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Posted 2/19/2009 4:13 PM (GMT 0)

All right gang. There is a wealth of knowledge in this forum. In your OPINION which do you believe has the best cure / long time survival rate radiation or surgery? Just curious because I was just reading an article on Tiger Wood's dad who was dx with PC and received radiation treatment in 1998 (which they thought was successful at the time) but the PC came back in 2004. He died from PC in 2006 at age 74.

Posted 2/19/2009 4:56 PM (GMT 0)
Thats one of those debates that even the doctors mull over. The best treatment is the one that the individual chooses. They all seem to be the same when it comes to cure / long time survival rates. But...as with any cancer...cure comes from early diagnosis more so than the treatment plan for the disease. Almost any cancer detected early enough can have very long term survival.

Now...about my own opinion...early stage, low grade cancer...hmmm...I go with surgery if watchful waiting is not an option.
Posted 2/19/2009 5:04 PM (GMT 0)
my personal choice, if early and presumed contained: would be either open or robotic surgery, and then save radiation if it came back.
Posted 2/19/2009 5:21 PM (GMT 0)
When I was first diagnosed I was told that my case was advanced and that surgery was not an option. I did a lot of research on the issue. Here is a brief summary.

Organ confined disease.  Surgery

Locally advanced disease. Surgery + radiation

Metastatic to lymph nodes in pelvic area.  Radiation + Hormone (knowing what I know now I would add surgery)

Metastatic to lymphatic system, lungs, and bones. Hormone

I would probably also try chemotherapy if the other approaches did not yield results.

Don

 

Posted 2/19/2009 6:13 PM (GMT 0)
I chose neither. There are other options you know. Especially in early stage PCa. Now there's an equivalent to a breast cancer lumpectomy for PCa. I know I've had it done. Yesterdays gold standard was yesterdays not the futures.

I also agree with the head of the Urologic Oncology Dept at the University of Colorado that better detection has brought an over treatment of PCa. Years from now people will look back and be some what shocked.
Posted 2/19/2009 6:19 PM (GMT 0)
well ziggy, that last statement can be said about almost anything related to the medical field. in mental health treatments, there use to be good arguments for frontal lobe lobotamy's and old school ECT, but they know different now.

the gold standard in PC treatment still has a sound and long foundation to it, especially with the improvements in both open/robotic surgeries, nerve sparing operations, many more available aids to ED after affects, etc.

in my opinion, i don't think its fair to refer to it as "yesterdays". still works today, still being improved upon, and has probably saved countless thousands of lives

david in sc
Posted 2/19/2009 6:29 PM (GMT 0)
The same can be said of a mastectomy a few years ago too. You must factor in the likely incontinence and ed problems too. I have none of the former and only a little of the latter which after kick starting my ED with the little blue pills has greatly improved. There's also the lifestyle vs possible longevity issues also to be factored in. Plus I'm only referring to early stage organ confined PCa of course.

As been said there's no correct answer in choosing treatments. You choose what you think is best for you, that said a knee jerk reaction in opting for major surgery I think happens too much with men in these days of earlier detection. Chalk it up as a result of psa testing. Also in my case unlike radiation if PCa were to return I still have all options available.
Posted 2/19/2009 6:31 PM (GMT 0)

Gentlemen, I choose the comparison between these two treatments because they are the most frequently used to treat PC. I am not discounting other treatment options.

After my dx and researching PC, I learned that radiation and surgery have similar cure rates initially. However, after ten years surgery cure rates appear to become superior to radiation.

I was just curious as what the men on this forum thought about the two.

Posted 2/19/2009 6:34 PM (GMT 0)

JerseyG said...
Gentlemen, I choose the comparison between these two treatments because they are the most frequently used to treat PC. I am not discounting other treatment options.

After my dx and researching PC, I learned that radiation and surgery have similar cure rates initially. However, after ten years surgery cure rates appear to become superior to radiation.

I was just curious as what the men on this forum thought about the two.

I admit for your age I would recommend surgery over radiation. If you were 25 years older I'd recommend maybe the opposite.
Posted 2/19/2009 6:45 PM (GMT 0)
There has never been a clinical trial that evaluated all treatment options on level playing field.
The best evidence we have is that the survival rate of all options are remarkable similar in early stage PC. Everyone has their opinion, but the evidence doesn't support one treatment over another. So the question has to be which option has the least long term side affects. Just reading the posts in this forum one can see the severe complications and side affects of surgery. Sardino at Slone Kettering states that 40% of all their surgeries are considered unsuccessful( long term side affects, no cure or complications). And this is at one of the best surgical institutions in the country. Looking at the radiation sites the side affects are not as severe early on, but continue to build over the years. With ADT3 the side affects are moderatly severe for some but are reversable when treatment stops. Cryo surgery has the greatest incidence of impotance of all the options. All doctors will claim that their treatment is the most effective, but the evidence just doesn't support the claims. So in reality it boils down to a personal choice of what side affects you feel the most comfortable living with.
For advance PC I think the treatment options make a difference. Some think that surgery is effective in debulking the tumor for other treatments. Others think that removing the prostate just sets of chemical markers that make the PC cells in the rest of the body grow faster. They point to the rapid PSA doubling time after failed surgery as one indicator of this. I don't think there is any proof of either. I personally think that having to live with the side affects of multiple treatments is just too costly and the fewer treatments the better.
Until there are clinical trials that prove one option is superior to another it's still a guessing game and people will continue to push and defend the treatment option they chose.
JohnT
Posted 2/19/2009 10:26 PM (GMT 0)
I agree with David (Purgatory). I'm choosing open surgery because, in my case, it gives me the best chance at a cure. If not, I still have radiation to fall back on. In addition, I want the bugger out of there and want to know where I stand re: progression. The only way to get that is by post surgery pathology. To top it off, my surgeon is the Chief of Surgery for Urology at MSK and he says it's the best way to go.

As someone on this site likes to say..."Do your homework, find a doctor you trust, make a decision and don't look back". Good advice.

Tony
Posted 2/19/2009 10:35 PM (GMT 0)
Tony, you are doing your homework, you have found a doctor you trust, sounds like you are locked into your decision, and now.....don't look back. I am not interested because you happened to have chosen my route, I am happy if you feel right inside about what you are deciding here, and do it, and can live with it come what may. I respect the path that all the men here choose for themselves. As you have learned in a short time, so many ways, so many variables, so few guarantees, and side affects and quality of life things that vary and jump all over the place. From my vantage, that absolute trust in your surgeon is critical to the path you are choosing. I for one, wish only the best and most positive results from your pending surgery. I will be happier when I know you are safely through it, and on the other side as we like to say. Then, you will be on the recovery side of PC. My best to you brother.

David in SC
Posted 2/19/2009 11:04 PM (GMT 0)
JerseyG - I chose the DiVInci robotic surgery but I know some that chose the rediation and are fine.
take care
Posted 2/19/2009 11:51 PM (GMT 0)
Frankly, I am confused as to the intent of your post.

You have had surgery, can't go back there.

It appears that the surgery was successful. Thats very good.

Scott
Posted 2/19/2009 11:55 PM (GMT 0)

Godfather said...
I agree with David (Purgatory). I'm choosing open surgery because, in my case, it gives me the best chance at a cure. If not, I still have radiation to fall back on. In addition, I want the bugger out of there and want to know where I stand re: progression. The only way to get that is by post surgery pathology. To top it off, my surgeon is the Chief of Surgery for Urology at MSK and he says it's the best way to go.

As someone on this site likes to say..."Do your homework, find a doctor you trust, make a decision and don't look back". Good advice.

Tony

Tony I have just noticed that our stats are remarkably similar. Myself, now 61, no symptoms, nothing felt DRE (that's because it turned out the tumour was to the front of the gland, top to bottom) , PSA 05....2.8, 06....3.2 07....3.9, 4 of 10 positive, Gleason 4+3, both lobes involved. Gland volume about 32cc. I chose surgery because (1) I wanted it out and if it was I would know the true extent. (2) Should surgery eventually not effect a cure then I could attack again with radiation. (3) Should the salvage radiation fail then ADT was available followed by chemotherapy if required. The more that time passes the more is discovered about the disease and the more advances are made. Hopefully I (along with all of you) should still be around when and if the ultimate breakthrough (gene therapy?) is made.
Bill
Posted 2/19/2009 11:58 PM (GMT 0)
Gpg you should have read my first post. I'm just curious as to what different people think about the two treatments. I am extremely satisfied with my treatment choice. 
Posted 2/20/2009 12:04 AM (GMT 0)

realziggy said...
The same can be said of a mastectomy a few years ago too. You must factor in the likely incontinence and ed problems too. I have none of the former and only a little of the latter which after kick starting my ED with the little blue pills has greatly improved. There's also the lifestyle vs possible longevity issues also to be factored in. Plus I'm only referring to early stage organ confined PCa of course.

As been said there's no correct answer in choosing treatments. You choose what you think is best for you, that said a knee jerk reaction in opting for major surgery I think happens too much with men in these days of earlier detection. Chalk it up as a result of psa testing. Also in my case unlike radiation if PCa were to return I still have all options available.


I must agre with most of this forum ... in early stages once the capsule out of your body with the cancer you can be clean for life by simply maintaining a healthy life style (and that is as per many long years studies ) and Surgery improved so much today that quality of life is back almost to normal ... the medical field nvested so much in improving these proven method that i am sure is for a good reason "THEY WORK BEST" with a great track record ... with all due respect your method above is a new one and yet to be proven as effective ... so in contrary to you i would have gone that route only if i had at least 10 years statistics as surgery and radiation... but again it is a personal choice at the end...

please keep us posted i wpuld be intersted to hear how that treatment turn out to be

GB
Posted 2/20/2009 12:53 AM (GMT 0)

JerseyG said...
Gpg you should have read my first post. I'm just curious as to what different people think about the two treatments. I am extremely satisfied with my treatment choice. 

My name is Scott and this thread is without merit.

Scott

Posted 2/20/2009 1:20 AM (GMT 0)

gpg said...

JerseyG said...

Gpg you should have read my first post. I'm just curious as to what different people think about the two treatments. I am extremely satisfied with my treatment choice.



My name is Scott and this thread is without merit.


Scott

Gee Scott, all threads have merit and the posters are doing what is known as musing and reflecting.
Bill
Posted 2/20/2009 1:55 AM (GMT 0)

My first oncology urologist recommended that I chose surgery, but added that surgery and radiation both are about equal when the disease is caught early.  The second  oncology urologist I saw suggested radiation.  He said that the side effects were different but the long term outcome are "probably" the same.  The first urologist was a surgeon, the second one was radiologist.  I chose radiation and though it is very early, I am very pleased with the side effects - or lack of side effects.  Then again, time will tell the tale.

Psst, regarding Scotts post questioning the merits of this post.  Scott, though I chose radiation I still read posts about surgery and any other procedure.  The two most common treatments are surgery and radiation and as such, tossing this thread around every so often is a good idea.  New members of the forum are able to see both sides of the treatment divide.

Tony 2

Posted 2/20/2009 3:17 AM (GMT 0)
To Scott (gpg): Not sure why you reacted the way you did to Jersey in the manner you did. I view all posts and threads of equal merit and value here. Didn't matter if he had surgery or not, he was just curious and asking opinions. I am still learning daily about all the other treatment methods even though I am 3 month out of surgery. I want to know more, and I want to be able to help others, better in the future.

David
Posted 2/20/2009 4:06 AM (GMT 0)

The purpose of my post was to learn what different people thought about the two treatments. I'm not second guessing anyone's decisions here. We all made the treatment choice we felt was best for us and god bless us all with that decision. 

In making our treatment choice we also had to discount other treatment options. I know why I choose surgery. Just wondering or musing as to the reason why some of you made whatever treatment choice you made.  

I've see that a lot of younger guys choose surgery and a lot of older guys choose some type of radiation. I know all the obvious reasons (complications,  recovery after surgery, etc) just wondering if there's something deeper that I'm missing. 

Tony1951, BillyMac and Purgatory thanks for the imput but we don't know what gpg (Scott) is going through I have very tough skin but thanks for posting.

Posted 2/20/2009 5:47 AM (GMT 0)
What kind of radiation are we talking about? If it is regular radiation, from what I understand, is like carpet bombing. It will damage everything around the prostate. If it is Proton Beam it is like a smart bomb. It only hits what it is aiming at.
Posted 2/20/2009 2:46 PM (GMT 0)
Well, YES, it is important to do your homework, find your doctor, make your decision, and then don't look back. We all try to do that, but it is almost humanly impossible, that once in a while, in your quiet moments, not to rethink things.....especially when you have the SECOND SALVAGE option looking at you. After radiation, brachy, lupron, and then salvage surgery, fistula operation, AUS operation....all by MSK.....(a good place to go), Pete's PSA seems to be rising quite fast again.
Every post has something to say I believe....and the friends that are here are helping newcomers try to figure out their way in a mire of overwhelming information that hits them when they are most vulnerable. Looking back eight years, the one thing I really wish, is that there would have been a forum like this to hear it like it really is....That is what would have helped us.... In the meantime we just keep forging ahead....

Learn everything you can, anytime you can, from anyone you can -- there will always come a time when you will be grateful you did.

Diane
Posted 2/20/2009 4:04 PM (GMT 0)
Smilinjack,

I had IMRT and I would beg to disagree with your comment that it is like "carpet bombing". If one has the image guided (IGRT) utilizing the gold fiducials the accuracy of the beam is quite good. The beam is modulated to administer a lower dose to the surrounding area and a higher dose to the diseased area. The dosage is contoured to treat the prostate while minimizing damage to surrounding organs. The patient lays on the treatment table and prior to treatment the rad techs locate the fiducials and align the beam for the day's treatment. The machine then makes a circle around the patient stopping at precisely defined intervals to administer the radiation. In my case there were seven stations. By administering the radiation at seven points the dosage to surrounding tissue is further reduced.

I have had no lingering side effects from my treatment and only experienced a week of urinary and bowel discomfort due to receiving a "full pelvic" dose. My research prior to treatment indicated that the results for proton and photon were essentially the same in the situation of localized disease. Just that one was more widely avaliable and less expensive than the other. The primary advantage to proton was the point of release of the energy. As I understood it the primary release of the energy was inside the targeted zone. (Bragg Peak) If one were so unfortunate as to have a locally advanced case then the proton would be combined with IMRT.

I am very grateful that the medical community has an arsenal of relatively effective tools to treat this disease and the knowledge to use them on a case by case basis.

Best of luck to you.

Don

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