Radiation vs. Surgery -- Success Rates and Choices

ASAdvocate said...
...I think that the common side effects of radiation in the 1990's have been greatly reduced by better accuracy and devices like SpaceOAR, which shield the rectum.

Effects were not greatly reduced according to results published in 2017...read THIS PC Infolink article (written by Tall Allen) about the risks and the generally not-statistically-different results between the test and control groups when SpaceOAR was blindly utilized.

NKinney said...

ASAdvocate said...
...I think that the common side effects of radiation in the 1990's have been greatly reduced by better accuracy and devices like SpaceOAR, which shield the rectum.

Effects were not greatly reduced according to results published in 2017...read THIS PC Infolink article (written by Tall Allen) about the risks and the generally not-statistically-different results between the test and control groups when SpaceOAR was blindly utilized.

Yes, I had read that article before, and should have re-read it when writing my post.

However, that is regarding SpaceOAR. Regarding my main point, do you have sources that would show that today's radiation is not better with side effects than that of the 1990's?

Listen to NKinney on this.

You are a G6 with very little cancer in your prostate. Stay on AS, watch it over time. There are other treatments for frequent urination.

The VAST majority of G6 PCa NEVER EVER becomes metastatic.

You risk- incontinence, erectile dysfunction, inability to father children.

ddyss: Is mass production a good thing for medical care? Personally, I'd prefer a little more time and care taken, regardless of the treatment.

I chose surgery. I never gave much thought to radiation. What I was told is that the cure rates are the same and the side effects are the same. I had a major surgery a few years ago with the DaVinci, and it was very successful and I knew what to expect.

With surgery, the assault on the body happens all at once, in the beginning, and then you get better. With radiation, the side effects might not kick in for a year or two. Just my own preference, but I wouldn't like that hanging over my head.

I would never presume to give medical advice. You're at a world class facility, and you should get your advice from your doctors, who are intimately familiar with your situation.

Great post TA....It should have it's own thread....

Subdenis,

Fecal incontinence was a reason I was advised by several RO specialists to AVOID RT. I suffered issues before cancer that involved surgery in my colon & rectum, and the scar tissue was expected to be damaged yet more by the RT.

In fact, since my adjuvant RT, I've had significant problems, which limit greatly my ability to travel by air (which cost me the job I had at the time). It has improved slightly after I went through 60 sessions of hyperbaric oxygen for urethra / bladder RT damage.

But the problem is very real, and impacts me every day.

Whenever this topic comes up, there are some things emphasized and (almost) proclaimed as Truth, that i think need to be debunked.

First is the assumption, frequently stated by diehard surgery haters, that surgery guarantees terrible, onerous, lifetime side effects that happen immediately. This is simply not true. Many men have the surgery, and within a few weeks or months are back to their lives, never need a pad, and have full and satisfying sex lives. Now, do I think there is a way to guarantee that outcome? In a word, no. One can increase their odds by being fit and healthy before hand along with having a highly experienced surgeon, but no one can guarantee it.

Second is the parallel assumption, that the reverse is true of the various radiation treatments. That if one has the commenters preferred radiation treatment (and it doesn't matter which one) that there will be equally good cancer control and that there won't be any significant side effects either during treatment or for years afterwards. Again, not provably true. For some of the newer technologies, there isn't enough history to argue for 10-15-20 year side effects, because those treatments haven't been around that long.

So, in the end, what do we do? I think in this and any other forum of it's type, we absolutely have to be willing to admit that we all only know what we know. We have to be cautious about stating absolutes and using words like always and never. And we have to always remind ourselves, and each other, that none of us are physicians, and that the best health care decisions are made in the context of shared decision making between a patient, his family, and his physician. Skepticism is good. Refusal to acknowledge our blind spots and denying the actual expertise of the medical community is bad. Really bad.

halbert said...


First is the assumption, frequently stated by diehard surgery haters, that surgery guarantees terrible, onerous, lifetime side effects that happen immediately. T

Second is the parallel assumption, that the reverse is true of the various radiation treatments. That if one has the commenters preferred radiation treatment (and it doesn't matter which one) that there will be equally good cancer control and that there won't be any significant side effects either during treatment or for years afterwards.

Halbert, my friend, it appears that perhaps you have exaggerated for effect as I rarely see such dogma in statements from my radiation brethren. Nevertheless, some of the implications are there and i get your point that us radiation guys are frequently highly enthusiastic about our treatment choice.

Moving on, I took some time to examine the article presented by Gemlin. I'm not sure I totally buy the apples and oranges to today's radiation (as ASAdvocate pointed out) as there have been dramatic reductions in radiation toxicity effects (at least at the 10 year mark) of modern day IMRT, LDR-stranded-seed Brachy, HDR Brachy and SBRT. But even if one accepts that men treated today will have the same SE profile as the men treated 22-23 years ago, the article still displays a huge SE advantage for the radiation treatment as compared to the surgery treatment.

Quoting the article:

1. Men in the prostatectomy group were significantly more likely than those in the radiotherapy group to report urinary leakage at 2 years and 5 years.

2. ...patients in the prostatectomy group were more likely to wear incontinence pads at all study time points.

3. Men in the prostatectomy group were significantly more likely than those in the radiotherapy group to report having erections insufficient for intercourse at 2 years and 5 years.

4. Assessment of 5-year outcomes in the current study revealed numerous differences between the two study groups. Specifically, men who underwent prostatectomy were five times as likely as those who underwent radiotherapy to have urinary incontinence and twice as likely to have erectile dysfunction.

The article also goes on to say that the after 15 years, "The causes of these declines probably include both advancing age and additional cancer treatments. Indeed, patients without prostate cancer have age-related urinary and sexual dysfunction" Not surprising when one considers the average age of the radiotherapy patient in this cohort was 69, meaning that a 15 year result would put them at 84...an age where ED and incontinence are unfortunately frequent regardless of PCa treatment.

I guess my point is that this study showed a considerable SE advantage to the radiation patients during the interval years even if the end point was the same. So, from an SE standpoint, wouldn't one want better results for many years even if the final outcome was the same???

Personally I feel there are valid (but limited in my opinion) reasons for a man to choose surgery but "equal SE's to radiation" just is not one of them.

Jim

NK, my point, if you would have noticed it (and after this I'm done with this thread), is that those who proclaim loudly that surgery ALWAYS results in debilitating side effects for ALL patients are flat out wrong. It's not true, and I refuse to believe that I'm the only one of the hundreds of thousands of us who have the surgery who don't have measurable side effects. Neither is it true that ALL urologists push unnecessary surgery on their patients. Not true at all.

Is (or more properly was) overtreatment a serious problem--absolutely. Is there still some of it happening? Probably. The reasons are legion for that.

THAT, however, is not the point of this thread. The OP was asking about relative benefits and side effects as part of his decision process. Those who make black and white assertions, using terms like Always and Never are part of the problem not the solution.