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Studies from ASTRO
radsrus
Posted: Thursday, October 28, 2010 6:37 AM
Joined: 10/10/2008
Posts: 4435


PSA screening, aspirin may reduce prostate cancer deaths October 26, 2010 -- Screening men who have been treated for prostate cancer based on prostate-specific antigen (PSA) levels can lower deaths by reducing the risk of metastasis within 10 years of treatment, according to a study to be presented at the upcoming American Society for Radiation Oncology (ASTRO) meeting in San Diego. In another study to be presented at the ASTRO meeting, researchers found that aspirin taken as an anticoagulant appears to reduce prostate cancer-specific mortality. Findings from both the screening and aspirin research were among several studies highlighted in an October 25 press conference held by ASTRO of Fairfax, VA, that will be formally presented at the meeting from October 31 to November 4. Prostate cancer screening Chandana Reddy, a senior biostatistician at the Cleveland Clinic, and colleagues retrospectively evaluated data from 1,721 prostate cancer patients who underwent a radical prostatectomy or received radiation therapy at the hospital. The men were divided into two groups: One group was treated before 1993, and the other group was treated from 1993 onward, when prostate cancer screening began to be routinely implemented through the use of PSA testing. Patients were classified as having high-, intermediate-, or low-risk disease to determine which groups may have benefited from prostate cancer screening. "Skeptics of routine screening have argued that it hasn't resulted in meaningful improvement with respect to survival," Reddy said. "A possible explanation is that clinical trials conducted used the wrong end point. The majority of men with prostate cancer tend to be older and have other medical conditions which often have an impact on their survival outcomes. We considered that the best way to measure screening's effectiveness was to measure its ability to decrease metastases within 10 years after treatment." The researchers determined that 13% of all patients had developed metastatic disease. However, the 10-year metastases-free survival rate for high-risk patients treated before 1993 was 58%, compared with 82% for patients treated 1993 and later who received PSA screening. The rate for intermediate-risk patients treated before 1993 was 79%, compared with 93% for the later group. For low-risk patients, the rates were 90% and 98% for before and after 1993, respectively. "Within each risk group, patients treated in the postscreening era had a lower chance of developing metastases," Reddy said. "Our study shows that routine screening not only improves a prostate cancer patient's quality of life by identifying the cancer earlier and initiating timely treatment to better stop metastatic disease, but it also decreased the burden of care that healthcare systems must provide." Aspirin and prostate cancer-specific mortality Regarding the aspirin study to be presented at the meeting, data from 5,295 men with localized prostate cancer in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database suggest that anticoagulants such as aspirin may inhibit cancer growth and metastasis. Kevin Choe, MD, PhD, a radiation oncologist at the University of Texas Southwestern Medical School in Dallas, and colleagues determined that men who took anticoagulants such as low-dose aspirin for 10 years following their prostate cancer treatment reduced their risk of dying from prostate cancer from 10% to 4%. In a subgroup analysis by risk category, the reduction of prostate cancer-specific mortality was most prominent in patients with high-risk disease. Their risk of dying at 10 years was 22% for the 3,313 men who were not taking anticoagulants, compared with 4% for the 1,982 men who were. All men in the study group had undergone a radical prostatectomy (3,523 patients) or received radiation therapy (1,772 patients). Almost 500 men undergoing radiation therapy also received androgen deprivation therapy in conjunction with their treatment. When asked if any man diagnosed with localized prostate cancer should begin to take low-dose aspirin, Choe emphasized that the findings were premature. "Findings from this study are promising; however, further studies are necessary before the addition of aspirin to prostate cancer therapy becomes standard treatment," he said.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Allen_E.
Posted: Thursday, October 28, 2010 11:42 AM
Joined: 8/8/2010
Posts: 666


I agree that the government has used the wrong end point in determining that PSA screening should not be included among the free preventative services in the new health care law. Neither the American nor the European study followed men long enough to use death as the end point. Even metastasis will be difficult to track in the limited timeframe of such studies. Perhaps some combination of metastasis, biopsy results, PSA doubling time, etc. should be used. It was interesting that they attributed the effect of aspirin to its anti-coagulant property, although they note in the study that much more powerful anticoagulants like warfarin seemed to have LESS association. There is much evidence that COX-2 inhibitors may play an anti-cancer role. I suspect that aspirin's COX-2 inhibition may be at the root of the association observed here.
radsrus
Posted: Thursday, October 28, 2010 12:02 PM
Joined: 10/10/2008
Posts: 4435


I think you are probably right. Do you have a reference showing that PSA screening will not be paid for?

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Allen_E.
Posted: Thursday, October 28, 2010 1:26 PM
Joined: 8/8/2010
Posts: 666


Here are the preventative services covered by the Affordable Health Care Act. New policies issued after September 23, 2010 must include these without co-pay. It's disheartening that while there are sections for women and children, there are none for men. The rationale for excluding PSA screening for prostate cancer is given in the following document by the US Preventative Services Task Force. They cite the US and European trials and insist that mortality must be used as the endpoint. USPSTF Screening for Prostate Cancer Recommendation Statement According to the National Cancer Institute, there will be an estimated 32,050 prostate cancers deaths in 2010. That works out to 21.1 PC deaths per 100,000 male population in 2010. That's a decrease of 74% from the peak in 1994, since PSA testing became prevalent. This, in spite of the fact that men are living longer -- we would expect deaths from prostate cancer to INCREASE because of that. The USPSTF inexplicably ignored this.
radsrus
Posted: Thursday, October 28, 2010 1:32 PM
Joined: 10/10/2008
Posts: 4435


Interesting - and depressing. But I think Medicare will still cover it. At least I have not seen anything to the contrary. This list is only the things that ALL insurers must cover.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


viperfred
Posted: Tuesday, September 13, 2011 10:50 PM
Joined: 10/10/2008
Posts: 850


The ASTRO and Trailblazer position on SBRT/Cyberknife for prostate cancer puts them on the DARK side of medicine!

Read the HHS Decsion Guide for Prostate Cancer.  Go to Treatment options Radiation, Other, newer therapies .....SBRT.   http://effectivehealthcare.ahrq.gov/index.cfm/guides-cmece-and-other-resources-for-clinicians/patient-decision-aids/?ECem=110912 

In my opinion the majority of ASTRO's BOD and leadership should hang their heads in shame and resign.


viperfred
Posted: Sunday, January 08, 2012 9:49 AM
Joined: 10/10/2008
Posts: 850


ASTRO Claims Proton Therapy effective for prostate cancer?

 

Effective for the economic well being of related stakeholders is more accurate?

 

This link covers ASTRO claims and open comments: http://prostatecancerinfolink.net/2012/01/06/astro-claims-proton-therapy-effective-prostate-cancer-treatment/#comments 

  


Jon N
Posted: Tuesday, July 24, 2012 10:36 PM
Joined: 6/7/2012
Posts: 67


In my research to formulate an appeal to my denial of CK prostate treatment by 'eviti', the oncology consultant to my insurance vendor, I ran across this interesting letter from ASTRO commenting upon a draft SBRT policy of Noridian Administrative Services, the Medicare contractor for Alaska, Arizona, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming: ----------------------------------------------- https://www.astro.org/uploadedFiles/Main_Site/Practice_Management/Reimbursement/Medicare/NoridianSRS-SBRT.pdf "Indications for Stereotactic Body Radiation Therapy (SBRT) The draft policy states that SBRT is unproven in the primary treatment of prostate cancer and that literature does not support an outcome advantage of SBRT over other radiation therapy treatment modalities. It is ASTRO's opinion that data supporting the use of SBRT for prostate cancer are rapidly maturing to the point where it might he considered an appropriate alternative for selected patients with low to intermediate risk disease. For example. the combined Stanford-Naples experience has demonstrated an excellent five year biochemical control rate with very low rates of serious toxicity. Additionally, other results that have reported safety outcomes at intervals expected to reveal the majority of late toxicity have demonstrated the safety of SBRT for prostate cancer5. Coverage of SBRT for prostate cancer patients enrolled on IRB-approved clinical trials or registries is strongly recommended so that a determination can be made as quickly as possible whether or not this potentially cost-effective treatment modality is appropriate for widespread implementation." ---------------------------------------------------- Although this is hardly an overwhelming endorsement of SBRT by ASTRO for CK treatment of prostate cancer, it is, however, not condeming it as 'experimental', and, was part of the evidence that resulted in Noridian to approve CyberKnife for its Medicare region. Since CK for prostate cancer is now approved for all Medicare regions in the U.S., in part because of ASTRO's comments, it would be rather professional of ASTRO to follow up with an explicit endorsement of SBRT and hence CK. One can hope.....

Jon N


DanL
Posted: Saturday, August 04, 2012 7:53 AM
Joined: 11/17/2011
Posts: 37


The approval process for cyberknife is a political/financial decision and not a medical one . When I was declined C/K treatment by my insurer at an independant facility accepting my insurance , I applied again through a large hospital . Suddenly , the insurance company approved me immediately . Ironically , the approval came about the same time my appeal at the free standing center was declined again , stating "experimental blah blah blah " and on and on . Experimental , yet instantly approved 5 miles down the road the same day by the same company where they have understandings with the hospital . Using this approval , the declination was immediately overturned when presented to them and VOILA! , Cyberknife was not experimental and unproven anymore , overnight . They also pay larger facilities astronomically higher allowances for the same procedures . They paid the hospital almost $2000 to make a $10 styrofoam mold of my legs , the free standing facility received only a few dollars . Ditto the consultation - 600 bucks at the hospital vs. 100 at the other . I can only imagine what the treatment fees would have been had I went with the hospital compared to what they paid where I went . I'm covered either way , but it just isn't right .
 

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