A few weeks ago I received an important and timely letter from a prostate cancer advocate in England which, to my regret, I somehow overlooked. Maybe because my life in the past two months has been hijacked by a single project: making improvements to my home in anticipation of selling it. Before the summer is gone. What I am most sorry about is that this (often nasty) business has taken me away from what I like most — writing this blog.

In any case, the lady from England wrote to tell me and all of you that there is a contest ongoing until the end of June in which ordinary blokes (”regular guys” to you Yanks) can vote online for the most creative advertisement from among a group submitted by ad agencies, nonprofit groups and others. The winning entry will grace the sides of the buses in London. For FREE.

What this has to do with us is that the UK Prostate Cancer Charity, an organization I practically worship, has submitted a funny and clever entry which is now holding first place in the contest! The ad reads:

“If the bus isn’t the only thing you have to dash for — see your doctor”.

.
Don’t have to explain, do I? And just so you know, alongside the text is a giant picture of a urinal. Now this ad may not be to everone’s liking (American humor is a bit more stodgy), but believe me, it will grab people’s attention.

Don’t like to circulate “toilet humor” but this is one case in which I consider it not just necessary but — er — urgent. You might not know that doctors in the U.K. do not routinely order PSA tests the way many do in the U.S. So it’s critical for men in Britain to learn to recognize the symptoms of prostate cancer so that they can get help early if needed.

So please turn off the telly (tr.: “TV”) or whatever you’re doing and cast your vote for PC awareness by clicking on the following link (if it’s not “live”, please cut and paste):

http://www.upeveryonesstreet.co.uk/wildcards/.

Vote early and often — you are allowed to do so daily! You are also encouraged to leave comments when you vote.

Thanks and tata until later.

Leah

I received a letter from a young man named James who asked what he could do for a friend who was grieving for a father lost to prostate cancer. This is a painful question, as grief and children should never interact. But unfortunately, they do. I know how painful it is to lose a parent — my own father died a few years ago, and I was having an argument with God about being rendered an orphan — at age 45.

I would like to suggest that James’ friend read the following:

(1) A copy of a letter Abraham Lincoln wrote to the daughter of a friend who had been killed in the Civil War (see below, italics mine). In addition to its sincerity and tenderness, I like this letter because it expresses accurately what, in my experience, happens after the loss of a loved one. For example:

“The memory of your dear Father, instead of an agony, will yet be a sad sweet feeling in your heart . . . “

(2) A guest post on this blog written by Alan Kearnley, son of my dear friend, Hugh Kearnley. Alan was 19 when his Dad died, and he wrote something heartfelt and beautiful about it afterwords. See “Caring for Pops and Being a Friend at the Same Time”, (link provided below, or do a search here).

(3) What looks like a good list of resources from the American Society of Cancer Oncologists.

Also consider:

On the New Prostate Cancer Infolink, an online support group was recently founded for the children of sick parents. Not exactly the same thing, but it might be useful.

(If the links aren’t “live”, I will fix them later.)

One last word: thank you, James, for being a good friend.

Leah
—————————————————————
Letter to Fanny McCullough

“Executive Mansion,
Washington, December 23, 1862.

“Dear Fanny,

“It is with deep grief that I learn of the death of your kind and brave Father; and, especially, that it is affecting your young heart beyond what is common in such cases. In this sad world of ours, sorrow comes to all; and, to the young, it comes with bitterest agony, because it takes them unawares. The older have learned to ever expect it. I am anxious to afford some alleviation of your present distress. Perfect relief is not possible, except with time. You can not now realize that you will ever feel better. Is not this so? And yet it is a mistake. You are sure to be happy again. To know this, which is certainly true, will make you some less miserable now. I have had experience enough to know what I say; and you need only to believe it, to feel better at once. The memory of your dear Father, instead of an agony, will yet be a sad sweet feeling in your heart, of a purer and holier sort than you have known before.

“Please present my kind regards to your afflicted mother.

“Your sincere friend.

“A. Lincoln

————————————————————–
“Caring for Pops: Trying To Be a Friend And a Son At the Same Time”, /strong>http://prostatecancerblog.net/?p=59.

————————————————————–
http://www.cancer.net/patient/
Coping/Grief+and+Bereavement/
Help+for+When+You+Are+Grieving

prostatecancerinfolink.net

I am glad to see the subject of “Watchful Waiting”, or “Active Surveillance as we call it now, being discussed more often as an option for men diagnosed with prostate cancer. I also think it’s good that more guys are pursuing AS rather than jumping into (or being prodded into) invasive treatments. It used to be that some guys who chose to wait and monitor their PC were branded as cowards. Unfortunately, some of this still goes on.

Our very own Darryl Mitteldorf of Malecare, the charitable organization that sponsors this blog, was interviewed at length for the article below, which appeared in the WSJ the other day. (”Watchful Waiting’ for Prostate Cancer Gains Traction”,  by Melinda Beck, Wall Street Journal, April 18, 2009.)

http://online.wsj.com/article/SB123972560757117417.html

Great job.  Dear husband loved the quote about micturation. 

Here are some excerpts:

“One evening a week for more than 10 years, a group of 15 to 25 men have met in a conference room in New York to talk about their prostate cancer. In the beginning, most of them swapped stories about their surgery or radiation, says Darryl Mitteldorf, a social worker who runs the group. Now, he says, more than half are doing “watchful waiting” — just monitoring their cancer to see if it grows.

“Some come in newly diagnosed and frightened, and they learn from the other guys that the word ‘cancer’ doesn’t necessarily mean it’s life-threatening,” Mr. Mitteldorf says.

“About 185,000 men are diagnosed with prostate cancer every year in the U.S. Experts say most of them have such slow-growing tumors that they would likely die of something else long before their cancer causes problems. Yet some prostate cancers do turn lethal, killing about 27,000 U.S. men each year.   It’s difficult to tell which men have which kinds of tumors.

“So patients face a tough decision: Should they treat what may be a harmless cancer with surgery or radiation — and run a high risk of impotence or incontinence? Or should they wait to see whether the cancer spreads and hope they can catch it while it’s still treatable?

“In the past, only about 10% of men have opted to just watch their disease. But with prostate cancers being found at ever earlier stages, more men are weighing the trade-offs carefully. ‘Doctors genuinely believe they are extending lives,’ says Mr. Mitteldorf. ‘But from a guy’s point of view, it may not be worth it to add five months to their life in the 95th year if they’ve been peeing in their pants for a decade.’

“Doctors say the best candidates for watchful waiting are men whose levels of prostate-specific antigen, or PSA, are below 10, whose Gleason scores (a measure of abnormal cells seen in a biopsy) are below 7, and whose cancers can’t be felt on a digital-rectal exam.

“It can take a lot of courage to live with untreated cancer. When Stephen Alston, an information-systems professional, was diagnosed with it in 2005, at age 48, every new sensation he felt gave him ‘visions of being eaten up by cancer,’ he says. But his cancer was small and low-grade, so he decided against surgery. He now has his PSA level checked every three months; a digital-rectal exam and a Doppler ultrasound scan every six months; and an MRI every year. ‘I’m comfortable with my approach, and I recommend it to others,’ he says.

“Some patients say they have trouble finding a doctor who will agree to supervise such a regime. Peter Scardino, chief of urology at Memorial Sloan-Kettering Cancer Center in New York City, says doctors often urge patients to have surgery ‘not because they think you have a more aggressive cancer, but because they can’t be sure you don’t.’ He says he has removed some prostates only to find a much more extensive tumor than expected and thought, ‘Thank God we operated.’

“Even so, Dr. Scardino believes that many more men could safely monitor their cancers. He’s running a clinical trial studying watchful-waiting patients at Memorial Sloan-Kettering. Similar studies are going on at Johns Hopkins University Medical Center in Baltimore and M.D. Anderson’s prostate clinic in Houston.

“For those facing the decision, a support group can provide a useful sounding board. Mr. Mitteldorf says the group he runs, part of the national organization called Malecare, operates much like a ‘neural network,’ with members pooling their knowledge. While some men learn that their cancer is comparatively low-grade and that the consequences of surgery might be worse, for others the group provides a reality check. ‘They’ll say, ‘You had 12 [biopsy samples] out of 12 positive for cancer — that’s really serious,’  he says.

“Indeed, for some men, watchful waiting is a euphemism for denial or indecision. Some don’t tell their wives or children about their diagnosis, and some neglect their own health to put a higher priority on their families. Tom Hall ignored his rising PSA for two years because his wife was dying of breast cancer. ‘I have two kids, and I didn’t think they could take the stress,” he says. Then he joined a clinical trial at the National Cancer Institute that is monitoring prostate cancer with MRI imaging. ‘The MRI gave me confidence to do the watchful waiting.’ he says. ‘I’m very comfortable now. My kids can tell I’m being very straight with them. I can show them the results.’

“For some men, the diagnosis serves as a wake-up call to make healthy changes in their lives. ‘I used to eat a lot of red meat and dairy. No more!’ says Dick Allen, a retired helicopter mechanic in Anchorage, Alaska. He opted out of robotic surgery last fall to try exercise and a radical dietary shift first. He has lost 30 pounds and cut his PSA to 4 from 8.2. ‘I realize I’m somewhat out on a limb, but I think the limb is fairly solid,  he says.

“Studies show that getting adequate vitamin D can help slow the progress of cancer, along with eating a Mediterranean diet, getting exercise and reducing stress.

“Of course, a diagnosis of prostate cancer itself is stressful. But many men who have opted for watchful waiting say that knowledge is power — and that monitoring their cancer is far more reassuring than ignoring it.’

“Guys, don’t wait to have it checked out,’ says Mr. Hall. “I know it’s the last thing you want to do, but do it. If you come in early, you still have a chance to see how aggressive it is, and you still have lots of choices.”

I am in middle of doing a cheap, on-the-fly kitchen renovation so I don’t have much time to talk, but I wanted to share this with you.  It always bugs me how old folks are underrated. 

A doctor wrote an article (excerpts below) on the excellent Health Care Blog today (healthcareblog.com) about how doctors and patients might work together in the future to optimize the use of the vast amount of medical information that is available on the Internet.   (This article also contains a number of links to patient-friendly websites that you might want to check out.)

What blew me away is the number of seniors vs. doctors who are “wired”, according to the author.   So much for stereotypes.
 
————————————————————-
What is the Physician’s Role in a Web-based World?

By JAY PARKINSON MD, April 15, 2009

http://www.thehealthcareblog.com/the_health_care_blog/2009/04/what-is-the-physicians-role-in-a-webbased-world.html

“The reality is this:

“Percentage of people age 65 and over online today = 41%

“Percentage of docs and hospitals who use computers = 9%

“Even the elderly are more wired than doctors! And guess what they’re doing? They’re visiting Dr. Google. If their team leader isn’t accessible, well, folks, it looks like patients are on their own turning to really helpful resources like ACOR,  MEDgle, other patients, Your Flowing Data, and rateadrug.com. Without a doctor on the other end of these links, even those cutting edge, senior netizens are leaving us behind blinded by their dust as we’re struggling to write our own chicken scratch paper notes.”

I must say I found the following article in USA Today ( 4/1/09, by Liz Szabo) , bonechilling.  A British study confirms what I’ve said many times: that when it comes to performing minimally-invasive radical prostatectomy or laparoscopy (which includes robotically assisted surgery, *although that was not the subject of this study*),  NO amount of experience on the part of the surgeon is enough. 

And there is another very important point being made which I have NOT heard before:  That “open” surgeons  (those who perform the traditional radical retropubic prostatectomy) who later switch to laparascopic surgery produce (much) worse results than doctors who initially specialize in this area.

Here are some excerpts from the USA Today article (more comments at end):

“Prostate cancer patients whose surgeons have anything less than the highest degree of experience with a popular new procedure may be at greater risk of relapse, according to a study in The Lancet Oncology April 1 edition.

<snip> “While it takes at least 250 surgeries for a doctor to become proficient at the traditional surgery — allowing patients to feel confident that doctors removed all of the cancerous tissue — surgeons need to do at least 750 keyhole procedures to become proficient. Doctors who are used to performing traditional surgery actually have a harder time learning keyhole techniques than novice surgeons who are learning to perform the procedure for the first time, the study shows.

“That suggests that doctors shouldn’t try to switch back and forth between techniques, but instead focus on perfecting their skills on just one type of prostate removal and patients who opt for keyhole surgery should go to cancer centers where doctors specialize in the procedure, authors say.”

The take-home message for men who have decided on laparascopic prostatectomy but do not live near a top-rated urologic oncology facility (”Center of Excellence) is that they should consider traveling to one or finding a “high-volume” surgeon in private practice.  (For some guidance about top hospitals, look at usnews.com, “Rankings”, keyword “Cancer”, not Urology”.  Also, at castleconnolly.com, “America’s Top Doctors for Cancer”.)  A lot of people are unaware that there are charities which make arrangements for patients and their families to stay close to the hospital for the duration of treatment.   I know because I was on the receiving end of such a favor.  Ask the hospital social worker or chaplain about this.

Need a respite from “populist rage”? Then read this news item I came across in the Wall Street Journal health blog the other day (3/20/09).  And some people think doctors are greedy.

“Doctors at Beth Israel Deaconess Medical Center in Boston are reaching into their own pockets to try to help shore up the hospital’s finances.

“The Boston Globe reports that the heads of 13 medical departments say they’ll donate a combined $350,000 to the hospital — about $27,000 from each one’s annual pay — to further cut down on expected staff layoffs.

“Hospital CEO Paul Levy, who has been engaging in a very public dialogue about the hospital’s budget woes, said earlier this week that he expects about 150 layoffs. He had anticipated about 600 before finding alternative cost-cutting ideas.

“The department heads also sent out a note soliciting contributions from about 1,100 doctors, the Globe reports. Some of those doctors are on staff, while others are affiliated with the hospital but not employed by it.

“In my two departments, I’m quite confident that the great majority of physicians will participate. I don’t know at what level,” DeWayne Pursley, chair of the Department of Neonatology and acting chair of obstetrics and gynecology, told the Globe. ‘People have their own personal issues. Personally, I have three kids in college.’”

“Levy, for his part, posted emails from hospital staffers expressing appreciation for the doctors’ help.”

The following statement about the recent controversy regarding PSA esting was issued this morning by the thirteen organizations, including Malecare (the sponsor of this blog), listed at the bottom of the statement:

A JOINT STATEMENT FROM AMERICA’S PROSTATE CANCER ADVOCACY, EDUCATION, AND SUPPORT ORGANIZATIONS

Since 1993, when the PLCO trial was started, we have awaited the results of this trial with eager anticipation, as have others. The initial report of the results of this study — and those of a comparable European trial — published last week in the New England Journal of Medicine have told us two things:

* The studies offer conflicting evidence about the possibility of a prostate cancer-specific survival benefit associated with the regular use of prostate specific antigen (PSA) testing and digital rectal examination (DRE).

* These studies provide no convincing evidence that mass screening of men over 50 or 55 years of age will lead to a prostate cancer-specific survival benefit within 10 years.

We have come together to make two clear statements about these trials:

* Above all we thank the patients, the investigators, and the national authorities that funded these two trials for their efforts. The
development and implementation of these trials over the past 16 years has been an enormous commitment by all concerned.

* We enthusiastically support the continued follow-up of patients in the prostate cancer arm of the PLCO study for at least a further 5 years, through 2014, as originally envisaged.

In addition, in the long-term interests of the health of every man in the USA, and with health reform recognized as a national priority, we wish to state the following:

* Every man, regardless of his age, has the right to know whether he is at risk from prostate cancer, a disease that still kills over 28,600
American men every year, and many more around the world. We encourage all men to be proactive, and to seek out information and support in regard to their health.

* We shall continue to encourage every man to discuss his individual risk for prostate cancer with his doctors, and to request the appropriate use of PSA and DRE tests until better options are
available. Further clinical action based on results of these tests is also a matter for serious discussion between each patient and his physicians.

* We call upon the federal government to emphasize the need for more research into early detection technologies and methods that will lead to better and more accurate diagnosis of prostate cancer.

* We call upon Congress to increase funding for the Prostate Cancer Research Program at the Department of Defense.

* We call upon the National Institutes of Health to increase funding for prostate cancer research through the National Cancer Institute.

* We call upon the medical research community to place greater emphasis on the development of new clinical tests that can differentiate between those men at greatest need for aggressive prostate cancer treatment and those with indolent forms of the
disease who can be well managed without invasive treatment.

The statement above was approved by the following US-based prostate cancer advocacy, education, and support organizations:

* American Urological Association Foundation
* Malecare Prostate Cancer Support
* Men’s Health Network
* National Alliance of State Prostate Cancer
Coalitions
* Prostate Cancer Foundation
* Prostate Cancer International
* Prostate Cancer Mission
* Prostate Conditions Education Council
* Prostate Health Education Network
* The Prostate Net
* US Too International
* Virginia Prostate Cancer Coalition
* Women Against Prostate Cancer
* ZERO — The Project to End Prostate Cancer

I wholeheartedly agree with the sentiments expressed in the article Prostate Cancer: Men Deserve Better, European Association of Urology, March 17, 2009 (exerpts below). http://www.alphagalileo.org/ViewItem.aspx?ItemId=56307&CultureCode=en. But talk is cheap. The question is, how do we bring about real change (change we can believe in!)? That’s a lot to ask — but heck, we are worth it. We also need a system in which newly diagnosed PC patients are seen by a multidisciplinary team of doctors, consisting perhaps of a urologist, radiation oncologist and medical oncologist. Fortunately, we have such a model now. I received this article a few weeks ago about a new, “patient-centered” unit at UCLA: “Urologic Oncology Institute Launched To Offer Multi-Disciplinary Care, Personalized Treatments To Patients” (March 04, 2009). https://mail.google.com/mail/?source=navclient#search/multi/11fdd1625aa370e2

In this case, a group of urologists (and patients) are pointing out some shortcomings of current PC management, such as a lack of communication between doctor and patient. In order to truly give consent to a treatment such as surgery or radiotherapy, I believe a patient must have been informed of the risks and benefits of all the reasonably accepted treatments available.

The burden is on the urologist to do this, because these doctors are almost always the “first stop” (and usually only stop) for newly diagnosed PC patients. There is an issue of time here, as the doctor can’t spend the whole day discussing PC with the patient, but one advocate has suggested that urologists provide patients with written materials about PC that they then could use for discussion. I think this is a good idea.

Also, the authors lament the poor quality of life that can ensue after prostate cancer treatment. But the comparison with breast cancer treatment is not a good one. Women who are treated for BC may have a better quality of life than men treated for PC for an obvious reason — their urinary and sexual functions have not been interfered with.

What we need is new treatments, applied sparingly, with fewer side effects.

Finally, I want to add a word about two neglected areas in PC treatment. We need to do more to diagnose and treat mood disorders and other psychological issues which may occur in PC patients. Second, we need to draw in a spouse or significant other (if there is one) into the discussion of PC options, and also monitor the partner’s well-being over time.
————————————————————–

“Prostate Cancer: Men Deserve Better”

“Vast improvements in prostate cancer recognition, management and treatment are needed, according to major prostate cancer groups speaking at the European Association of Urology’s 24th Annual Congress today.

“… The group’s overarching concern is a lack of clear and consistent information, particularly in areas that affect a man’s quality of life and that of his family. Prostate cancer and its treatments impact on all elements of a man’s life and not just his physical being. Many men experience urinary incontinence and impotence which can severely compromise their sense of masculinity and day-to-day quality of life, affecting their work, social activity and love life. The charter asks for practices to be put into place to better inform and educate men, their families and all those involved in prostate cancer care of the far-reaching effects of the disease and to encourage a more open, communicative and holistic approach to its treatment and management.

“Tom Hudson, Chairman of Europa Uomo, explains, ‘Our charter highlights the shortcomings in the current management of men with this condition but from a very practical viewpoint. For example, maintaining key relationships, love life and intimacy throughout prostate cancer is incredibly important but can often be overlooked. Many men feel uncomfortable discussing these issues and avoid them altogether. It is an area which is absolutely key to men’s quality of life and there needs to be a cultural shift in the way it is approached and managed’.

“Louis Denis, Secretary of Europa Uomo, adds “There is still much room for improvement in the management of prostate cancer and the fight against the disease is far from over. Prostate cancer does not receive anywhere near the level of interest and funding it warrants and this must be addressed. With the right holistic approach, men diagnosed with prostate cancer can live long and fulfilled lives. This approach has been taken very successfully to women with breast cancer and we believe that men deserve to be treated in the same way. At the moment, quality of life for men with prostate cancer can be very low, and steps must be taken to recognise and treat the whole person behind the disease, not just the disease itself.”

http://www.europa-uomo.org/

http://www.eaustockholm2009.org

I came across this story on the wonderful blog, Cell2Soul  http://cell2soul.typepad.com/cell2soul_blog.  It’s about Oscar Houck, a 50-year old screenwriter, poet and teacher.  A self-described agnostic, Houck was nevertheless on the lookout for “definitive evidence of God”.   One night he found it. . . in an unexpected way.

“Like any hopeful agnostic with a decidedly spiritual bent, I spent years, nearly fifty of them, looking for some definitive evidence of God. I was always a very “me, me, me” person in my own shy and retiring way, so I thought God should probably come to me.

“Finally, on an otherwise uneventful Friday night, January 30th, 2009, just after I’d finished watching a Kurosawa DVD, God gave me a heart attack. It was a pretty good one and it got my full attention. Immediately, for the first time, I understood the wrathful God from the Old Testament. I’d never believed in that God before. But, we are so damn busy, so caught up in ourselves and our meaningless problems, that nothing will do to wake us but a hard slap to the face.

“God has a hard time talking to us because we’re terrible listeners. The worst. It takes something like a plague of grasshoppers or global warming for him to be heard. And even then … We don’t have enough respect or even a beginner’s knowledge of the soft and gentle messages found in rain, the wind, flowers. Some of us understand sunsets or the benevolent, merciful light of early dawn. But we have to be sitting perfectly still, computer screen down, cell phone off. How often does that happen?

“My heart attack wasn’t a bit of God’s seemingly churlish randomness, like a hurricane or an avalanche. It felt very direct, as if God’s own boot heel was grinding down on my chest. The doctors opened my clogged arteries, put in five stents, basically surrounding my heart. They got the blood flowing again and plenty oxygen to my brain. 

“When I awoke, I saw you there in my room in intensive care. And you, and you, and you. My Mary, my dear friends and family. A seemingly endless supply of visitors, of big-time, serious well-wishers. Everyone seemed so glad to see me. I felt like Sally Field giving that goofy, embarrassing speech she gave at the Academy Awards one year, way back when: “They like me! They like me!” Except that it was love that I felt, an abiding love that lifted my spirit in that hospital bed and carried me right through to recovery. Love from everyone that prayed for me, to those that held my hand as I slept, to those who spent hours at vigil in the waiting room.

“Do you think I would have made it without you? I don’t. God cracked me open and the light that came pouring in to fill me was from you good people, your love. My newly remodeled heart was pumping, the danger was past and I was glowing inside, even if I couldn’t tell you at the time. If God is love, and that’s about the only definition that works for me really, I had found my heaven on earth, at Northeast Baptist Hospital of all places. I was surrounded, around the clock, by people that loved me. I could see it in their eyes. I gave up then and stopped disbelieving. I gave in to the kindness and I rested. I slept. I slept the good, sound sleep of the true believer.”

This article touting the benefits of adjuvant radiotherapy for advanced PC patients is consistent with others that I’ve read.   Do a search here and you will bring up some of the things I’ve written on this subject.

I just want to explain that *adjuvant RT” means RT that is done after surgery but *before* there has been a rise in PSA.  In contrast, “salvage RT” is done *after* the PSA has begun to rise.

From what I’ve read, adjuvant therapy has been shown to be much more effective than salvage RT.  And the sooner done the better.  For example, there’s a added benefit to having RT before your PSA rises to .5 vs. say, 1.0 or 2.0. So if you are an intermediate- or high-risk patient, talk to your doctor about adding adjuvant RT to your treatment regimen.  Or see a radiation oncologist.

Adjuvant Radiotherapy Useful for PT3 N0M0 Prostate Cancer

Last Updated: 2009-02-16 7:25:16 -0400 (Reuters Health)

“NEW YORK (Reuters Health) - Adjuvant radiotherapy can cut the risk of metastasis and improve survival in men who have undergone radical prostatectomy for pathological T3N0M0 prostate cancer, according to a report in the March issue of The Journal of Urology.

“Prior research has shown that roughly a third of men who undergo radical prostatectomy for apparently localized prostate cancer will develop extraprostatic disease. Whether adjuvant radiotherapy may help cut risk of metastatic disease and mortality was unclear.

“Dr. Ian M. Thompson, from the University of Texas Health Science Center, San Antonio, and colleagues addressed this topic by assessing the outcomes of 431 men who were randomized to receive adjuvant radiotherapy (60 to 64 Gy) or observation after radical prostatectomy. Seventy of the 211 men randomized to observation later received radiotherapy.

“Radiotherapy increased the odds of metastasis-free survival and overall survival. Specifically, the hazard ratio for metastasis in the radiotherapy arm versus the observation arm was 0.71 (p = 0.016), and the corresponding mortality hazard ratio was 0.72 (p = 0.023).

“The investigators conclude that “adjuvant radiotherapy within 18 weeks after radical prostatectomy in a man with T3N0M0 prostate cancer significantly reduces the risk of PSA recurrence, metastasis, and the need for hormonal therapy, and significantly increases survival.”

“J Urol 2009;181:956-962.

–