Posted 11/11/2012 5:53 PM (GMT 0)
Thanks everyone for your responses!
I have spoken to two surgeons, one radiation therapist, and a cancer oncologist (who I know from treating my father), all at Duke. They have a nice system there that assures that these consolations take place. However it is still hard to escape human nature, and was were definitely some ego involved in all of the conversation. The least was from the cancer oncologist who, as you note, is likely the most objective as he would not treat me at this stage. It is also good that I know him from work with my father. I have a call into him for a follow-up conversation. I spoke to the radiation therapist last, who had a different spin on radiation than Walsh (Walsh clearly has some bias too, but he does try to bring in other opinions to control this). The bad news re. your advise is that he would not use brachytherapy. He only uses external radiation. We did not get into why this is, but he did not give me the option of brachy. He did mention several times that I could enroll in an experimentally higher radiation trial he has going on, but I am not considering this (and it was somewhat worrying to me that he mentioned this more than once - I worry about his motives - What his more important to him, his research or my health?). The conversation was good in that I did not realize the that external radiation has a lower complication rate than surgery. I have looked into this (he sent me papers from the scientific literature to review - I am a scientist, a biologist in a field that is far from medicine). They seem to validate what he says, but evaluating the scientific evidence is not trivial, and I am still thinking about what the papers say. One of the main problems that I see is that the long term outcomes of radiation are hard to evaluate. At least that is what the radiation oncologist seemed to say. I would not think that was the case, but I think that is what is told me. Can anyone comment on that?
In the short term, I have two problems with radiation: (1) there is no way what I know of to assure that the radiation was effective in getting all the cancer. Your PSA may drop after surgery, but this could only mean that the caner was "hit hard" not destroyed. There is no clear way that I know to assure that it is gone. This brings us to #2. My father was treated at Duke (by a Dr. who is no longer there). His initial treatment was about six years ago, and in summer 2011 his PSA was back to 100. Clearly they did not get all of the cancer. Worse, it metastasized. Now, I do not know his original Gleason scores, or T level. I was not involved in his therapy at that time. I am now. It may be that his cancer was beginning to metastasize when he had the radiation. I can try and find this out. In addition to his cancer returning, he has been incontinent since soon after the treatment (badly incontinent), and has has rectal bleeding. This may be unrelated to his radiation treatment, but since bowel damage is possible with this treatment, I tend to suspect it is involved.
So I guess my main question is about long term survival after both types of treatments. Does anyone know a good source for this information? Perhaps I should post a new topic on this question so that people who are not following this thread can follow it.
Also, if anyone in NC has a recommendation for a brachtherapist I will consider going to see them.