I think Tud answered most of your questions. My personal opinion is although the pathology obtained from surgery is valuable, it comes at too high of a price. You have to break the bottle to find out what is inside of it. Also pathology just looks at the tumor, it will not pick up micro cells that were left behind. Unless the pathology is really bad (and this can be determined by scans before the surgery), then the recommendation is to wait for a psa rise to do anything, so what have you gained from the path. For positive margins 50% never progress and if you have negative margins there is a 20% chance of progression. So you have a major surgery with side affects, get a path and wait for you psa to do something. I don't have any problem with the strategy of debulking and exploration as a strategy, but it should be done only on high risk cases and for cases in which surgery is the only way to get more information after scans.
An, Transition zone tumors are usually non agressive and have the best chance of all prostate tumors of being contained. Accoriding to Scardino in his book they are very difficult to operate on and it takes a skilled surgeon to be successful in getting all the prostate tissue without causing permanant incontinance.
As long as the primary diagonosis of PC and staging is done by urologists, surgery will always the the most popular option. Urologists will refer their older or advanced patients to radioligists and the radiologist is dependent on the urologist for referrals. If the urologist sends a patient that he recommends surgery to a radiologist for a 2nd opinion on the patient's request, and the radiologist recommends radiation, how many future referrals will that radiation doctor get? The real customer of the radiologist is the urologist, not the patient, as this is where he gets a large portion of his business.
I've done several consulting projects for speciality medical practices and the 1st step is determining who is the firm's real customer, and it is always the doctors that refers their patients to them. These are the customers you market to and who you please, and you are not about
to challange the recommendation of your best customer unless you have a very good reason.
This is why I always recommend getting a 2nd opinion from a doctor that is not in anyway affiated with or recommended by your original doctor.
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.