Posted 10/8/2015 12:15 AM (GMT 0)
daz, the key to getting the best treatment for you is to educate yourself. No ifs, ands or buts about it. Generally that means reading, reading, reading. Medical journal articles (google and google scholar are great tools for finding them), various university and cancer center sites, and forums like this one. Then you can have an intelligent conversation with your docs, and you'll know when/if you aren't getting the straight story.
The bad news is that educating yourself takes time. The good news is that you have lots of times based on your profile.
I am also considering the options to treat my "low risk" PCa.
Based on my extensive reading these last 2 months since I was diagnosed (my stack of journal and other articles is 3" high and growing.....), and on talking to various docs, the vast majority of us with low and intermediate risk disease can expect to survive another 10-15 years even if we received NO treatment at all. The data show that our risk of dying in the next 10-15 years is the SAME as those low/intermediate risk folks who DO get treatment.
However, because you and I are supposed to live much longer than 15 years, we can also expect to develop symptoms and significantly worsening disease over that 15 year period, too, which is why all the docs are recommending I treat sooner rather than later, especially because I have a strong family history of PCa. So I will. But for the family history, most docs have said I could do active surveillance.
Thus, for me, the ultimate treatment is the one covered by insurance, and has the lowest permanent side effect risks. That seems to be everyone's objective when selecting a treatment, and it should be based on the excellent survival rates for low and intermediate disease.
One of the conundrums in picking a treatment option is knowing that the medical community is generally uncomfortable endorsing a particular therapy unless there's 10+ years of hard data to support it. But few radiation therapies today have that track record, where new treatments have burst onto the scene in just the last 10 years or so. Only surgery has a 20+ year track record, but it's not an enviable one in terms of the permanent side effects, and the da Vinci surgery hasn't changed that.
In discussing surgery options, my urologist said he preferred the "old" open/radical procedure so he can feel the penile nerves rather than trying to guess where they are with da Vinci machine. He explained that the penile nerves and the prostate margins/walls blend together making it very difficult to distinguish one from the other, which is why some of the prostate is usually left behind in either procedure in an effort to spare those nerves and erectile function. But the remaining tissue happens to be where the cancer likes to hide and recur.....
I stopped considering surgery once my urologist admitted the ED rates were over 50% in his experience, and my reading confirmed those numbers. Also, surgery is associated with permanent urinary issues much more so than most radiation therapies. My urologist recommended radiation.
The radiation therapies started in earnest in the early 1990s and got lousy results both in terms of recurrence rates and permanent side effects for a variety of reasons, mostly the dosing ended up being too low and the radiation beam was cast too wide, hitting vulnerable organs like the bladder and rectum. So the early radiation numbers are bad. But fortunately, the technology, knowledge and machinery has made tremendous strides in the last 10-15 years.
I am strongly leaning toward HDR brachy monotherapy because it has excellent survival rates at 9 years, the longest the data currently runs, and it appears to have among the lowest risk of permanent side effects, if not the lowest, of all the other radiation treatments. Here's a thread I started on another forum on this radiation therapy in case you're interested:
[url]https://www.inspire.com/groups/us-too-prostate-cancer/discussion/side-effects-hdr-monotherapy-seems-to-have-the-least/
If I weren't leaning toward HDR, I'd likely be choosing SBRT/Cyberknife where the treatments are 8 sessions or less, and the cure rates and side effects are very good at 9 years.
If you are wondering about the mortality rates associated with each form of treatment, here's Peter Grimm's tables based on risk level at the time of treatment:
[url]http://www.prostatecancertreatmentcenter.com/prostate-cancer/study-group/[url]
Dr. Mark Scholz is an oncologist of some renown who specializes in prostate cancer. You might find his blog rather interesting: [url]http://prostatesnatchers.blogspot.com/
Good luck!!