Neoadjuvant vs Adjuvant Chemo

Hi Joe, my oncologist told me today that chemo before surgery is becoming increasingly popular in the USA. My chemo has been delayed due to a problem which needs further investigations. I am due at the Shands center this week and it will be interesting what their views are, I will let you know next week. My tumor size and location is very similar to where yours was.

Don my choice was made back in 4/20 when my chemo was done and then I had my RC on 6/20. As Wendy mentioned my surgeon and myself saw eye to eye on this having the chemo done b4 the RC since the cancer was contained to my bladder and this way hopefully keep it that way. My surgeon Dr. Malkowicz out of Penn said he had a better success rate doing the chemo b4 the surgery. And like you I love to see them 5 years out I now got 7 months out so I got a ways to go good luck to you. Cheers, Joe

Wendy...i second Rational Theraputics......they have done amazing things with cultures that supposedly should respond to the "one coctail cures all"...and found breast cancer drugs and colon cancer drugs that knock out a distant met or tumor. I wouldn't hesitate for a minute to use their lab........www.rationaltherapeutics.com/
Pat

Hi Joe: AS for my case, The DR came in said the cancer was not in any of the 33 nodes or prostate and only slightly into the muscle. In his words he knows of no one that would recomend further treatment. I will have the normal visits to keep a lookout for problems. I am not affraid of shemo. It just is in my opinion like raping the body. But if it is needed then it must be done. But for me not on the if come. I will let you all know in say about 5 years. I hope God and docters give you the rite guidence in your choice, This is only my thoughts about me. Don

Unfortunately there are no hard answers about this Joe, only opinions and a tiny bit of data that gets argued over. I was just reading in a cancer journal that by the time 'guidelines' get published they are already out of date. The AUA hasn't really made official guidelines for invasive blc, and only mentions the various options. As you know, both neo-adjuvant as well as post-op chemo are stated as viable options for bladder cancer.

I've known people stage IIIB post-op, who were never offered chemo and never had a recurrence (8+ yrs later). I know others who were staged IIIa or II, get no chemo and get a recurrence, and then they are stage IV. Heck, this happens to people on BCG. Until now, there is no way to predict who needs chemo and who doesn't so it's more or less hit and miss.

Actually, there are pioneers out there in the field of predictive assays (Larry Weisenthal, Rational Therapeutics and others, see blcwebcafe.org/ccdrt.asp

I have always wondered why this isn't more mainstream, although I've been reading more and more about this kind of thing being investigated for bladder cancer, mainstream. I can hardly wait, really.

When a doctor asks me what patients really want, I have been saying for years: we want assays to predict which treatment works best. It seems like a no-brainer, investigating this line of research, to spare us all useless and toxic treatments.

For the rest, it's got to be about patient preference and treating each person as an individual, not a stat. So...that means presenting options as a doctor, and learning about them as a patient. In an ideal situation, someone can choose based on a good idea about the possible options, their doctor's expertise (and trust in same) and what they can live with, what is tolerable to them.

You are lucky because you and your doctor came to decisions together, what you were able to tolerate, and giving you an aggressive approach that you feel increases your chances. Some people are terrified of chemo. Others find it tolerable and worth it.

It's a good question, I wish we had *the* answer.

Stay well,
Wendy

Hi- I think it all comes down to education. Looking back I wish we had been better prepared. In Canada, we tend to believe what Dr.'s tell us. We don't question them. This is a big mistake. We are like sheep being led by those we believe know best. I agree Joe, if there was a chance of spilling cancer cells, we should have prepared for it in advance, but this was never mentioned. We are not medical people (except for our daughter that is), the Dr.'s didn't even tell us that the Prostate was coming out as well- nothing was mentioned about spilling cells. It was just the other day that I heard that cancer cells can get in the bloodstream & spread. Who knew? We trusted those who we thought knew best- to all of you just beginning the journey, please educate yourselves & ask the questions. I think in our case, we were afraid of the answers & maybe that's why we didn't do more research on our own. Regards, Lorrie