You point has some validity, but in my case at least, I think I can be
relatively objective.   My urologist suggested either surgery or
radiation as appropriate for a man my age with my particular diagnosis
(age 67, T1c, PSA 4.5, Gleason 7=3+4).   At my age, as best I could
tell, it was really a toss-up.   I had several reasons for choosing
surgery, some rational and other based on my gut feelings.  On the
rational side, I learned that the likelihood of bowel problems was
higher for radiation, while for a man my age, the likelihood of
impotence was higher with surgery.  (For a younger man, impotence after
surgery would be less likely.)  I figured that bowel problems or
impotence could be treated, but bowel problems would impact more on my
daily life.  I also felt the long term prospects after surgery were
better understood at the time than those after radiation.  On the less
rational side, I was one of those who wanted to know the status of my
cancer through post-surgical pathology.  The greater undertainty
following radiation would have been difficult for me to live with.
finally,  I've always had something of a fear of radiation.   Radiation
can itself cause cancer, including leukemia, which my father died of
relatively young.  (In fact, in his case, the most likely cause, if any
can be ascribed, was smoking.)   I had had several surgeries before,
including one for a pilonoidal cyst when I was 16.  So I didn't find
surgery particularly frightening.  I've had dental surgery tha was more
painful overall, and a herniated disk I had in 1995 had a much greater
effect on my life than my prostate surgery.

I chose surgery, but had I been 5 years older, I probably would have
chosen radiation for a variety of reasons I won't go into here.

So I don't find any cognitive dissonance there.  A lot of people fear
surgery for irrational reasons without looking at it objectively.  It
may or may not be the best way to proceed but one shouldn't reject it
out of hand.

5 months after my surgery I had been back to normal in all respects
except erections for over 3 months.  I was impotent for 18 months, but
my wife and I managed a relatively normal sex life by use of a pump.  My
prospect for potency after radiation were not too much better than after
surgery.

How do present-tense verbs imply "IMRT might be available in the future"? In
fact, the UW/VA team that collectively wrote "Dummies" is a leading center
of RT development and a Designated Teaching Hospital in that field. IMRT is
also available four miles from my home in my town of 40,000 people in a
regional community of 150,000, but its chief radiation oncologist advised me
to get surgery instead because the likelihoods of long-term bowel problems
were incompatible with my active lifestyle and my stated aversion to chronic
bowel problems.

If I were among the 47% of pts who have bowel problems two years post-RT, I
wouldn't say they were "mild" or "a small percentage".

Yup . . . but clinical proof also lags technology by many years, and very
often a pt's choices are between new technology and proven technology, a
legitmate debate with many personal considerations. Since it takes 10 years
to prove survival efficacy and 15 to address the PC mortality surge, chosing
between new technology and proven technology is another example of the
Hobb's choice that's been around for centuries.

That's both anecdotal and highly personal. I don't think many people would
be well advised to base a decision on any anecdotal scenario.

I've not seen anyone say their approach is "better", or "I made this choice,
therefore, it must be the right one", or "I chose the pain and these side
effects, therefore, they must be OK." without adding, "in my circumstances
and by my criteria". So these claims you cite have eluded my server.

Not only have I experienced none of your SEs other than ED due to cancer
having invaded one of my neurovascular bundles, but
1. I consider your SEs FAR worse than any of the effects of my surgery,
2. Yours may get worse as my SEs get better, and
3. I've never recommended surgery to anyone.

I felt ready and eager to play football a month post-op, and was approved to
do so at 6 weeks.

So, Mike, you have a TON of reading ahead of you. This is the most
complicated decision you will ever face, and you should let neither ckh's
nor my anecdotal circumstances contribute too much to your decision.

I.P.

I took that as a classic Freudian slip.

If the original poster wants to avoid surgery, then of course his
chances are about the same with radiation or surgery.

But I don't like medical situations of any kind, and I wanted a one-time
cure.  That's what I got with surgery.  Steve and makingprogress have
both said it better than I can.

jimhoney
standard (big incision) RRP age 52, cured, no significant aftereffects

Hi, my husband had a robotic laparoscopic radical prostatectomy 7 weeks
ago. He's 59 and diabetic.   His PSA was 6.2, he had a Gleason of 3+3,
level T2a no seminal vesicle involvement, and negative margins.  His tumor
was 30% of the right side of his prostate.  After a few problems in the
first couple of weeks he is doing well.  No incontinence, and potency is
returning.  He is still not 100% as far as energy levels go, but that is
getting better, too.  Right now if he had to do it all over again, he
would still choose surgery.  We actually feel fortunate that it was caught
now, and removed. For us, the "seeds", and other choices were not
controllable enough.  I hope this helps you with your decision, and good
luck, whatever your choice.

Unless the cancer has already reached the spots controlling continence and
potence.

I.P.

"Dave LaCourse" <dplacourse@pirateaol.com> wrote >

I'm not posting just to "add posts" to the group total.  :-)

I honestly wish that there were no need for this group at ALL...meaning
no PC.

I'm to meet with my surgeon for the first time tomorrow and since I have
decided that surgery is the way to go...

age 56, PSA 7.2 Biopsy T1c

Gleason 7=3+4

I'm wondering what kind of questions I can come up with.

I'm aware that as a surgeon, Dr. Catalona at Northwestern here in
Chicago will strongly lean toward surgery, but after all my reading and
research, I agree with that idea as well.

Thus my choice.

Yet, since I'm still scared of all of it, the PC, the anesthesia, the
surgery, the after effects, the cath etc....I'm trying to think of some
decent questions that aren't just fear based. (Those...I have plenty of

Thanks for any help.

Ron B.

 

that's seminal

Now I understand the surgical bias that some have.

Incontinence is MUCH less after Rad compared to Surgery.  It's not
that it starts later; it's that it almost never happens.  That's  what
the books say.

Lange, in my (C) 2003 Dummies book says about incontinence after
Rad,

  "1 percent to 3 percent of all patients.  Only rarely (less
  than 1 percent of cases) is it permanent."

He's going by old data, the EBRT standard and not 3D-CRT and
definitely not IMRT.  

I'm not sure that Rad itself is the cause.  You take a bunch of 65
year olds, give 'em a catheter, run a cystoscope up to their
bladder, how many of them will be dripping pee after that?  Could it
be 1 to 3 %?

When Lange talks about incontinence after surgery, he doesn't
directly quote the percentages but hints at 5-10% as the mark of a
good surgeon.  So what are the numbers for an "average" surgeon?, a
bad surgeon? 20%,  30%?  

Seems inappropriate to compare good numbers in the case of surgery
with overall numbers in the case of Rad.   I realize that Lange
isn't doing it directly but he is setting it up so that we do that.

ED after rad is a real problem but even here, the "just wait, it'll
happen later than surgery and be as bad."  is not quite accurate.

According to Lange, Rad's ED numbers

 "may still be as high as 20 percent to 40 percent" (page 151)

Again, discussing surgery, he doesn't use the same direct phrasing
but says about selecting a surgeon,

 "if his personal success rate is lower than 40 percent, consider
 seeing another urologist."

But here's another problem.  When talking about Rad, Lange is saying
20-40% may have ED.

When talking about surgery, he's saying that a good surgeon, doing
nerve sparing, working with a patient whose cancer is capsule bound,
should have a success rate of 40% (or better).  

He's not using the same terminology:

 Rad 20-40% failure.  
 Surgery 40% success.

When you use the same terms as he used with Rad, which is talking
about those who walk out with ED, surgery has a 60% failure rate.

 Rad 20-40% failure across all cases
 Surgery 60% failure, good surgeon, nerve sparing, select patient

I can't tell from Lange's prose but there is enough wiggle room that
he could be cherry picking the data.  

For example, Rad patients tend to be older that surgical patients.
This alone should cause ED among Rad to be higher.  It's not.  ED is
lower.

Second, the 40% success rate for a good surgeon applies only to
cases where nerve sparing was attempted.  

Of course, that's only if the patient is a candidate for "nerve
sparing".  

Finally about outcomes and certainty - radiation, even focussed
radiation like an IMRT, is a zone of destruction thing.  Your
statement about "time to spread" has validity but it also can mean
the converse.

With surgery, they cut here and not there.  This is removed and that
is not.  This is the right thing to do if the cancer is here and not
there.

My rad doc mentioned the possibility of microscopic extracapsular
extensions.  If there is just one of these, unnoticed, in a surgical
patient and it's left behind, then over time, the cancer could flare
up.  

Rad will include these margins in the zone of destruction.

It's wrong thinking to believe that surgery cuts the cancer out,
guarenteed.  

It does, if the cancer is where they are cutting.  There must be
some percentage of cases where the cancer has already extended
beyond the capsule.  

If the cancer is not where they are cutting, then they will miss
some of it and over time, the PSA climbs and the patient is looking
at salvage.  

The above statement may explain why the cancer "comes back" in some
surgical patients.  The recent report here, that Rad has better long
term numbers that surgery, is also consistant with this idea.

In this newsgroup, there's a really strong bias toward braving
surgery because it's a certain cure and rad is not.  There is a
belief that rad patients have similar side effects to surgical
patients or will eventually experience the same or worse.

None of that is true.  

Surgery is not certain, at least no more so than Rad.  There are
hints in the literature that Rad produces better results.  That's
not proven either.   I believe that both choices have many more
successes than failures and that to the individual, the "odds" work
out to be very good, either way.

For side effects, ED, incontinence, ability to return to
pre-treatment life, on the whole, Rad wins hands down.  

Even Rad+Lupron is still the winner by far.  There's been mention in
the group about Rad side effects.  

My primary complaint is that I've felt tired for 5 months.  I'm
still working a 10 hour day.  I climb stairs.  

My other complaint is that I have to pee every couple hours and
there is a burning sensation.  That's a well documented side effect
but not a show stopper.  

I'm starting to think that most of my side effects are from the
Lupron.  In the last month, things have gotten a whole lot better.

In the last week, there's been a big improvement.

Last night, I slept 7 hours without going to pee. This is the first
time in 5 months.  

I've missed a few days of work.  I've taken naps every weekend.  
With Rad, there is no pain to manage.

I'm not advocating for Rad or surgery.  Both options offer a good
chance of a cure for the cancer.   Both have side effects and in
most cases, the side effects can be tolerated, managed, or
mitigated.

I'm simply noticing that this group (and the literature) has a
surgical bias that is not justified by the numbers.

There're been comments about anesthesia's side effects.  If this is
a concern, consider that RP is complex surgery and require many
hours of heavy anesthesia.  

Rad, seed implants are commonly done with a local.  Many guys are
awake and aware during the entire process.  Consequently, there are
minimal side effects from the anesthesia.  

The choice is a personal one.   Either is appropriate threatment.  I
wouldn't say it's a coin-toss.   Look at it from all angles.  One
might choose surgery because, as some have mentioned, they are not
comfortable with the idea of radiation, period.