Playing with the interactive graph at the above-linked site, if you show (for example) only all RP treatment results and look at the success rate 10 years out, you'll see the results in the ellipse range from about
30 to 60%, with outliers at 25% and 85%! It's very important to compare not only apples to apples, but Granny Smith to Granny Smith. Even within your risk group, much of any treatment's success rate depends, IMO, on whether or not your cancer is prostate-confined. This can only be estimated before treatment, and even if surgery is you choice, you won't know with certainly until after the path exam of the whole prostate, which is obviously too late to influence your treatment choice.
Complicating the issue is how the relatively recent introduction of genomics affects traditional risk groups. AFAIK, almost all comparison studies to date have not
incorporated genomics into success stats (nor could they, since genomic science is relatively new). But your particular cancer's risk of forming metastases most likely does enter the success equation. No one dies from prostate-confined cancer. Many men have circulating tumor cells (CTCs) in their bloodstream long before they undergo their primary treatment. (Don't worry about
a solitary cancer cell "escaping" from your prostate if you delay treatment a bit.) Fortunately, a CTC has an extremely
difficult time establishing itself outside the prostate and forming a micrometastasis, but this is not true for everyone -- thus the interest in how genomics enters the picture. We now know that low, intermediate, and high risk for mets cuts across all Gleason scores from 6 to 10
. (No, this does not
mean that G6 can metastasize; it cannot. But some men with only G6 lesions will progress and develop higher-grade lesions, and those can metastasize.)
Finally, there is the issue of newer RT treatments. There is little doubt that some, like SBRT, have quite impressive success rates. The measure of success for newer treatment modalities is necessarily BCR-free stats (i.e., freedom from a rise in PSA). Study authors themselves and others point out that BCR rates are a stand-in for overall survival (OS) and PCa-specific survival, the gold standard. It obviously takes time to collect these stats. So keep in mind that probably less than 50% of men who encounter BCR go on to clinical recurrence (detectable lesions) and take on the average 5 years to do so. It remains to be seen whether better BCR stats translate into better OS figures.
For me, the take-away messages when researching treatment are (1) learn as much as possible about your particular status
-- risk group, tumor burden and lesion
location, prostate-confinement estimate, genetics, both familial (germline, e.g. BRCA2 mutations) and specific to your cancer (genomics); (2) Keep your status in mind when looking at trial results; (3) The newer the RT modality, the shorter the follow-up period for outcome data, whether oncology outcomes or long-term toxicities. 15-Year stats don't answer all questions a 50-yr-old man may ask -- he may want to know what happens after he turns 65; (4) Better BCR rates may or may not translate into better OS rates. (5) See whether hyperfactionation is available/advisable for your RT choice (fewer RT sessions with a higher dose per session); (6) Focal treatment may be OK for a very select group of patients; however, one review concluded -- prudently IMO -- that they should be undertaken only in the context of a clinical trial, at least for now. (7) IF you should choose surgery, know that your choice of a good surgeon is the most important thing you can do to ensure the best possible outcome for your status, and that overall, larger institutions have better RP outcome stats than smaller ones.
My two cents,
Post Edited (DjinTonic) : 1/17/2020 1:10:19 PM (GMT-7)