Primary Radiotherapy May Not Increase Survival in Men Under 70 Years Old!

[JoelT]

Increasingly we are seeing more younger men diagnosed with prostate cancer. There was a study done to evaluate the survival advantage that younger men (under 70 years) who elected to have radiotherapy as their primary treatment. The results of the study showed that men under 70 years did not receive any survival advantage from this treatment. This means that men under 70 years should be sure to also consider alternative treatments like surgery and HIFU.

[Dr_WHO]

There are benefits to having surgery as your first procedure.  More and more surgeons are willing to do surgery even if the cancer has spread.  I am 58, have high risk (T3N1, G8) cancer.  Based on reading I decided to have surgery (had to convince the surgeon).  Once I recover this will be followed up with radiation/hormonal therapies.  

[JoelT in reply to Dr_WHO]

God luck to you and GOOD health

Joel

[jack51]

I was 62 (2013) and had IMRT followed by 25 sessions of radiation therapy.  Rising PSA in early 2015 of 2.15 and Gleason 7 & 8.  Opted for cryotherapy in summer 2015.  PSA level as of March 2016, 0.9.  In hindsight I should have chosen surgery.

[JoelT in reply to jack51]

Jack,

With cancer there is no value in hindsight.  Never look back, look only to today and a little towards tomorrow.

 

If you take the time you need to learn as much as you can about your cancer you will make the best decision for yourself based on the current level of knowledge and the combined experiences of others.  As long as you do your homework you will know that you have made the right choice. 

It is OK to not be happy with a result or a side effect, but you NEVER know what would otherwise have been the result or side effect if you had gone off in a different direction.

In reality, it doesn't matter because you can not change what has happened, you can change today and tomorrow (to some extent).

Learn as much as you can, then make an educated decision and NEVER look back and never regret an educated decision. 

Regret and looking back  has no place in cancer care.  Take it from a man who has 5 different cancers, who is suffering from side effects, but doesn't waste his time with regret, because it serves no purpose other then to make life unhappy.

Joel

[ng27868168 in reply to JoelT]

JoelT.., you are so right!  As a facilitator for our local PC group, I have known more than a few men who took the easy way and regretted doing so.  "if I would have known then what I know now...."  is a terrible statement to hear. 

[maley2711 in reply to jack51]

jack -

many surgery patients also experience recurrence...no guarantee at all that surgery would have given you a better result.

[ng27868168]

That's exactly what my primary doctor and several Urologists told me 23 years ago when I was deciding what to do at age 52. 

[JoelT]

It is good to hear what our doctors say, but when making such major decisions we need to hear more than one doctor.  We need to speak to multiple docs as well as others who have already walked the same path.  We need to read and discuss the options until we have all the information we can find and then we need to filter it down to speak to us as the individual we each are.  This way we make the best personal decision for ourself,  we must decide not to ever look back and never to have regret.  Our only job  is to look at today and make decisions for today only,never looking   back.

This is how I try to conduct my life and all the decisions having 5 cancers has forced upon me. 

Joel

[adlerman in reply to JoelT]

Good advice. Many people learn too late that urologists cut and radiologists radiate.  If you find one with a different recommendation give it a little more weight.

[adlerman]

If the goal is to get rid of the cancer I still think cryotherapy is better than radiation or surgery. Cryo kills the undetectable cells the other treatments miss and it is repeatable. If the goal is to avoid impotence then roll the dice.

[maley2711 in reply to adlerman]

please provide a study supporting your view?

[JoelT]

Each therapy has its positives and negatives.  The best treatment is very much dependent upon the patient, his cancer and the performing doctor.  For example; surgery and cryo (which is surgery) can not be done on older men or men who have some co-morbidity issues, radiation can not be given if a man has had some prior radiation exposure.  

Cryotherapy does not ablate the undetectable cells as the doctor only destroys the part of the gland that has been identified by a scan has having cancer.  The doctor does not go after cells since they are not visible and have not been identified.  If the doctor ablates an identified tumor he still might leave other cells behind because they are located in a different part of the gland and they have not been identified by a scan.  Scans only show cancer once there are billions of cells.  This is the reason that sometimes a second treatment is needed.

Just like all the other treatments, men who have had cryo still can progress and develop mets.  The reality is no treatment can be credited with a blanket label as being superior.

Joel

[adlerman in reply to JoelT]

My cryo was done 14 years ago- it was not the procedure you described which is cryo's version of the nerve sparing technique.

[adlerman]

I thought that was what I said- and did.

[AlanMeyer Moderator]

Hello Joel,

I think you may have misinterpreted the study cited at:

translational-medicine.biom...

That was the article cited by the page you cited.

If I understand it correctly, the men studied did NOT receive primary radiotherapy. They received radiation to their bone metastases. Therefore the study provided no evidence that primary therapy via surgery or HIFU was more effective than radiation.

What the study attempted to find out was whether radiating bone metastases prolonged survival. The conclusion was that it may have relieved bone pain, but did not prolong survival. I suspect that a reasonable interpretation of the results is that most men who die of metastatic prostate cancer die of metastases in soft tissue - heart, lungs, brain, kidneys, liver, etc., rather than their bone metastases. This appears to confirm the general belief that radiation for prostate cancer in the bones can be used to reduce pain and improve quality of life but shouldn't be expected to prolong survival.

Alan

[JoelT in reply to AlanMeyer]

Hi Alan,

In re-reading the study I think that you are correct. My error. According to the study radiating bone mets had no effect on survival (it does have a positive effect on pain). Primary radiation was not evaluated in this study.

Thanks for finding the error

Joel

[maley2711 in reply to AlanMeyer]

Moderator ..IMHO, you shuld remove this old post, because its headline and the body of post are incorrect summary of the study used by the post author. Don't spread incorrect info....the author himself has admitted the error!!!

[maley2711]

there is no study that shows surgery patients have no recurrence.......IMO your surgeon was guilty of lying.