Hopefully it will be the gold standard, but at this time it isn't. That standard is surgical removal, and according to my oncologist, who does not do either peronally, it is in his books that way, and that my decision is so far giving me, a pT3b guy, better odds. When I did my T-bar of certainties, surgery way out performed any radiation as a primary treatment. Keep in mind I am a high risk patient and not maybe one. This might not be as true for localized disease. But how do you know that you are localized? Here are my certainties that swung me into the operating room.
1> It is certain that post treatment surgery will clarify if this is local disease or not and its aggressiveness. Radiation only leaves you guessing until it recurs. (read about
PSA bounce and the roller coaster ride that can have on you)
2> It is certain that if it is not extraprostatic, then you will less likely need to consider Taxotere, HT, and such. Right now your center is ASSUMING that chemo with RT is going to help marginally with lots of side effects.
3> There are no 15 year studies on Proton treatments and its success rates with advanced PCa patients.
4> Loma Linda, the busiest and largest proton center in the world until MD Anderson just
opened theirs, boasts 350,000 treatments on their web site for cranial, lung and prostate cancer. Let's see an average of 40+ treatments per patient that's only 8200 patients for ALL cancers they have treated. Menon has done 2200 LRP's, Wilson 1700, Kawachi 1500, ***in 1200, Patel 900, just five surgeons have treated more patients for prostate disease using the daVinci robot since 2000.
In the bottom line RT does make a comeback of sorts. The long term studies as to which is better do indeed level out with a slight edge to surgery. But that is only studying if those treatments are the lone treatments. In other words if a patient has surgery, finds out the there is still some disease there, can still decide to have RT (like me). When to introduce chemo is now not as much guess work. I like the idea of having control and know I still do. At this time as a confirmed stage III cancer patient, I know that I still have that one more torpedo to fire. I would still be a stage II guy with radiation until my PSA rose then I would have skipped stage III treatment selections. I know this is what was good for me. You have to pick your selections. As one HW poster once said, you get to choose from slicing, burning, castrating or poisoning your disease. I am certain that there is a great need for emerging treatments. Proton is a proven form of radiation treatment. But it can't tote the line alone. And you knew that by expecting the possibility of more than just proton treatment. The reason for that is IMRT is shown to perform better with WPRT treatment. I had that treatment to address to lymph nodes in my pelvic region. Some places will do brachytherapy with IMRT or proton. I felt like if yu are going in with the seeds you might as well take the darn prostate out too. After all that radiation you going to have side effects. Proton only boasts a 10% drop in side effects. Most of that goes away in six months.
Gosh I am not banging this form of treatment, just stating why it was not an option for me. And a few facts you can look up at their sites.
Age 45 (44 when Dx)
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
My PSA did drop out after surgery to undetectable. It has not returned and I will continue HT until January '08.
My Life is supported very well by family and friends like you all.