Surgery or radiation? ?

I have been studying this for the last few weeks since being diagnosed, have seen multiple doctors, surgeons, radiation oncologist, urology oncologist and one who focus' on brachy. They all essentially recommend the treatment that is specific to their area of expertise which is what I expected as I sought out the best in each that I could find in my area. The one exception was the urology oncologist who said that any of the options would work in my situation he believed. But he added that he personally would not do brachy because of the high chance (15%) of severe side effects that he would not want to live with for the long term. My confusion is that the stats I look at I have probably a 30 to 40 percent chance of long term failure with surgery and would have to do some type of salvage therapy along with all those side effects. When I look at the brachy specialists stats they look the best. He has done about 1500 with half low risk 1 quarter intermediate and 1 quarter high risk. Across all these he had about an 80 percent cure rate and around 85 percent rate for intermediate of which I am.

As I am at an intermediate stage on the partin tables they say my risk is 40 percent that the cx has escaped the capsule. If that is the case why do a majority of the doctors favor surgery over brachy and or external beam? It seems to me as a laymen that either form of radiation would have a much better chance of getting all the cancer both in and it off the prostate than even the best surgeon could do unless they just took everything out including the nerves. Am I missing something here in my thought process?

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

The long term side effects for brachy and beam radiation are often exaggerated. Most of us who've done radiation don't have more SEs then our brothers who've done surgery. With your numbers, I have to say you'd be fine with any treatment mode.

I chose radiation over surgery for a couple of reasons, one heart/lung issue and second there was a slight chance of some PC near the margins. It was felt I'd tolerate RT better and they could open up the beam enough to target the suspect areas on the edges of the prostate.

It worked for me and I am happy with my choice.

I have two brothers with about the same numbers, one chose surgery, one brachy and I did beam radiation. A few years out, we all have very low PSA and all about the same amount of SEs.

You'll be fine with whatever you choose. And that will be the hard part - choosing and not constantly second guessing your choice.

Hang in there and keep us updated on your progress,
Andrew

http://prostate-cancer.org/PDFs/Is14-2_p3-11.pdf

this is a good article on the results of all treatment options. The last section compares the side effects of all options.

While I'm not one that knows all of the latest research, the 15% chance of "severe" side effects for brachy is a bit of a head scratcher for me. I've never heard that before.

I'm only one data point and it's only been 18 months since I had HDR brachy and IMRT, but I currently have no side effects from that. (Now don't get me started on the SEs from my HT...)

I don't think you are going to be able to know for sure, because rarely are the studies provided by unbiased investigators. For example, the figures given at the study from prostatecancer.org linked to by John T is done by: "Doctor Peter Grimm is the Director of the Prostate Cancer Treatment Center in the Seattle area. In the late 1980’s he pioneered, with his partners, low-dose brachytherapy technique known as seed implantation for prostate cancer. "

Now don't get me wrong, I am not saying that his stats/results are not dead on, they may well be. Would not surprise me at all. But his results show much better cure rates and much lower SEs(except for bowel) for seeds and seed/EBRT than surgery, especially for other than low risk. And, I do not personally find this hard to believe, and I do believe it when it comes to the SEs, with only bowel related being worse for RT and all others being better.

However, I have now seen several large studies showing much better results for surgery than Doctor Peter Grimm's study from above indicate , even with high risk patients. I have even seen studies showing BETTER results with surgery than with seeds/RT. But guess who did those studies? One hint: NOT RT guys!

For example, there is this study of surgery done on high risk pts:
http://www.renalandurologynews.com/study-supports-surgery-for-high-risk-prostate-cancer/article/338483/

And if you don't mind getting your info from the folks who manufacture and sell DaVinci robots, here is some info showing surgery ( some open, some RRP) to be clearly superior to various radiation and/or hormonal approaches:
http://www.davincisurgery.com/da-vinci-urology/treatment-comparison/

Since I had surgery and have had a some definite distressing SEs, reading these latter, pro-surgery studies plus a few other studies make me feel a little better about it all. But I am also well aware of the old saying which confirms human nature: "If a man has a hammer, everything looks like a nail". What type of hammer do your advisers have? A knife hammer, or a radiation hammer? Something else?

Good luck on figuring it out. I lean somewhat towards seeds or seeds plus EBRT, but even looking at all the pros and cons after the fact it is not easy to proclaim the correct choice.

Post Edited (BillyBob@388) : 9/8/2014 8:19:54 PM (GMT-6)

Your choice alone to make. Good arguments, as you have found out in your own research, to prove either RT or Surgery as being the one chance to get a curative effect from a primary treatment.

In the end, you are going to have to go with the school of thought that best fits your mind set. Choose wisely, as there aren't any re-set buttons. If you want the fewest side effects, go with the seeds, with your numbers. If you want it "out of you" (Not really a good ideal to lock onto that notion, imo) then go with the surgery. Either one hopefully will do the prime purpose for you - which is to hopefully eradicate all of the cancer.

However, and HW PC is full of endless surgery stories - of men dealing with incontinence and/or severe ED issues, despite some having nerve sparing surgeries, etc. So there is always going to be a bit of a crap shoot with what you will end up with post surgery. This even goes for men that had "brand name nationally known" surgeons at their side. Just no guarantees with surgery.

Good luck, its never an easy decision to make. Just got to do what is right for you.

David

My story: I chose surgery over seeds for reasons others have stated. It gave me another option if surgery failed. Even though my path has had bumps, I still don't think I would change my mind if I had it to do over again. In my case, the pathology report showed my cancer was worse than suggested from the biopsy which made me feel more comfortable with going the surgery route. With seeds I would have never known the cancer was more advanced. On the downside, I have ED and nothing has helped (although I had mild ED prior to surgery), I still have incontinence to the point that I have to wear a pad everyday due to a small amount of leakage (more if I sneeze or pass gas) and of course the biggie...surgery failed. But on the bright side, at least, radiation was still an option and I am at the point of waiting to see if it was successful. As others have stated, in the end it is your choice to make but I hope my story can help steer you in the direction best for you. Good luck!

One thing I have not heard you say is Cyberknife/SBRT. It has a lot of appeal to me since it is completed in 5 fractons over 2 weeks rater than daily over 7-9 weeks. SBRT uses a total of 35 Gy - 40 Gy with 5 days times 7-8 grays. So the old saw about no do-overs to same location is overcome and you can get a second bite of the apple (actually walnut) if needed.

cyberknife.com

If very overweight, I heard at PCRI Conference at LAX Marriott yesterday that low dose brachy gets the nod. Tis is not to say one should not do brachy is in shape or under weight.

With any treatment your sex life will go all to hell for a couple of years.

In your case you have a lot of good options, go with the most experienced doctor that you also have a good rapport with, and let them decide which tools to do their job with.

You seem to have taken all the right research steps, so now pick an approach and stick with it, never looking back.

One other thing you can do is indicate what country or area of US you live in and your brothers here can recommend doctors in your area they have had good successs with.

Good luck.

LupronJim