Radical Prostatectomy Versus Radiation Therapy

Radiation oncologists use a longterm PSA level of .20 to determine whether the PCa has been eliminated, determined by ASTRO (American Society for Radiation Oncologists). Surgeons us a level of <.10 to indicate the PCa is gone.

Testosterone increase following HT does not cause PSA to rise, only Prostate cells and their cancerous variants produce PSA. Hormone therapy does not "mask" PSA, rather it kills some or all of the PCa and it no longer can give off PSA. If after HT therapy the PSA rises, it indicates not all the PCa has been killed and is growing and spreading. That signals the need for additional therapy. When you have brachytherapy and IMRT/IGRT most all of the benign prostate is ablated so that very little is left to either function or give off PSA. My docs said it mostly turns to scar tissue. Thus the very low PSA target that radiation seeks to achieve. PSA of .20 would indicate about .13 CC of benign prostate tissue. Compared to a normal prostate size of 30-35cc this is a very small amount left after radiation.

I had Brachytherapy and IMRT with neoadjuvant HT. From the start I was told by all my docs that the HT would cause an immediate drop in my PSA as the cancer would be starved by the drop in T from the HT. I went from PSA 59 to <.10 in 90 days. Under this situation the usual long PSA drop from the radiation working would not be observable nor would I expect to see the usual PSA bounce in the 18-36 month range. Sure enough, everything my docs said would happen has happened. I am now three years out from primary therapy and my last shot of Lupron will begin wearing off this spring. From there I should expect a gradual rise in Testosterone. If my PSA starts going up it will indicate we need to do more to fight the cancer that remains. If the PSA does not go up, it will indicate that I continue to be in remission.

Since surgery removes nearly all the prostate and hopefully all the cancer, it is expected that the PSA sould be <.1. If there were any rogue PCa cells left behind or had already gone somewhere the surgery didn't reach then they may start to grow and multiply. The only way you will know is if your PSA starts to increase. One of my clients had a PSA increase 15 years after his surgery. That indicated that some PCa cells were in his body laying dormant and after 15 years perked up. He is now on HT.

Hopefully you surgery will be successful for the long term and no further treatment will be needed.

I'm a surgery guy and have seen first hand how effective surgery can be.

Although I fully respect the choice, I'm not sure I fully understand why surgery would be more effective in cancers that will probably require follow up radiation anyway. I'm drawing a blank as to what the advantages of surgery would be in such cases but I recall people here listing some.

If I didn't think I could knock this out with one treatment I would personally not elect a form of treatment that from the get-go would be seen as being needed in conjunction with a follow up treatment if there was the possibility of effectively knocking it out with one treatment.

Age and general health is a huge factor in such a decision. Surgery is quite restricted in whom it's available to as a logical option.

All these studies are obsolete the day they are released.