Lotsahope,
I'll try to address your question as to why we don't all share your "JUST CUT IT OUT" mentality. Probably almost all of us did feel that way at some point in our journey, and can certainly relate to that attitude. It is our first reaction to the word "cancer," mostly based on our experience of the disease in its other forms, cancers that progress quickly and are deadly if not treated immediately. This is not typical of PC. Many men, like yourself, retain that attitude, and most men with PC do in fact choose surgery. But a minority of us do not. Here's why.
RP has a failure rate of 30%. The reason for the high failure rate is because the cancer has in those cases already left the prostate, and surgery can only remove what is encapsulated. The risk that it has already left the prostate increases with the risk level, as stratified by Gleason score, stage and PSA. So let's take a look at how well the cancer was controlled by men who had surgery at Johns Hopkins, arguably one of the best surgical treatment centers around.
This is based on an analysis they did of 6,652 men treated between there between 1984-2005. They use a measure called 5-yr biochemical relapse-free survival (bRFS), which means that the PSA did not go up again after treatment. By risk group, here's how those men fared:
Low Risk - 95%
Intermediate Risk - 77%
High Risk - 55%
Now look at how well the cancer was controlled by a radiation technique called SBRT.
This is 6-yr data from 515 men treated by Dr. Katz.Low Risk - 97%
Intermediate Risk - 92%
High Risk - 70%
As you can see, the oncological control was about
equal for low risk men, but was markedly better in favor of SBRT as their risk level increased. This is because radiation kills cancer cells outside of the prostate as well as in the prostate, and modern techniques do it quite well - they've learned a thing or two over the years. For brevity, I won't show you the numbers for other radiation techniques like seeds, but they are equally impressive.
The other reason a lot of men don't "just want it out," is because of the side effects of treatment. Surgery has very high rates of impotence even with nerve sparing. Nationally, according to the Sanda study, only 37% of previously potent men were still potent more than 2 yrs after surgery. Some of the best treatment centers, surgeons can get the potency rate up to 60%. Compare that to SBRT where 74% retained potency.
Incontinence, which is practically unheard of after radiation, affects almost all men who have surgery. After a year, 90% achieve continence, but 10% don't and many of those never do. Many are left with stress incontinence (e.g., while coughing, sneezing, etc.), about
a quarter experience climacturia (urinating at orgasm). In addition, penile shrinkage is common. With radiation, the urinary and rectal symptoms are irritative - typically mild and transient.
The big downside of radiation is that one doesn't get a pathology report telling one what was in there. For those whose cancer was well-contained, it may be comforting to have that assurance. But for many undergoing surgery, that assurance will never come. There may be positive margins, SVI, EPE and rising PSA.
So far, I've only addressed surgery vs radiation. But for some men who don't have the "I just want it out" mentality, Active Surveillance may be a great choice. They would argue that because PC often follows a very slow, indolent course and often never progresses at all, then why risk
any of the side effects of treatment - surgery or radiation? Why not just monitor it carefully, since we have some excellent tools for doing that now (as you can see from Windsor's post), and then be prepared to treat it if it seems to be growing. In the largest study of this approach, 97% were still PC survivors after 10 years. In that group, 70% of them have not progressed such that treatment would be called for. Another benefit to those who choose this approach is that treatments improve over the years - there may be symptomless treatments 10 years from now.
I hope this helps you appreciate why many of us take the time to carefully explore options. I think there's a temperament element too: far from finding this educational process stressful, I found that it quelled my initial anxiety. I actually enjoyed meeting with doctors and learning about
their varied approaches.