Surgery vs radiation
Note: Gleason score 3+4 =7 (ISUP grade group 2) may not need either treatment for many years (active surveillance possibly recommended). Gleason score 3+3 = 6 (ISUP grade group 1) almost never needs treatment but active surveillance is usually recommended. Active surveillance avoids treatment side effects - sexual and urinary, usually for several years, often for life.
In general, extract from:
https://www.nejm.org/doi/full/10.1056/NEJMoa1606221
The study involved:
36+ doctors, 1,643 men, took 6 years, and reported in 2016
The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radio- therapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools;* bowel function was unchanged in the other groups. Urinary voiding and nocturia* were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety, depression, or general health-related or cancer-related quality of life.
**nocturia = getting up more than once a night to pee
*Graphs in this paper show bowel habits surgery, radiation same at year 4, bloody stools 6.7% at year 6. Laser therapy, rinsing with formalin or botox can stop rectal bleeding caused by radiation.[jm]
Extract about the treatment of the most aggressive cancers:
https://www.sciencedirect.com/science/article/abs/pii/S0302283816303980
The study involved:
15 top doctors, 487 men, took 4.6 years, and reported in 2017
Radiotherapy and RP provide equivalent CSS and OS. Extremely dose-escalated radiotherapy with ADT in particular offers improved systemic control when compared with either EBRT or RP. These data suggest that extremely dose-escalated radiotherapy with ADT might be the optimal upfront treatment for patients with biopsy GS 9–10 CaP.
CSS = cancer specific survival - not dying of prostate cancer
OS = overall survival - not dying at all during the study
extremely dose-escalated radiotherapy = HDR brachytherapy boost
ADT = hormone therapy
biopsy GS 9–10 CaP = most aggressive (dangerous) cancers (Gleason score of 9 or 10 = ISUP Grade Group 5)