Age consideration surgery vs RT

I think they usually use age as a "disqualifier" for surgery when the patient is old enough that surgery presents higher survival risk than desired. Also, when appropriate, surgery is often presented as a definitive solution/cure, as in "we got it all out." We (most of us) understand that "all" really means "all we could see" and that there are no long-term guarantees with this disease. They often push surgery to younger patients, claiming "if it comes back, then we always have radiation." And some even imply that radiation "doesn't last as long" so we only use it for the guys who won't live as long after treatment." (I call BS on this one, though.) The usual differentiator, one that I sort of accept, is that younger surgery patients usually have an easier/quicker recovery from the procedure. In my case, I had already experienced far too many major surgeries, and just didn't want to risk going through another, even though my uro said I would do fine.

Of course, you probably already know that properly applied, both surgery and radiation have very similar "cure" rates for your G3+4=7 cancer. You probably should consider all the information you can get (e.g. How many cores are positive, % cancer in each, %G4 vs G3 in each, % of entire gland involved, aggressiveness, etc.) as well as your own preferences before you try to choose a treatment.

When I was in this "discernment" stage, I determined (with my uro) which treatments were medically appropriate to my situation. Then I researched the efficacy of each (odds of non-recurrence.) Then I looked into the side effects of each treatment. It is my opinion that at your "young" age (I was 68 at diagnosis), the side effects are more important, as you should be expected to have a long time to live with them after treatment.

After I determined which treatments were potentially for me, I then met with a doc who would deliver to me that specific treatment. Only a doc who performs a particular treatment will be fully prepared to discuss with you his success rate, the side effects you personally should/could expect, how it will go, etc. (In other words, if you are considering low-dose brachy/seeds, be sure you meet with a doc who actually does them. The others can talk about it, but not from experience.) Whatever you do, do not let a doc who proposes "treatment A" talk you out of "treatment B."

Never too young for radiation. After all it is one of the leading treatment methods for childhood cancers. You do get too old for surgery, but you aren’t there yet.

How many years you have left statistically sometimes decides what they recommend. My own urologist thought surgery gave you a statistically better long term survival rate (after 15+yrs) so he favoured that for younger patients. This is his opinion only and assumes you're a candidate for surgery. I suspect maybe his numbers are probably out of date as non-surgery options have changed a lot over the past 20 yrs.

Bigcat63 said...
At 56.5 yrs old with G. [3+4] and reasonably healthy. Am I to young for RT? Uro. says I'm a tweener. Any thoughts appreciated..

view your uro as a used car salesman when it comes to treatment. he is a surgeon. I am in my 9th year of remission and I was treated at 54.

Cat...I hope you heed the advice you’ve already been given. Urologists are trained in surgery and a scalpel maybe the only tool in their toolbox. You need to consider all the treatments to find what’s best for your particular situation. My Urologist was ready to schedule surgery even though my biopsy showed a small amount of Gleason 6. He had no knowledge of SBRT or HD Brachytherapy. Unless you have urinary issues associated with BPH you should investigate all the radiation options. Yes there is a small risk of secondary cancer associated with radiation; however, for radiation as a monotherapy that risk is far less than 1%. There are no treatments risk free. This forum has a ton of information available to you to assist in making an informed decision.

Here is my rule, plain and simple.

When being assessed and receiving advice regarding a specialized medical treatment or procedure, only listen to the board certified specialist that performs the treatment procedure. Period. To get your advice from any other doctor means there are two unintelligent people....the doctor providing assessment/advice outside their area of speciality and the patient for accepting it.

Get surgical assessment and advice from the surgeon. Get radiation therapy assessment and advice from the radiation oncologist. Clear...simple...and distinct. Then make your decision and live with whatever comes your way.

Lapilot, several studies have shown your point to be incorrect. In one study from Sweden of several hundred men showed the incidence of a secondary radiation induced cancer to be less than .3% at 15 years. This is much less risk than dying from surgical complications. Plus, most of the men were treated on machines before the age of IMRT/IGRT. The modern machines will prove to have much less in the way of secondary cancers.

There simply isn’t a practical risk to consider. And I always love the line that since you are young you should only consider surgery, but if surgery doesn’t work (35% of the time) we will go straight to salvage radiation. So not too young for salvage radiation, buT too young for radiation as a primary treatment? Yeah, right.........

A lot of good info shared by other people here. I would just add that you consider going to a large, well-known cancer center for opinions from their urologist and RO. I think that way you get two opinions from one provider which will perhaps result in less, or perhaps no bias. I regret not having done that on my first round of treatment. I did, however, take that approach when my cancer recurred and I felt much more comfortable with my treatment decision. Good luck to you.

Guys, please don't let this thread fall into the surgery vs radiation sniping contest. To the original OP's point: The question of which treatment is better and various ages is, IMO, moot. The decision on which treatment is best for a particular patient is up to the patient, his doctors, his family, and his situation. That is one of the most basic rules of this forum: a patient's choice of treatment is his, and is not up for criticism by the rest of us.

I spent a year trying to decide on how to treat, many hours on forums like this one and read the recommended books that were suggested. Talked to 3 URO's(Surgeons) and 2 RO's and they all gave me about the same survival and cure rates. My decision ended up being based on immediate known SE from surgery and unknown down the road complications from Radiation. If I was 10 years older I probably would have chosen a different treatment. Being 56 and weighing all the issues with both I chose surgery but I drove 8 hours away from home to have it taken out by a surgeon that is considered one of the best at MD Anderson. If I had no choice to travel I probably would have had radiation here at home. For me I felt like I could handle the SE that I knew were coming from surgery as opposed to the unknown ones that could be coming later with radiation. Everyone of the Dr.s I talked to told me that within 5 years it was about even for urinary and ED problems.

With surgery things very well COULD continue to get better over time good odds they won't but with radiation they would more than likely continue to get worse. Not my words these were the words of both kind of Dr's.

The RO I talked to at MDA gave me a 98% cure rate but also told me with my age he could not tell me what the affects would be for me 20 years from now, it was the unknown that I couldn't deal with. I met an older guy at MDA that was there for bladder cancer from radiation due to prostate cancer. I work with a guy who's father in law just got done a few months ago with radiation that is having all kinds of problems, enough that they definately regret the path they took.
Plenty of post surgery guys that are very unhappy with the life they have now, it's a crap shoot in my opinion that everyone that has to make that decision deals with.
Pros and Cons to both it's a very personal decision and I would never suggest one path or the other for anybody nor would I bash anyone's decision afterward we are all different just have to do our due diligence make a choice and move on. Any two guys choosing the same path with the same Dr. can have very different outcomes.
I am 8 weeks post surgery and completely at peace with the path I chose, life is not the same but the cancer is gone at least from what we can tell right now, and things are improving hopefully it stays that way but no guarantee's for sure.

One thing I can say is that this forum does a lot better job of not letting this discussion get out of hand, one other one I spend time on let's the surgery guys get beat up pretty often so search around until you find the one's that you are comfortable getting involved in like you are already doing and keep asking questions

Good luck with your decision and may the path you choose make you cancer free with many happy years to come.

hey if you can't offer evidence to support your claim you're not doing anyone any favors. we have already made our choices. this is for the new guy. I had two forms of radiation more than nine years ago and I have been on this forum 10 years. no LT SEs except mild ED which is cured with Cialis.

the tales of woe I see are largely from surgery -- both short term and long term. scroll the forum and it is obvious. I can't name one person who has gotten a secondary cancer from radiation therapy. and you want me to believe these guys are on other forums?

smacks of "many people have said".

logoslidat said...
or another way to say it is....smacks of "they say"...logo's definition of "they" = they are the backside of us...boink!!

logo -- i'm sure you know if your hear that smacking sound it's already too late haha