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Cancer: Prostate Message Board

  • Surgery VS Radiation

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    Old 01-13-2019, 11:51 AM   #1
    JeffreyF
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    Surgery VS Radiation

    Hey Folks,
    Very overwhelmed from biopsy results. I'm 56, healthy and have just been diagnosed with prostate cancer. I had 12 samples, 4 of which came out positive for cancer. 3 of 4 were gleason 5/6. 1 was a 7(3+4). I am research stage and am overwhelmed with info. I have some folks saying get rid of the prostate which I can understand, but huge side effects which are fairly important to me at 56. Does anyone have info of success of just radiation, proton or external??Maybe a combo of seeds and radiation etc...

     
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    Old 01-15-2019, 02:29 PM   #2
    IADT3since2000
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    Re: Surgery VS Radiation

    Welcome to the Board!

    Feeling overwhelmed is so typical for us prostate cancer patients and our loved ones. The silver lining is that there is so much information out there because there have been so many and such important advances over the past two or three decades.

    It is very important for you to understand that one size does absolutely NOT fit all for prostate cancer patients. Especially for intermediate risk patients, which you appear to be based on that Gleason 7, radiation, likely supported by a short course of androgen deprivation therapy, is AT LEAST as effective as surgery and with side effects that are usually substantially less burdensome both short and long-term. That said, for some patients surgery is a better option, based on their particularly biology and history, and some patients just flat out prefer the side effects that are more likely with surgery versus those typical of radiation. Many patients just want to have their doctor do all the thinking for them, and, as the gatekeeper doctors for us prostate cancer patients are urologists, who do surgery, those patients tend to advocate surgery without really knowing the lay of the land for other options.

    Regarding the success of radiation (external – various forms including proton, and brachytherapy – known as “seeds”), research suggests that for many years now radiation is more effective than surgery at curing the cancer or holding it at bay, with the added advantage of a typically substantially lower burden of side effects. That was not always true. Especially prior to the early 2000s, except at very advanced centers, surgery was superior against the cancer. Advances in radiation technology, including associated imaging technology, have flipped that picture. It’s not that surgery success has declined; it is rather that radiation has improved and overtaken it. There have been many research studies of surgery and radiation with low, intermediate and high risk patients, and the overall result is that radiation has an edge, though surgery can be a very respectable option, especially at the outstanding centers on the US East Coast (but also elsewhere). (For low-risk patients results are probably about equal because a great many of these patients would have been better off with active surveillance and no therapy close to the time of diagnosis.)

    There is a powerful resource that you can use to do your own research, one you are paying for through taxes: PubMed, at www.pubmed.gov. I just entered this search string - prostate cancer recurrence AND (surgery Or radiation) NOT salvage – and got a list of 691 research papers listed in order of “best match”. That’s a bit much , but if you are a glutten for punishment and being even more overwhelmed, have at it! Clicking on the filter on the left for “Humans” brings the list down to 655. Adding the filter for “Clinical Trials” brings the list down to “just” 75. Adding more filters or search words, such as "AND intermediate risk" will reduce the list further. By clicking on the blue hypertext title of a paper you can read a brief description of key points (the “abstract”), and sometimes there is a link to a free copy of the entire paper. Generally radiation will result in what appears to be a cure, judging by non-recurrence for about five years or more, in 80% of cases that are higher than low-risk (where active surveillance is often best rather than treatment). With some forms of treatment and some types of higher-risk prostate cancer, success rates at five or more years look considerably better. If you do your own research, you should ignore results for low-risk cancer and focus on the intermediate and high-risk groups. I can help answer questions about particular studies and the typical statistics used to describe results.

    You can do your own search strings and filter sets. It’s pretty easy. For example, here’s another example search - prostate cancer AND IMRT AND recurrence – with a filter set for Clinical Trials: 14 papers listed. Happy hunting!

    Good luck!

     
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    Old 01-16-2019, 04:51 AM   #3
    JeffreyF
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    Re: Surgery VS Radiation

    Extremely helpful information! Thank you, thank you, thank you.

     
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