Comparing Treatments:

Don’t just take Radiotherapy Clinics of Georgia word for it, review the numbers.

Below you will find a table of cure rates and scenarios that will help you cut through the clutter to make an informed choice. This table, like treatment at Radiotherapy Clinics of Georgia, is based on the latest research the medical community has to offer.

Please print this handy table for reference as you discuss treatment options with your family and physician.

For questions 110-117, please reference Table 1 below:

Question 110:
What is the cure rate if a man is treated only with IMRT external beam radiation?

All IMRT beam radiation cure rates have been calculated with either the ASTRO or nadir+2 definition. The 10-year cure rate with beam radiation of 6,500–7,000 cGy is only 3%.8 With IMRT beam radiation, the doses have been increased approximately 20% (7,800–8,600 cGy), and we now find prostate cancer earlier with the PSA test.53,54 Due to these factors, it is estimated that overall cure rates for IMRT beam radiation would increase from 3% to approximately 25% (Table 1).

Question 111:
What is the cure rate for men treated only with seed implant, either radioactive I-125 or palladium seeds, and no beam radiation?

Doctors from several major facilities, including M.D. Anderson, New York Prostate Institute, Mayo Clinic in Scottsdale, the Seattle Center, Cleveland Clinic, Harvard, Memorial Sloan Kettering and University of Michigan, treated 2,693 men with seed implant alone (either iodine or palladium seeds) and calculated their 10-year cure rates with PSA cutpoint 0.5 ng/ml.9The overall 10-year cure rate was only 35%. Had the cure rate been calculated with PSA cutpoint 0.2 ng/ml, a stricter definition, the 10-year cure rate would have been less, probably 30% (Table 1). Furthermore, seed implants alone are almost always used for men with very early prostate cancer — pretreatment PSA below 10.0 ng/ml and Gleason score 6. Because of this low cure rate, especially in men with early cancer, treatment with seed implant only for prostate cancer is not recommended.

Question 112:
What is the cure rate if doctors first give beam radiation followed by a seed implant, the reverse of ProstRcision?

One group of highly-experienced seed implant doctors did calculate 10-year cure rates with PSA cutpoint 0.2 ng/ml. The 10-year cure rate was 65%.10 This 10-year cure rate will be much better than those achieved by the average seed implant doctor in the United States. This is an acceptable way to treat men with prostate cancer, but the cure rates are significantly less than those after radical prostatectomy or ProstRcision.

Question 113:
What is the cure rate for cryosurgery for prostate cancer?

Cryosurgery is a treatment for prostate cancer that involves freezing the prostate gland. All outcomes published in medical journals have been calculated either with the ASTRO or nadir+2 definition. One medical report did show that only 28% of men treated with cryosurgery had PSA 0.2 ng/ml or less five years after treatment (Table 1).11 Ten-year cure rates will be even lower. Because of poor cure rates, cryosurgery is not recommended as a treatment for men when first diagnosed with prostate cancer. However, it is of use as a salvage treatment for men who have recurrent cancer in the prostate after irradiation.55

Question 114:
What is the cure rate for High Dose Rate (HDR) irradiation, using the radioactive isotope called iridium (IR-192)?

In contrast to radioactive iodine or palladium seeds, which are both permanent implants, iridium is a temporary implant whereby a patient is taken to the operating room on two or more occasions to have the iridium inserted into the prostate for only a few minutes at a time, later followed by beam radiation. Most medical reports on this method have had outcomes calculated with either the ASTRO or nadir+2 definition. One overall report did show that 72% of men achieved PSA 0.2 ng/ml within five years after treatment.12 However, whether men maintained PSA 0.2 ng/ml through 10 years of checkups is unknown. Given these factors, it is estimated that the 10-year cure rate for HDR will be approximately 60%. An increased number of complications have resulted from HDR, especially strictures (scarring) of the urethra tube, which leads to urinary blockage and requirement of a catheter or additional surgery. Men with prostate cancer would have a better chance for cure with fewer complications if treated with either radical prostatectomy or ProstRcision.

Question 115:
What is the cure rate with proton beam irradiation for prostate cancer?

The doctors at Loma Linda University have treated the largest number of men (1,255) with proton beam irradiation for prostate cancer but calculated their outcome with the ASTRO definition.13 Given the degree that ASTRO or nadir+2 definition inflate the results with external beam radiation, it is estimated that the cure rate for proton beam radiation would be approximately 30% if calculated with PSA cutpoint 0.2 ng/ml. Proton beam irradiation is not recommended for men with prostate cancer because the cure rate is one-half of either radical prostatectomy or ProstRcision. The only proven use for proton beam irradiation in the entire field of cancer is for a few rare childhood cancers.

Question 116:
What is the cure rate for High Intensity Focused Ultrasound (HIFU) treatment methods for prostate cancer?

All medical studies of cure rates have been calculated for HIFU with either the ASTRO or nadir+2 definition. One report revealed that 42% of men who received HIFU treatment achieved PSA 0.5 ng/ml.14 If a 10-year cure rate were calculated with PSA cutpoint 0.2 ng/ml, it is estimated the cure rate for HIFU would be approximately 30% (see Table 1). The only known role for HIFU in the treatment of prostate cancer is as salvage treatment.56

Question 117:
What is the cure rate for Cyberknife irradiation?

Cyberknife is a technique for giving beam irradiation. Although the owners of the Cyberknife Company have claimed that Cyberknife cures prostate cancer with little to no side effects, no medical study has ever been published in a peer-reviewed medical journal showing the results with this technique in comparison with other treatments for prostate cancer. Two highly-respected doctors, Bentzen and Wasserman from the University of Wisconsin School of Medicine and Washington University School of Medicine, respectively, wrote a report in a peer-reviewed medical journal concerning the false claims of success by the owners of Cyberknife. These authors pointed out that Cyberknife is an unproven, experimental treatment for prostate cancer that has only been in use for approximately three years. Men with prostate cancer should not be treated with Cyberknife unless they volunteer in writing to be part of a medical experiment.15 Since men usually have only one chance to be cured, there are significantly better proven treatment methods for prostate cancer than Cyberknife.

Question 118:
What about watchful waiting as management for prostate cancer?

Watchful waiting (i.e., active surveillance or expectant management) is a unique way to manage cancer and is based on the observation that many men diagnosed with prostate cancer die from other causes before dying from their prostate cancer.57 Men receive no treatment for their disease but are followed with PSA levels every six months and have a repeat prostate biopsy every two years. Medical studies have shown that 8–40% of men who initially elect watchful waiting will need to be treated within five years.58,59 There are two basic problems with watchful waiting. Although most men with early prostate cancer will not have significant progression, you never know which man will have spread of his cancer. Additionally, it is often difficult psychologically for men and their wives to be told they have cancer and then be advised to do nothing except watch it. For this reason, although offered, few men elect watchful waiting unless they are elderly or have other severe medical problems.