There has never been a clinical trial that evaluated all treatment options on level playing field.
The best evidence we have is that the survival rate of all options are remarkable similar in early stage PC. Everyone has their opinion, but the evidence doesn't support one treatment over another. So the question has to be which option has the least long term side affects. Just reading the posts in this forum one can see the severe complications and side affects of surgery. Sardino at Slone Kettering states that 40% of all their surgeries are considered unsuccessful( long term side affects, no cure or complications). And this is at one of the best surgical institutions in the country. Looking at the radiation sites the side affects are not as severe early on, but continue to build over the years. With ADT3 the side affects are moderatly severe for some but are reversable when treatment stops. Cryo surgery has the greatest incidence of impotance of all the options. All doctors will claim that their treatment is the most effective, but the evidence just doesn't support the claims. So in reality it boils down to a personal choice of what side affects you feel the most comfortable living with.
For advance PC I think the treatment options make a difference. Some think that surgery is effective in debulking the tumor for other treatments. Others think that removing the prostate just sets of chemical markers that make the PC cells in the rest of the body grow faster. They point to the rapid PSA doubling time after failed surgery as one indicator of this. I don't think there is any proof of either. I personally think that having to live with the side affects of multiple treatments is just too costly and the fewer treatments the better.
Until there are clinical trials that prove one option is superior to another it's still a guessing game and people will continue to push and defend the treatment option they chose.
I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%
I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.
in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.
2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.
Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.
Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.