NYT: Results Unproven, Robotic Surgery Wins Converts

Results Unproven, Robotic Surgery Wins Converts

By GINA KOLATA

Published: February 14, 2010

Robot-assisted prostate cancer surgery makes sense in some ways, but it is not clear if its outcomes are better.

At age 42, Dr. Jeffrey A. Cadeddu felt like a dinosaur in urologic surgery. He was trained to take out cancerous prostates the traditional laparoscopic way: making small incisions in the abdomen and inserting tools with his own hands to slice out the organ.

But now, patient after patient was walking away. They did not want that kind of surgery. They wanted surgery by a robot, controlled by a physician not necessarily even in the operating room, face buried in a console, working the robot’s arms with remote controls...

Full text after the jump here.

blood donation

I gave blood yesterday for the first time in years.

The American Red Cross now allows prostate cancer patients to donate if it has been at least a year since treatment, and there is no sign of recurrence. The same holds true for most other cancers.

This is a change from past rules, which said it had to be five years.

If you can help Tim Johnson...

I have been in contact with the family. If you would like to give by PayPal or by mail, I have that information. Email me at galileo1962@cox.net .

If we all give a little, we can help a lot. In the last month, 465 of you visited my little blog here. You came from 46 states and 55 countries. Can you imagine the impact, if just half of you threw $10 Tim's way?

In case you're wondering, I don't know Tim or anyone in his family (or town, for that matter). I read his story this morning, following a link on prostatecancerinfolink.net.

Let's see what the power of the blogosphere can do.

Whatever you're doing right now...

I urge you to stop what you're doing now, go to this news story, and ask yourself what you can do to help this guy with advanced prostate cancer. We can't do everything, but we can all do a little. We're all brothers in this fight, right? Let's all do a little to help, and combined, that will mean a lot.
Tim's Story

Salvage RT and ADT Compared: Study

Researchers in South Korea have found that when PSA rises after prostatectomy, treating men first with salvage radiation and then hormone therapy later, if needed, controls PSA in most cases and slows clinical progression, compared to hormone therapy alone.

49% of the patients failed salvage radiation during the study, after an average of 30.7 months. Those patients were then put on ADT. 14% of those patients successfully controlled their PSA with ADT for 20.7 months, leaving 86% who controlled their PSA for over 3 years.

Fast doubling times (less than 3 months) were predictive of RT failure.

Treatment failure and clinical progression after salvage therapy in men with biochemical recurrence after radical prostatectomy: radiotherapy vs androgen deprivation.

Song C, Kim YS, Hong JH, Kim CS, Ahn H.

Departments of Urology and Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

This is personally troubling to me on a couple of points--first, my doubling time was very fast--well under 90 days. Secondly, this study reinforces my belief that I'm far from out of the woods. I'm a little under three years out from the end of salvage radiation, just about the point, on average, where men who fail RT see their PSA rise again. Obviously, I need to keep monitoring my PSA. If it begins to rise and the doubling time is as fast as it was before treatment, I should probably not delay hormone therapy.

another excellent PSA

Just got the results from the nurse. Less than 0.1 once again. It's been about 3 years since I started salvage radiation, or about 34 months since the end of treatment.

I always think it's going to be bad news, and so far it's been just the opposite every time. Years to go before I can start to say "cured," of course.

Photo credit: Bithead (Creative Commons license) http://www.flickr.com/photos/bithead/340102475/

Outcome of salvage radiotherapy for biochemical failure

Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy.

Not sure how I missed this one--probably because I usually search "radiation" and not "radiotherapy"--but a study from MD Anderson in 2005 reaffirmed the idea that the earlier you start, the better, with salvage. Like Stephenson et al at Cleveland Clinic, they found that the best results were obtained when the man's pre-radiation PSA was 0.5 or less.

The MD Anderson study put men into two groups: favorable and unfavorable. Those in the favorable group had pre-RT PSAs of 0.5 or less, and positive margins. Unfavorable included everyone else. 81.7% of those in the favorable group had no PSA progression 5 years later, compared to 61.7% in the unfavorable.

I'm in the unfavorable group. The 61.7% chance of being progression free at 5 years (which would be spring of 2012 for me) matches up well with other research I've read.
___________________________________________________________

Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):134-40.

Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy.

Cheung R, Kamat AM, de Crevoisier R, Allen PK, Lee AK, Tucker SL, Pisters L, Babaian RJ, Kuban D.

Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. mrcheung@mdanderson.org

BACKGROUND: This study analyzed the outcome of salvage radiotherapy for biochemical failure after radical prostatectomy (RP). By comparing the outcomes for patients who received RT alone and for those who received combined RT and hormonal therapy, we assessed the potential benefits of hormonal therapy. PATIENTS AND METHODS: This cohort was comprised of 101 patients who received salvage RT between 1990 and 2001 for biochemical failure after RP. Fifty-nine of these patients also received hormone. Margin status (positive vs. negative), extracapsular extension (yes vs. no), seminal vesicle involvement (yes vs. no), pathologic stage, Gleason score, pre-RP PSA, post-RP PSA, pre-RT PSA, hormonal use, radiotherapy dose and technique, RP at M. D. Anderson Cancer Center, and time from RP to salvage RT were analyzed. Statistically significant variables were used to construct prognostic groups. RESULTS: Independent prognostic factors for the RT-alone group were margin status and pre-RT PSA. RP at M. D. Anderson Cancer Center was marginally significant (p = 0.06) in multivariate analysis. Pre-RT PSA was the only significant prognostic factor for the combined-therapy group. We used a combination of margin status and pre-RT PSA to construct a prognostic model for response to the salvage treatment based on the RT group. We identified the favorable group as those patients with positive margin and pre-RT PSA < or =" 0.5" p =" 0.03).">

PMID: 16111581 [PubMed - indexed for MEDLINE]