"Given my numbers, and your experience, would you lean towards robotic surgery or IMRT radiation treatment."
What any of us, or any doctor, would do is irrelevant - you have to figure out which therapy is right for you.
"Does one vs the other give a better chance for cure?"
You can see what your odds are by filling in this nomogram: /www.mskcc.org/nomograms/prostate/pre-op
As you see, the odds that you will remain progression-free within 5 years is 63%; within 10 years it's 48% if you have surgery. The odds for a man with GS 4+3 having, say, SBRT is 79% at 7 years.
Are there well-documented percentages for cure with each treatment?
Yes - as you see, many men having radical therapy have no further progression.
Does one vs the other result in fewer urinary and bowel problems?
They are different in number and kind. about
20% of men electing surgery have lasting incontinence. Incontinence is rare after radiation, but irritative symptoms often transiently occur.
Preserving erectile function would be great, but on balance is less important than than urinary and bowel control for quality of life reasons.
75% potency preservation with SBRT or HDR brachy. about
37% potency preservation after nerve-sparing surgery.
Do I need to ask for a bone scan before treatment?
Not necessary with your Gleason score, and PSA.
Are the 2 options I’ve been offered the best ones to choose from?
Other SBRT, HDR brachy monotherapy, EBRT with an LDR brachy boost are better options. There is no reason to have 40 IMRT treatments - it can be done in a lot fewer treatments if you have to have IMRT.
One source said that radiation would result in turning the entire prostate into scar tissue and would make future treatment more difficult if it failed. Another source said the radiation targets the cancer cells and does not damage the healthy cells, so afterwards you still have your prostate and it is healthy. Which of those descript
ions is closer to the truth?
Radiation does not turn the entire prostate into scar tissue. It ablates tumor cells and leaves many healthy cells intact. It does, however, make salvage surgery more difficult. They prefer other kinds of salvage techniques after radiation.
Would I have a catheter for 2 weeks following either procedure, or only following surgery?
Catheter not used with radiation.
Is there any data on the frequency of positive surgical margins using the Da Vinci system.
Yes - ask your surgeon what his positive margin rate is. If it's over 10% for men with stage T2, find another surgeon.
Can IMRT radiation be targeted accurately enough to get cancer cells near the outer margin of the prostate and still miss the nerves.
Radiation doesn't impact nerves - it may impact blood vessels.
Can IMRT treat the whole prostate and still miss the urethra that runs through it? The oncologist says yes.
No - of course not. They don't target the urethra but it gets a high dose of radiation anyway. Count on having some urethral inflammation for a few weeks. There are medications that you can take during that time to feel more comfortable and make peeing easier.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog