In your radiation as the primary treatment methodology, which I understand why you feel that way, what do you really subscribe as a good salvage treatment if the radiation fails? Regardless of IMRT, Seeding, with or without HT added into the mix. What would you choose if your seeding ultimately failed?
To our new friend here, my official opinion is neutral in choice as it should be. But there is still a lot to be said for having the pathology of the entire prostate once its removed. Then, you are going to know more fully the real staging, Gleason, % of tumor, and locations of tumor(s) within
the gland itself. No way of knowing all that info without surgery. Plus, if there's a lot of cancer present, the "debulking" theory of removing the primary and most major source of the cancer has merit that surgery offers.
I don't have the stat in front of me, but surgery is still the overwhelming choice of primary treatment for PC, unless you got some to show that proves otherwise. Yes, there are plenty of uro/surgeons, regular surgeons, and not shortage of radiation centers. So there has to be another reason while surgery is still the number one choice in quantity.
What concerns me with our new friend in his stats, is the % of Gleason 7 found just in a low core biopsy. If it were upgraded, then it could even be more serious. I hold to the growing school, that Gleason 7 cases should be handled as if they were 8's or above in many cases. The Type 4 component is what makes the risk higher and more unpredictible to the patient. In my opinion, it leaves too much room for making a guess erroring away from treatment, or not having a treatment strong enough to make a difference on the first pass.
If ultimately my SRT does prove to be a failure, then the whole question of surgery vs. radiation as a primary becomes very mute to me, and the almost two years I have suffered with the effects of both surgery and radiation will to me, seem like an incredible waste of money and pain and suffering to have gone through for nothing in the end.
It is a tough choice, and there is no magic in making the decision, but I still come back to, with our new friend stats, I would want an independent review of the biopsy, and as you suggested, getting a neutral opinion from a good Medical Oncologist to help even out the surgical and radiation related opinions.
David in SC
Of course, the primary treatment needs to be the right one, and should be based on sound facts and opinions from the medical community, but a person still needs to have a good "backup" plan if the primary fails. Couldn't imagine anyone disagreeing with that logic.
Age: 58, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marginIncontinence:
1 Month ED:
Non issue at any point post surgery, no problem post SRTPost Surgery PSA
: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16Post SRT PSA:
1/10 .12, 4/8 .04, 8/6 .06, next test 11/10Latest:
7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped 9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4, Caths #11 and #12 ,Cath #11 - 21 days, Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19
Post Edited (Purgatory) : 8/10/2010 5:06:05 PM (GMT-6)