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User
Posted 30 Sep 2023 at 00:58

Good to see another improvement in treatment. We have seen a few members have the reduced number of doses. It is good to see the trial has concluded that five larger doses work as well as 20 or even 37 doses.

The trial was on medium risk patients, it showed a five year disease free survival rate of 96% rather than 95%. I am sure that is statistically insignificant. The main benefit is the treatment is now one or two weeks rather than a month or two. Also those on the hypofractionated arm were not given HT which is a great benefit to patients.

Whether this will change treatment for higher risk groups or recurrence we don't know.

A big thank you to people who volunteer for trials, it's the only way things move forward.

 

https://www.bbc.co.uk/news/health-66946336

 

An article from 2019 discussing the trial

https://www.sciencefocus.com/news/prostate-cancer-could-be-treated-in-two-weeks-with-advanced-radiotherapy

 

Dave

User
Posted 03 Oct 2023 at 21:31

I think HT at a cost of about £1000 per year is one of the cheapest cancer treatments so I doubt they are trying to get rid of it on cost grounds. However it probably only adds any benefit in about 8% of cases, so to get that benefit you have to waste £12,500 on treating men who won't benefit.

If with the new RT it only added benefit in 1% of cases the NHS would be treating 99 extra men at £1000 each just to benefit one person. That would be a big waste of money.

###################

Only read beyond here if you want to check my maths and logic. I'm quite capable of making mistakes and false assumptions.

For the old style RT accompanied by HT, Microcolei (Jules) posted these figures on another thread. (Slightly edited by me)

********************************

...disease specific survival 36 months HT Vs 18 months HT. it was 97.6% v 96.4% at five years and 87.2% for both arms at ten years...

***********************

The extra 18 months of HT added no benefit at 10 years, and the 1.2 % benefit at five years probably just reflects the fact that the 36 month arm were barely out of treatment by five years (allowing for testosterone recovery), whereas the 18 month arm had been out of treatment about three years.

It would be interesting to know what the ten year survival rate is with no RT, I think I saw a figure of 79% once (I don't know where, so take this as a hypothetical figure).

So using old fashioned RT (and assuming ten year survival is your target), if you treat 100 men with HT it is wasted on 13 of them because they will die anyway. It is wasted on 79 of them because they would survive anyway. For 8 men it is the difference between life and death. I guess if you are currently on HT and thinking of giving it up the odds are still well in your favour (unless you are one of those 8 men).

Dave

User
Posted 30 Sep 2023 at 00:58

Good to see another improvement in treatment. We have seen a few members have the reduced number of doses. It is good to see the trial has concluded that five larger doses work as well as 20 or even 37 doses.

The trial was on medium risk patients, it showed a five year disease free survival rate of 96% rather than 95%. I am sure that is statistically insignificant. The main benefit is the treatment is now one or two weeks rather than a month or two. Also those on the hypofractionated arm were not given HT which is a great benefit to patients.

Whether this will change treatment for higher risk groups or recurrence we don't know.

A big thank you to people who volunteer for trials, it's the only way things move forward.

 

https://www.bbc.co.uk/news/health-66946336

 

An article from 2019 discussing the trial

https://www.sciencefocus.com/news/prostate-cancer-could-be-treated-in-two-weeks-with-advanced-radiotherapy

 

Dave

User
Posted 01 Oct 2023 at 00:05

Originally Posted by: Online Community Member
The trial was on medium risk patients, it showed a five year disease free survival rate of 96% rather than 95%. I am sure that is statistically insignificant. The main benefit is the treatment is now one or two weeks rather than a month or two. Also those on the hypofractionated arm were not given HT which is a great benefit to patients.

If you're given HT for 3 out of the five [survival] years, your chances of dying in the next couple of years are going to be quite low given your testosterone is probably going to be missing for 4 out of the 5 years. For men who had no HT after their RT you'd expect that, having testosterone in their system for 5 years would raise the risk rate for cancer. Maybe that makes the 96% 5 year survival more significant?

Jules

User
Posted 03 Oct 2023 at 21:30

Originally Posted by: Online Community Member
I am wondering if this new RT kills the cancer more quickly? We've seen other threads saying it is targeted more precisely. So are they giving such a high dose of x-rays that it is killing the cells on treatment day rather than months afterwards?

I think that could be right Dave. With the treatment I had here in Australia my psa plummeted almost instantly, indicating that they appeared to have done away with the "slow death" period for cancer cells. One of the key differences with my treatment was that my lymph node mets were hit with RT at the same strength as that used on the prostate. I was still sentenced to 3 years of HT but the treatment is still in its early stages and I've been wondering for some time if they could lower or drop the duration of HT.

I doubt that it's a money saving scheme but it will certainly require modern equipment like LINACs with the necessary computer backing to provide precision and active feedback during RT sessions.

Jules

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User
Posted 30 Sep 2023 at 13:56
3 threads now covering same news. Interesting that this trial was led by the Royal Marsden as was the CHHiP one that led to the adoption of 20 fractions gradually replacing the 37 fraction protocol. If results are as good with 5 fractions it seems a win win.
Barry
User
Posted 30 Sep 2023 at 19:16
''A big thank you to people who volunteer for trials, it's the only way things move forward.''

Hear hear- its a big thing to leave the choice between RT and RP to a random call.

It's worth highlighting that there are more variables here than just the number of sessions: the total radio hit is less ( but each session is more intense) and you need a top end MR Linac machine to deliver the enhanced accuracy. For the NHS as a whole, there will be a chunky capital investment needed to realise the running cost savings from fewer appointments. But my onco guy was clear a couple of years ago that this was going to become the standard way forward, even though his machine couldn't do the job.

The strong numbers of success at the 5 year point are interesting, but perhaps not too surprising since ( in appropriate cases) most treatments seem to be delivering something close to that. The 10 year perspective will be the one to watch in due course.

User
Posted 01 Oct 2023 at 00:05

Originally Posted by: Online Community Member
The trial was on medium risk patients, it showed a five year disease free survival rate of 96% rather than 95%. I am sure that is statistically insignificant. The main benefit is the treatment is now one or two weeks rather than a month or two. Also those on the hypofractionated arm were not given HT which is a great benefit to patients.

If you're given HT for 3 out of the five [survival] years, your chances of dying in the next couple of years are going to be quite low given your testosterone is probably going to be missing for 4 out of the 5 years. For men who had no HT after their RT you'd expect that, having testosterone in their system for 5 years would raise the risk rate for cancer. Maybe that makes the 96% 5 year survival more significant?

Jules

User
Posted 02 Oct 2023 at 16:26

Hi Dave.

What is your opinion on salvage treatment after surgery, do you think the trial results could be of benefit to people going through salvage radiotherapy.

User
Posted 02 Oct 2023 at 17:51

Hi Jeff,

Well if I offer my opinion, please bear in mind I am a lay man with no expert knowledge.

I think in a newly diagnosed patient the cancer is either well contained or has started to spread. T1 and T2 are contained and T3 it has started to spread. I think for all these T stages there is a probability that some cancer cells are a few millimetres beyond the tumour, the higher the T stage the more probable this is and the further they may be. Please note I am citing no scientific papers for this theory, so feel free to take it with a pinch of salt.

So if you have surgery with a T1 or T2 there is a high chance all these extra cells are still in the prostate and surgery will be successful. If you have a T3 or it is upgraded to a T3 at surgery, I would say there is a high chance these extra cells are beyond the surgeons scalpel, your immune system may be able to deal with these small number of cells, but if not you will have recurrence.

Radiotherapy has the advantage over surgery that it can get to these odd cancer cells as long as they are in the treatment area. They can't hide away behind healthy cells as the very nature of x-rays is that they go through things. So with RT the treatment area can be selected it can be larger than the area a surgeon would remove, it can have reduced dose further from the main tumour. 

With the new technique I suspect they are targeting the main tumour very precisely but presumably giving a fuzzy margin to pick up cells a little further a field. With SRT there is no longer a main tumour to target so the RT field needs to be quite spread out. I'm not sure but I suspect this spread out field may lend itself to smaller doses over a longer time i.e traditional fractionation.

They are just my opinions.

Dave

User
Posted 02 Oct 2023 at 18:18

Not sure why the hormone therapy is no longer required your thoughts Dave 

User
Posted 02 Oct 2023 at 22:01

Hi Gaz, no I don't know either. If we are to come up with an answer we would start by asking why is HT ever required?

I think the answer to that is that all our cells have the same DNA and any cell could become any type of cell in our body. This would not produce a functioning human being as we need liver cells only in the liver, brain cells only in the brain etc. So in reality cells look for chemical signals from their surrounding to know when to divide and what sort of cell they should become.

Testosterone is a very import signal as it tells certain cells to become male genitalia etc. Females have the DNA to produce a prostate glands but those cells are never switched on because they don't get the testosterone signal.

So I think in a man on HT the prostate cells must feel completely out of place. Cell suicide (apoptosis) is a likely response to this.

Old fashioned RT does not kill the cancerous cells but it breaks the DNA so when they do divide they can't form proper daughter cells, which means they are now dead.

So old fashioned RT along with HT provides for a long slow death of the cancer.

I am wondering if this new RT kills the cancer more quickly? We've seen other threads saying it is targeted more precisely. So are they giving such a high dose of x-rays that it is killing the cells on treatment day rather than months afterwards? If so, maybe having the cells inclined to suicide isn't necessary as the x-rays are going to ensure they are dead.

Would HT improve outcomes in addition to the new treatment? Probably, but maybe by only 1%. That means you would be inflicting HT on 99 men just to save one of them. 

 

Dave

User
Posted 03 Oct 2023 at 07:11

Thanks for that Dave I appreciate your opinion, my thoughts were on if they where doing salvage to the prostrate bed area would you need as many treatments,  or could they zap that area with the higher dose.

Thanks Jeff.

 

User
Posted 03 Oct 2023 at 09:22

Anything that can get rid of this poisonous HT treatment is a blessing!

User
Posted 03 Oct 2023 at 19:31

Amen to that Decho - but it does very much sound like a 90deg change in the thinking - I find that a bit odd.
Is it actually more about saving money? 


User
Posted 03 Oct 2023 at 21:30

Originally Posted by: Online Community Member
I am wondering if this new RT kills the cancer more quickly? We've seen other threads saying it is targeted more precisely. So are they giving such a high dose of x-rays that it is killing the cells on treatment day rather than months afterwards?

I think that could be right Dave. With the treatment I had here in Australia my psa plummeted almost instantly, indicating that they appeared to have done away with the "slow death" period for cancer cells. One of the key differences with my treatment was that my lymph node mets were hit with RT at the same strength as that used on the prostate. I was still sentenced to 3 years of HT but the treatment is still in its early stages and I've been wondering for some time if they could lower or drop the duration of HT.

I doubt that it's a money saving scheme but it will certainly require modern equipment like LINACs with the necessary computer backing to provide precision and active feedback during RT sessions.

Jules

User
Posted 03 Oct 2023 at 21:31

I think HT at a cost of about £1000 per year is one of the cheapest cancer treatments so I doubt they are trying to get rid of it on cost grounds. However it probably only adds any benefit in about 8% of cases, so to get that benefit you have to waste £12,500 on treating men who won't benefit.

If with the new RT it only added benefit in 1% of cases the NHS would be treating 99 extra men at £1000 each just to benefit one person. That would be a big waste of money.

###################

Only read beyond here if you want to check my maths and logic. I'm quite capable of making mistakes and false assumptions.

For the old style RT accompanied by HT, Microcolei (Jules) posted these figures on another thread. (Slightly edited by me)

********************************

...disease specific survival 36 months HT Vs 18 months HT. it was 97.6% v 96.4% at five years and 87.2% for both arms at ten years...

***********************

The extra 18 months of HT added no benefit at 10 years, and the 1.2 % benefit at five years probably just reflects the fact that the 36 month arm were barely out of treatment by five years (allowing for testosterone recovery), whereas the 18 month arm had been out of treatment about three years.

It would be interesting to know what the ten year survival rate is with no RT, I think I saw a figure of 79% once (I don't know where, so take this as a hypothetical figure).

So using old fashioned RT (and assuming ten year survival is your target), if you treat 100 men with HT it is wasted on 13 of them because they will die anyway. It is wasted on 79 of them because they would survive anyway. For 8 men it is the difference between life and death. I guess if you are currently on HT and thinking of giving it up the odds are still well in your favour (unless you are one of those 8 men).

Dave

User
Posted 03 Oct 2023 at 21:33

Hi Jules, my reply 1 minute after yours was to Bob_suffolk's post but certainly ties in with your post.

Dave

User
Posted 03 Oct 2023 at 22:10
As in this development, any innovation is started on a small scale using set parameters and if it looks to be promising a trial progresses to subsequent larger phase trials and if early promise is justified and there is benefit this may be generally adopted where appropriate. Unless the trial has another arm so patients are randomly entered into one or more alternative arms using set criteria and conclusions are made, it can't be assumed that results would be similar with or without HT for example. But whereas we know with standard radiation HT for 6 months prior to it is generally beneficial, it may be that this low number of high dose fractions means that HT has very little benefit, only time will tell.
Barry
User
Posted 10 Oct 2023 at 01:29

Originally Posted by: Online Community Member
The extra 18 months of HT added no benefit at 10 years, and the 1.2 % benefit at five years probably just reflects the fact that the 36 month arm were barely out of treatment by five years (allowing for testosterone recovery), whereas the 18 month arm had been out of treatment about three years.

Dave, a more valid comparison for  18 months HT v 3 years HT might be between 5 year survival v 6.5 year survival but there are certain practices to be maintained. Of course RT will fail in some cases just as it does with prostatectomies, because some mets were missed for one reason or another.

As far as ten year survival goes, it has to be close to meaningless given the advances in RT treatment in that time. What might be interesting would be the historical year by year changes in 10 years survival rates, to show any trends. Still, not all that helpful with recent advances in RT and the 10 years lag time. Ha, I'm a living moving 10 year experiment, staying tuned for 2032.

Jules

Edited by member 10 Oct 2023 at 05:01  | Reason: Not specified

 
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