Advocating specific treatments for prostate cancer

October 1, 2008

I don't like to promote any specific treatment modality for

prostate cancer over any other because, first of all, I'm not an

expert, and second of all and more importantly, because the

people who are experts disagree. I have read numerous abstracts

in Pubmed and articles in Medscape, Medpage Today, or other good

sources of medical information but, as far as I can tell, there

just is no consensus. The various studies and clinical trials

appear to me to agree on many broad conclusions, but they don't

agree on what is the best treatment, either in general, or even

in stratified cases specified by stage, PSA and Gleason score.

However there are sometimes tides of advocacy that seem to sweep

over the PCa community. In alt.support.cancer.prostate I recall

a period when a fair number of posters were promoting surgery as

the only effective treatment and castigating all forms of

radiation as ineffective or worse. In this group there have

been periods when a number of posters believed that proton

therapy was the best way to go, and at other periods it seemed

to me that watchful waiting received a lot of advocacy. I seem

to remember another time when cryotherapy was all the rage.

In every case, the advocates have been well intentioned. Their

goal has always been to save lives, reduce side effects, or

eliminate unnecessary treatment. I applaud that. But I would

like to caution everyone that we really don't know enough to

give very specific treatment recommendations to people.

I thought about this in particular in regard to two recent

postings by B with citations to articles in " Medpage

Today " . One was a critique of proton therapy in which a doctor

reviewing preliminary results in a proton beam study said he

wasn't seeing anything to get excited about. The side effects

he was seeing looked no better than for other forms of

radiation. The other was a study of high dose rate

brachytherapy showing quite good outcomes with very low side

effect toxicities.

I can't conclude from those two studies that HDR brachytherapy

is better than proton therapy. But I am leaning toward the

opinion that we don't know which one is better, or whether one

of the other forms of radiation is better, or whether some

combination treatment is better, or whether surgery is better.

If anything, it seems to me that we have evidence that the

outcomes are pretty comparable.

So I caution everyone to be circumspect in giving advice. The

only two pieces of advice that I always give to everyone are,

educate yourself as much as you can and find the very best

doctor that you can. I will advise people against treatments

that have no track record or have been shown to be inadequate,

but I won't tell someone that proton therapy or, brachytherapy,

or surgery or any of the other well accepted therapies is the

best one because I just haven't seen proof, or even very strong

evidence, for any such conclusion.

Alan

October 1, 2008

(snip)

> So I caution everyone to be circumspect in giving advice. The

> only two pieces of advice that I always give to everyone are,

> educate yourself as much as you can and find the very best

> doctor that you can. I will advise people against treatments

> that have no track record or have been shown to be inadequate,

> but I won't tell someone that proton therapy or, brachytherapy,

> or surgery or any of the other well accepted therapies is the

> best one because I just haven't seen proof, or even very strong

> evidence, for any such conclusion.

Well said.

Regards,

Steve J

" We must tailor the treatment to the nature of the disease. We must

listen to the biology. "

-- B. Strum, MD

Medical Oncologist

PCa Specialist

October 1, 2008