Essentially, you took 3 separate, incomparable studies to make the assertion "The recurrence rate for intermediate risk men is 6 percent versus about 35 percent for surgery"
First of all, the surgery study was not intermediate risk as it includes high risk. In fact, 25% were >= Stage 3.
Second, you cannot compare BCR for surgery to BCR for radiation. For Surgery, the definition is PSA > 0.2, whereas for radiation it is NADIR + 2.0. BCR or Biochemical Recurrence, is not the same as Clinical Recurrence as most who BCR do not proceed to clinical recurrence. You are using relatively small study 6-year SBRT data to compare with large > 10-year surgery data. It has also been suggested that the radiation BCR definition produces smaller rates short-term and higher rates long-term compared to the surgery BCR definition. These BCR definitions are simply made up by some committee for treatment and are not meant to be compared. For example surgery BCR is often followed up by radiation, whereas radiation BCR is often followed up by chemotherapy or hormone therapy.
Your assertion that recurrence (I assume you mean BCR) of 6% for intermediate risk SBRT is just plain wrong. It's for the whole cohort including low risk men. The actual BCR risk in the larger SBRT studies for intermediate risk men is currently 10%, while for unfavorable intermediate risk men, it is 15%. There were no high risk men. I note that Kishan in his 2019 published article only had 6 yrs of data for intermediate risk men and the 10 & 15% were 7-year projections so its really early days.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2723641
In summary, you are using a 7-year SBRT study (including statistical projections) of low and intermediate risk men to compare with a long-term surgery study where 25% were high risk. Additionally BCR definitions of surgery & radiation are like apples and oranges.
The proper way to compare surgery with SBRT is a long-term randomized clinical trial. The PACE trial is exactly that trial comparing SBRT, conventional radiation and surgery. It is ongoing and initial results will be published around 2022. We might have to wait until 2030 or so to properly compare clinical recurrence of cancer between the treatments.
One thing which came out from the PACE trial this year is there is no difference in early stage rectal or urinary side effects between SBRT and EBRT. Obviously, there is no data for late stage yet.http://ascopubs.org/doi/abs/10.1200/jco.2019.37.7_suppl.1?af=r
While I think you are doing a good job overall in advocating active surveillance, might I gently suggest that your SBRT advocacy should be based on more careful study.
Now 57 Dx Dec '16, PSA 4.313
Jan '17 MP MRI PR 5, Bn Scan -ve; Fusion BX 4 of 12 +ve G7 (3+4)
RALP Feb 2, 2017
Path: G7 (3+4), PT2c No ECE, margins, LN or SV all -ve
2017: 0.029-0.059(Siemens); <0.008(Abbott); <0.03(NCCS); < 0.01(Bck Coulter); <0.006(Labcorp)
2018: 0.019-0.029(Siemens);<0.008(Abbott); <0.03(NCCS); <0.006(Labcorp)