Prostate Cancer Diagnosed Jan 2

"Old school" was that prostate cancer mortality was higher after radiotherapy than after radical prostatectomy and hence RP was more often selected by younger and healthier men. However this is not true therefore the potential side effects should be emphasized when selecting treatment.

As this study shows there is just a small survival difference in favor of RP in men with low- and intermediate-risk but for high-risk there is almost no difference.
- Low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58)
- High-risk cancer, HR 1.03 (95% CI: 0.81–1.31)

Prostate Cancer Death After Radiotherapy or Radical Prostatectomy: A Nationwide Population-based Observational Study

Gemlin-

Just to be clear, that reference was among a Swedish cohort, and many men were treated with radiation doses that would now be considered substandard (the "irrelevance" of long term retrospective data!). While the RT cohort was treated heterogeneously, you can see the steady improvement over time from RT in Figure 3 (whereas RP outcomes improved little).

To have a true comparison, we need a randomized trial. ProtecT was the first trial where favorable risk patients were randomized to RP, RT, or AS. And the ten-year outcomes were no different. However, even there the radiation doses were too low (74 Gy).

The oncological advantage of radiation, and particularly with augmented radiation, over surgery is mostly among unfavorable risk patients.
/pcnrv.blogspot.com/2017/02/for-very-high-risk-patients-ebrt-bt-is.html

I was able to see a radiation oncology specialist the other day. From what I understood based on my case it was recommended that I get a combination of IMRT for most likely 5 weeks and then at the end take 2 weeks off and I would have seeds implanted. When I asked how many seeds an estimate was at about 50-60 seeds. Seeds placed using ultrasound. The dr pretty much gave me the impression I would be a good candidate for this type of therapy. They felt I would not have side effects while in their hands. I specifically asked about incontinence and they said they hardly see it. I asked about ED and they said that would not be much of a worry either. Not sure if this was being based on me as the patient and my current good overall health but that is how I understood it as well as what my wife understood from the meeting. I asked if they would prescribe any drugs like Cialis for before and after to facilitate likelihood of avoiding ED and they didn't seem to do that either. I asked about colon issues due to getting radiation and they were not worried about that for me either. I asked about getting info for patient outcomes that they had and will have to follow up with the office to get that.

This visit did not satisfy me about going the radiation route over RP (open). I am going to go to another radiologist in a couple weeks to get an additional opinion and more details.

I was told I would not be a candidate for active surveillance, CK, HIFU and I think some other newer stuff I asked about.