I'm not advocating radiation over surgery in this post. Just stating that the side affects of surgery are often underestimated.
Reynolds and Colleaques published a report in 2009 on incontenence after Robotic surgery. This is good recent data from one institution with good follow up of over 1000 patients:
After surgery, the proportion of patients who were LFPF at specific time periods was
4 percent (40/1,005) at 1 month
9 percent (90/1,005) at 3 months
17 percent (171/1,005) at 6 months
24 percent (241/1,005) at 12 months
28 percent (281/1,005) at 24 months
In other words, although about
three-quarters of the patients were LFPF before surgery, only about
a quarter were LFPF at 1 year after surgery, and that didn’t increase much at 2 years after surgery.
10% of the patients had severe permenant incontinence.
I think that most patients undergoing robotic surgery do not expect these resuts. Scardio at MSK in his book also indicates that 40% of all surgeries done at MSK are considered failures; defined as no cure, permanent side affects or severe complications. I also don't think that most patients undergoing surgery think they have a 40% chance of failure. This is real quantifiable data not estimates by someone. These were also done at the best institutions so one can assume that the results are better than those done in a community setting.
My own opinion is that after using partin tables and artificial neural networks to compare treatment options in your individual case and two treatment options are equal in cure rate then you should choose the one that gives you the least amount of side affects. I think this is a very logical approach and takes emotion out of the decision; but that's just me. I would gladly give up a few percentage points of cure rate as a trade off for quality of life issues. Others may not, but the main point I'm trying to make is to make that choice with good data and accept the outcome with with eyes
open and not with unrealistic expectations.
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.