You need to keep in mind that everyone is different; all cases are different. Different ages, different case characteristics, etc. Also outcomes are based partly on the practitioner’s skills, but also largely on the patient’s luck-of-the-draw. There is no one-size-fits-all treatment solution for all cases. But there is a very “common” (frequently occurring) descript
ion of case characteristics based on clinical stage T1c,N0,M0; discovered based on follow-up from slightly elevated PSA (under 20 ng/mL), Grade Group 1 or 2…in other words, a generally favorable risk case. There are more of these types of PC cases than any other. If I had a higher risk case than this “common” example, knowing what I know now 9 years after my own treatment, I would seek radiation therapy and probably a multi-modal therapy depending on how high the risk of recurrence was assessed. But for the “common” case, age is a strong factor in the decision model.
There is a reason for the “rule of thumb
” that doctors often do NOT recommend radiation therapy for “younger” men 60s and under very commonly diagnosed with prostate cancer (not recommended because of their age): namely, late-term effects. If I was diagnosed in my 70s and I felt treatment was appropriate, I would probably go right to RT. The reason doctors align with this is that often the patient won’t outlive the deepening onset of consequential late-term effects. Also, surgery on elderly is more risky, and the RT approach is certainly more “convenient” if nothing else. If on the other hand I was diagnosed in my 50s, I would likely go right to RP for the flip-side of those same two reasons: I wouldn’t like the age that I am impacted by the late-term gastrointestinal toxicity, if that were to happen, and also I would be younger, healthier and more likely to fully recover from the pulse-impact of surgery. The recovery profiles for the “younger” men are quite different & opposite. With RT, in the “common” case, there is usually little or no side-effects in the immediate- or short-term; often men wonder whether the seeds were charged or the beam was turned on because they feel next to nothing. Some short-term effects eventually come and usually go within a few months. Late-term effects (which often go under-reported in the cancer treatment context because the patient goes to a different type of doctor) show up starting at least several years later, if they do show up, and degrade steadily from there. On the other hand in the “common” case with RP, the effects are immediate, but the recovery is relatively quick (although it seemed long at the time, with my 9-year perspective I know it was brief for me—a handful of months—and certainly was brief in the medical perspective which takes the long view). So now let’s repeat, that not all cases are the same and there are exceptions…but there definitely is the “common” paths for the “common” cases. Not being a hypochondriac, I’m aware of the worst case scenarios, but I don’t count on them occurring. In my personal case, as a “younger” man diagnosed with a “common” case, I knew that when I was going to hit my 60s & 70s there’d be other, new medical issues which would pop-up that I’d need to confront, and I wanted to put my PC issues in the rear view mirror for this long term perspective…not have my late-term RT issues start doubling-up and compounding golden-age issues.
So as I’ve described, there is no one-size-fits-all treatment mode
. I chuckle at the ignorance of those who say something like “I’m a strong advocate for RT (or others who say the same about
RP)” because they are really demonstrating their failure to understand the differences in case characteristics which define the world, and their inflexible bias which has distorted their viewpoints. I'm personally an advocate for treatment only when treatment is needed, and the right treatment for the unique circumstances of the case.
Post Edited (Normal59) : 10/16/2018 8:57:42 AM (GMT-6)