I admit that in the past I was not fair to the radiation community (even though I am among them). It was wrong and it does not promote a positive environment to the survivors who went that rout. I am doing my very best to work on it and have repositioned my thoughts and biases more towards the center. Perhaps this is because of education, perhaps it is because I have learned to be more objective because I now run a large live group.
Here is an example of how I look at things now:
On studies I have stated the following:
1> I have said that EVERY study has some bias regardless of modality it is studying.
2> I do not trust studies in general because they lack the maturity necessary to give us true results on survival. BFRS is not a good marker alone especially in any study under ten years median. For example: Any study that has 18 year patients mixed with 3 year patients in an attempt to show "excellent long term results" are useless and deceiving.
3> Studies that have differing criteria in defining failure are useless to use in comparison.
4> It is pointless to look at studies when what really matters for anyone who has made their decisions that we try to give equal support to. This is in the spirit of providing support moving forward.
5> I still find it important to point out the imperfections of unsubstantiated claims as it indirectly degrades the support group...
I still am in the learning process and don't think I will never not be. This is in contrast to anyone who would try to take studies that truly are not designed to make fair comparisons and do so anyway. As I pointed out to sancarlos, I have to believe that MSK and the Grimm report information differs because both are done with some bias. My personal surgical results are more consistent with the MSK nomograms at this point. but I know many here whose results are less favorable. I have used top of the line doctors to date and perhaps that has something to do with it?
We have discussed the positive surgical margins thing before and it seems that some look at every positive margin as failure or that AHA! moment, yet only look at BFRS when referring to radiation failure. Positive margins is not a failure in itself and many men with them never have a PSA increase after surgery. We can find dozens here at HW with those results. John, I agree with your point that adding IMRT helps improve the overall results but that it is not exclusively used in combination with seeds. Surgery/adjuvant IMRT is very common and a growing protocol, but it is only used when it might be helpful after surgical results have that indication. There is growing criticism when using combination therapies except only when necessary. Combination radiation therapies for high risk cases seems to be used regardless of if it's necessary but rather a play of the odds. The argument to adjuvant radiation after post prostatectomy is only suggested when there are more definitive information available and is being studied by virtually ALL major cancer centers. But the results are there and it is going to continue to grow in application.
On the Dattoli study you mentioned, I am wondering why the percentages you mention don't match the study here:www.goldjournal.net/article/S0090-4295(06)02249-7/abstract
This study with the same author and title of your example shows far less desirable results than you posted. Help me out here...please...
On the subject of morbidities, your best argument, there are increasing cases of them with combination therapies regardless of the primary treatment modality. Simply put adding IMRT regardless of whether its with seeds or done as adjuvant therapy post prostatectomy, is going to increase morbidity. Typically seeds/IMRT tend to do very well early on but when things eventually do go wrong they tend to be worse than "surgical alone" morbidity. Probably still the case with the surgery/IMRT, however, as I stated, with a surgical approach it is only presented as an option when there are positive seminal vesicles or other determinate factors as opposed to a "best guess". (I know that it is maybe only a "better guess" but the decision is made with more information post prostatectomy.
I think Bui Doi's comments above are too strong, but they are not entirely inaccurate. If anyone wants to have both radiation and surgery in their pocket, they should start with surgery. The benefit is that they may never need to add radiation.
My hope is to get to a point that we work together to provide better support to anyone here. Less bias and more balance. My experience with my disease is a good reference for anyone whom has similar numbers to mine that wants to do surgery. John's experience with his disease is a good reference for anyone wanting to go his rout. All you have to do is look and see it is possible to do either path with no incontinence or ED. And most importantly with desirable results aginst prostate cancer.