Re: Re: what to do?

[Guest guest]

Doug wrote:

....

> What I wonder is why radiation is not given following surgery.

> If the tube running through the prostate is reconnected once

> the prostate is  removed, would it not also have cancerous

> cells on it and be responsible for reoccurence?

....

Some doctors do prescribe radiation following surgery, without

waiting for a recurrence.  Some don't.  The ones who do

apparently believe that signs of an aggressive cancer such as a

high Gleason score, high PSA, or the kinds of pathology reports

that Chuck described in his response, indicate that failure is

likely and it's better to radiate as soon as possible, before the

cancer can spread.  The ones who don't prescribe radiation

apparently believe that the side effects of radiation can be

significant and should only be incurred if there is a rising PSA

to indicate that radiation may actually be needed.

There was a clinical trial to test the hypothesis that radiation

in the absence of recurrence is worthwhile.  If I remember

correctly, the arm of the trial that underwent radiation without

waiting for recurrence had an 11% disease free advantage over the

arm that only had radiation if there was evidence of recurrence.

Is that a worthwhile percentage?  Does it justify the side

effects in the men who got the radiation but didn't actually

need it?

I don't know the answer.  Maybe it's a decision that doctors

should discuss with patients instead of just recommending

radiation or not mentioning it.  However, I confess that if a

doctor told me about radiation as a possibility even though I

might not need it, the first thing I'd ask the doctor is, What

would you do if it were you?  I'm sure different doctors, like

different patients, would answer differently.

    Alan