Only if the radiation is AIMED outside the prostate and goes where it is
intended to go. Assuming that, where do they aim it, or STOP aiming it?
Generally speaking, anything RT can fry, RP can cut. The REAL issue, it
seems to me, is determining what needs to be destroyed, THEN deciding how or
whether to destroy it. I asked my surgical oncologist whether a surgeon
can't tell better than a rad onc what to destroy and what to save bescause
the surgeon is right in there up to her wrists, examining nerves and
vesicles and meat and vessels and lymph nodes with eyes and fingertips and
the pathologist's microscope real time. Makes sense, doesn't it? His answer
was, "No, there's no clear advantage to hands-on evaluation in determining
where to cut. We -- whether RT or RP -- pretty much determine what to fry or
cut before we go in, with obvious exceptions. They weren't sure in advance
whether my nerve bundles were involved (although I seem to recall that he
said they could make that determination in advance if I had chosen RT), but
hands-on did help make that judgement real time.

But unless someone here can definitively, authoritatively, and with
references, answer your question unequivocably, I'd keep reading. I was
"fortunate" enough to have other compelling reasons to choose one treatment
over the other, which is why my recollection of the literature on that is
shaky. But to return full circle, I'd worry if a rad onc said, "We'll just
fry a little extra Alen in case some cancer has escaped."

I.P.

Out of curiosity, Les, from whence do your hail?  This approach sounds great
and I've seen it with a few others, mostly outside the U.S.

American Urological Association Annual Meeting
May 21 - 26, 2005
San Antonio, Texas, USA

Publishing #: 468
Presentation Title: HIGH GRADE PROSTATE CANCER: WHAT IS THE BEST
TREATMENT APPROACH?

Category: 39 Epidemiology and Natural History
Author Block: Ashutosh Tewari*, New York, NY; Ram Dasari, Detroit, MI;
Assaad El-Hakim, New York, NY; George Devine, Detroit, MI; M Mendel
Shemtov, New York, NY; Christopher R Porter, Seattle, WA; Eduard J
Gamito, Peter N Schlegel, New York, NY; Mani Menon, Detroit, MI

Introduction and Objective: To compare long-term cancer specific and
overall survival of men with high-grade prostate cancer (Gleason = 8)
managed with watchful waiting (WW), radiation therapy (RT) and radical
prostatectomy (RRP) in a large observational cohort of 3159 patients
with prostate cancer treated between January 1980 and December 1997.
Methods: 453 patients (14.3%) with high-grade prostate cancer (Gleason
= 8) on biopsy specimen were included in this study. 197 (43.5%) were
managed with WW, 137 (30.2%) with RT, and 119 (26.3%) with RRP.
Propensity score analysis was used to balance individual's covariates
and to better reduce bias. In addition to cancer related variables and
treatment modality, outcomes were adjusted for age, race, Charlson
comorbidity index, income, and year of diagnosis. The median follow-up
was 55.5 months (range 0.1- 226.8).

Results: 261 patients (57.6%) were white and 192 (42.4%) were
African-American. At last follow-up, 124 patients (27%) were dead from
prostate cancer. On multivariate analysis treatment modality was a
significant predictor of overall and cancer specific survival. The risk
of overall death following RRP was 32% lower than WW (RR 0.32 [95% CI
0.20-0.51]) and 42% lower than RT (RR 0.46 [95% CI 0.28-0.75]).
Similarly overall survival was higher with RT than WW (RR 0.70 [95% CI
0.50-0.99]). Importantly, the risk of cancer specific death following
RRP was 68% lower compared to WW (RR 0.32 CI [0.17-0.61]) and 49% lower
compared to RT (RR 0.51 CI [0.26-1.01]). Disease specific survival was
not statistically different between RT and WW.

Conclusions: Radical prostatectomy seems to confer a survival advantage
over watchful waiting and radiation therapy in patients with high-grade
(Gleason = 8) prostate cancer.

Yes.  I forgot to add that.  That was another of the "plus" things we
considered about RRP.  Since my RRP, I have had 6 friends who have
been treated for pCa, four by surgery (including robotic) and 2 by
radiation.  Neither of the radiation treatments have been successful,
and though all the others are doing well (zero psa), three are
incontinent.  

Dave

Let me add some confusion to the mix.....

Now that a cure is possible in the near future, how would each of you or
some of you decide knowing that you might live long enough for the long-term
effects of radiation?

Not that I had a choice in the matter, but it is a concern of mine.  I'd
have mixed emotions about living long enough to see some serious sides.