Thank you for your replay Ijaz Durrani

I have started this discussion forum to discuss the same, Oncologically ( in terms of cancer control both may be similar . )

How do we explain like

what is the possibility of having urinary issues with my radiation or surgery?

what is the possibility of having an @@ED with surgery/radiation?

what is the possibility of RE-admission with either surgery or radiation?

IF we take hormones for 6 months with radiation ? do they carry any risk?

What is the possibility of failure of my primary treatment and option for the second primary treatment with either surgery or radiation?

Is there any long term risk of having secondary malignancy with radiation in the long term?

what is the difference in the overall cost between the two groups?

what is likely hood of additional procedure in both groups?

any other questions you can add/answer that comes to your mind?

Thanks

This topic causes great debate & conflict between urologists & radiation oncologists - each would consider their own modality to be best. Truth is we dont have reliable comparative data.

When advising my patients, I firstly draw attention to my bias/conflict of interest as I am a surgeon & offer opportunity to consult a radiation oncologist.

Then I use the following to help guide decision-making:

Beyond that, individual patient preference for type of treatment, side-effects (present for both treatments), recovery period as well as convenience/availability also come into play - no absolute right or wrong, important that patient feels comfortable with decision (some end up never being able to decide!)

Thank You, Shomik Sengupta, Dr.Shomik, Thank you for your replay,

regarding point 3, do you do TURP for large prostate when you have decided for radiation? In your practice have you seen more complications after TURP ( with EBRT or EBRT +BT combination ? )

If the prostate is large & the man has obstructive symptoms, then yes. Best time to do the TURP is prior to the radiation. Certainly there is a higher risk of complications such as bladder neck contracture

@shomik sengupta , Dr Shomik

Thank you

I inform patients that for localsied disaese eitheris a suitable option but the side effect prophile is the biggest consideration. RTX tends to have later onset of side effects and for younger men this needs to be considered as the effect can be significant. SX tends to have instant side effects that with time and councelling most are managed.

David Heath Valid Points , for younger patients are more likely to benefited from surgery as long term side effects of radiation are still not known fully ?

one more thing do you tell your patients that your patient is likely to have 1-4 % long term of second malignancy when radiation is given more so in younger patients ?

We discuss the risk of secondary maligancy from RTX but the radiation oncologist discuss this further at time of consultation once referred from urology.

David Heath Thank you