excellent article. from my reading surgery is not superior to other treatments in any circumstance. did i miss something? here are some salient points that jumped out at me:
"From the figures, it is apparent that, with low risk disease, the surgeon will leave cancer behind 15-20% of the time and, therefore, you will likely need post operative radiation, 15-20% of the time."
"External radiation does a good job of treating the prostate and the area immediately around it, where cancer can spread. The reason the external radiation fails in some low risk disease is likely that the dose delivered is not sufficient enough to control the disease in the prostate itself."
"Why might there be an advantage to brachytherapy approaches? For intermediate risk patients, the risk of disease beyond the gland increases, subsequently, any treatment that just treats the prostate, such as surgery, has a higher risk of failing."
"Implantation alone, or in combination with EBRT, do appear, on the graphs, to do better than either surgery or external beam radiation. Seed implantation is likely better than surgery in intermediate risk disease due to the high local control rate of seed implantation and its ability to treat an area beyond the capabilities of surgery."
"However, we have chosen, for high risk disease, to recommend a combination of six months of hormonal therapy during which both external beam and seed implantation are given."