Guys, let's not argue on a thread started by a newbie looking for help. Posting facts, studies, reports is what this young man needs - and 'opinions' from us yes - but let us not get so engrossed in our own stances to let that overshadow what we are trying to do, myself included if I am being honest with myself.
To that end the gold standard used to be surgery, hands down, particularly because radiation therapy 10 years ago had not quite yet evolved to where it is today nor were long term data available - in 2013 that is no longer the case. Is surgery still a good, viable option - absolutely yes. Is it the best? That depends - primarily on the patients PCa statistics as well as what is most important to each of us.
PeterDA I'll step in and answer the "why is brachy/radiation recommended less often for younger men?" by sharing some of the research results I found during that part of my own journey (bold and underlines added)
"Louis Potters, MD, chairman of radiation medicine at North Shore University Hospital and LIJ Medical Center, and his colleagues said in the paper published in The Journal of Urology that the urological community generally refers younger patients for radical prostatectomy -- the surgical removal of the prostate -- over radiation or no therapy at all. However, better screening and detection methods are discovering prostate cancer earlier in men. Knowing the long-term outcomes for each of the available treatments across the mid-to-late lifespan is vital. “It is even more important to understand treatment options and associated outcomes for younger patients diagnosed with prostate cancer.”
"In a study of 2,119 patients in different clinical stages of the disease, scientists looked at the five and 10-year so-called “freedom from progression” (FFP). At five years, 90 percent of those who underwent the seed implant were treated successfully; and at 10 years, 86 percent had successful outcomes. Those rates did not change when the population was stratified into two groups – under 60 years old and over."
“It appears that a prostate implant, when performed well, is an effective treatment option for younger patients,” Dr. Potters said. “Therefore, patient age should not bias one’s options.”
"Is surgery best for younger patients? Is prostate brachytherapy as effective as surgery in reducing the risk of disease progression and death over a five-to-10-year period? And what are the benefits of seed implantation versus directing radiation beams at the tumor?"
“There is no gold standard for outcomes in younger men with prostate cancer,” said Dr. Potters. According to the new findings, he said, “Outcomes are impacted by disease-related risk factors but not by age.”
"He added that the advantage to brachytherapy is that the risk for incontinence is small, and impotence is not nearly as common as it is following prostate surgery."
And here's more:
"Myth: Young men should have surgery."
"Fact: Published data (cite 1-2,4,7 below) has demonstrated brachytherapy to be an excellent and equal or better treatment option for younger patients. There is no scientific data to suggest younger patients have better cure rates with surgery. This has long been a misconception on the part of some physicians."
"A recent study showed that the 8 yr control rates for younger (<60 y/o) men were 92% vs 88% for > 60 y/o. In fact, there are numerous studies that show that there are no differences in cure rates with young patients (age 62 or less) versus older patients (cite 1-2,4,7 below). Another recent study concluded that of patients with prostate cancer and treated with single (brachy, surgery or EBRT) approach, better urinary continence was exhibited in those who underwent radiation-based therapies. Furthermore, higher sexual function scores were seen in men who selected Brachytherapy (cite 3 below). Bottom line is that if you are a younger man you should explore all the options."
1.Ho, AY et al. Young Men have Equivalent Biochemical Outcomes Compared to Older Men After Treatment With Prostate Brachytherapy Volume 69, Issue 3, Supplement, Pages S90-S91 (1 November 2007)
2.Merrick, GS et al. Brachytherapy in men age less than or equal to 54 years with clinically localized prostate cancer. BJU Int'l (98), 324-328, 2006.
3.Frank SJ, et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. J Urol, Jun 177(6), 2151-6, 2007.
4.Sharkey J, et al. 103Pd brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer: a 12-year experience from a single group practice. Brachytherapy, 4(1): 34-44, 2005.
5.Ganswindt U, et al. Adjuvant radiotherapy for patients with locally advanced prostate cancer-a new standard? Eur Urol, Jun 23, 2008
6.Stone et al Int. . Radiation Oncology Biol. Phys. 76: p355-360 2010
7.Burri, R et al. Young Men have equivalent Biochemical outcomes compared with older me after treatment with Brachytherapy for PCa Int. J. Rad Onc. Biol Phys 2009 (article in press)
There are many more studies and reports available, including the "Grimm et al" report published just this year that includes 15 year results that echo the above - but I'll conclude my rather long post with the comments being made 'currently' in the medical profession including above:
Bottom line is that if you are a younger man you should explore all the options.
Aachen and all - I am NOT preaching one treatment over another, that is a decision that is far too personal for anyone to push on anyone else - however I also can't stand in the background with facts and data that need to be presented when some of these threads start drifting too far towards our own passions.
Peace. . . .