Post by Admin on Sept 16, 2016 9:46:42 GMT -8
While I cannot voice a thing from our meetings at the American Urological Association this week in Maryland, I can say "what an enjoyable experience."
A key topic over the last couple days were the ProtecT trial results. This trial compared the use of RT versus RP versus AS. Basically a long overdue trial that has shown us that the largest risk category over ten years was the active surveillance arm. This arm was is where men had progressed to metastatic disease and prostate cancer specific survival categories. Now to be clear everyone felt the same as I did ~ that start any of these treatments 20 years ago is probably the largest contributing factor to the trial results. For example:
1. When this trial started, the term "active surveillance" was not even around yet. These patients were placed on a basic "watch and monitor" that does not come close to how we do AS today. What's more is that adding imaging and other practices such as repeat biopsy tailored to the patient certainly would cause a shift from AS to definitive therapy in many cases before the disease became metastatic.
2. Surgery in 1995-2005 v. Surgery today. Clearly there has been a shift in surgical intervention to drawing lymph nodes, the emergence of robotic technology, and clinical practice that treat positive margins before they become problematic. Even the Robots used in 2006 versus today barely resemble themselves.
3. RT in 1995-2005 v. Many RT approaches today. Same as surgery we now do so much a better job in this treatment area.
In summary, it is reasonable that RT morbidity at 10 years is better than that of surgery. How that will pan out at 20 years remains to be seen. There were areas where the surgical approach were favorable in the morbidities but they were far less than the morbidities of surgery. These results do provide us the best available comparisons. While the mortality was significantly higher in the active surveillance arm, it was still quite small and as I stated it may be quite different using AS protocols in place today. Patients should not be afraid to be on AS through the results of this trial.
My biggest take away from the AUA meetings was how well the organizations, ASCO, AUA, SUO, and ASTRO were working together to make for some great results.
About the team:
7 urologists, 2 med oncologists, 2 RO's, 1 patient advocate worked many hours together on this phase which will repeat itself. I was treated exceptionally well by the staff members and they very much included me at every opportunity.
Again I am under non-disclosure for at least one year after the release of these new guidelines. That means I won't be able to write about it in 2018. So I'll honor that and stop here.
A key topic over the last couple days were the ProtecT trial results. This trial compared the use of RT versus RP versus AS. Basically a long overdue trial that has shown us that the largest risk category over ten years was the active surveillance arm. This arm was is where men had progressed to metastatic disease and prostate cancer specific survival categories. Now to be clear everyone felt the same as I did ~ that start any of these treatments 20 years ago is probably the largest contributing factor to the trial results. For example:
1. When this trial started, the term "active surveillance" was not even around yet. These patients were placed on a basic "watch and monitor" that does not come close to how we do AS today. What's more is that adding imaging and other practices such as repeat biopsy tailored to the patient certainly would cause a shift from AS to definitive therapy in many cases before the disease became metastatic.
2. Surgery in 1995-2005 v. Surgery today. Clearly there has been a shift in surgical intervention to drawing lymph nodes, the emergence of robotic technology, and clinical practice that treat positive margins before they become problematic. Even the Robots used in 2006 versus today barely resemble themselves.
3. RT in 1995-2005 v. Many RT approaches today. Same as surgery we now do so much a better job in this treatment area.
In summary, it is reasonable that RT morbidity at 10 years is better than that of surgery. How that will pan out at 20 years remains to be seen. There were areas where the surgical approach were favorable in the morbidities but they were far less than the morbidities of surgery. These results do provide us the best available comparisons. While the mortality was significantly higher in the active surveillance arm, it was still quite small and as I stated it may be quite different using AS protocols in place today. Patients should not be afraid to be on AS through the results of this trial.
My biggest take away from the AUA meetings was how well the organizations, ASCO, AUA, SUO, and ASTRO were working together to make for some great results.
About the team:
7 urologists, 2 med oncologists, 2 RO's, 1 patient advocate worked many hours together on this phase which will repeat itself. I was treated exceptionally well by the staff members and they very much included me at every opportunity.
Again I am under non-disclosure for at least one year after the release of these new guidelines. That means I won't be able to write about it in 2018. So I'll honor that and stop here.