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Posted 6/6/2018 6:22 PM (GMT -5)
I am now more confused after reading Nkinney's post. I had read an article a month or two ago (I can see the page in my mind) which cited stats from a large database. It commented that surgery had been 60 percent of treatment choice before the rise of AS, radiation had been about 30 percent, and "other" made up the final 10 percent. Since then, surgery rapidly declined inversely to AS, and that surgery, radiation, and AS were now all even at about 35 percent of choice.

I cannot find that article, but it seemed close to what TA cited. I had even emailed TA asking if he had written it. Apparently not.

But, the numbers I recall reading add up, while Nkinney's expansive post does not account for a large section of men's choices. For instance, if surgery was 40 percent in 2004, and radiation was also 40, and 5 percent was unknown, there is still 15 percent not accounted for.

The 60/30/10 numbers in my "missing" article just seem to make more sense to me as the starting point before the recent popularity of AS/WW. Has anyone else seen such percentages?
Posted 6/6/2018 8:17 PM (GMT -5)

ASAdvocate said...
I am now more confused after reading Nkinney's post. ...

But, the numbers I recall reading add up, while Nkinney's expansive post does not account for a large section of men's choices. For instance, if surgery was 40 percent in 2004, and radiation was also 40, and 5 percent was unknown, there is still 15 percent not accounted for.


I'll ask you to forgive me for confusing you, and I will attempt to clarify here. Paraphrasing a quote attributed, I believe, to Benjamin Franklin: If I had more time, I would have written a shorter letter. It turns out that I actually did have some work to do today...

But I do believe my numbers from my last post were all correct (although maybe I didn't provide ALL the key values adding each time to 100%)...maybe that's why you got confused. This might be clearer:
  • Surgery was about 35% in 2004 (and up to just below 40% in 2014).
  • All forms of radiation in 2004 were about 40%, now down to about 30%
  • Expectant management was about 20%, now up to just below 30%
  • "Other" category was a couple percent, almost 5%, steady across the time period
It adds up.

Here's the data in graphical/tabular formats (SEER, 2004-2014): LINK
(This data does NOT include initial treatment modes for new cases initially diagnosed as systemic; localized PC at the time of diagnosis only.)

Let me know if you got it now...

Post Edited (NKinney) : 6/6/2018 7:33:23 PM (GMT-6)

Posted 6/6/2018 8:43 PM (GMT -5)
Here's the points that I think are interesting from this data and the chart I just posted...
  • Brachytherapy as mono-therapy has just about disappeared (although it was never very popular, despite A Yooper's steady drumbeat)...it's now less than 5% of all localized cases.
  • The high-risk cases going into surgery has increased. I've posted in several other threads in just the past couple days that this is nonsensical to me when there is already a know high likelihood of having to do SRT...hey, but who am I??
  • Expectant management is actually much higher in the VA program, and we've seen other recent posts on that...close to 75% uptake by the "eligible" men (note that not all men represented on the chart were "eligible" candidates, so can't do apples-to-apples with this data)

What do you think is interesting?

Post Edited (NKinney) : 6/6/2018 7:52:06 PM (GMT-6)

Posted 6/6/2018 8:48 PM (GMT -5)
Thank you for the link to that succinct chart. I think that the unknown risk cases are the missing ones.

The decline in radiation puzzles me, especially since I keep reading posts across the internet of men choosing SBRT, HDR-BT, and, recently, proton beam therapy.

My fixation with the article I recall is my problem. I have requested SEER access to try to better inform myself. Thanks again.
Posted 6/6/2018 8:54 PM (GMT -5)
There's shifting going on in RT...shuffling the deck chairs on the Titanic?!?! SBRT, for example, is just a subset of the larger set of EBRT options; it can just be applied in fewer cycles, which is more appealing, for sure. But proton (another EBRT category) for prostate cancer is, I believe, going the way of BT. It was a way-more-expensive-but-not-really-better solution looking for a problem to solve, until they discovered and started marketing it for the exploding numbers of low-risk PC cases. Now, low-risk PC cases are not being biopsied/diagnosed, and/or have woken up to not needing treatment. Vanishing market. Proton therapy for PC is a case study of what happens when they give the marketing people too much voice in the meeting.

Post Edited (NKinney) : 6/6/2018 8:08:39 PM (GMT-6)

Posted 6/6/2018 9:23 PM (GMT -5)
The few guys that I know personally, and a few others on PCa forums, who
Have done PBT, speak highly of it. Construction of new proton facilities keeps happening.

I agree that it is expensive and time-consuming, without superior results. But, institutions keeping investing big bucks on proton. Maybe they hope that the next version will realize its theoretical potential.
Posted 6/6/2018 11:33 PM (GMT -5)
We are done here. Someone needs to read Rule 3 before busting everyone else's chops.

This is not a science class or technical debate session. It is a support group.
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