My question is probably one more of odds and statistics than studies that show the potential value of adjuvant radiation.
It comes down to the potential risks of radiation without a clear diagnosis versus the odds of having a surgical cure without the adjuvant therapy. Probably even a third dimension to this dilema is the odds that the PC is systemic, and that the adjuvant will not get it either.
In my case with a T3 G9, this study would imply that I was a potential gainer by undergoing adjuvant therapy. However with incontinence, and with excellent post-op PSA's, I chose to follow the surgeon's advice who said that more current thinking was to wait for rises in PSA before undergoing salvage.
So, now at 15 months and PSA < .01, I am getting cautiously optimistic that the surgeon may have gotten it. In another 10 years I will be a little more certain. But my question still remains unanswered. Should I have underone adjuvant based on some of these studies that showed a 40 to 50 % chance of a curative treatment vs a 30 to 40 % with slavage treatment, and a 1 1/2 % chance of radiation tumors, and permanent incontinence, and potentially permanent ED.
I guess I am playing the odds here. For a 10 % better chance of a cure, with potential or worse QOL issues, and the potential for radiation induced tumors, and rectal damge, etc., etc., I decided that the numbers weren't there. I am waiting for PSA increases.
I suppose my age plays a part here as well. I guess my entire point of this post is that this is not a simple decsion that is easily arrived at, and nothing but upside. There is a rather complex decsion tree here.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic 4/14/09 Nerves spared, but carved up a little.
0/23 lymph nodes involved pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free 6 week PSA <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED. Trimix injection
No pads, 1/1/10, 9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01