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  1. Jim Marshall (not a doctor) said ... If your first treatment for prostate cancer is radiotherapy, getting to each session, five days a week for several weeks can be a problem. These researchers asked whether this would affect your results. Their answer - it does not make a difference in the first four years. Four years because that is the length of time they studied their patients. Longer time results will have to wait more years. ... end Jim J Med Imaging Radiat Oncol. 2018 Feb;62(1):116-121. doi: 10.1111/1754-9485.12675. Epub 2017 Oct 13. Effects of interruptions of external beam radiation therapy on outcomes in patients with prostate cancer. Dong Y1, Zaorsky NG1,2, Li T3, Churilla TM1, Viterbo R4, Sobczak ML1, Smaldone MC4, Chen DY4, Uzzo RG4, Hallman MA1, Horwitz EM1. Author information Abstract INTRODUCTION: To evaluate if interruptions of external beam radiation therapy impact outcomes in men with localized prostate cancer (PCa). METHODS: We included men with localized PCa treated with three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) of escalated dose (≥74 Gy in 1.8 or 2 Gy fractions) between 1992 and 2013 at an NCI-designated cancer centre. Men receiving androgen deprivation therapy were excluded. The non-treatment day ratio (NTDR) was defined as the number of non-treatment days divided by the total elapsed days of therapy. NTDR was analysed for each National Comprehensive Cancer Network (NCCN) risk group. RESULTS: There were 1728 men included (839 low-risk, 776 intermediate-risk and 113 high-risk), with a median follow up of 53.5 months (range 12-185.8). The median NTDR was 31% (range 23-71%), translating to approximately 2 breaks (each break represents a missed treatment that will be made up) for 8 weeks of RT with 5 treatments per week. The 75 percentile of NTDR was 33%, translating to approximately 4 breaks, which was used as the cutoff for analysis. There were no significant differences in freedom from biochemical failure, freedom from distant metastasis, cancer specific survival, or overall survival for men with NTDR ≥33% compared to NTDR<33% for each risk group. Multivariable analyses including NTDR, age, race, Gleason score, T stage, and PSA were performed using the proportional hazards regression procedure. NTDR≥33% was not significantly associated with increased hazard ratio for outcomes in each risk group compared to NTDR<33%. CONCLUSION: Unintentional treatment breaks during dose escalated external beam radiation therapy for PCa did not cause a significant difference in outcomes, although duration of follow up limits the strength of this conclusion. © 2017 The Royal Australian and New Zealand College of Radiologists. KEYWORDS: outcomes; prostate cancer; quality; radiation therapy; treatment interruption PMID: 29030906 This extract can be found on http://PubMed.com, and is in the public domain. On PubMed.com there will be a link to the full paper (often USD$30+, sometimes free). Any highlighting (except the title) is not by the author, but by Jim Marshall. Jim is not a doctor.
  2. Jim Marshall (not a doctor) said ... Metastases (mets) are cancers growing away from the original cancer. In prostate cancer, metastases are often found growing in bone. This can become very painful. A common treatment for a painful met is a strong dose of radiation (X-rays) focussed on the met. A special problem arises at the end of life. No one wants to give a treatment that won't work in time. So Rachel McDonald and her colleagues looked at how quickly radiation to one or two mets gave pain relief and a better quality of life. The answer: Men who responded (around 40%) reported significant pain relief at day 10, and a greater quality of life at day 42 in a number of ways. The authors conclusion: ... end Jim The link below is to a page or document that we do not control. Parts of it may be wrong or misleading. Check with your doctor if something interests you. You may need to subscribe to the site to view the article. If it is temporarily or permanently unavailable, you may receive an error message. http://jamanetwork.com/journals/jamaoncology/article-abstract/2601221
  3. The European Society for Medical Oncology (ESMO) has just had its Annual Conference in Copenhagen. Click here and here for 2 reports from Practice Update about some of the things discussed at ESMO 2016 and the implications for patients.
  4. Since the start of this century there are been a number of proposals to establish a Proton Beam Therapy Centre in Australia. The New South Wales Government has done a number of feasibility studies for a Proton Beam Therapy Centre in Eastern Sydney. The South Australian Government put forward a proposal for a Centre in South Australia. In 2014 an alliance between a commercial company, Proton Therapy Australia and Mater Health Services, Brisbane announced the building of Australia’s first proton therapy facility. On 8 August 2016 the Victorian Government announced the establishment of a National Proton Beam Therapy Centre to be located in Melbourne's Parkville Medical Research Precinct. It will be operated by the Peter MacCallum Cancer Centre with assistance from the University of Melbourne and other partners of the Victorian Comprehensive Cancer Centre. Proton Beam Therapy is mainly used for adult cancers in the head and neck and cancers in children, due to its precision, reduced toxicity and reduced risk in causing cancers later in life. Take a deep breath Proton Beam Therapy is the much hyped latest and greatest technology and is extremely expensive. But is it any better than existing conventional radiation treatments? At the moment there's little scientific evidence that Proton Beam Therapy is better than existing conventional radiation treatments. In June 2016 at the American Society of Clinical Oncology (ASCO) Scientific Meeting data was presented from the very first randomized clinical trial of three-dimensional proton beam radiation therapy (3D-PBRT) compared to intensity-modulated radiation therapy in the treatment of any type of cancer - non-small cell lung cancer. The "New" Prostate Cancer Infolink commented: "Obviously this is not prostate cancer, but the outcomes of this trial do seem to confirm the suggestions that PBRT is not necessarily any better than other modern forms of conventional radiation therapy in the treatment of at least some common forms of cancer." Click here to read the The "New" Prostate Cancer Infolink article.
  5. Some men who are diagnosed with prostate cancer have metastases at the time of their diagnosis. Until recently the primary treatment for these men was Androgen Deprivation Therapy (ADT). Since the CHAARTED and STAMPEDE trials, ADT + Chemotherapy (Docetaxel) has become the standard of care for these men. What about ADT + Chemotherapy + Radiotherapy for these men? Maybe. Removal of the primary cancer has been used effectively in other cancers, either using radiation or surgery to increase cancer-specific survival time. "Whether radiotherapy or surgery is of any benefit after early chemotherapy is still very much an open question" for prostate cancer. Mike Scott and Allen Edel of the New Prostate Cancer Infolink suggest that it's something that a patient who is diagnosed at the outset with metatastes should discuss with their radiation oncologist. Click on this link to read the article.
  6. "Much that has been learned about the treatment of liver metastases comes from reviewing common methods for managing metastatic colon cancer. The liver is the cancer’s preferred site of metastatic spread for colon cancer. Treatments that have been employed include surgery, radiation and blockage of the blood supply to the liver by embolization of the arteries, all with variable success. More recently, radioactive microspheres injected directly into the tumor, called SIR-Spheres, have shown notable efficacy with very tolerable side effects." Dr Mark Scholz is now using SIR-Spheres to treat some of his prostate cancer patients who have liver metastases. To read more about this, click on this link. SIR-Spheres® Y-90 resin microspheres are tiny radioactive 'beads' used in selective internal radiation therapy (SIRT)
  7. The Pilot study of Patients with Oligometastases from Prostate cancer treated with STereotactic Ablative body Radiosurgery (POPSTAR) trial is no longer recruiting. I was at Peter Mac for one of my regular follow-up visits (21 months after stereotactic radiation). No results have been published for this study but apparently some trends are developing. Talking to my radiology oncologist I got the impression that, although the stereotactic radiation had successfully sterilised the metastases being treated, many of the patients (including me) had further metastases develop. There were a few patients who had not had any recurrence after their treatment. Were the patients on the study who progressed after stereotactic radiation truly oligometastatic? Or did we already have the further metastases which did not show up on imaging at the time but are being detected now by improved imaging technology? I’ve recently read a study* which said that it is important to define the true oligometastatic stage and suggests that there are differences between polymetastatic, oligometastatic, or oligo-recurrent disease. The study said that a patient who is oligometastatic on diagnosis is not the same as one who is oligometastatic after treatment. Poly = many. Oligo = few. Improvements in imaging (eg Ga68 PET Scans) are going to make easier in the future to define the true oligometastatic stage. In my opinion (I’m not a doctor) there is a benefit in sterilising known metastases with stereotactic radiation even in cases which are not truly oligometastatic. Although not curative, this treatment reduces cancer load in the body, eliminates a potential source of further metastases and hopefully delays progression of the cancer. My radiology oncologist says that he’d like to think this too but at present we don’t have any evidence. * Oligometastases in prostate cancer: restaging stage IV cancers and new radiotherapy options Moreno et al. Radiation Oncology2014,9:258 http://www.ro-ournal.com/content/9/1/258
  8. The Prostate Cancer Foundation of Australia has posted a video on YouTube of the following talk on Radiation Therapy for Prostate Cancer given by radiation oncologist A/Prof Michael Izard at Sydney Adventist Hospital on 22 June 2015 .
  9. An article posted on the ABC news site (12 May 15) has revealed a Gamma Knife Radiation Treatment System is being installed at the PA Hospital. While the article focuses on it's capability to more safely treat brain cancers, it does note the following-"The machine can also be used on benign and cancerous tumours in other parts of the body" Here is the link - http://www.abc.net.au/news/2015-05-12/radiation-machine-will-turn-brain-surgery-on-its-head-oncologist/6463294 EDIT-(2hrs later) Unfortunately, from further research It appears that this machine (as pictured) is not capable of full body treatment, as it is not a full tunnel through the back, so may not be much use for other parts of the body. The Hospital press release does not mention 'other parts' http://www.health.qld.gov.au/metrosouth/news/150512-pah-gamma-knife.asp Geoff.
  10. An article from today's Herald-Sun newspaper about stereotactic radiation at the Peter MacCallum Cancer Centre in Melbourne To read the article, click on this link.
  11. On 13 November 2014 Snuffy Myers’s weekly video was on the subject of “Treating Ogliometastatic Prostate Cancer.” On 26 November 2014 a copy of a letter by Dr Michael Dattoli was posted on the internet to the Malecare Advanced PCa Group in which he said; “I have recently viewed a video from a prominent Oncologist, entitled “Treating Ogliometastatic Prostate Cancer.” I found this presenting Oncologist to be woefully mistaken about numerous issues” and gave his comments on what he believed to be “the misinformation promulgated in the video blog”. This came as a surprise to those of us familiar with Snuffy Myers’s cancer journey. Dr. Dattoli was the Radiation Oncologist who treated Snuffy Myers with aggressive radiation therapy and seed implantation and Snuffy Myers subsequently referred patients to Dr. Dattoli many times. On 5 December 2014 Snuffy Myers has done a further video “Treating Ogliometastatic Disease with Radiation” to clarify his earlier video.
  12. Overall the risk of getting bladder and rectal cancer is very low. But if you have received radiation therapy for Prostate Cancer, long term surveillance is important. You and your doctor should be careful to monitor for symptoms of bladder and rectal cancer in the long term. This is the advice of Dr Kathleen A. Cooney, the senior author of a new study from the University of Michigan Comprehensive Cancer Centre. The researchers looked at the number of second primary cancers that developed 10 or more years after men were diagnosed with prostate cancer. Because prostate cancer patients typically survive a long time, it raises concerns about the risk of second cancers. As a whole, men diagnosed with prostate cancer were at a lower risk of developing a second cancer than the general public. But when researchers looked at patients who received external beam radiation therapy, they found these patients were more likely to be diagnosed in the long term with rectal cancer or bladder cancer than the general public. Radiation therapy is a standard treatment for prostate cancer and the researchers stressed that their findings should not prohibit anyone from choosing this treatment, in particular men who are not good candidates for surgery. Reference: “Risk of second primary tumors in men diagnosed with prostate cancer: A population-based cohort study Issue” published in the Journal “Cancer” Volume 120, Issue 17, pages 2735–2741, September 1, 2014.
  13. Hi all My story is going on this post as a quick overview and account from the first diagnosis of Prostate cancer to the present In the hope that others may see similarities and possibly help others One good bit of advice is DONT PANIC just make a decision thats best suited for your stage, get a second opinion if needed and follow through It was December 2010, just at my 51st birthday my wife insisted I get a check up with the doctor I protested and made the point that I don't get sick, I don't take any prescribed medications, and in fact I haven't been to the doctor for about 12 years ( hence the title of my post ) Last time I visited the doctor was for a bone fracture in the hand. It's true I simply don't get sick, I have a physical job that keeps me fit and trim, I am 3/4 vegetarian, don't drink except a glass of beer on special occasions ect That equates to a healthy lifestyle by anyone's standards The physical or check up consisted of a blood test and a follow up appointment to evaluate the findings Dr said PSA level looks high Paul but I don't think it's an issue with you ? But just in case I better send you to a specialist Specialist appointment A poke up the rectum and the answer was - Paul just by the feel of it you have an 80% chance you have prostrate cancer but will need to do a biopsy Biopsy showed that I had a 3+4=7 - T2 on the Gleason scale and he gave me many options to consider Christmas was a few days away but I found it more comforting to tell the family over holding the news inside me I returned to the specialist with a list of what I wanted 1) I want to save my nerves if possible 2) I want a fall back if needed in the future 3) I want the procedure ( irrespective of pain ) that gives me the longest observed success rate 4 ) I don't like radiation if I can avoid it He advised me and referred me to a another specialist of the Robotic Prostatectomy procedure I did that and booked in the operation for January 2011 This is the funny bit, my operation was scheduled to be done and the Brisbane floods were in full swing. My operation had to be rescheduled for a week later due to The Wesley Hospital being cut off Procedure done on a Da Vinci robot with all my requests achieved, recovery was a fast but not completely pain free 6 weeks Lots of walking as therapy around the neighbourhood gave me a pleasant feeling of being alive And the reason for that was that I had a phone all from the specialist to inform me that the post operation biopsy came back as a 4+5=9 T3 on the Gleason Scale The next hurdle was to become continent again that took 2 years and only archiving 80% At this time on my last follow up with the specialist my PSA started to rise again and I was referred to a radiation specialist in prostrate oncology Advice was get a sling procedure to be 100% continent and return 4 months after the operation Also in the meantime I was prescribed 2 doses of a hormone therapy capsule that is inserted under ones skin and slow releases over 3 months I think it was Zoladex Sling procedure was booked in and done within 3 weeks with a successful and desired result achieved I am 100% dry hooray Last PSA test, only a few weeks ago has shown that its now 0.1 or negligible due to the hormone therapy another hooray That brings us to the present - This Thursday I am starting on a seven week radiation therapy programme to eradicate any stubborn cancer cells that refuse to give up Well the little buggers won't get a chance to regroup if I have anything to do with it Back soon with an update on the current treatment Be positive and in control - think like a general in the battlefield Regards Paul
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