Hi beazerman. I would place great weight on expert opinion at a prostate center of excellent regarding their advice for your particular status
. However, I would not rule out surgery from consideration unless, of course, your docs do. Your scan results will probably figure into their advice for your best treatment options.Surgical management versus combination radiotherapy in Gleason score 9-10 prostate cancer
For men with Gleason score 9-10 prostate cancer, studies have demonstrated conflicting results on the outcomes from combination radiation therapy (ComboRT) with external beam radiation therapy plus brachytherapy boost versus radical prostatectomy (RP), with or without adjuvant radiation therapy (ART). Differences in patient selection and management may explain some of the disparate outcomes of prior reports. Methods:
The Surveillance, Epidemiology, and End Results database identified 10,396 men managed with ComboRT versus RP (+/-ART). Competing-risks regression analysis with treatment pr
opensity adjustment defined hazard ratios (aHR) for prostate cancer-specific mortality (PCSM)
, controlling for patient-specific demographic factors. To explore the possible effect of patient selection, analyses were conducted before and after excluding men from analysis if they had evidence-based indications for ART (adverse pathology, i.e. pT3-T4 or positive margins) but did not receive it. Results:
Median age was 64 years; median follow-up was 69 months. Five-year PCSM was similar between patients treated with RP (with or without ART, regardless of pathologic features, N=8,934) and ComboRT (N=1,462) (6.9% vs 8.1%, aHR=0.94, 95% confidence interval [CI] 0.78–1.13, P=0.51). After excluding RP-treated men with adverse pathology who did not receive ART (N=4,527 excluded), patients treated with RP+/-ART (N=4,407) had improved 5-year PCSM compared with those treated with ComboRT (5.3% vs 8.1%, aHR=0.74, 95% CI 0.60–0.91, P=0.004). Conclusions: For Gleason 9-10 prostate cancer, ComboRT was associated with similar PCSM compared to RP, but risk-tailored surgical management may be associated with superior PCSM.
Keep in mind, as the Abstract explains, that the good results in the RP group applies to those men who either (1) had no adverse findings after RP or (2) had an adverse finding and completed their primary treatment with adjuvant RT. Excluded were men with post-op adverse findings who declined adjuvant RT. Note also that today most G9-10 men opting for RT have what is known as MaxRT: external RT + brachy boost + 12 months (avg.) ADT