(Best Syndication News) Researchers say that advanced prostate cancer patients who undergo radical prostatectomy can experience 20-year survival rates. Doctors are getting better at determining surgery candidates.
"We are doing a much better job of identifying and expanding candidates for surgery, which results in better, longer outcomes for so many of our patients," says R. Jeffrey Karnes, M.D., of Mayo Clinic's Department of Urology.
There are various stages and grades of prostate cancer. Stage cT3 prostate cancer has spread beyond the prostate. Currently, patients with cT3 prostate cancer are typically given radiation or hormone treatment only. But this may change.
Giving chemotherapy before breast-conserving surgery is as effective against breast cancer recurrence as giving chemotherapy after breast-conserving surgery. These results were presented at the 2011 Breast Cancer Symposium.
Breast-conserving surgery (also referred to as lumpectomy) involves removal of the breast cancer and some surrounding normal tissue. For some women, giving chemotherapy prior to surgery can shrink the cancer and make it easier to remove. There’s been some uncertainty, however, about whether chemotherapy followed by breast-conserving surgery is as effective against local-regional recurrence (cancer recurrence in or near the breast) as breast-conserving surgery followed by chemotherapy.
To evaluate whether risk of breast cancer recurrence varies by timing of chemotherapy, researchers collected information about roughly 3,000 women who underwent breast-conserving surgery and radiation therapy between 1987 and 2005. Roughly three-quarters of the patients underwent surgery first and the remaining patients underwent chemotherapy first. Women who received chemotherapy first tended to have cancers with worse prognostic features.
Factors that were linked with an increased risk of breast cancer recurrence were young age (less than 50 years), clinical stage III cancer, grade 3 cancer, cancer that was estrogen receptor-negative, and close or positive surgical margins (cancer at or near the edge of the tissue that was surgically removed).
After accounting for tumor characteristics, risk of breast cancer recurrence was similar among women who underwent surgery first and women who underwent chemotherapy first.
These results suggest that tumor characteristics—rather than the timing of chemotherapy—influence risk of breast cancer recurrence.
Reference: Mittendorf EA, Buchholz TA, Tucker SL et al. Impact of chemotherapy timing on local-regional failures in patients with breast cancer undergoing breast-conserving therapy. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 82.news.cancerconnect.com
It goes without saying that those who battle breast cancer are forced to endure an incredible amount of physical, mental, and emotional stress. After all, the impact of cancer extends far beyond the body—even those who are fortunate enough to survive the disease find their lives transformed by the physical impact of the disease, making their emotional recovery even more difficult. The fact is that living with physical reminders of an ordeal like breast cancer can present an immense challenge.
Fortunately, as noted at www.aboutplasticsurgery.com there are plastic surgery methods available today that can be very helpful in mitigating the sometimes debilitating physical impact of breast cancer treatment. These reconstructive surgical techniques can help women regain physical balance and emotional well-being.
For many women diagnosed with breast cancer, treatment will include a single or double mastectomy (removal of one or both breasts). While this surgical step is often a critical aspect of treatment, it also results in a dramatic, and permanent, change to the body. For women who mourn this change, breast reconstruction is an option to consider. Though a reconstructed breast will never feel, or look, exactly like the breast that has been removed, several surgical techniques are available today to help achieve the most natural look, and many women find that reconstruction offers an acceptable alternative.
Women can work with their reconstructive surgeons to find a solution that suits their unique needs and desires. This process may involve overcoming common issues related to reconstruction, including creating symmetry between the two breasts, if only one breast has been removed. This may include surgery to the unaffected breast to augment or to reduce its size to create symmetry between the reconstructed and unaffected breast. Though the perfect natural symmetry that your breasts may have had pre-cancer may not be possible, augmentation, reduction, and other related procedures can be very helpful in creating the best result possible.
Ultimately, every woman who has undergone cancer treatment presents with unique physical and emotional issues. However, for many women, the physical impact of breast cancer, particularly for those women who have endured the loss of a breast, can be lessened through the many reconstructive options now available. If you or to someone you know is interested in pursuing reconstructive surgery, consider the benefit of researching various surgical options, and speak with your health care team about the possibility. It may prove to be a very vital part of the recovery process.
For more information, visit www.aboutplasticsurgery.comnews.cancerconnect.com
Researchers at the Mayo Clinic have queried their large, nearly 20-year-long database of men who have undergone radical prostatectomy in an attempt to assess the correlation between positive surgical margins at the time of surgery and subsequent occurence of systemic disease or prostate cancer-specific mortality. Boorjian et al. carried out a careful retrospective analysis of the Mayo prostatecancerinfolink.net
motivation is something you have to work on and experience dailyjust like bathing - "paraphrased zig zigler"
Question:
I am 63 years old and in good health. I was recently diagnosed with prostate cancer (Gleason 6; low volume; TIC Stage 2). My urologist–a surgeon–went through the options with me and my wife. He also stated that he felt I was a prime candidate for using the new trueBeam radiation method (45 treatments). He set me up to meet with radiology oncologist. I also have an appointment with a surgeon he recommended that performs the daVinici Robotic surgery. After reading your book and the Johns Hopkins book, I was leaning towards the surgery — the “gold standard.” Now after meeting with the radiologist, many of my fears and concerns relative to radiation were “debunked.” Do you have any insight or could you direct me to any studies relative to the trueBeam radiation therapy? Treatments would be done less than six miles from my home — a real plus.
From the Varian Website about TrueBeam radiation:
With TrueBeam, we have seamlessly integrated imaging, beam delivery and motion management to produce a system that delivers unmatched synchronization. The result is a revolutionary and elegant solution with improved operation, precision and speed.
de·bunk
tr.v. de·bunked, de·bunk·ing,
de·bunks
To expose or ridicule the falseness, sham, or exaggerated
claims of: debunk a supposed miracle
drug.
de·bunker n.
Word History: One can readily see that
debunk is constructed from the prefix de-, meaning “to remove,”
and the word bunk. But what is the origin of the word bunk,
denoting the nonsense that is to be removed? Bunk came from a place where
much bunk has originated, the United States Congress. During the 16th Congress
(1819-1821) Felix Walker, a representative from western North Carolina whose
district included Buncombe County, carried on with a dull speech in the face of
protests by his colleagues. Walker later explained he had felt obligated “to
make a speech for Buncombe.” Such a masterful symbol for empty talk could not be
ignored by the speakers of the language, and Buncombe, spelled
Bunkum in its first recorded appearance in 1828 and later shortened to
bunk, became synonymous with claptrap. The response to all this
bunk seems to have been delayed, for debunk is not recorded until
1923.
The best treatment? Answer…there is no best treatment.
But here’s the great thing about the above case…he is a reasonable candidate for all treatments including surveillance therapy. This patient as all the good stuff…age is good, health is good, path report is good. Now the issue is which treatment best meshes with him and limits the downside of any of the potential side effects. Well, you won’t know until you have the particular treatment.
I chose to have mine removed and basically was lucky that I dodged all the bad side effects. If I had had my procedure on a different day or by a different doctor, I might not have been so lucky.
Now to “debunking” any fears about radiation. What would be my fears about having radiation?
The really bad stuff happens infrequently-colitis, persistent diarrhea, urgency incontinence, impotence and the unknown side effects down the road like hemorrhagic cystitis. I have seen patients with prostato-rectal fistulas. I was consulted on one last week with radiation colitis and had a colostomy. I’ve had post radiation patients with urethral strictures.
I did not like that any procedure that might be needed down the road would be more difficult because of the effects of radiation on surrounding tissues.
I had some obstructive voiding symptoms and I was concerned that would worsen with radiation and then I’d be limited as to what I could then do about it surgically.
Regarding seeds: I was concerned about all the voiding symptoms and the “non exact science” of placing the seeds.
Here’s the thing…you can’t really debunk these issues. The minor side effects occur commonly-how severe or the duration is an unknown…that’s a fact. And there are patients out there who have had a bad time with the aftermath of radiation. That’s a fact. You can debunk that the chances of the bad things about radiation probably won’t occur, but it would be disingenuous for any radiation therapist to state that they are unfounded fears and that they won’t happen. That’s a fact. Not a bad idea to ask a radiation therapist, “Tell me about some unfortunate things that have happened with your prostate cancer patients after radiation.” They will have a few examples-uncommon yes but “you know what” happens.
The TrueBeam as best as I can tell is a system that allows for the treatment of prostate cancer with radiation and has corrected a problem with older systems and that is making sure the beam is on the target, i.e. that all the radiation goes where it is supposed to go and adjusts if the patient moves. Obviously if a patient moves even a bit the radiation would then be off target. Does this mean that it limits collateral damage? Yes. Does it mean there will be no collateral damage or that the prostatic urethra won’t get inflamed? No. Radiation is radiation and its effect on the body is a given-again to what degree is an unknown. A good question for the radiation therapist might be to clarify that TrueBeam is synchronized, but the radiation, the dosage and the time frame are the same as non TrueBeam. It seems that all the non surgical forms of radiation all have a catchy name…nanoknife, prostarecision, etc.
External beam radiation (a broad term of which TrueBeam is and radioactive seeds aren’t) is much better tolerated with fewer prostate side effects than seeds. Seeds probably do a better job of putting large amounts of radiation right where it needs to be. In this particular prostate cancer-favorable pathology-I think that external beam radiation is a good choice.
It fits the patient, the disease, and the “who are you” factors as the treatment is convenient. Also I hear in the tone of the patient that he likes the idea of radiation over surgery. I like it!
I also think (if the patient can live with it and wrap his mind around it) that surveillance is a good option.
Before you think I was hard on radiation…surgery has its own issues and it is a less than perfect treatment with unknowns after the treatment.You could die on the table or leak urine, I mean flat-out leak forever or for 3 months like I did. “There is no free ride my friend.”
Summary:The TrueBeam makes sure that patient movement is accounted for in the treatment to assure that the maximum dose of radiation gets where it should. I don’t think its “better radiation.” The favorable path makes external beam a good option. And I think this patient has “done it the right way.” He understands his disease and has matched the disease with the treatment in the context of his personal situation. He should think a bit about surveillance…once a year biopsy and twice a year PSA and proceed to treatment if any untoward change. Of note, at five years, about 20-30% of the people in surveillance “fall out” and pursue treatment and with a very low % consequence to waiting until signs of progression.
And of course…a bit of luck that the bad things that happen to the unfortunate few don’t happen to him.theprostatedecision.wordpress.com
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