Re: Re: Long Term Outcomes for Prostate Cancer Therapy Choices [1 Attachment]

[Guest guest]

I was considering brachytherapy until I was confronted with two negatives:1. I have mild to moderate ulcerative colitis and radiation treatment tends to exacerbate colorectal problems.2. I would have to undergo three or more months of Lupron shots to shrink the prostate before the procedure could be done. I though opted for surgery, which was done via the perineal approach, with rapid healing comparable to robotic r/p access. My PSA has been unmeasurable since the first test after surgery was done in Sept., 2006. Louis. . . To: ProstateCancerSupport Sent: Saturday, July 30, 2011 12:19 PMSubject: Re: Re: Long Term Outcomes for Prostate Cancer Therapy Choices [1 Attachment]

I've heard various opinions about the study. One of the specialists who worked on this- Dr. Crawford- told us that surgery is the best treatment for my husband (intermediate risk) when I asked him if he agreed with the findings of his study that brachytherapy plus seeds is the best. One of the best radiation research doctors in the country (can't say his name because it was a personal communication) said that the study is full of holes- hidden biases.

One huge hole that I noticed is that the ASTRO biochemical recurrence criterion is applied to the radiation studies while the >0.2 ng/ml PSA is applied to the surgery studies. The 0.2 criterion is more stringent than the ASTRO. Since brachytherapy ablates the prostate (removes it like surgery but with radioactive seeds) and leaves no viable prostate tissue behind, it would make more sense to use the >0.2 PSA criterion for brachytherapy. Some of the best brachytherapists (Dr. Critz and Dr. Dattoli) use the > 0.2 PSA criterion. Perhaps the

brachytherapy studies in this PCRI report should have used the >0.2 PSA criterion in order to compare them more accurately to surgery. Then they would not come out so far ahead. I contacted Dr. Grimm's group with this question but have not heard back from them.

There's another problem with the study. I looked up one data point for Dr. Menon's group at Vattikuti. The actual study listed their success rate at something in the upper 80% range. The data point on the graph listed it in the upper 60% range. I'm guessing that this is because they adjusted the published success rate to estimate success rate at so many years beyond what the study looked at. When I have time, I'll go back and get the details