RADIATION VS. RP

Hello Everyone... this is my first posting. I am trying to decide between radiation with hormone therapy (6 months of hormones with radiation for the middle 2 months) versus an RP. I have traveled to Boston and met with a number of doctors. They are all optimistic. A very experienced surgeon (over 3 thousand prostatectomies!) says that he can get this done. A very experienced radiation oncologist says the same thing. I am wondering if anyone has been in the same dilemma. I am wondering what your experiences are with the side effects from either one. Thank you.

age: 68 - 5' 6" - 137 pounds
very athletic - still play basketball, tennis and running.
biopsy June 25; Gleason 3+ 4 = 7
PSA's are all under 4 - there was some concern about acceleration which led to biopsy
Perineural Invasion; some evidence of extracapsular invasion

Sorry you are here Temenos, but welcome to the board..

This is the age-old question..Your stats point to a cure either way..You left out some key information, how many cores, how many positive cores, percentage of cancer in each positive core...DRE result? "Stage"?

Both the surgeon and the R-doc can back up their claims as far as curing you, so it's basically a choice of side effects..Your small stature and athleticism should help mitigate them but the combo of radiation and HT is not a cake-walk by any means. With a PSA under 4, you can take your time and research your decision carefully. This board is FULL of threads that deal with this subject. Of course, everyone favors the treatment that worked for THEM and the guys who had treatment that did not work, well, they don't write much anymore...

If you don't already have one, get a copy of "Guide to surviving prostate cancer" by Dr. Patrick Walsh. 2007 edition. Read it cover to cover. Knowledge is power..

I too am in the same situation as you, my prognosis is somewhat worse, but so far I'm going with surgery (robotic) because, well, I think it's as good a place to start as any..But I'm not 100% committed.. With surgery, 3 days later, (when the complete biopsy comes back) you pretty much KNOW where you stand...

Good luck to you, read and learn and then make an informed decision..

Hey,

Some more info on your biopsy would help us to understand your case. Arguements can be made pro/con both methods you mentioned. I agree too, that a second opinion from a higher source of your biopsy slides could be useful. Do you have any family history with PC? What kind of velocity issues did you have? Velocity has been the most darning thing in my own case so far. Sounds like you are doing the right stuff by getting opinions out there, and not racing for a decision. That's a good start.

I agree to, the Walsh book is a good primer, and of course its biased toward surgery, but its still a bible of good general information. With have men here experienced with almost any kind of complications and side effects you can imagine, my own case included. We also have men that just breeze right through the process.

Be leary of any doctor guaranteeing anything, doesn't work that way in reality. Please keep us posted on your case. This is a great place to be if you are dealing with PC, we got a good group of brothers and sisters, more like family most time.

David in SC

I wish there was a magic formula that made it very plain.

It is a complex decsion cycle. You will find men on this site who have selected most the standard treatment choices and have failed to some degree. Not necessarily because they chose the wrong treatment, but because the PC is such a nasty bugger.

If you look at the nomograms, and the various studies, you will also find that the outcomes are all comparable in success and failure rates.

It really will come down to what you feel comfortable with. The more you can learn about each treatment and how it may affect you, and the diagnosed PC, the more you will find yourself becoming more comfortable with a choice over another.

Good luck on your journey.

Escaping the prostate capsule and escaping the prostate margin are 2 different things. We can have an EPE, but a skillful surgeon can cut around it and leave it inside the cutting margin.

Sometimes HT is used prior to surgery, to shrink the prostate, or to arrest the cancer until the surgery is performed.

The location of the tumor is of primary importance in whether surgery would work or not. If there was any question of extra capsular extension than radiation certaintly would have the advantage as radiation can get a good 15mm of margin compared to the 5mm or so of surgery. Also if there is ECE there is a probability that cells at the margin will not be seen by the surgeon or patholigist. Radiation does a very good job on these.
JT

@April 6th
The debate as to whether to use HT alone or not is relatively shot down in several studies unless there is confirmed metastatic disease. If there isn't confirmed mets, the use of HT alone is not a good idea. Here is a link in today's Prostate Cancer InfoLink news feed:

tinyurl.com/394us88

There is consistent mounting data that HT is a bad idea for local prostate cancer, and that RP consistently outperforms radiation therapy in all risk groups. I can probably site a dozen retrospective studies that agree with this post at the InfoLink. But the Sitemaster at the InfoLink asks a valid question: Is it necessary to do the more invasive procedure to get those results. I posted a reply to his post that will show up tomorrow. I think that it is important to look at age and life expectancy and also the aggressiveness and stage of the disease. In this post, Temenos is 68 years old. If he is genetically tied to a family that lives into the 90's, and he is otherwise healthy, then he should take the prostate cancer specific mortality rates more seriously. If not then it is possible that will do well with radiation therapy of any kind, or possibly even not treating the disease if his health is poor. I'll let Temenos clarify that. But combination therapies have more side effects, and adding HT is going to be the potentially worst one.

I do not know of any circumstance where HT alone is a best procedure except in stage 4 disease or where life expectancy is very short.

John T, you and I will debate that forever. EPE or positive margins alone are not a basis for eliminating a surgical intervention as an effective therapy. In the link above Michael Zelefsky is the Editor in Cheif of Brachytherapy magazine and even he acknowledges that.

Tony

TC-LasVegas said...
BB_Fan I was thinking the opposite...

The new guy is 68, he might even be better suited for active surveillance if he is just Gleason 6.

Tony

I believe it was stated that his Gleason was 7, not 6.

It would seem to me that Temenos, or perhaps that is "tememos" at age 68 might consider brachytherapy, or brachytherapy in combination with IMRT in place of either radiation alone or RP. At age 68 with his situation I am a bit surprised that RT was even recommended. Many surgeons would not even consider RP in a man over 70 years of age, and Temenos is very close to that.

Sancarlos

The age 70 bit is not a hard line in the sand, would depend whether the patient is a "young" 70 or an "old" 70, factoring in their general medical history and current ailments if any.

Perhaps you should look at combining brachytherapy (seeds) and IGRT.. If its already outside the capsule and you are thinking radiation, you might as well do the Full Monty, take the heavy dose that only the combined treatment can provide (150 Gr) and hope for the best..The side effects for this are no worse than EBRT radiation alone if done properly..There is no reason to go through surgery and then have to endure radiation treatment too...

You and I are standing in exactly the same place..

I put your numbers in the Han table and you have a 94% chance of having an undetectable PSA after 10 years with surgery...You have a 73% chance your cancer is organ confined..But don't take my word for it, read the Han and Partin tables yourself!

Not only do you have to decide between RP or RT, you need to investigate the different flavors of RT. I was lucky to hear about proton beam therapy soon enough to look at it pretty thoroughly, and once I did the decision was a no-brainer. Buy Bob Marckini's book ("You Can Beat Prostate Cancer", $18 from Amazon). It's the best $18 you'll ever spend. Go to his website (www.protonbob.org) and contact some of the survivors. Take your time -- you've probably got plenty of it -- and make your decision.

The interesting thing I found when doing this was that if you talk to anyone who has survived any treatment with a decent overall experience, he'll recommend whatever treatment he had. He is, after all, alive, in spite of minor difficulties, perhaps, like incontinence, impotence, recurrence, etc. But the average proton patient is positively enthusiastic about it. He is not only alive, but the treatment itself was a genuinely enjoyable experience, he's living a normal life now, and has joined a growing social fraternity. I'm planning for my 6-month checkup now, and the hardest part is arranging the social schedule at the treatment center (UFPTI in Jacksonville). My 1-hour checkup has become a small part of a 3-day vacation.