From reading these posts, seems like the majority of treatment failures are from surgery as a primary treatment?
I think that there are really two much bigger questions:
(1) Why do so many men proceed into a treatment decision (of any sort) based largely on a single, non-expert reading of their biopsy slides. I suppose I know that answer to that—they simply have rushed their decision and not done a diligent background analysis to learn about
their disease before pulling the "cancer hysteria" trigger—and so they don't realize that local, non-expert prostate biopsy readings are WRONG nearly 50% of the time (about
25% are too high, and about
25% are too low). Since most biopsy findings are in the low- or intermediate-risk categories, a correct biopsy reading makes a CRITICAL difference in treatment decisions. For example, if a too-high initial reading gets corrected downward, then typically Active Surveillance and no immediate treatment is the very best choice. On the other hand, if the initial reading is too-low and the expert reading is higher then a good choice (depending) might be to switch from surgery to radiation. Or worst case, if the too-low DOESN'T get corrected by an expert reading, the patient might NOT switch from surgery to radiation when they should have.
(2) Why do so many men choose surgery when the estimated risk is clearly high that their cancer has NOT been contained...thus leading to likely
failure based on risk calculations. Nomograms are outstanding estimators of outcomes...they cannot tell you exactly what your case will result in
, but they do tell you what many, many other cases very much like yours have resulted in so that you can understand the probabilities and risks, and from that information most people can make a smart decision. I think that it is less-so these days—even though as recently as only a few years ago this was VERY prevalent—that the urologist/surgeon is putting inappropriate pressure on naive patients to "rush" into surgery, but we definitely DO still see a trickle of these examples. I think today surgeons are playing the "go for a cure" card too aggressively, and patients are putting too much faith that they wouldn't get steered wrongly by their doctor/businessman.
Moreover, in the big picture, the "failure rates" are about
the same, and any mis-perception of significant differences is simply that...mis-perception.