RE: Re: High-Dose Brachytherapy As Cure for Localized Prostate Cancer

[Guest guest]

Dan you need a bit of cynicism to get by

in this strange world we PCa people live in. Just a couple of comments on your

post:

You

say the urologists you spoke to were the ones who informed you about the

waste of money which is radiology treatment. Most urologists are surgeons

and surgeons are biased towards their specialty.

If

you had asked the urologists for proof that surgery was a better option

than radiology, they would have been unable to produce it – because there

are no studies that show that any of the treatment choices is superior to

another..

There

are some studies that appear to indicate that a combination of EBRT

(External Beam Radiation Therapy) and Brachtherapy might produce a better

result than either treatment alone.These are the same kind of studies as

those that show that surgery is better than radiation.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of buckeyedan73

Sent: Friday, 19 December 2008

9:38 AM

To: ProstateCancerSupport

Subject:

Re: High-Dose Brachytherapy As Cure for Localized Prostate Cancer

Thanks for the information. I was speaking to several

urologists and

it is amazing that they were telling me how many Dr's use both forms

of radiation, internal and external and that it is not proven that

together is any better than one or the other but the financial gain

is immense! millions and millions...

Dan

>

> High-dose-rate brachytherapy is a relatively new radiotherapeutic

> intervention that is used as a curative treatment for patients with

> many types of cancer. Advances in mechanical systems and computer

> applications result in a sophisticated treatment technique that

> reliably delivers a high-quality radiation dose distribution to the

> intended target. Patients with localized prostate cancer may benefit

> from high-dose-rate brachytherapy, which may be used alone in

certain

> circumstances or in combination with external-beam radiotherapy in

> other settings.

> Click on the below link for the full

story:<http://www.urotoday.com/61/browse_categories/prostate_cancer/hi

ghdoserate_brachytherapy_in_the_curative_treatment_of_patients_with_lo

calized_prostate_cancer__abstract.html>

>

[Guest guest]

Some current radiation options include:Low dose brachytherapy with permanent seeds.High dose with seeds that come in and out again.Traditional external beam with any of:3DCRTIMRTIGRT"Hypofractionated" external beam with Cyberknife.External beam with protons.Various combinations of the above.Various combinations of the above combined with variouscombinations of neo-adjuvant and adjuvant hormone therapy.Next week there might be more options.Is one of these the best for treatment outcome and/or side effectprofiles?I don't know if anyone knows the answer, but there are a fewgeneral rules that I'm aware of:Brachytherapy alone should not be used if it is thought that thecancer may have penetrated outside the capsule. If it has (orthe Gleason or PSA scores indicate a significant likelihood ofthat), then some kind of external beam should be used to treatthe area around the prostate that seeds don't reach.If the cancer is thought to be intermediate or high risk,neo-adjuvant hormone therapy (therapy started some weeks ormonths before radiation and continuing through it) is thought toimprove the outcomes.There are differences in the treatment regimen that may make adifference to some patients:Low dose brachytherapy can be administered in a single session,typically with a single night's hospital stay.High dose brachytherapy typically requires two or three hospitalprocedures, which may be separated by weeks (I had two of

them,five weeks apart.)External beam takes 35-40 sessions (fewer if combined withbrachytherapy), but with no hospital stay.Cyberknife takes about 5 sessions (I think.)What should a patient do if he wants radiation?In my view, he should find the best radiation oncologist he canfind, at the best clinic, and listen to his advice.Alan

[Guest guest]

Some current radiation options include:Low dose brachytherapy with permanent seeds.High dose with seeds that come in and out again.Traditional external beam with any of:3DCRTIMRTIGRT"Hypofractionated" external beam with Cyberknife.External beam with protons.Various combinations of the above.Various combinations of the above combined with variouscombinations of neo-adjuvant and adjuvant hormone therapy.Next week there might be more options.Is one of these the best for treatment outcome and/or side effectprofiles?I don't know if anyone knows the answer, but there are a fewgeneral rules that I'm aware of:Brachytherapy alone should not be used if it is thought that thecancer may have penetrated outside the capsule. If it has (orthe Gleason or PSA scores indicate a significant likelihood ofthat), then some kind of external beam should be used to treatthe area around the prostate that seeds don't reach.If the cancer is thought to be intermediate or high risk,neo-adjuvant hormone therapy (therapy started some weeks ormonths before radiation and continuing through it) is thought toimprove the outcomes.There are differences in the treatment regimen that may make adifference to some patients:Low dose brachytherapy can be administered in a single session,typically with a single night's hospital stay.High dose brachytherapy typically requires two or three hospitalprocedures, which may be separated by weeks (I had two of

them,five weeks apart.)External beam takes 35-40 sessions (fewer if combined withbrachytherapy), but with no hospital stay.Cyberknife takes about 5 sessions (I think.)What should a patient do if he wants radiation?In my view, he should find the best radiation oncologist he canfind, at the best clinic, and listen to his advice.Alan

[Guest guest]

Alan, I think you'll find (in the UK at any rate) EBRT is now more often delivered in 20 fractions of higher dosage than 35 at lower dosage. I believe this is thanks to the Physicists getting more accurate, stronger doses where they do most good using variable conformation of the beam, based on what the scans have shown them needs to be done.

rgds .

To: ProstateCancerSupport Sent: Friday, 19 December, 2008 4:22:30 AMSubject: Re: Re: High-Dose Brachytherapy As Cure for Localized Prostate Cancer

Some current radiation options include:

Low dose brachytherapy with permanent seeds.High dose with seeds that come in and out again.Traditional external beam with any of:

3DCRTIMRTIGRT"Hypofractionated" external beam with Cyberknife.External beam with protons.Various combinations of the above.Various combinations of the above combined with variouscombinations of neo-adjuvant and adjuvant hormone therapy.Next week there might be more options.Is one of these the best for treatment outcome and/or side effectprofiles?I don't know if anyone knows the answer, but there are a fewgeneral rules that I'm aware of:

Brachytherapy alone should not be used if it is thought that thecancer may have penetrated outside the capsule. If it has (orthe Gleason or PSA scores indicate a significant likelihood ofthat), then some kind of external beam should be used to treatthe area around the prostate that seeds don't reach.If the cancer is thought to be intermediate or high risk,neo-adjuvant hormone therapy (therapy started some weeks ormonths before radiation and continuing through it) is thought toimprove the outcomes.There are differences in the treatment regimen that may make adifference to some patients:

Low dose brachytherapy can be administered in a single session,typically with a single night's hospital stay.High dose brachytherapy typically requires two or three hospitalprocedures, which may be separated by weeks (I had two of them,five weeks apart.)External beam takes 35-40 sessions (fewer if combined withbrachytherapy) , but with no hospital stay.Cyberknife takes about 5 sessions (I think.)What should a patient do if he wants radiation?In my view, he should find the best radiation oncologist he canfind, at the best clinic, and listen to his advice.

Alan

[Guest guest]

Alan, I think you'll find (in the UK at any rate) EBRT is now more often delivered in 20 fractions of higher dosage than 35 at lower dosage. I believe this is thanks to the Physicists getting more accurate, stronger doses where they do most good using variable conformation of the beam, based on what the scans have shown them needs to be done.

rgds .

To: ProstateCancerSupport Sent: Friday, 19 December, 2008 4:22:30 AMSubject: Re: Re: High-Dose Brachytherapy As Cure for Localized Prostate Cancer

Some current radiation options include:

Low dose brachytherapy with permanent seeds.High dose with seeds that come in and out again.Traditional external beam with any of:

3DCRTIMRTIGRT"Hypofractionated" external beam with Cyberknife.External beam with protons.Various combinations of the above.Various combinations of the above combined with variouscombinations of neo-adjuvant and adjuvant hormone therapy.Next week there might be more options.Is one of these the best for treatment outcome and/or side effectprofiles?I don't know if anyone knows the answer, but there are a fewgeneral rules that I'm aware of:

Brachytherapy alone should not be used if it is thought that thecancer may have penetrated outside the capsule. If it has (orthe Gleason or PSA scores indicate a significant likelihood ofthat), then some kind of external beam should be used to treatthe area around the prostate that seeds don't reach.If the cancer is thought to be intermediate or high risk,neo-adjuvant hormone therapy (therapy started some weeks ormonths before radiation and continuing through it) is thought toimprove the outcomes.There are differences in the treatment regimen that may make adifference to some patients:

Low dose brachytherapy can be administered in a single session,typically with a single night's hospital stay.High dose brachytherapy typically requires two or three hospitalprocedures, which may be separated by weeks (I had two of them,five weeks apart.)External beam takes 35-40 sessions (fewer if combined withbrachytherapy) , but with no hospital stay.Cyberknife takes about 5 sessions (I think.)What should a patient do if he wants radiation?In my view, he should find the best radiation oncologist he canfind, at the best clinic, and listen to his advice.

Alan

[Guest guest]

Alan, I think you'll find (in the UK at any rate) EBRT is now more often delivered in 20 fractions of higher dosage than 35 at lower dosage. I believe this is thanks to the Physicists getting more accurate, stronger doses where they do most good using variable conformation of the beam, based on what the scans have shown them needs to be done.

rgds .

To: ProstateCancerSupport Sent: Friday, 19 December, 2008 4:22:30 AMSubject: Re: Re: High-Dose Brachytherapy As Cure for Localized Prostate Cancer

Some current radiation options include:

Low dose brachytherapy with permanent seeds.High dose with seeds that come in and out again.Traditional external beam with any of:

3DCRTIMRTIGRT"Hypofractionated" external beam with Cyberknife.External beam with protons.Various combinations of the above.Various combinations of the above combined with variouscombinations of neo-adjuvant and adjuvant hormone therapy.Next week there might be more options.Is one of these the best for treatment outcome and/or side effectprofiles?I don't know if anyone knows the answer, but there are a fewgeneral rules that I'm aware of:

Brachytherapy alone should not be used if it is thought that thecancer may have penetrated outside the capsule. If it has (orthe Gleason or PSA scores indicate a significant likelihood ofthat), then some kind of external beam should be used to treatthe area around the prostate that seeds don't reach.If the cancer is thought to be intermediate or high risk,neo-adjuvant hormone therapy (therapy started some weeks ormonths before radiation and continuing through it) is thought toimprove the outcomes.There are differences in the treatment regimen that may make adifference to some patients:

Low dose brachytherapy can be administered in a single session,typically with a single night's hospital stay.High dose brachytherapy typically requires two or three hospitalprocedures, which may be separated by weeks (I had two of them,five weeks apart.)External beam takes 35-40 sessions (fewer if combined withbrachytherapy) , but with no hospital stay.Cyberknife takes about 5 sessions (I think.)What should a patient do if he wants radiation?In my view, he should find the best radiation oncologist he canfind, at the best clinic, and listen to his advice.

Alan

[Guest guest]

DAVID COLLINS wrote:

> Alan, I think you'll find (in the UK at any rate) EBRT is now

> more often delivered in 20 fractions of higher dosage than 35

> at lower dosage. I believe this is thanks to the Physicists

> getting more accurate, stronger doses where they do most good

> using variable conformation of the beam, based on what the

> scans have shown them needs to be done.

>

> rgds .

That's interesting. Some damage to healthy tissue occurrs

during the radiation sessions. By keeping the dosage low, the

theory was that the healthy tissue would be only slightly

damaged and would repair itself between sessions. The cancerous

tissue cell repair mechanisms don't work so well and so the

cancer does not repair itself between sessions.

If they cut the sessions down to 20 then they must either:

1. Have developed better targetting that does less damage to

healthy tissue in spite of the higher dose, or

2. Have decided that the healthy tissue damage is not as bad,

or the repair mechanisms better, than once thought.

Or, heaven forfend,

3. Decided to cut the cost of the radiation in half and let

the patient suffer a little more to save money.

Alan

[Guest guest]

DAVID COLLINS wrote:

> Alan, I think you'll find (in the UK at any rate) EBRT is now

> more often delivered in 20 fractions of higher dosage than 35

> at lower dosage. I believe this is thanks to the Physicists

> getting more accurate, stronger doses where they do most good

> using variable conformation of the beam, based on what the

> scans have shown them needs to be done.

>

> rgds .

That's interesting. Some damage to healthy tissue occurrs

during the radiation sessions. By keeping the dosage low, the

theory was that the healthy tissue would be only slightly

damaged and would repair itself between sessions. The cancerous

tissue cell repair mechanisms don't work so well and so the

cancer does not repair itself between sessions.

If they cut the sessions down to 20 then they must either:

1. Have developed better targetting that does less damage to

healthy tissue in spite of the higher dose, or

2. Have decided that the healthy tissue damage is not as bad,

or the repair mechanisms better, than once thought.

Or, heaven forfend,

3. Decided to cut the cost of the radiation in half and let

the patient suffer a little more to save money.

Alan