Surviving Prostate Cancer Without Surgery by Bradley Hennenfent

Author:Bradley Hennenfent [Hennenfent, Bradley]
Language: eng
Format: epub
Publisher: Roseville Books
Published: 2009-12-20T16:00:00+00:00

Radiation or Surgery

The big upside to external beam radiation compared to radical prostatectomy is that it’s not a major operation and there are fewer side effects. Impotence and incontinence are less likely with external beam radiation therapy than with the radical prostatectomy.

The argument is which is better at curing prostate cancer, XBRT or radical prostatectomy? It hasn’t been proven in controlled studies that the radical prostatectomy works, thus comparing XBRT to the radical prostatectomy is almost an exercise in futility, yet that’s what almost everybody does.

Proponents of XBRT say that if you control for the fact that urologists take the healthiest patients with the smallest tumors and with the lowest Gleason scores, that XBRT is clearly better than radical prostatectomy. XBRT is better, advocates say, because efficacy is similar and there are fewer side effects than with radical prostatectomy. Advocates of radical prostatectomy will argue that their operation is best. The shame of both specialties, urology and radiology, is that neither has done the proper controlled trials to show whether either therapy actually cures prostate cancer, or whether one is truly superior to the other.

It’s true that XBRT patients often have more serious cancers than do men undergoing radical prostatectomy. In a 1997 study, patients who had either radical prostatectomy or XBRT were stratified according to their pretreatment biopsy Gleason scores and PSA levels. The authors found that at 2 years there was no difference in the relapse rate after the treatments as measured by the PSA test. The authors concluded that because of the “vast difference in morbidity” between the two therapies that it is unfortunate that studies have not stratified patients by PSA and Gleason score and compared treatments head to head.101 In a large Medicare study published in 1995, the authors found that when accounting for cost, efficacy, and side effects that external beam radiation therapy “dominated” the radical prostatectomy.102 One radiation oncologist wrote:

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