The debate goes on. You can't evaluate radiation and surgery unless you have the exact same stats for patients going in. Basically any local treatment will cure a G6 tumor at a very high rate of probability. It's when you get into the higher grades and other factors such as margins, tumor
location, size of tumor, node involvement ect. that it becomes difficult to compare. In some cases where the tumor is in an unfovorable
location or has just penetrated the margin or where there is small lymph node involvement radiation is probably better. Radiation is also better on smaller size tumors than larger size. In the cases where the tumor is contained and not next to any major organs or structure, such as seminal vessels, urethea or rectum, then surgery is very efficient.
The biggest difference is the side affects and the time period in which they occur. Radiation generally has less adverse side affects.
Salvage radiation is effective in about
30% of procedures. This is mainly because if a patient has micro mets then salvage radiation won't work. Salvage only works when there is a local positive margin or when the surgeon has left some prostate tissue behind, you can never get it all and if that tissue contains PC cells it will grow. Initial radiation treatments would have generally taken care of these two issues. If there is a local reoccurrance in radiation it is because the dose was too small or the radiation wasn't delivered properly or the initial tumor was very large. There are few salvage procedures that work well in this case. The main failures in modern radiation and surgery is because the PC is already in the bloodstream by the time of treatment.
Killing PC in radiation is a matter of dose and accurracy, The new machines can delver a higher dose more accuratel to the prostate without affecting the surrounding tissues. An even higher dose can be obtained with a combination of seeds and IMRT.
When PC has escaped the capsul and is in the blood stream then niether radiation or surgery will cure it.
Some knowledgable experts believe that new PC can still grow years after radiation, because there is still prostate tissue and surgery may be sightly more favorable for younger patients
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.
2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.
Scheduled for 5 weeks IMRT in July