Radiation vs. Surgery -- Success Rates and Choices

Hope4Happiness said...
During the past few months (and especially since my diagnosis), I have been reading a lot about surgical and the various radiological treatments. Most current studies are showing the rates of success to be fairly congruent.

It appears, however, that most folks that I've been speaking to and coming in contact with here -- who had the choice -- chose the surgical option.

I'm just wondering what were the factors swayed that decision in either direction -- type of side effects? chance of recurrence? studies available at the time? doctor suggestion?

Thanks in advance for any replies.

Chance for recurrence (cancer control) is far, far more dependent on the patient's case characteristics than on the type of treatment. It only makes sense to look at cases similar to yours for comparison.

For low-risk cases like yours (and not even as favorable as yours), the cancer control is the same for all treatment modes AND for no treatment. There's no cancer control advantage for treatment. (No side-effect advantage for choosing treatment, either...haha.)

Post Edited (NKinney) : 10/4/2017 2:20:54 PM (GMT-6)

I did surgery followed by RT because that’s what my Uro and RO said was best. They both were part of the largest Urological group in Tucson, so maybe they tag teamed me. lol. Prior to my diagnosis I assumed doctors would always recommend what is best when it came to something as important as cancer treatment. I probably was naive. Did my doctors do their jobs without personal or financial bias? Maybe. Did I choose the right treatment plan? There’s no way of knowing.

H4H: As you see from my signature I have not had treatment as of yet. I have made the final decision though.

My process as follows:
When DX on 8/11/2017 I had already started a "little" research here at HW. The Uro who did the BX and is a "open" style surgeon suggested right away that I should have surgery. He did go through the other options, it took 5 minutes, but felt surgery should be my choice. I said thanks I would think about it. Next day I called his office and asked to have a referral to an RO from their same group (just to get the ball rolling).
On the 15th I saw the RO, who by the way was not an MD but she is a DO.??????? She said I should do IMRT with 44 visits over 9 weeks and that I should start with 2-4 months HT then the IMRT and then follow with up to 16 months HT. I said thanks I'll think about it.
On the 16th I got in touch with the University of Washington Med Center in Seattle and scheduled appointments with an RO for the 21st and with Expert RALP Surgeon for the 31st.
Spent hours every day on line, mostly at HW, researching.
On the 21st saw the RO. Could not do Brachy LDR as my prostate is too large 60cc. They did not offer HDR nor did they offer SBRT. He suggested IMRT but felt HT was not called for. I said thanks I'll think about it.
Spent the next 9 days continuing to do research ( some how at this point I let SBRT slip through the cracks ). By the time of my Surgical appointment with William Ellis I had convinced myself that if he would take me I would have the RALP. The extended number of visits for IMRT was a deal breaker for me as I could not stay at home and take treatments. I would have to live near the treatment center for 9 weeks. Well Dr. Ellis said I was perfect for RALP, explained all of the SE's and gave me a 90% cure estimate, the other 10% because unknown if the cancer has spread. I agreed and scheduled. This is a great surgeon with an amazing track record and a great personality.
Came home and started reading even more, mostly personal stories of RALPers. Within 3-4 days I was beginning to waiver and then, all of a sudden SBRT jumped into my head. I said to myself, "self" you have not done your due diligence. You left out SBRT.....so into the vat I went again with hours more research. TA suggested Dr. Robert Meier RO at Swedish Hospital in Seattle as a leader in the field of SBRT. Appointment set and went to see him last thursday the 28Th of Sept. Accepted by him and now in the authorizing phase with the insurance people. Dr. Meier gave me a 90% chance of cure. Other 10% because can't guarantee all of the cancer is in the prostate.
Final reasons I used for choosing SBRT:

Quality of life issues. I am 69 with great health. Family history suggests life span of another 20-30 years.
After much thought I decided that reduced number of years with great QoL was more important to me than more years fighting fighting fighting. I just couldn't bring myself to do the surgery and take on what I thought of as guaranteed SE'S when with SBRT the SE's are a maybe and then generally reduced significance.

Brevity of the treatment. Treatment will be 2 days prior to treatment for marker placement and various
scans for mapping purposes. Then 5 treatments on consecutive days. Wah
Lah.....Done.

As almost everyone here at HW says..........All treatment options are personal. There is no solid treatment better than all others.

I hope I have been helpful and may you never need to go beyond AS.

Roger

my decision was based on three main points:
1. salvage radiation is an option available if surgery failed (salvage surgery after radiation is an extremely difficult surgery to perform)
2. I had "frequent urination and restricted flow" issues that I wanted to take care of
3. I am relatively young - so was confident that my body could withstand surgery
I also had a misinformed fear of radiation - that it might cause cancer to nearby areas.

For me it all revolved around my personality. AS was not an option. I would be wondering about every little ache and pain. With radiation you never really know because your PSA my never become undetectable. Bottom line is I wanted it out ASAP. Will be 6 years in February and so far so good with no important side effects. Good luck.
Tom

Hope4Happiness said...


I'm just wondering what were the factors that swayed that decision in either direction -- type of side effects? chance of recurrence? your age? studies available at the time? doctor suggestion?

Thanks in advance for any replies.

First of all I'm impressed with the replies you already received from men who took their time, got educated and carefully reviewed their options before pulling the trigger.

For me, especially in retrospect, it seems pretty simple (not so simple at the time). The studies showed that the radiation options delivered equal chance of cure but with a significantly better chance of avoiding incontinence and ED. I didn't have any psychological hangups about "getting it out" nor did I have the need for immediate pathological information. What I wanted was the combo of cure + minimal sides effects so I went with an option that gave me the best chance of both. I chose LDR Brachy with great success but today would also give a long look at HDR Brachy and SBRT.

Jim

You are young, and should be a good candidate for surgery. As others have said, with your diagnosis, surgery or radiation would be equally as effective.

I had surgery, and am happy with the outcome. The only radiation option I considered was IMRT. In hindsight, I would have felt better from a due diligence standpoint having learned more about SBRT.

One thing your should consider is the sexual SE of surgery. Many urologists don't volunteer enough information about it. I've read the younger you are, the more likely you will return- eventually - to the same level of potency you had prior to surgery. However, there are no guarantees.

I see you have been in AS at MSKCC. At Sloan, John Mulhall practices in the field of sexual rehab after RP. He's even written a book. You might want to consult with him on that aspect of your treatment.

Take your time, because you have time! Good luck.

ddyss

There is low incidence of salvage after radiation because radiation as an initial treatment is so effective. It covers a larger area than surgery and succeeds where surgery does not. about a third of surgeries in the intermediate and high risk cases require radiation salvage. My logic asks why not start with the treatment used to bail out failed surgery and save yourself the inherent harm that surgery does? Why cut when it just isn't necessary to achieve great results?

Every story is different.

After diagnosis, i evaluated surgery, radiation and AS. With a family history of PCa (Dad had surgery 3 years age older than me and with a major spread of the cancer), AS did not seem like a good choice to me.

After discussions with doctors, reading, reviewing, i chose surgery. One factor was for the future option of radiation if needed and the treatment schedule for radiation. Also, with my age and health, i was confident in the outcome and recovery from surgery.

I don't regret my choice. If i was in the same situation again, i might choose differently, but every day there is more information available - so i don't second guess.

Gemlin, I had not heard of fecal incontinence with RP only in very rare cases? Denis

Folks, I do appreciate the replies!

For clarity, I'm currently not making any decisions or looking for prescriptive advice. I just joined the active surveillance crew in September, so my next formal move is a PSA test in February 2018. Now, I know I could be looking at direct treatment in 6 months or 6 years, but I was just curious to get some insight from those who've traveled the path and how they've reached their respective decisions. I know a lot of it is dictated by the risk category we find ourselves in.

What I appreciate so much about this message board is the direct contact from the "soldiers" coming back from the "front," as it were, telling it like it is... as opposed to the "press releases" coming from the "state department" and those with a financial investment in certain treatments.

ASA spacoar was at the PCRI conference, very interesting. Denis