Surgery vs Radiation

There are many excellent books out there about prostate cancer so you can read up and learn more about what the pros and cons are for each type of treatment. A lot of this information is on this website too, but I think its worth taking the time to read from the source. Afterwards you need to discuss which one you and your husband think you are comfortable with.

I left that to two urologists who know each other ( and I trusted them both as top doctors ) They made the decision about what was the best treatment for me, surgery, which I had just over 4 weeks ago..

The decision making process is difficult mostly because there is so much information out there and it's difficult, unless you are an experienced doctor, to apply the treatment options to your unique situation. In the end, most people would be wise to get a few opinions, and then go with the doctor who you are most comfortable with, get treatment you together decide is best, and get on the road to recovery.

Everyone here is on a different road, and I wish you well as you move forward.

Welcome to HW, sorry you need to be talking to us.

I choose beam radiation over surgery because I've got some heart/lung issues that make surgery difficult. The cancer clinic I went to had me talk to a surgeon and RO during the same appointment. The surgeon listened to my fears about surgery, looked at my medical history and said, "I'll get the RO, let's not do surgery." If I ever need surgery, I am going back to that doctor.

You husband will do fine with radiation. Seeds are a good choice as is beam radiation.

One big thing to remember about PC - most of the time there are no symptoms until the cancer is very advanced. Treating now puts you in the 'cure' zone. That is you've got a very good chance of beating this thing.

The other thing that will drive you nuts is that there is no real good science that says surgery is better or RT is better with numbers like yours. A lot of times it comes down to what you feel most comfortable with. I have two brothers, both with PC. One did surgery, one did brachy seeds and I did IGRT. 2 years after treatments we're all doing about the same and all have PSA in the very low to undetectable.

Frankly, I'd just go with your gut instinct - after getting a couple of good second opinions. You might want to consult with a medical oncologist who specializes in PC. The toughest problem you'll have is deciding which treatment to do.

Ask any other questions you have, we're here most days.
Hang in there,
Andrew

One thing that you and your husband absolutely want to do in making your decision is to choose the very best doctor that you can find to treat your husband, regardless of form of treatment that you finally decide on. (Fairwind in his post above hinted at this).

Think of it as like hiring a mechanic to fix your car. A poor mechanic will do a poor job and your car still has a problem. A good mechanic who knows what he's doing will fix it and your car problem is solved.

Of course we're talking about something far more serious than fixing a car here, but the same principle applies to doctors: you need to get the best one you possibly can to get the best results for your husband.

We have in the past had a number of discussions here on this forum on this very topic. For example, see:

www.healingwell.com/community/default.aspx?f=35&m=1852935

for some thoughts on choosing physicians.

You can also use the "Search" function at the top of this screen, and search something like "prostate find doctor" in the box (without parentheses) and hit Enter to locate some other useful discussions that we have had on this topic.

Good luck!

My husband's urologist/surgeon referred us to the radiation oncologist so we could see all the options. The oncologist suggested getting another PSA test and another reading of the slides. We will do that. We are between low risk and medium risk.

The oncologist mentioned, as Ravineman also did, younger, healthier men chose surgery. That surprised me. The surgery just seems so grueling. And if given the choice, radiation seems less grueling. But That goes make sense that younger guys will survive surgery.

From what I am gathering, the complications are immediately after surgery but will improve over time. With radiation, the side effects come later. And after a few years, it's all same for those who had RP and radiation. Is that that semi correct? I know it's hard to put numbers on these things, but is survival rate the same?

By the way, thank all for your posts. They are very helpful.

stowal33 said...

From what I am gathering, the complications are immediately after surgery but will improve over time. With radiation, the side effects come later. And after a few years, it's all same for those who had RP and radiation. Is that that semi correct? I know it's hard to put numbers on these things, but is survival rate the same?

basically true. after a few years everything evens out a bit. RT guys seem to have less ED but I don't know the stats on that. Younger men are often steered towards surgery because of the fear that radiation might cause secondary cancers. Something the older (with fewer years to live, to put it bluntly) have to concern themselves with.

as far as I know and what my doctors said, the survival rate is about the same but there are so many factors that it's a very broad statement and difficult to prove one way or the other.

I will say that beam radiation isn't all that easy - not as traumatic as surgery but it will test your endurance to do the treatments every day for 6-8 weeks. Some get very bad fatigue by the end and other SEs aren't fun. Of course with surgery you get 4-8 weeks of recovery and some never completely recover continence or sexual function.

over time the SEs from radiation fade but new things will pop-up once in awhile. For example, my hemorrhoids got much worse after RT - the worst being at about 18 months. It hasn't really improved much but I've learned to cope better and keep the really bad episodes at a minimum. Frankly for every bad thing you can say about radiation, a equally bad thing can be said about surgery - and the other way around.

Andrew

Tall Allan, I understood maybe 1/4 of what you posted. But I did enjoy reading the parts I did understand.

This board is awesome because it so helpful in so many ways !

Stowal,

If you could find out for us whether his Gleason 7 is of the (3+4) type or the (4+3) type we could help a bit more. A Gleason 7 is always a mix of two Gleason "grades" which describe the two types of cancer cell patterns that were seen under the microscope. Gleason 7 (3+4) has more of the less-aggressive grade 3 pattern cells and fewer of the more aggressive grade 4 pattern cells. Gleason 7(4+3) has more of the bad (grade 4 cells). Gleason 7(4+3) is worse than Gleason 7(3+4). On the other hand neither of them is as bad as my Gleason 9(4+5) and I'm doing OK, so not to worry excessively.

The thing is a lot of the therapy decisions, for surgery and for radiation, divide between Gleason 7(3+4) and Gleason 7(4+3). To treat the (4+3) kind doctors will add more to the treatments -- more aggressive treatments for more aggressive cancers. Often this extra treatment that comes with the higher risk are in the form of hormone therapy added to surgery or radiation or a second kind of radiation added in with radioactive seeds.

The two things you said about surgery are sort of true but need to be taken in context. Surgery is better for younger men, when compared to surgery for older men. For really old men this can get so extreme that even the surgeons will admit that radiation would probably do better. So for older men one typically doesn't consider surgery but for younger men one does.

And yes, the side effects of surgery hit a man immediately and then, hopefully get better while the side effects of radiation come on gradually, as do most of the side effects of hormone therapy. Its probably true that, on average, after all the improvements a man makes after surgery have happened, and after the late-breaking problems of radiation have occurred, the radiation guys are probably still a bit better off, on average, although men treated by rock-star surgeons may do better yet.

And now, if you will excuse me I will quibble with Tall Allen who knows much more than I do.

Tall One.

Your study's abstract said...
Biochemical recurrence was denoted as 1) adjuvant therapy or 2) 2 prostate specific antigen values above 0.2 ng/ml. Biochemical recurrence-free survival, and patient and tumor characteristics were investigated.

One of the advantages I see to surgery is that it allows for a mid-course correction. That's the flip side of the "assurance" you get when things go well. I consider surgery plus adjuvant therapy to be one combined treatment. If I understand the wording right I would be considered to have had a biochemical recurrence despite two years of undetectable PSAs. Seems odd.

PDA,

I don't have access to the full text, so I have to guess. Adjuvant means that the radiation was started fairly soon after RP; salvage means radiation was begun only after PSA was confirmed to rise above .2. In either case, the radiation is given because RP failed. I think they include adjuvant radiation in the recurrence category because it's often given because the PSA never went down completely after surgery. Sometimes it's given when there are multiple risk factors after surgery even in the absence of persistently detectable PSA (e.g., positive high grade margins, pT3b). With adjuvant RT, there is a higher probability that the failure was local, and there are RCTs that confirm an advantage to it. With salvage RT, it is less clear that the failure was local, and the survival advantage of SRT is less clear.

So it seems your adjuvant RT would count you as a biochemical recurrence by their definition. If the surgery were successful, you wouldn't have needed adjuvant radiation. It's not a single treatment. The ART was conditional upon the results of RP. Why would anyone intentionally go into RP+ART from the start?

- Allen