Pro tech group study UK

The kings of Bath · New User Joined: 17 Jul 2006 Posts: 9

Hi everyone, I"ve been asked by a newly diagnosed friend with prostate cancer to seek advice about the Pro Tech Study group here in the UK that has offered him a place. He seems to think that a place offers him extensive check ups/monitoring but no choice in the treatment . He is a fit 55yr old and needs to know what prostate brachytherapy really means. Can anyone help.
I'm meeting with him tonight to read through the options but I don't yet have exact diagnosis other than he's been told that they have caught it very early.

kind regards

My 86yr old father is a survior of bladder cancer ( 10 years free) treated with TB washes. I hadn't heard of this but hey! it worked.
best wishes to everyone and keep fighting!
xx x
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Terri and Russell xx

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

I think you're talking about the ProtecT Study, commissioned by your National Health Service. According to the NHS website:

"The ProtecT study was commissioned by the NHS R & D Health Technology Assessment Programme to evaluate the effectiveness, cost-effectiveness and acceptability of treatments for men with localised prostate cancer. The study will compare three treatments (active monitoring, radical prostatectomy and radical radiotherapy). Recruitment of men will be undertaken in nine clinical centres in the UK over a period of five years commencing September 2001. Over 100,000 men will be involved. The major objective will be to assess the survival of men treated for localised prostate cancer at 5, 10 and 15 years following treatment."
http://www.cancerscreening.nhs.uk/prostate/research.html

And from the project's website:

The study aims to evaluate treatments for localised prostate cancer. It is comparing Surgery (radical prostatectomy), Radiotherapy (radical conformal) and Active Monitoring (monitoring with regular check-ups). We do not know enough about the outcome of each of the treatments above to be able to advise men which treatment to have.

The ProtecT study is a randomised controlled trial (RCT). This means that in the ProtecT study we discuss with participants whether they are willing to have their treatment decided by a process called randomisation. Randomisation means that they have an equal chance of having any of the three treatments. This produces comparable groups of patients and provides data of the highest scientific quality. In the study, we will be investigating general health, quality of life, prostate cancer development, treatment outcome, length of life, and cost implications. The study will be open for recruitment from June 2001 until May 2008, but follow-up will continue for 10-15 years.
http://www.epi.bris.ac.uk/protect/

Also see:
http://www.medscape.com/viewarticle/569891

I'm not sure I understand the benefit to the patient, beyond contributing to the common good. Wouldn't your friend receive monitoring and treatment at no cost anyway, under the NHS umbrella?

As a patient, I definitely see the downside--first, loss of choice. Why would anyone who might have a good chance at a cure take a chance on missing the window of curability? You'd have a 1 in 3 chance of being thrown in the "active monitoring" group, even if you were young with a Gleason and PSA that indicated curable cancer. Second, the study is imposing a narrowed range of treatment modalities--conformal radiation, surgery, or active monitoring. No mention of brachytherapy, protons, or HIFU.

Will the study provide salvage treatment if the primary treatment fails?

It sounds pretty dicey to me, for the individual. But maybe I don't see the whole picture.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

The kings of Bath · New User Joined: 17 Jul 2006 Posts: 9

Thank you so much for your reply. Trying to help a friend make a potentially life saving decision is difficult enough but without the relevant information we really are, as they say, 'operating in the dark'. There are a few treatment options that we haven't come across so if anyone can enlighten us as to what " protons or HIFU" are we'd be grateful. Perhaps these are not avaiable in the UK or just not available on the (protecT) group treatment programme, in which case perhaps it is not for him.
I know my friend has an initial reluctance to go for surgery because of the risks but are the risks/ rewards really any different for other options such as radiation?
_________________
Terri and Russell xx

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Your friend is lucky to have help from people like you! Kudos.

I doubt protons are available in the UK. They're not widely available in the U.S. The main center is in Loma Linda, California (not far from Los Angeles). Protons use, like the name implies, protons to deliver ionizing radiation to the cancer. The effect is the same as "regular" radiation, which uses photons in the form of X-rays. However, protons deliver their radiation in a precise 3D space. This allows the radiation oncologist to hit the prostate and avoid surrounding tissues. Protons are famous for their low rate of side effects. But the treatment requires temporarily relocating to the treatment city for a couple of months, and since demand is high and supply is constrained, there can be times when there is a waiting list.

HIFU is pretty new--I don't know a whole lot about it other than it uses high-intensity focused ultrasound. It's not yet available in the US, so US patients travel to Canada and other places where it's approved.

The outcomes of radiation in its various forms and surgery are pretty much the same. (See Walsh, page 241: "Most physicians agree that, for men with prostate cancer in its early stages it would be difficult to show a definite difference in cure rates between radical prostatectomy and external-beam radiation.")

If the cancer is localized, you have a good chance of curing it. Surgery has a two big benefits over radiation in my mind: a pathologist can examine the removed organ and if you have a recurrence after surgery, and the cancer is still localized, it's a much more common and safe procedure to have salvage radiation than it is to try salvage surgery after radiation.

Dr. Walsh, a leading (and pioneer) urologist, on p. 240 of his latest book, says the ideal candidate for surgery is:

*Under age 70
*T1 or T2 disease (in some cases, T3

And the ideal candidate for radiation is:

*Over age 60
*Any stage of cancer.

He cites the main advantages of surgery as: mental satisfaction of knowing the prostate is out, and the main disadvantages as the side effects: impotence (10-70%), and incontinence (2-20%).

For radiation, Walsh says the main benefit is that it is less invasive, and the main disadvantages are the risk of rectal injury (1-2%), and impotence (20-70%). By inference, he's saying that a benefit of radiation is a lower chance of incontinence.

He says, and I totally agree, that there is no "one size fits all" solution. Age, health, stage and aggressiveness of cancer, and personal preferences all play a role in the choice of modality. This choice is apparently taken away in the ProtecT study, and like I wrote earlier, I don't see the benefit to the individual participant. Your friend is nervous about surgery, yet ProtecT could easily assign him to the surgical arm of the study when he *might* rationally opt for radiation.

One last item: you can take this with a grain of salt since Walsh IS a surgeon and some would say every doctor has a natural bias towards their own specialty. Walsh writes, on p. 251: "If cancer is confined to the prostate, there is no better way to cure it than radical prostatectomy. Today, radical prostatectomy cures the vast majority of men with cancer confined to the the prostate...and if the operation is performed by an experienced surgeon, preserving potency is common, and few suffer from serious incontinence. And yet, radical prostatectomy is not for everybody. It is intended for the younger man with curable disease, the otherwise healthy man who can reasonably expect to live another fifteen years. In other words, it is for the man who is not only curable, but who's going to live long enough to need to be cured."

I highly recommend going out and buying "Dr. Walsh's Guide to Surviving Prostate Cancer", by Patrick C. Walsh and Janet Farrar Worthington (2007). It's packed full of useful information for your friend, and it's easily accessible. It's also affordable--the paperback costs about $17 US.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

The kings of Bath · New User Joined: 17 Jul 2006 Posts: 9

Hello replicant thanks again for advice. Have just spoken to my friend who says that the ProtecT people are very keen for him to join as his latest PSA now reads 1.1 which falls way outside the UK cut off for flagging up prostate problems ( he was told 2.9+ but Scandanavia is 2.5).

His reading of 3.5 some 12 weeks ago was what got them interested and they are now interested in this seeming anomaly. I will post a seperate question on the forum to ask if anyone with a psa of 1.1 has gone on to develop prostate cancer which like my friend was only cofirmed after biopsy.

I can't tell you what this help and support means to my friend and us.
_________________
Terri and Russell xx

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Walsh, on p. 156 cites a study originally published in the New England Journal of Medicine, that showed that when PSA was 0.6 to 1.0, the odds of cancer being found (positive biopsy) were 10%. From PSA 1.1 to 2.0 ng/ml, the odds were 21%. The odds of high grade disease (Gleason 7-10) increase with PSA. When PSA is 1.1 to 2.0, the probability of high grade disease is just 2.6 percent.

Walsh says the only threshold he likes is 1.0 ng/ml. Even though some men with PSAs that low and lower will be found to have cancer, it's unlikely to be high-grade, says Walsh.

The NEJM article Walsh cites, by the way, is the same one that indicated 15% of men with PSAs lower than 4 had prostate cancer.

Good luck to you and your friend..hope you keep us posted on his case.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

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