Radiation v Surgery

[Canoehead]

Diagnosed 11/17 metastatic stage 4, Gleason 8, PSA 36, Mets in pelvis, one rib, and probably in pelvic lymph nodes. Large tumor in pelvis.

Treated with usual ADT and 6 infusions of Docetaxel. PSA undetectable after 5th chemo. Bone scan shows no new Mets. CT scan shows pelvic tumor now just a bulge on prostate gland.

Dr. Agreed that we could try to eradicate the visible cancer. I call it a potential cure although Dr. won’t use that terminology. Radiation for the Mets is obvious enough, but when I suggested a RP, he said that since we were already using radiation in pelvic area, that was the best choice for attacking the cancer in the prostate gland itself. He also said side effects of radiation were less than side effects of RP.

What do those of you who have had either radiation or surgery to the prostate Think?

[Tall_Allen]

It isn't a cure, but maybe it can slow it down - no one knows for sure yet. Because the benefit is so uncertain, I think your doctor has a good point about going with the therapy with fewer side effects. But I also know the "just cut it out' mentality.

If you decide for radiation, I think you should consider whole pelvic radiation with a brachytherapy boost to the prostate. I think you'll need that boost to kill those relatively resistant cancer cells in the prostate. The external beam reaches places that the surgery can't. That kind of heavy radiation comes with its own set of urinary (obstructive) side effects.

If you decide for surgery, they probably won't be able to spare the neurovascular bundles, increasing the probability of incontinence. Plus, they will have to do an extended pelvic lymph node dissection (assuming you have a surgeon experienced at it), and that carries risk of lymphocele and lymphedema.

Here's a couple of articles discussing experience so far with "debulking" therapy:

pcnrv.blogspot.com/2016/08/...

pcnrv.blogspot.com/2016/08/...

[billfenley2 in reply to Tall_Allen]

Allen, considering the possible obstructive side effects you mention from brachy, and possible rectal ones? -- would you say that RP's side effects are still probably worse overall than brachy's?

[Tall_Allen in reply to billfenley2]

Well, since incontinence is a very rare side effect of radiation, while common with surgery, and that is the most life-changing side effect any of us incur, I would say so. Impotence rates are also likely to be much worse with surgery, because with high risk cases they often have to cut wide and can't do nerve sparing (this also affects incontinence rates). We saw that there were increased rates of serious late-term urinary side effects, primarily obstructive, but they only occurred in 18%. The rectal side effects seem to be adequately controlled with modern IGRT technology. Here's an analysis of side effects after brachy boost:

redjournal.org/article/S036...

[kenner]

RP can be very difficult with lasting incontinence.....that's me. Others have done amazingly well. Just like all PC Meds, some people suffer badly & others do better. My answer is not what you're looking for I guess. Good Luck!!!

[j-o-h-n]

Heed Tall_Allen's advice, he really knows his stuff.

Good Luck and Good Health.

j-o-h-n Sunday 04/22/2018 12:47 PM EDT

[abmicro]

In my case, my oncologist said surgery, if it will eradicate the cancer, would have been better than radiation. Radiation has a cumulative side effect if you have to do a lot of it later, and could affect bone and blood counts. Surgery wont do that. In your case, I cant say which is better because you want to also radiate other areas.

I had radiation twice to a pelvic bone because of a very painful met and fracture that developed when the cancer came back a 2nd time in the same bone, and now I cant do anymore radiation there. If I had done surgery the first time, that cancer would NOT have been recurrent in that area.

[PhilipSZacarias]

Hello Canoehead, I have a similar history and pattern. I opted for the radiation because of the fewer side effects and also the potential of eliciting an abscopal effect (an immune response) which is rare but still possible for people on ADT. Diagnosed in Feb 2016 - my PSA is presently around 0.2 ng/ml and stable. There have been recent papers in PubMed indicating that RP is beneficial even in a metastatic setting. Either RT or RP should provide some benefit with respect to OS. Cheers.

[Canoehead in reply to PhilipSZacarias]

Thanks everyone. I will report back after meeting with the radiation oncologist.