Still comes back to the degree of PC one is dealing with after their dx.
If the dx is real low grade, low core, low %, no family history kind of thing, then we know that intelligent AS can make perfects sense to some men that meet that framework.
When the criterea for Seeding along, or seeding with IMRT added, it is an excellent choice to consider, especially eliminating the trauma of surgery and the too hard to predict side effects and quality of life issues. Despite being a surgery and now a SRT guy, seeding still would have been my choice had my numbers been ther.
At still a higher level of cancer present, a stronger RT treatment can be effective, and can knock out the cancer. At the higher combined gys that JohnT mentioned, RT and/or seeds can still be a powerful methodology for cancer eradication.
But I feel that once you reach a strong Gleason 7 case, with lots of postive cores high % cores, that surgery, either robotic or
open like I underwent, is the best way, while there is still hope that the cancer is contained. When it proves that it wasn't, i.e. a positive margin like I inherited after surgery, then having the option or RT or SRT as a possible curative means is still easily on the table.
If surgery is the best choice, the argument of having RT or SRT as a backup, secondary curative possible plan is not just small talk. For all practical purposes, its best to take salvage surgery off the table altogether. Most surgeons won't touch it, it's bound to leave the patient with all kinds of perm. quality of life issues, etc. Can it be done, yes, should it be done? Most surgeons would say know.
Then of course, once the curative treatments have been used and failed, then there is the entire HT route along with its cousins.
If the patient's mindset will be calm and logical, and one really looks at their total PC related history, there are correct choices in a good sequence of order to follow. I am all about
freedom of choice, etc, but sometimes, our freedoms lead to poor choices or poor sequences just because we could do something, doesn't mean it makes the best medical sense.
David in SC
57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.33rd Biopsy
: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3Open RP:
11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09Path Rpt
: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence: 1 Month ED: Non issue at any point post surgery
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped 9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time