Confused, Radiation vs Surgery

Hi Guys,

I've been reading a lot of threads on why a lot of you picked surgery vs radiation. The most common reason was that if surgery failed you could always use radiation as a backup, but if radiation failed, surgery was not a viable alternative.

Here's what  is confusing to me: I understand that if the cancer is contained in the prostate that the cure rate using surgery and radiation is the same. The most common cause of surgical failure is when the cancer has penetrated beyond the prostate and a positive surgical margin was not achieved or that the cancer has metastizied (high gleason and high PSA). It also seems logical to me that a higher positive margin can be achieved with radiation because you can radiate the area around the prostate.

A  reoccurrance after surgery is not a local reoccurance as the prostate does not exist. You can have a local reoccurance after radiation because there is still a prostrate; does any one have any stats on how often this occurs? I would guess that most reoccurances after either surgery or radiation are due to the fact that the cancer had already spread outside of the scapel or radiation beam.

I also think that an effective backup to either a surgical or radiation failure would be hormone therapy rather than more surgery or radiation. How often does the 2nd procedure really cure the cancer? Any stats? Do most reoccurances end up on hormones or chemo anyway?

Can any of you shed some light on my confusion? The side affects of all treatments are substantial and stacking the side affects from multiple treatments is not very appealing to me.

JohnT

 

John: a positive surgical margin is a Bad Thing as it means positive for cancer -- contrary what we might normally think. A negative margin is desirable as it means clear of cancer.

I am a bit confused by your stats which say "location of tumor makes positive surgical margin unlikely" -- does this mean that the tumor is unlikely to be confined to the prostate? If so, surgery is a less attractive option, and radiation becomes relatively more attractive.

Surgery removes the prostate and a varying amount of tissue surrounding the prostate (margins). Even with negative margins (clear of cancer) there is no guarantee of "cure". It is always possible for a microscopic amount of the cancer to have escaped and not be noticed. Microscopic amounts in the margins may not be noticed by the pathology.

Escaped cancer can lurk in the prostate bed for years before making its presence known via rising PSA. A local recurrence like this is very treatable by radiation -- radiologists radiate the area where the prostate used to be.

But as you say, if the cancer has spread elsewhere, then the best option is hormone therapy.

John T, My husband stood in your shoes eight years ago. The doctors at that point said that with a PSA of 16 and Gleason of 4 +3 that radiation would be the best....He had lupron to shrink the prostate four months before the external radiation and then the seed inplants...followed by another year of lupron. You would have thought that would have gotten the cancer, right?

Well, we did for four years....(by the way, four years goes by very fast), He was just getting his mojo back, when the psa began to rise,,,doubling in two months.....The surgeons at Sloan Kettering said that they could do salvage surgery..(one of the few places in the country that did salvage surgery two years ago..maybe more now), to debulk the tumor. They said a 40% chance of total cure with 2% chance of fistula...Well....

The side effects have been really difficult for Pete....because of the radiation damage. When you have radiation, it is like frying an egg...It cooks the prostate....leaving lots of scar tissue that will not heal properly. They did debulk the tumor, but when the surgery was over, the surgeon said to me that he was disappointed that there was a lot of scar tissue and that the cancer had positive edges and also lymph node involvement. That cancer had four years to grow.

Plus Pete got a fistula...connection between rectum and bladder... needed surgery for that....The radiated area has been an ongoing problem. So, to make a long story short....from my point of view, initial surgery makes a great deal of sense. Radiation can always be done in a salvage situation much easier for the patient. I think medical knowledge is about two years behind reality. No one told us two years ago the damage of salvage surgery. I am telling everyone now.. ...
..I guess I am somewhat worn out tonight, I just came from the hospital again...Pete had to have hip replacement due to worn away bone in his hip.....But after saying all of this, there are many who have done really well with the External radiation and seed implant.....If it works it is great.......Pete's radiation was very extreme, I believe, and it still did not get all of the cancer in the beginning. Diane

Nothing is perfect in this arena,  (edited by myself  over the top for newbies)

Post Edited (zufus) : 1/12/2009 12:02:13 PM (GMT-7)

I am going through the exact same thing....trying to decide between surgery (robotic) and radiation (IMRT and HT). I've talked to several people who have had the surgery and have talked to 4 different docs. In my opinion it comes down to this, there really isnt a right or wrong answer here. The 4 docs I spoke with where evenly divided on which option seemed best for me. Two out of the 3 guys that had surgery had great results and are doing fine. The other, well not so much. It really is a personal choice. The best you can do, and is what I am trying to do now, is educate yourself, talk it over with family and make a decsion. My PCP basically told me, that we aren't dealing with something that is black and white here. Medicine isn't an exact science so the decision that you make, what ever that is, is the right choice. Good luck!

In many cases, it does appear that equal results can be achieved with either surgery or radiation. With that in mind, I chose the one which was less likely to produce unwanted side effects.

This is a 5 year old thread, most times it will get locked down and a new thread on the subject will be started. I find this a bit confusing based on such an old thread.

David