Surgery vs. Radiation?

My father-in-law, age 65, was recently diagnosed with prostate cancer (pT3 N0 M0).   Some evidence of extracapsular and seminal vesicle spread via biopsy and transrectal ultrasound, no evidence of bone or lymph involvement (via CT and bone scan).  Biopsy revealed 12 of 12 cores positive, Gleason scores of 8 and 7 (4+3) for most samples.  Last PSA measurement was ~6.  He is otherwise healthy.

We're trying to decide between surgery and combination therapy (hormones/radiation), and the evidence favoring either direction isn't definitive.  The combination therapy approach suggested is Cassodex + Lupron followed by HDR brachytherapy followed by IMRT for 5 weeks.  Surgical approach is radical prostatectomy.

Any thoughts on the consideration set of tradeoffs?  We're told that continence and sexual function tend to be better preserved via radiation, although hormone therapy does drop levels to castrate.  Long term survival rates don't seem dramatically different in either course, nor do rates of recurrence.

[claytex]

I had prostate cancer in 2005.  My numbers were similiar to your father in laws.  I did my own research and finally decided that proton radiation was the best option.. Proton Radiation is different from conventional radiation in that about 85-90% of the treatment energy is delivered to the exact spot or tumor being treated.  Therefore it has little to no side effects.. the reason being that the surrounding organs and tissues are not damaged by unneeded radiation as is the case with traditional radiation... Proton Radiation has approximately a 90% cure rate and little to no side effects... I had my treatments at Loma Linda University Medical Center in Loma Linda California.  it was like I was never sick.  I never felt bad one single day as a result of the prostate cancer or the proton treatments.Its like I am healed and was not sick.  As far as I am concerned, I can not see any reason to have any other treatments if you can have proton radiation... 90% cure and no side effects... There are now 5-6 places that offer proton treatments.. Loma Linda pioneered it in this country about 20 years ago and have had such good success with it.. that others are now offering it... MD Anderson in houston started it about 2 years ago.. Many doctors wont recommend it... ( they are not trained for it, dont have the facalities and dont make money sending patients elsewhere) bottom line...Ohh my PSA is no .05... If you have any questions or would like more info, please send me a message here on medhelp.. Ill be glad to share my experience with you.. ohhh Medicare pays for Proton Radiation also.. hope this helps.. Claytex

[Jmusmacher]

With the chance of extracapsular disease I would most certainly look into hormones and RT.  The RT can be IG/IMRT or Stereotactic Radiosurgery or even brachytherapy.  All of these would require some form of external beam therapy for 5 weeks.  Following this treatment one could have a prostate seed implant or a Cyberknife radiosurgery boost.  This would entail only 3 visits.  I have assisted in the HDR procedure as well as the others.  One word of advice, the HDR is a barbaric procedure that can be replicated (with better results and without any incisions or pain) with the Cyberknife.  I would stay far away from any physician that offers HDR.  Proton Beam therapy when put alongside the others sems to have equivalent outcomes but is a very costly prospect.  Yes Medicare does pay for it, but many insurers do not, in fact Medicare is looking into reimbursement this year as it can cost as much as $80,000 to treat a patient with prostate cancer using proton beam radiation compared to $25,000 using Cyberknife with data that has longer follow-up and better outcomes.  Good Luck and you can send me a message if you need more information.