After extensive research and networking, i decided on Proton Therapy which will begin soon. My two choices were robotic surgery with one of the top surgeons and Proton Therapy with one of the top radiation oncologists. After much thought and considering my age (notwithstanding that I am still healthy and youthful in many respects), I decided against surgery because I didn't want to take the risk of almost certain impotence (possibly permanent at my age) and possibly total or some degree of incontinence. If I were substantially younger, I might well have elected robotic surgery. I met with a top medical oncologist and the conclusion was that the chances of a potential cure were about
the same for surgery, radiation and brachytherapy (seed implants), but the potential negative side effects vary greatly among the various treatments. Quality of life is very important to me--I would rather live fewer years and live them well without having to deal with treatment side effects that make life miserable. I concluded that Proton Therapy offers as good a chance of success as surgery (the supposed gold standard) with the potential for little or no negative side effects short and longer term. It is true with radiation therapy that longer term side effects may occur, especially some form of impotence. However, I believe with radiation therapy, viagra and other similar pills can overcome impotence in many cases which is not always true with surgery. The problem with brachytherapy is the potential for some nasty urinary problems (e.g., strictures of the urethra making is impossible or difficult to urinate without some medical procedures). IMRT photon (x-ray) therapy is the most sophisticated type of x-ray radiation today, but not as safe as proton radiation. Proton radiation enters and leaves the body at a low dose and the high dose is directed to the cancerous area; x-ray radiation enters and leaves the body at the full dose. It has more potential for damaging good tissue surrounding the prostate. I believe that IMRT x-ray radiation has the potential for greater negative side effects than proton radiation. It is true that with radiation therapy (either proton or photon), it will take up to two or more years for the PSA to get to its lowest level compared to surgery where the PSA goes to zero immediately. It is true with surgery that it makes future radiation treatments possible if the cancer recurs. It is not necessarily true that the prostate cannot be removed if the cancer recurs after radiation therapy if the cancer has not escaped the prostate capsule. Some surgeons just refuse to do the surgery, but surgeons at such top hospital as Sloan-Kettering in Manhattan have removed the prostate after radiation therapy if the cancer recurs, depending on the circumstances.
You might also want to visit these websites:
The first website relates to Prostate Nomograms developed by Sloan-Kettering in New York City. You can input various information relating to your stage of cancer (i.e., PSA, Gleason Score, Tumor Stage based on DRE, etc.). The end result will give you 5-year progression free probability statistics comparing radical prostatectomy, external beam radiation therapy and branchytherapy.
The second website is an interesting study, again comparing the success rates of the various prostate cancer treatments and related side effects.
Keep in mind that EBRT (external beam radiation therapy) is an older form of radiation therapy and IMRT is the most sophisticated form of photon (x-ray) radiation today with the potential for fewer negative side effects. This should be taken into consideration when evaluating this data.
I suggest that you visit these websites for more information on Proton Therapy if you have not already done so.
Good luck to you in your decision--let us know what you decide.
68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in one area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/07.
Post Edited (pcdave) : 1/25/2007 12:42:45 PM (GMT-7)