Invasion of the Prostate Snatchers: Revised and Updated Edition by Mark Scholz & Ralph H. Blum

Author:Mark Scholz & Ralph H. Blum [Scholz, Mark & Blum, Ralph H.]
Language: eng
Format: epub
Publisher: Other Press
Published: 2021-08-24T00:00:00+00:00

WHAT WORKS BEST?

Any discussion about radiation being less toxic than surgery is only meaningful if we can be certain that the cure rates are equal or better. Well…what say the studies? Essentially, cure rates with radiation are at least as good as they are with surgery for men with Intermediate-Risk disease.4 However, Intermediate-Risk is relatively easy to cure with practically any approach, because metastases are infrequent. The true test is in the men with High-Risk disease. With High-Risk, radiation cure rates are far better than surgery.5

How is this possible? The problem is that surgeons are frequently unable to remove all the cancer in men with High-Risk disease. In roughly 25% of High-Risk cases, there’s a positive margin, meaning the surgeon has cut through the tumor but left cancer behind after the operation.6 The reason radiation therapy has higher cure rates is because the radiation field can be safely extended outside the margin of the prostate capsule, which is not true of surgery.

The difficulties surgeons face achieving an adequate margin relates to the surrounding anatomy of the pelvis, where the prostate is located. Let’s take colon cancer for example: With colon cancer the surgeon removes a foot of colon on each side of the tumor. The goal with any type of cancer surgery is to ensure that every last cancer cell is removed. The problem with the prostate is that it is located just millimeters from the bladder and rectum, limiting the surgeon’s ability to cut a margin around the gland. And if the surgeon nicks the colon or bladder during a radical prostatectomy the situation turns out like Matthew’s.

Another reason radiation results in higher cure rates than surgery is because radiation targets the lymph nodes surrounding the prostate. Lymph nodes are the initial site of cancer spread, and they need to be treated when the cancer is High-Risk. Surgeons often attempt to remove a few nodes during the operation, but radiation achieves much broader coverage than is feasible with surgery.

There is a third reason for radiation’s superiority: surgeons don’t use TIP, even for High-Risk. Everyone knows that men with High-Risk are much more likely to have microscopic metastases. TIP attacks the cancer cells, wherever they may be in the body. To this day, High-Risk patients having surgery don’t get TIP, even though studies show that adding TIP to surgery improves cure rates.7 The surgeon’s policy of forgoing TIP, the substantial risk of leaving cancer behind (positive margins), along with the suboptimal ability of surgery to eradicate cancer in the pelvic lymph nodes, all contribute to disappointing cure rates when using surgery for men with High-Risk prostate cancer.

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