Choosing a treatment option because if it fails you have a 2nd backup sounds good, but in fact is faulty logic. You have to look at the reasons that local treatments fail.
1. The cancer is systemic and not local. No local treatment will cure you and no salvage therapy will work.
2. If you have surgery it can fail because you have extra capsular extension, or the tumor is located in a hard to get to place and not all of the PC cells are removed. In this case you can have salvage radiation with some degree of success. (about
30%) If in fact this is the case, you were not a good candidate for surgery in the 1st place and radiation would have resulted in a cure if used 1st instead of surgery. A color doppler ultrasound can give you a bettter idea if surgery will work.
3. You have a poor surgeon who fails to get all the prostate tissue. This is more common that one is led to believe. There is always prostate tissue left; good surgeons leave less.
4. Radiation fails because the dose given is not enough to kill the PC. With IMRT now being able to deliver 81 gys vs 65gys the killing power is much better. A combination seeds and IMRT will give close to 100gys, more than enough to kill everything in the prostate and 10mm to 15mm in the surrounding bed. If you have a reoccurrance it will in all probability be systemic and not local.
5. You have a poor radiologist who fails to target the entire prostate with the correct dose and leaves dead spots.
You can easily eliminate #3 and #5 if you choose only the best, most experienced doctors.
Having the pathology after surgery and knowing where you stand is always brought up as a major advantage; but what are you going to do with the information? 50% of extra capsular extensions never progress and you will just wait for your psa to rise indicating failure just like everyone else does before you do anything. Forget the final pathlogy; either your psa stays low and you are cured or your psa rises and the surgery failed. In either event you actions are based on your psa levels and not the pathology. Great pathologies have reoccurrances and poor pathologies sometimes don't. It's the psa not the pathology that indicate success or failure, unless the pathology reveals major PC in the ajacent organs. A color doppler can give you this information without having to operate.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.
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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.