Posted 5/21/2013 1:35 AM (GMT 0)
Going back to the topic of this thread, would still like to see what the real criteria is for "being over treated", and who gets to make that determination. And it would seem like by the nature of the term, it would be subjective at best.
As for myself, with a lot of PSA velocity issues, a G7, and a PSA of 16.x, no part of me feels over treated.
I was ruled out for seeds at the time, wasn't interested in RT (due to my prior terrible RT experience), and in my area, robotic surgery was too untried - and I wasn't willing to go way out of town for robotic treatment. In the end, regardless of my preference, I would have had to had open surgery regardless. So my primary treatment choice was a mute thing in the end.
When my surgery failed fast, I do feel (in blessed hind sight), that I was pushed into SRT too fast. My oncologist feels strongly that way, as did the infamous Dr. "K". That was one thing they agreed upon. Based on my prior bad RT experience, I had a lot of apprehension about pulling the trigger, but in the end, it seemed the right thing to do.
Obviously, had I known it would turn out to be the life changing disaster that it did turn out, wished a thousand times I had never agreed. It didn't work regardless of the damage done, which is even more of a slap in the face. Hard to say if my SRT was over treatment, needless treatment, or what - since it turned out so poorly on all fronts.
This is why I ask men in that situation to make darn sure they really have verified recurrence before considering pulling the trigger. Bad things can and do happen, its not as ultra rare as some believe. I don't like how SRT is still an educated guess at best, because in most all cases, the RO's don't have a clue where any remaining cancer is located in the patient. Most assume the prostate bed, but its often long escaped that location, and no clear way to see it on scans.
I have changed one view over the years, I use to argue that surgery made the best sense as a primary treatment choice, because you can have radiation easily for a secondary treatment. But considering the high failure rate of SRT, it to me, seems like a less than ideal situation. It's better to get the most bang out of one's primary treatment in the first place. I no longer see SRT as an advantage to having surgery first.
And I am a big believer in AS for those that qualify, and if were up to me alone, I wouldn't allow any invasive treatment on a patient that clearly qualifies for AS, until such a time that their cancer progresses and warrants a full treatment. I was never opposed to AS, but even 5 years ago, it was rarely talked about here or anywhere else. Back then, surgery was clearly the "gold standard", even here at HW.
david