of men who undergo proton beam therapy who five to seven years or so after treatment find themselves dealing with a gradually increasing PSA level and, ultimately, a recurrence of prostate cancer?"...Is an unequivocal NO!!!! There are some, but the percentage that have experienced recurrence is approximately the same as in any other prostate cancer treatment.And lastly, it is the post-treatment lack of significant side effects that distinguishes proton beam therapy for cancer treatment. Potential side effects should be a full discussion with your doctor.Fuller

See what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

Laurel, Makes perfect sense to me. Thanks a bunch. Best, Tom yellow_laurel wrote: Tom, My husband Gregg's proton treatment ended a little over 6 months ago. We will be holding our breath just like everybody else for, hopefully years to come. I have never claimed that Gregg is a success story. We simply don't know yet. To piggy back on what Fuller wrote, we went with proton, not because we

believed it to be a sure fire cure. We readily admit that the cure rate is probably no better with protons than surgery or IMRT, brachytherapy or the others I have not mentioned. Kaiser was only offering Gregg 3D conformal which is a pretty archaic form of radiation in this day and age. Our biggest concern was with the minimal side effects that every proton veteran we have spoken to has confirmed. We tried to find men as far out from treatment as possible.You all must do your own research. There are lots and lots of articles and studies about protons from all over the world. Between us Gregg and I filled a bankers box with printed research. We did not take the opinions of a handful of men as our deciding factor. I read five books on prostate cancer in the 3 weeks we had before our consult with Gregg's urologist. I took all 5 of the books and some of the studies with me so that he would know we were

informed.We believe that Gregg has a good a chance at a cure as he would have with any treatment, but that we have minimized the potential for side effects for reasons I have stated many times.For the record, Loma began treating PCa patients in 1991. In the beginning they used photon radiation with a proton boost. I have read hundreds of studies. I do not recall any of them showing a higher success rate for any one treatment over another. Our Kaiser urologist confirmed this and when asked what he would do, replied that he does not know.Laurel

[Guest guest]

<snip> Are you aware of any statistics addressing the following

question: Among the universe of patients who have had prostate cancer

and who have elected to undergo proton beam treatment, what

percentage eventually (5 - 7 years post-treatment or later) have to

undergo additional treatment for prostate cancer of one sort or

another?

And I guess I'd ask the same question about having a prostatectomy

performed. In other words, if you have a prostatectomy performed,

what percentage of those men, by comparison, have to undergo some

future treatment for prostate cancer again?<snip>

1. On the first part of the first question, I don't know how to

answer the time related issue (five to seven years) Maybe someone

else here does? WHEN the PSA starts rising, and establishes a rising

trend, then is when it is time to worry. Could be six months; could

be never (we hope)!

2. For the percentages, the best info I have on Protons is from Dr.

Carl Rossi of LLUMC:

Dr. Rossi's Comparison with surgery at Hopkins:

" Results of treatment have been published in numerous peer-reviewed

medical journals. Currently, the most comprehensive review of long-

term results from Loma was published in the International

Journal of Radiation Oncology, Biology, and Physics in 2004. This

paper focused on 1,256 patients with stages Tl- T3 prostate cancer,

all of whom were treated between October 1991 and December 1997, and

none of whom received any adjuvant hormonal therapy. The radiation

dose employed was 74-75 Gy (our institutional standard at the time,

based on the Harvard experience), and the median follow-up was sixty-

three months. Biochemical disease-free survival (as defined by PSA-

based criteria) was 95% in patients with pre-treatment PSA's of <

4.1 , 85% for PSA of 4.1-10.0, 65% for PSA of 10.1-20.0, and 48% for

PSA's of 20.1-50.0. These numbers compare favorably with a similar

group of patients (stratified by pre-treatment PSA, Gleason Score,

and clinical stage) who underwent radical prostatectomy at s

Hopkins[ 10]. The five and ten year incidence of moderate to severe

Genitourinary and Gastrointestinal morbidity was 1%. This series

represents one of the largest groups of individuals treated with a

three-dimensional conformal proton beam technique treated at the same

institution and demonstrates that the treatment is well tolerated and

capable of producing biochemical disease-free survival rates

equivalent to those achieved with other treatment methods. "

Note: The standard protocol for PBRT was later increased to 79.2 Gy

with improved results. I don't have those numbers at my finger tips.

My personal opinion is that the PBRT stats are slightly better than

the RP stats, as shown below:

Note: You can prpbably find several sources for typical prostatectomy

stats. Here is one:

Buchanan Brady Urological Institute, Department of Urology,

s Hopkins Medical Institutions, Baltimore, land, USA.

" In a large series of 2404 men with a mean follow-up of 6.3 plus or

minus 4.2 years (range, 1-17) after anatomic RRP for clinically

localized prostate cancer, 412 men (17%) have recurred. A detectable

PSA was the only evidence of recurrence in 9.7%, whereas 1.7% and

5.8% had local recurrence and distant metastasis, respectively.

The overall actuarial 5-, 10-, and 15-year recurrence-free survival

rates for these men were 84%, 74%, and 66%, respectively. ... "

To me this is not as clear as tying the results to a range of pre-

treatment PSA's as Dr. Rossi did. Others here can probably expand on

this or provide additional references.

But the point is results are " comparable. " I think you will find the

same sort of comparable results for all the different treatments.

That is why I came to the conclusion that for me, a 73 year old in

reasonably good physical condition, hoping for another 10 to 15 years

on God's earth, who did not want the risk of incontinence, impotence,

or other such degrading occurances, the " quality of life " issues

became paramount, and I chose PBRT.

And you said <snip> " I can understand, though I have some questions

about, the insights derived from saying that once you've been

diagnosed with prostate cancer you're at higher risk for developing

other forms of cancer later on. " <snip>

I don't recall seeing this statement anywhere; If I said it I did not

mean to. I know of nothing that says prostate cancer makes you at

higher risk for developing other forms of cancer.

Anyone??

Good luck with your research and decision Tom!

Fuller

[Guest guest]

Fuller, Thanks for the cogent analysis and data. The observation I'd made and that you quoted at the end of your reply wasn't directed at you. It was more of a generalized comment directed at the notion that even if you've been diagnosed with prostate cancer that appears to be confined to the prostate gland itself, there's always the possibility that some of the cancer cells may have escaped and migrated to other areas of the body and might also be undetectable to modern imaging techniques. As they say in statistics "Correlation doesn't necessarily imply causality." My guess is that some of the men who have prostate cancer that is confined to the prostate itself will develop other forms of cancer later on that have nothing whatsoever to do with their bout with prostate cancer. Just like some men who have prostate cancer are going to have a heart attack at some point. Other guys

who have prostate cancer are going to get run over by a truck and killed. And so forth. It's longevity, not localized prostate cancer, that is a marker for future incidents of other forms of cancer. I can deal with that. :-) The Han statistics on the s Hopkins website, and this particular ongoing discussion, have been real eye openers for me. Thanks so much for your contribution to that process. Best, Tom Fuller wrote: <snip> Are you aware of any statistics addressing the following question: Among the universe of patients who have had prostate cancer and who have elected to undergo proton beam treatment, what percentage eventually (5 - 7 years post-treatment or later) have to undergo additional treatment for prostate cancer of one sort or another?And I guess I'd ask the same question about having a prostatectomy performed. In other words, if you have a prostatectomy performed, what percentage of those men, by comparison, have to undergo some future treatment for prostate cancer again?<snip>1. On the first part of the first question, I don't know how to answer the time

related issue (five to seven years) Maybe someone else here does? WHEN the PSA starts rising, and establishes a rising trend, then is when it is time to worry. Could be six months; could be never (we hope)!2. For the percentages, the best info I have on Protons is from Dr. Carl Rossi of LLUMC:Dr. Rossi's Comparison with surgery at Hopkins:"Results of treatment have been published in numerous peer-reviewed medical journals. Currently, the most comprehensive review of long-term results from Loma was published in the International Journal of Radiation Oncology, Biology, and Physics in 2004. This paper focused on 1,256 patients with stages Tl- T3 prostate cancer, all of whom were treated between October 1991 and December 1997, and none of whom received any adjuvant hormonal therapy. The radiation dose employed was 74-75 Gy (our institutional standard at the time, based on the Harvard experience), and the

median follow-up was sixty-three months. Biochemical disease-free survival (as defined by PSA-based criteria) was 95% in patients with pre-treatment PSA's of < 4.1 , 85% for PSA of 4.1-10.0, 65% for PSA of 10.1-20.0, and 48% for PSA's of 20.1-50.0. These numbers compare favorably with a similar group of patients (stratified by pre-treatment PSA, Gleason Score, and clinical stage) who underwent radical prostatectomy at s Hopkins[ 10]. The five and ten year incidence of moderate to severe Genitourinary and Gastrointestinal morbidity was 1%. This series represents one of the largest groups of individuals treated with a three-dimensional conformal proton beam technique treated at the same institution and demonstrates that the treatment is well tolerated and capable of producing biochemical disease-free survival rates equivalent to those achieved with other treatment methods."Note: The standard protocol for PBRT

was later increased to 79.2 Gy with improved results. I don't have those numbers at my finger tips.My personal opinion is that the PBRT stats are slightly better than the RP stats, as shown below:Note: You can prpbably find several sources for typical prostatectomy stats. Here is one: Buchanan Brady Urological Institute, Department of Urology, s Hopkins Medical Institutions, Baltimore, land, USA. "In a large series of 2404 men with a mean follow-up of 6.3 plus or minus 4.2 years (range, 1-17) after anatomic RRP for clinically localized prostate cancer, 412 men (17%) have recurred. A detectable PSA was the only evidence of recurrence in 9.7%, whereas 1.7% and 5.8% had local recurrence and distant metastasis, respectively. The overall actuarial 5-, 10-, and 15-year recurrence-free survival rates for these men were 84%, 74%, and 66%, respectively. ..."To me this is not as clear as

tying the results to a range of pre-treatment PSA's as Dr. Rossi did. Others here can probably expand on this or provide additional references. But the point is results are "comparable." I think you will find the same sort of comparable results for all the different treatments. That is why I came to the conclusion that for me, a 73 year old in reasonably good physical condition, hoping for another 10 to 15 years on God's earth, who did not want the risk of incontinence, impotence, or other such degrading occurances, the "quality of life" issues became paramount, and I chose PBRT.And you said <snip>"I can understand, though I have some questions about, the insights derived from saying that once you've been diagnosed with prostate cancer you're at higher risk for developing other forms of cancer later on."<snip>I don't recall seeing this statement anywhere; If I said it I did not mean

to. I know of nothing that says prostate cancer makes you at higher risk for developing other forms of cancer.Anyone??Good luck with your research and decision Tom!Fuller

[Guest guest]

Tom

I had RRP in 1996 and soon found that the expectation that it was totally in the capsule was not true.

The truth is that there are tests that point to the fact that there is a high chance that it is all in the prostate. The stats do give indications as to if it is 75% certain or 90% certain etc.. I don't think medical staff can ever be 100% certain.

Re: Protons and treatment choices

Fuller,

Thanks for the cogent analysis and data.

The observation I'd made and that you quoted at the end of your reply wasn't directed at you. It was more of a generalized comment directed at the notion that even if you've been diagnosed with prostate cancer that appears to be confined to the prostate gland itself, there's always the possibility that some of the cancer cells may have escaped and migrated to other areas of the body and might also be undetectable to modern imaging techniques.

As they say in statistics "Correlation doesn't necessarily imply causality." My guess is that some of the men who have prostate cancer that is confined to the prostate itself will develop other forms of cancer later on that have nothing whatsoever to do with their bout with prostate cancer. Just like some men who have prostate cancer are going to have a heart attack at some point. Other guys who have prostate cancer are going to get run over by a truck and killed. And so forth.

It's longevity, not localized prostate cancer, that is a marker for future incidents of other forms of cancer. I can deal with that. :-)

The Han statistics on the s Hopkins website, and this particular ongoing discussion, have been real eye openers for me.

Thanks so much for your contribution to that process.

Best,

Tom

Fuller <cnsjones> wrote:

<snip> Are you aware of any statistics addressing th e following question: Among the universe of patients who have had prostate cancer and who have elected to undergo proton beam treatment, what percentage eventually (5 - 7 years post-treatment or later) have to undergo additional treatment for prostate cancer of one sort or another?And I guess I'd ask the same question about having a prostatectomy performed. In other words, if you have a prostatectomy performed, what percentage of those men, by comparison, have to undergo some future treatment for prostate cancer again?<snip>1. On the first part of the first question, I don't know how to answer the time related issue (five to seven years) Maybe someone else here does? WHEN the PSA starts rising, and establishes a rising trend, then is when it is time to worry. Could be six months; could be never (we hope)!2. For the percentages, the best info I have on Protons is from Dr. Carl Rossi of LLUMC:Dr. Rossi's Comparison with surgery at Hopkins:"Results of treatment have been published in numerous peer-reviewed medical journals. Currently, the most comprehensive review of long-term results from Loma was published in the International Journal of Radiation Oncology, Biology, and Physics in 2004. This paper focused on 1,256 patients with stages Tl- T3 prostate cancer, all of whom were treated between October 1991 and December 1997, and none of whom received any adjuvant hormonal therapy. The radiation dose employed was 74-75 Gy (our institutional standard at the time, based on the Harvard experience), and the median follow-up was sixty-three months. Biochemical disease-free survival (as defined by PSA-based criteria) was 95% in patients with pre-treatment PSA's of < 4.1 , 85% for PSA of 4.1-10.0, 65% for PSA of 10.1-20.0, and 48% for PSA's of 20.1-50.0. These numbers compare favorably with a similar group of patients (stratified by pre-treatment PSA, Gleason Score, and clinical stage) who underwent radical prostatectomy at s Hopkins[ 10]. The five and ten year incidence of moderate to severe Genitourinary and Gastrointestinal morbidity was 1%. This series represents one of the largest groups of individuals treated with a three-dimensional conformal proton beam technique treated at the same institution and demonstrates that the treatment is well tolerated and capable of producing biochemical disease-free survival rates equivalent to those achieved with other treatment methods."Note: The standard protocol for PBRT was later increased to 79.2 Gy with improved results. I don't have those numbers at my finger tips.My personal opinion is that the PBRT stats are slightly better than the RP stats, as shown below:Note: You can prpbably find several sources for typical prostatectomy stats. Here is one: Buchanan Brady Urological Institute, Department of Urology, s Hopkins Medical Institutions, Baltimore, land, USA. "In a large series of 2404 men with a mean follow-up of 6.3 plus or minus 4.2 years (range, 1-17) after anatomic RRP for clinically localized prostate cancer, 412 men (17%) have recurred. A detectable PSA was the only evidence of recurrence in 9.7%, whereas 1.7% and 5.8% had local recurrence and distant metastasis, respectively. The overall actuarial 5-, 10-, and 15-year recurrence-free survival rates for these men were 84%, 74%, and 66%, respectively. ..."To me this is not as clear as tying the results to a range of pre-treatment PSA's as Dr. Rossi did. Others here can probably expand on this or provide additional references. But the point is results are "comparable." I think you will find the same sort of comparable results for all the different treatments. That is why I came to the conclusion that for me, a 73 year old in reasonably good physical condition, hoping for another 10 to 15 years on God's earth, who did not want the risk of incontinence, impotence, or other such degrading occurances, the "quality of life" issues became paramount, and I chose PBRT.And you said <snip>"I can understand, though I have some questions about, the insights derived from saying that once you've been diagnosed with prostate cancer you're at higher risk for developing other forms of cancer later on."<snip>I don't recall seeing this statement anywhere; If I said it I did not mean to. I know of nothing that says prostate cancer makes you at higher risk for developing other forms of cancer.Anyone??Good luck with your research and decision Tom!Fuller