First is the assumption, frequently stated by diehard surgery haters, that surgery guarantees terrible, onerous, lifetime side effects that happen immediately. T
Second is the parallel assumption, that the reverse is true of the various radiation treatments. That if one has the commenters preferred radiation treatment (and it doesn't matter which one) that there will be equally good cancer control and that there won't be any significant side effects either during treatment or for years afterwards.
Halbert, my friend, it appears that perhaps you have exaggerated for effect as I rarely see such dogma in statements from my radiation brethren. Nevertheless, some of the implications are there and i get your point that us radiation guys are frequently highly enthusiastic about
our treatment choice.
Moving on, I took some time to examine the article presented by Gemlin. I'm not sure I totally buy the apples and oranges to today's radiation (as ASAdvocate pointed out) as there have been dramatic reductions in radiation toxicity effects (at least at the 10 year mark) of modern day IMRT, LDR-stranded-seed Brachy, HDR Brachy and SBRT. But even if one accepts that men treated today will have the same SE profile as the men treated 22-23 years ago, the article still displays a huge SE advantage for the radiation treatment as compared to the surgery treatment.
Quoting the article:
1. Men in the prostatectomy group were significantly more likely than those in the radiotherapy group to report urinary leakage at 2 years and 5 years.
2. ...patients in the prostatectomy group were more likely to wear incontinence pads at all study time points.
3. Men in the prostatectomy group were significantly more likely than those in the radiotherapy group to report having erections insufficient for intercourse at 2 years and 5 years.
4. Assessment of 5-year outcomes in the current study revealed numerous differences between the two study groups. Specifically, men who underwent prostatectomy were five times as likely as those who underwent radiotherapy to have urinary incontinence and twice as likely to have erectile dysfunction.
The article also goes on to say that the after 15 years, "The causes of these declines probably include both advancing age and additional cancer treatments. Indeed, patients without prostate cancer have age-related urinary and sexual dysfunction" Not surprising when one considers the average age of the radiotherapy patient in this cohort was 69, meaning that a 15 year result would put them at 84...an age where ED and incontinence are unfortunately frequent regardless of PCa treatment.
I guess my point is that this study showed a considerable SE advantage to the radiation patients during the interval years even if the end point was the same. So, from an SE standpoint, wouldn't one want better results for many years even if the final outcome was the same???
Personally I feel there are valid (but limited in my opinion) reasons for a man to choose surgery but "equal SE's to radiation" just is not one of them.
Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey: