Posted by hinwai on February 15, 1998 at 01:49:26:
In Reply to: Re: Mestatic Ca Prostate posted by CLDing on February 14, 1998 at 19:48:27:
: In no uncertain terms, I told the patient that personally I would have not
recommended DXT in this instance and suggested very strongly that there will be little in
the literature to support the move. They came to me for a second opinion and I suggested
that if they choose to go ahead with the DXT, they should continue their follow up with
the first Urologist and not me. Radiation side effects to be risked in the absence of any
clear cut indication seems illogical to me as well.
As for the MAB issue, this was exactly what I was pushing at the IUN when I returned when
most people were dishing out the flutamide with the orchidectomy. Both the NCI trial and
the EORTC paper which supported the MAB were criticised when they were reviewed. The
initial recommendations was for only people with a good performance status and minimal
disease and even this was debated upon when the further analysis showed that the subset
involved was too small for meaningful conclusions. Apparently though, I gather there is a
more recent metaanalysis from Louis Denis that suggest that the subset analysis actually
does support its usage again in minimal disease.
Villis Marshall were one of the chief investigators with Flutamide in Adelaide and as you
said, the incidence of side effects at the 250 mg tds dose were really quite unacceptable.
Really, unless the indications are clear, the physical and financial cost should force
clinicians to be clear about the issue.
It is most unfortunate however that patients with a diagnosis of advanced cancer continue
to shop around and somehow, somewhere, somebody will dish out that additional treatment to
be seen as the good guy.
Cynical of me, I guess!