Radiation and surgical local failures are caused by different things. In a surgical failure it is becase prostate tissue is left behind, there is a positive margin somewhere, most likely at the Apex or that some cells are left in other structures such as the nerves or seminal vesicles.
Radiation does a much better job as a primary treatment in hitting these areas.
Radiation failures are caused by too low a dose, A very large tumor that can't be overwhelmed by the radiation, or dead spots that the radiation may have missed. Surgery would have eliminated these.
Of course the combination of surgery and radiation would much better than any one treatment alone, as it gets what the other would have missed, except that one has to live with the morbidity of two treatments.
Mel, it does make sense. Tumor
location and evidence of minor extracapsular extension would make radiation a better primary treatment as these are primary causes of surgical reoccurrance. I think you go with the best primary treatment possible for your individual case and don't worry about
a backup as this is like the tail wagging the dog. There are also backups for failed radiation like low and high dose brachy, cryosurgery and HIFU that have the same success rate as salvage radiation after failed surgery.
Any combination treatment, sugery and radiation, radiation and Brachytherapy, HT and surgery and HT with radiation are all more effective than a primary treatment alone, but all come with a high price.
I think it is prudent, and the PCRI also recommends combination treatments for all high risk patients.
All combination treatments have more morbidity, so pick the primary treatment that has the best chance of getting your particular PC, depending on it's volume,
location and grade with the least amount of side affects to you.
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.