It is typical in this forum that each time somebody asks about
surgery outcomes there is a flow of posts about
what we have already discussed many times before.
With respect to this general discussion, I can say that I followed the advice given here and I talk to two RO offering the most praised treatments, SBRT and HDBR. Both were very helpful, gave me their own statistics and explained me in detail the procedures and secondary effects. They added that both radiation and surgery are reasonable for most clinically localized cases (in contradiction with the non-professional opinion of some people here). Also, I went to a surgeon urologist whose first question was if I have already done the pre-op tests and told me that surgery is the only good option available. I made my own research. I should add that I am a professional science researcher and therefore I consider myself to be qualified to understand what I read in medical publications. And, finally, I chose surgery. Why? Because a mix of facts, some personal, some local, some psychological and some learned here. I explained them in a long post right after my surgery and I do not feel the need to justify my decision every time this topic is discussed. Key points were that I had a large prostate requiring additional treatment together with radiation and that my surgeon has a excellent technical reputation despise the biased advice he gives to his patients.
But I will explain with more detail how, ironically, I was also lead to choose surgery by what I learned in this forum because it is related with the real question that was posed in this thread, why there are so many recurrence cases after surgery. I followed the evolution of some of these cases, probably the same ones that inspired the question we are trying to answer now. And I discovered that the onset of BCR can be monitored after surgery with great precision and, more importantly, that acting early may give some advantage. I know the number of declared BCR after surgery is higher than after radiation. Then, I compare the definitions of BCR after both treatments and the conclusion is that they are not meaning the same and only surgery offer the possibility of a fast reaction while you have to wait several years to know if there is a recurrence after radiation. Whether this translates or not in a higher overall survival is something very difficult to show. But, at leat , it helped me to put in context the claim of my HDBR RO that he has had just one recurrence in more than 700 treatments after 7 years. However, it is clear that some types of radiation may offer a one shot cure in cases where there is a clear clinical evidence of extraprostatic extension. Therefore, each case is different. But I am sure most people reading this forum have not be blinded lead to a given treatment. At least, not to surgery.
67 years old.
PSA: 2008:2.8; 2012-2016: 4.5-5.5. 2013: two biopsies (ASAP, neg) and a neg mpMRI.
Feb, May, July 2017: 5.5, 6.1, 7.6; free: 25%-20%
mpMRI, July 2017: PIRAD5 5.
Dx August 2017,Gleason 3+3, 2 cores, left 5%, right 3%.
Prostate more than 100 g. DRE +.
Manual LRP, november 6, 2017.
Bilat., 30% and 5%. G 5+3. Clean margins, not other features.
psa 2018: 1-31:0.08; 4-16: 0.05; 7-16: 0.03
Post Edited (jmadrid) : 10/10/2018 6:14:39 AM (GMT-6)