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Somewhere in the chaos of files on my computer I have a very interesting report of a conference about three or four years attended by a couple of hundred leading doctors, but I haven't been able to find it. So I'll have to rely on my memory in relating what happened.
This section of the conference was a presentation by some of the big guns who discussed a a theoretical progression and how to treat it, with the audience voting for the various options at each stage where a decision had to be made.
The Chairman oened the session by saying that the audience were not being asked to deal with the intial primary treatment because if that had been done, the exercise would have got no further because it would have been impossible to get agreement. So it was assumed that the man had surgery.
From then on, there was simply no agreement among these experts. At every decision point, the room was split on the best treatment.
It illustrated very clearly to me how difficult it is for us men diagnosed with the disease to make the 'best' decision. If the peopl with the best technical knowledge can't do it, how the heck can we?
I can only tell you about my situation. During discussions with my urologist/surgeon was that if the PCa had escaped the prostrate and was already well established in the lymph system then surgery would not be curative. The inherent dangers of surgery (infection, invasion of the bladder or rectum, bleeding, blood clots, etc.) and the possible side effects of surgery out weighed what the surgery would (could) accomplish. If this was the situation then other treatments would be more suited, ADT and or RT. My surgeon and I came to an agreement that biopsies would be taken of my lymph nodes and if cancer was found then the surgery would be aborted.
CT scans prior to surgery did show enlarged lymph nodes on my left side. During surgery my biopsies did come back positive (multiple nodes) and my surgery was stopped. I then was started on Trelstar injection and Casodex for two months. IMRT for 9 weeks and now Trelstar injection every three months.
