During my recent participation in a prostate cancer review panel (see: Proton beam vs. x-ray therapy) I asked two professors, one a radiation oncologist and one a urological surgeon, what they thought should be done about high risk cancer, e.g., Gleason 9 or 10. Their answers surprised me.
The surgeon said that she didn't believe that high risk cancers are easily cured by a single treatment. She thought multiple treatments were needed. She recommended surgery to get rid of the whole prostate, and Lupron + radiation to treat the area around it.
I then turned to the radiation oncologist. He was present and heard what the surgeon said. I said that my radiation oncologist had told me that she thought that, if surgery didn't cure the cancer and radiation was needed to finish it off, then the patient would probably have been cured by radiation alone without having to go through surgery.
His answer surprised me too. He said that up to just a couple of years ago he would have said the same thing, but now he's not so sure. He thought it was possible that a very aggressive, high Gleason cancer might not be completely killed off by radiation. He therefore endorsed what the surgeon had said, thinking that surgery followed by radiation + Lupron offered the highest odds of a complete cure.
The answers weren't what I expected. I thought the surgeon and rad onc would disagree, as they traditionally do. Neither of the two people seemed to me to be shy about expressing their opinions forcefully, so I'm not ready to say that they were just being polite to each other, though it's possible that they were.
I guess that all I can do here is report what they said.