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<p><img class="alignleft size-full wp-image-158" style="margin-top: -46px;" alt="" src="Prostate%20Cancer%20Results%20Study%20Group%209%20OCT%2018_files/ProstateCancerFeature.html" srcset="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/ProstateCancerFeature.jpg 876w, http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/ProstateCancerFeature-300x33.jpg 300w" sizes="(max-width: 876px) 100vw, 876px" width="876" height="99"><br>
<a title="The Big Picture" href="http://www.prostatecancertreatmentcenter.com/prostate-cancer/the-big-picture/">The Big Picture</a> | <a title="What Is It?" href="http://www.prostatecancertreatmentcenter.com/prostate-cancer/what-is-it/">What Is It?</a> | <a title="Diagnosis" href="http://www.prostatecancertreatmentcenter.com//prostate-cancer/diagnosis/">Diagnosis</a> |<a title="Understanding Risk" href="http://www.prostatecancertreatmentcenter.com//prostate-cancer/understanding-risk/"> Understanding Risk</a> | <a title="Treatment Options" href="http://www.prostatecancertreatmentcenter.com//prostate-cancer/treatment-options/">Treatment Options</a> | <a title="Prostate Cancer Results Study Group" href="http://www.prostatecancertreatmentcenter.com//prostate-cancer/study-group/">Prostate Cancer Results Study Group</a></p>
<h2>Results of Treatment Prostate Cancer Results Study Group (PCRSG)</h2>
<p>There are currently no randomized studies comparing the effectiveness
of modern treatments. A randomized study is one in which patients
voluntarily undergo whatever treatment is chosen for them. Most patients
want to choose their treatment. Therefore, we are limited to studies
that look at a single treatment and then try to compare them. In an
effort to compare these treatments from center to center, the following
prostate experts (the Prostate Cancer Results Study Group or PCRSG) from
around the world have cooperated to review the world’s literature. This
is an ongoing effort and will be updated regularly here at the Prostate
Cancer Center of Seattle. If you wish a updated version please
contact Lisa at <span style="color: #3366ff;"><a href="mailto:Lisa@pccseattle.com">Lisa@pccseattle.com</a> </span>and
request the PCRSG results. The Prostate Cancer Results Study
Group comparative analysis study is supported by the Prostate Cancer
Treatment Center Foundation.</p>
<h3>Study Experts</h3>
<ul>
<li> Peter Grimm, DO, Prostate Cancer Center of Seattl</li>
<li>Ignace Billiet, MD, Europe</li>
<li>David Bostwick, MD, Bostwick Laboratories</li>
<li>David Crawford, MD, University of Colorado</li>
<li>Brian Davis, MD Mayo CLinic Rochester , Minnestoa</li>
<li>Addam Dicker, MD Thomas Jefferson U Philadelphia Pa</li>
<li>Jos Immerzeel, De Prostaate Kliniek Netherlands</li>
<li>Steven Frank, MD MD Anderson Houston Texas</li>
<li>Mira Keyes, MD, BC Cancer Agency Vancouver , BC</li>
<li>Patrick Kupelian,, MD, UCLA</li>
<li>Stephen Langley, MD St Luke’s cancer centre, Guildford, England</li>
<li>Robert Lee, Duke University Medical Center</li>
<li>Stefan Machtens, MD, Europe</li>
<li>Alvaro Martinez ND. Michigaan</li>
<li>Brian Moran, MD, Chicago Prostate Center</li>
<li>Greg Merrick, MD, Schiffler Cancer Center</li>
<li>Jeremy Millar, MD, Australia</li>
<li>Luis Campos-Pinheiro, MD, New University of Lisbon</li>
<li>Mack Roach, MD, UCSF</li>
<li>Richard Stock, MD, Mt. Sinai, New York</li>
<li>Katsuto Shinohara, MD, UCSF</li>
<li>Mark Scholz, MD, Prostate Cancer Research Institute Marina Del Ray California</li>
<li>Ed Weber, MD, Prostate Cancer Center of Seattle</li>
<li>Anthony Zietman, MD, Harvard Joint Center</li>
<li>Michael Zelefsky, MD, Memorial Sloan Kettering, Fellows</li>
<li>Jason Wong, MD UC Irviene California</li>
<li>Jyoti Mayadev, MD UC Davis California</li>
<li>Robyn Vera, DO, Radiant Care Olympia , Washington</li>
</ul>
<h3> Purpose of the PCRSG</h3>
<p>The purpose of the PCRSG is to compare and share results for prostate
cancer that are understandable to both patients and physicians. The
study group, to date, has reviewed greater than 25,000 articles
published from 2000-2012. These articles have come from all available
respected journals. From these articles, 1066 Treatment Results
Articles were identified as related to treatment. The expert panel
agreed that many studies were poorly done and therefore established the
following criteria for inclusion of an article to allow comparison of
different treatments. If you wish a updated version please contact Lisa
at <span style="color: #3366ff;">Lisa@pccseattle.com</span></p>
<p><strong> Criteria for An Article to Be Included for Comparison Purposes</strong></p>
<ol>
<li>Patients must be stratified into recognizable <a title="Understanding Risk Groups" href="http://www.prostatecancertreatmentcenter.com/prostate-cancer/understanding-risk/">Pre-Treatment Risk Groups</a>:
Low, Intermediate, and High Risk by either D’Amico, Zelefsky or NCCN
stratification. The risk group must be maintained after treatment.</li>
<li>A biochemical (PSA) result must be reported by standard means recognizable and comparable. <span style="color: #cf6600;">BRFS (biochemical relapse free survival)</span>* standard endpoint ASTRO, Phoenix, and PSA < 0.2 (surgery).</li>
<li>Patients must be clinically staged pre-treatment. <span style="color: #cf6600;">Stage</span>**</li>
<li>No exclusions. I.e. No Pathologic staging. In other words after
surgery the surgeon could not eliminate or exclude a patient from future
analysis because of an unfavorable feature (positive margin, positive
lymph nodes)</li>
<li>External doses must be modern doses. Minimum 72 <span style="color: #cf6600;">Gy</span>*** IMRT/conformal.</li>
<li>All treatment modalities must be considered; Seeds, Surgery, IMRT, HIFU, CRYO Protons and/or HDR.</li>
<li>Peer reviewed journals only. Peer reviewed journals are those in
which every article is first reviewed by an expert panel before
publication.</li>
<li>Low Risk Accepted minimum number 100 pts. This is to insure an adequate number are evaluated.</li>
<li>Intermediate Risk Accepted minimum number 100 pts.</li>
<li>High Risk Accepted minimum number 50 pts.</li>
<li>Minimum median follow up: 5 yr. This was to insure that patients
were followed long enough to adequately evaluate the results long term.</li>
</ol>
<p><strong> How to Use These Results<br>
</strong>Establish your risk group with your doctor. Look at the slides
related to your risk group. The other risk groups will not be pertinent
to your evaluation.</p>
<p>Each treatment is represented on the graph by a symbol. For example,
the surgery results are represented by a red triangle and the seed
implant (Brachy) alone is represented by a blue dot. The numbers within
the symbol represents the article which can be found beneath the slide
in the notes section.</p>
<p>The first slide in your risk group represents all of the articles
that met the PCRSG criteria, the second includes a graphic that circles
all the articles of that treatment and makes the comparison of results
easier. The third and fourth slides look at results if the criteria are
relaxed a bit to allow more studies for comparison. In all situations,
the results do not substantially change when the criteria are relaxed.</p>
<h3>Low Risk</h3>
<p>Overall, 80% of all Low Risk patients will do well with any
treatment. While it appears on the graphs that Brachytherapy does the
best overall, it is apparent that most patients can do well with any
treatment. Therefore, for cancer control purposes, we advise most
patients that they cannot make a bad decision. However, there is a
slight difference in results. Why does Brachytherapy appear to do
slightly better overall than external beam or surgery? The difference
may lie in the nature and capabilities of each treatment to address all
of the cancer. If you wish a copy of the entire update
version please contact Lisa at Lisa@pccseattle.com and
request the PCRSG results. (Click on Graphs to enlarge)</p>
<p><a href="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Low-risk-normal-.jpg"><img class="alignnone size-medium wp-image-755" alt="Low risk Results" src="Prostate%20Cancer%20Results%20Study%20Group%209%20OCT%2018_files/Low-risk-normal--300x225.jpeg" srcset="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Low-risk-normal--300x225.jpg 300w, http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Low-risk-normal-.jpg 960w" sizes="(max-width: 300px) 100vw, 300px" width="300" height="225"></a></p><div class="woo-sc-divider"></div><p></p>
<p><a href="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Low-Risk-all-Studies-40-mo-.jpg"><img class="alignnone size-medium wp-image-756" alt="Low Risk all Studies 40 mo" src="Prostate%20Cancer%20Results%20Study%20Group%209%20OCT%2018_files/Low-Risk-all-Studies-40-mo--300x225.jpeg" srcset="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Low-Risk-all-Studies-40-mo--300x225.jpg 300w, http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Low-Risk-all-Studies-40-mo-.jpg 960w" sizes="(max-width: 300px) 100vw, 300px" width="300" height="225"></a></p>
<p> </p>
<p><span style="font-size: 13px; line-height: 19px;">The primary reason
surgery fails in Low Risk prostate cancer is likely that disease around
the nerve is left behind, which the pathologist can recognize post
operatively or suspected when the PSA rises after surgery. Despite some
statements by surgeons, it is not possible to see this microscopic
disease at the time of surgery and make a decision at the time of
surgery on whether to take the nerve. From the figures, it is apparent
that, with low risk disease, the surgeon will leave cancer behind 15-20%
of the time and, therefore, you will likely need post operative
radiation, 15-20% of the time. Note, on the graphs, that there are no
reported results yet for robotic surgery that met the criteria. However,
results to date for robotic surgery have not shown any improvement in
cancer control over standard radical prostatectomy. So these results are
not expected to change.</span><strong>Surgery (Red Triangles)<br>
</strong>Whether the surgery is an open radical or robotic radical
prostatectomy, almost all surgeries done for low risk disease are nerve
sparing. The risk of disease outside the gland with low risk disease, as
predicted by the Partin Tables, ranges from 6-28%. The majority of this
is disease that penetrates beyond the edge of the capsule called
capsular penetration or sometimes extraprostatic extension. You can
determine your risk of lymph node, capsular penetration and seminal
vesicle involvement from the Partin Tables.</p>
<p><strong>External Radiation (Green Squares)</strong><br>
There are several forms of this. IMRT (Intensity Modulated Radiation
Therapy), Protons, Tomotherapy and Cyberknife. IMRT is the most common,
with only a few long term studies for the other treatments. Patients
should be aware that just because a therapy is new does not make it
better. All of the external beam treatments give very similar biological
doses (75-81 Gy) and, therefore, the results are also similar. The area
treated is also similar. This area includes the prostate and a small
margin. As can be seen in the graphs, external beam treatments do well
for approximately 80% of the patients. Many years of study will still be
required to ultimately determine whether any type of external beam
treatment will actually be better.</p>
<p>External radiation does a good job of treating the prostate and the
area immediately around it, where cancer can spread. The reason the
external radiation fails in some low risk disease is likely that the
dose delivered is not sufficient enough to control the disease in the
prostate itself. The external dose that can be given to the prostate by
external beam techniques is limited by the structures surrounding the
prostate, primarily the rectum, bladder and hips. While techniques have
been developed to minimize these areas receiving high doses, it is
difficult to give doses beyond 75-81 Gy equivalent doses without a
higher risk of rectal, bladder and hip injury.</p>
<p><strong>Seed Implantation Alone/Brachytherapy (Blue Dots)<br>
</strong>Brachytherapy has a very low local failure rate in the Low Risk
setting. Local failure is reported to be less than 1% in reported
series. The reason for this is that the dose delivered to the gland and
tumor is considerably higher than external beam techniques. The dose
with seeds are 120-145 Gy compared to 75-81 Gy for external beam. The
reason seeds can deliver a higher dose to the cancer is that the seeds
are placed directly into the gland and tumor. The dose from the seed
falls off rapidly, resulting in lower doses to the bladder, rectum and
hips than external radiation. Typical seed implant techniques also
include the area where the cancer spreads and the planning for an
implant always includes the area around the nerve. Reports on cancer
spread beyond the gland have shown that disease is less than 3 mm from
the gland in 98% of these low risk situations. By including a typical
margin of 5-10 mm, the extraprostatic disease is covered by the doses
from seeds. Therefore, seed implantation may do slightly better overall
than surgery or external beam because it gives more dose to control the
cancer in the prostate than external beam radiation and does better than
surgery, which has excellent local control, and because seed
implantation is designed to control the disease beyond the gland.</p>
<p><strong>External Beam Radiation and Seed Implantation (Blue Stars)</strong><br>
A number of studies have included the addition of external beam
radiation (EBRT) to seed implantation for Low Risk disease. The addition
of external beam radiation is controversial and typically only
recommended for low risk patients with a large number positive biopsies.
The rationale for the external beam radiation in this setting is to
cover disease that may have spread beyond the implant margin. Most
patients will not need this additional treatment. If EBRT is
recommended, it is generally because of a large number of positive
biopsies or for technical reasons to cover areas not possible by an
implant. The cancer control results are similar to implant alone and
excellent for this approach. If you wish a copy of the entire
update version please contact Lisa at Lisa@pccseattle.com
and request the PCRSG results.</p>
<h3>Intermediate Risk</h3>
<p>Intermediate Risk disease is highly variable group of patients in
terms of results and approaches. There is a wide variability of risk of
disease beyond the gland ranging from 16-57% which can explain why the
results vary widely. Also, the definitions are slightly different
between centers, which makes comparisons more difficult.</p>
<p>The first step, once it has been determined that you fit in this
category, is to determine what the risk of disease is beyond the gland.
The Partin Tables can help determine for you, individually, what the
risk might be. The good news is that, for many patients, intermediate
risk disease behaves very similar to low risk disease and can be treated
in a similar fashion. However, we help each patient determine what the
risk of disease is beyond the gland and individualize the treatment to
treat all of the disease both inside and outside the gland.</p>
<p>On first glance at the graphs, it appears that brachytherapy
approaches with either permanent seed or HDR implants are superior to
the either surgery or external beam radiation. There are no long term
(> 5yrs) HDR studies to date, however. Why might there be an
advantage to brachytherapy approaches? For intermediate risk patients,
the risk of disease beyond the gland increases, subsequently, any
treatment that just treats the prostate, such as surgery, has a higher
risk of failing.</p>
<p><a href="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Intermediate-Risk-.jpg"><img class="alignnone size-medium wp-image-757" alt="Intermediate Risk" src="Prostate%20Cancer%20Results%20Study%20Group%209%20OCT%2018_files/Intermediate-Risk--300x225.jpeg" srcset="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Intermediate-Risk--300x225.jpg 300w, http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Intermediate-Risk-.jpg 960w" sizes="(max-width: 300px) 100vw, 300px" width="300" height="225"></a><br>
<a href="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Intermediate-40-mo-.jpg"><img class="alignnone size-medium wp-image-758" alt="Intermediate 40 mo" src="Prostate%20Cancer%20Results%20Study%20Group%209%20OCT%2018_files/Intermediate-40-mo--300x225.jpeg" srcset="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Intermediate-40-mo--300x225.jpg 300w, http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/Intermediate-40-mo-.jpg 960w" sizes="(max-width: 300px) 100vw, 300px" width="300" height="225"></a></p>
<p><strong>Surgery for Intermediate Risk (Red Triangles)<br>
</strong>Surgery can be a good option, in this group, if the disease
beyond the gland is calculated to be low. Many patients in this category
can have surgery. Surgery likely fails in intermediate risk disease
because there is a significant amount of disease beyond the prostate
which the surgery doesn’t treat. The calculation of disease beyond the
gland using the Partin Tables can be very helpful. If the risk of
disease beyond the gland is low, surgery may be a very good option. The
surgical results on the graphs likely represent a failure to carefully
select patients who may be good candidates.</p>
<p><strong>External Radiation Beam Therapy (EBRT) for Intermediate Risk Disease (Green Squares)<br>
</strong>Because intermediate risk patients are at higher risk for
disease beyond the gland, External Radiation for intermediate risk
disease has the advantage over surgery of treating both the prostate and
a wider area of potential spread. Conformal, IMRT (Intensity Modulated
Radiation Therapy), Protons, Tomotherapy and Cyberknife are all forms of
external beam radiation. Each has its own technical advantages.
Conformal and IMRT are the most common forms, with the most results,
with only a few long term studies for the other treatments. Patients
should be aware that just because a therapy is new does not make it
better. All of the external beam treatments give very similar biological
doses (75-81 Gy equivalent) to the prostate and, therefore, the results
are also similar. The area treated beyond the gland, which may include
the seminal vesicles and lymph nodes, is also similar. As can be seen in
the graphs, external beam treatments do well for approximately 60-80%
of the patients.</p>
<p>External radiation does a good job of treating the prostate and the
area immediately around it where cancer can spread. For intermediate
patients, external radiation likely fails in this setting due to an
inability to give enough dose to control the disease in the prostate
itself. The external dose that can be given to the prostate, by external
beam techniques, is limited by the structures surrounding the prostate,
primarily the rectum, bladder and hips. While techniques have been
developed to minimize these areas receiving high doses, it is difficult
to give doses beyond 75-81 Gy equivalent doses without a higher risk of
rectal, bladder and hip injury.</p>
<p><strong> Brachytherapy/Seed Implantation for Intermediate Risk Patients (Blue Dots)<br>
</strong>Brachytherapy (Seed implantation alone) has a very low local
failure rate in the Intermediate risk setting. Local failure is reported
to be approximately 1.4% in reported series. The reason for this is
that the dose delivered to the gland and tumor is considerably higher
than external beam techniques. The dose with seeds are 120-145 Gy (dose
equivalent) compared to 75-81 Gy for external beam. The reason seeds can
deliver a higher dose to the cancer is that the seeds are placed
directly into the gland and tumor. The dose from the seed falls off
rapidly, resulting in lower doses to the bladder, rectum and hips than
external radiation.</p>
<p>Many intermediate patients behave similarly to low risk patients and
can be treated with seed implantation alone. The Partin Tables can help
determine for you, individually, what the risk might be of disease
beyond the gland and whether seed implantation alone is appropriate.
Typical seed implant techniques also include the area where the cancer
spreads and the planning for an implant always includes the area around
the nerve where most of the extraprostatic disease is found.</p>
<p><strong>Brachytherapy Alone vs External Beam and Seeds for Intermediate Risk Disease<br>
</strong>The value of external beam radiation (EBRT) with seeds is its
potential to treat a wider area than seeds alone. This estimate of need
for external beam for seeds takes into account the Partin Table
calculation of risk beyond the gland, the number of biopsies that are
positive, the risk of seminal vesicle involvement and whether there is
nerve invasion. Each of these factors may influence your doctor’s
opinion on the value of EBRT. The data from the graphs do not allow for a
clear distinction on which patients should get seeds alone versus
combined EBRT and seeds. We, therefore, have conducted several surveys
of experts to ask their opinion on what treatment they might give for
each clinical situation they might encounter in this group. These
opinions will be shared and discussed with you at the time of
consultation to help decided on the most appropriate approach in your
situation.</p>
<p>Implantation alone, or in combination with EBRT, do appear, on the
graphs, to do better than either surgery or external beam radiation.
Seed implantation is likely better than surgery in intermediate risk
disease due to the high local control rate of seed implantation and its
ability to treat an area beyond the capabilities of surgery. Since
external beam and seed implantation techniques treat a similar volume
beyond the prostate, seed implantation with or without external beam
radiation is likely better than external beam radiation because of the
substantially higher dose to the prostate. Therefore, seed implantation
techniques may do slightly better overall than surgery or external beam
because it gives more dose to control the cancer in the prostate than
external beam radiation and does better than surgery, which has
excellent local control, because it is designed to control the disease
beyond the gland.</p>
<h3> High Risk Disease</h3>
<p>Patients with Gleason Scores 8-10, Stage T2c or a PSA greater than 20
or two intermediate factors, such as a PSA 10-20 and Gleason Score 7,
are considered to have high risk disease. High risk simply means that
there is a higher risk that disease is outside the prostate. Estimates
of risk of disease beyond the prostate range from 23-88%. Most patients
in this group have a risk of at least 50%, making them poor candidates
for treatments that treat the prostate alone (i.e. surgery, seed
implantation alone, EBRT to just the prostate). The graph results for
surgery, for example, demonstrate that only 25-50% of patients will be
successfully treated with surgery. There are no “good” high risk
patients which can be definitively identified as being better candidates
for local treatment alone. The graphs demonstrate that more aggressive
treatments which combine treatments generally have better results.<br>
<a href="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/High-Risk-.jpg"><img class="alignnone size-medium wp-image-759" alt="High Risk" src="Prostate%20Cancer%20Results%20Study%20Group%209%20OCT%2018_files/High-Risk--300x225.jpeg" srcset="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/High-Risk--300x225.jpg 300w, http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/High-Risk-.jpg 960w" sizes="(max-width: 300px) 100vw, 300px" width="300" height="225"></a></p><div class="woo-sc-divider"></div><br>
<a href="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/High-Risk-40-mo-.jpg"><img class="alignnone size-medium wp-image-760" alt="High Risk 40 mo" src="Prostate%20Cancer%20Results%20Study%20Group%209%20OCT%2018_files/High-Risk-40-mo--300x225.jpeg" srcset="http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/High-Risk-40-mo--300x225.jpg 300w, http://www.prostatecancertreatmentcenter.com/wp-content/uploads/2013/08/High-Risk-40-mo-.jpg 960w" sizes="(max-width: 300px) 100vw, 300px" width="300" height="225"></a><p></p>
<p><strong>Surgery for High Risk Disease (Red Triangles)<br>
</strong>Surgery is generally a poor option in this group because the
risk of the disease beyond the gland is calculated to be high. Estimates
of risk of disease beyond the prostate range from 23-88% with an
average of at least 50%. Surgery likely fails in high risk disease
because there is often a significant amount of disease beyond the
prostate which the surgery cannot cover. If you have doubt about this,
the calculation of disease beyond the gland using the Partin Tables can
be very helpful to confirm this. We would rarely recommend surgery as a
primary option for high risk disease.</p>
<p><strong>External Beam Radiation (EBRT) for High Risk Disease (Green Squares)<br>
</strong>The routine use of external beam radiation in this setting has
as its rationale the ability of external beam radiation to treat
microscopic areas beyond the prostate than either surgery or seeds alone
cannot treat. EBRT alone in this setting has resulted in only 35-65% of
the patients being successfully controlled. External radiation does a
good job of treating the prostate and the area immediately around it
where cancer can spread. For high patients, external radiation likely
fails in this setting due to an inability to give enough dose to control
the disease in the prostate itself. The external dose that can be given
to the prostate by external beam techniques is limited by the
structures surrounding the prostate, primarily the rectum, bladder and
hips. While techniques have been developed to minimize these areas
receiving high doses, it is difficult to give doses beyond 75-81 Gy
equivalent doses without a higher risk of rectal, bladder and hip
injury.</p>
<p><strong>External Beam Radiation (EBRT) and Hormonal Therapy for High Risk Disease (Black Stars)<br>
</strong>Hormonal therapy has been added to external beam radiation for
high risk disease to try to improve the effectiveness of this modality.
The rationale is to kill as many cancer cells prior to EBRT by
temporarily blocking testosterone production. This approach thereby,
theoretically, allows for fewer cells that the radiation needs to
eradicate at the doses which can be safely delivered (75-81 Gy). For the
most part, as demonstrated in the graphs, this can be accomplished. The
results for this approach appear to be better than EBRT alone with
60-70% cancer control versus 35-65% with EBRT alone. The course of
hormonal therapy is debated but most centers restrict the hormonal
therapy to 6- 12 months with an occasional center giving it for up to
three years.</p>
<p><strong>External Beam, Seed Implantation Plus or Minus Hormonal Therapy for High Risk Disease (Blue Diamonds<br>
</strong>The triple modality approach (External Beam, Seed Implantation
and Hormonal Therapy) for High Risk disease begins with the rationale
that Hormonal Therapy may reduce the number of cells that need to be
killed. EBRT (IMRT) can deliver an adequate dose to kill microscopic
disease beyond the gland and seed implantation can deliver a dose
sufficient to control the disease within the gland. The small number of
studies using this approach indicate that this rationale may be
supported with cancer control rates long term of 85-92%. Note that this
may be grade dependent as the subset of high risk patients with very
high grade (9-10) in less mature studies usually fair worse. The use of
external beam plus seeds appears to be quite variable from center to
center. More studies will be needed to determine the best treatment.
However, we have chosen, for high risk disease, to recommend a
combination of six months of hormonal therapy during which both external
beam and seed implantation are given. If you wish a copy of
the entire update version please contact Lisa
at Lisa@pccseattle.com and request the PCRSG results.</p>
<h6>* bRFS Biochemical Relapse Free Survival: As standard form of
measuring results of treatment. It reports on whether a patient has
failed by PSA criteria. It dose not indicate wheter a patient has live (
survived) or not. It is only reflects PSA. It means, Are you alive
without evidence of a PSA relapse? Common methods use a rising PSA on 2
or three consecutive occasions to define a failure.<br>
** Stage: The definition of the size and extent of a cancer at a
particular point in time. Usually cancers are staged using the T(tumor) N
(nodes) M metastasis) staging system. T1a, b, c , T2a,b,c T3 are
examples of stages. Older systems using A, B, C, D are rarely used and
usually not helpful in deciding treatment. Current prostate cancer
staging does not include PSA and Gleason scoring. Defining ones
prognosis or recommending a particular course of therapy based on stage
alone should not be done. Risk group classifications were developed
which include stage, PSA and Gleason score information and are better at
evaluating treatment outcomes.<br>
*** Gy – Gray: A unit of measuring radiation. Typical external doses are
75-80 Gy. Implant doses range from 90- 160 Gy. May also sometimes be
recorded as cGY centigray which is a 1000 Grays.</h6>
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