Per the NCCN guidelines, the treatment options for High-Risk prostate cancer are surgery, beam radiation, or a combination of beam radiation plus radioactive seeds. Hormonal therapy (with Lupron for example) is usually given along with the radiation for two to three years. But patients certainly wonder if one of these three treatment options is better than the other two. A study published recently in the October 2016 issue New England Journal of Medicine compared surgery and beam radiation prospectively in men with mostly Low-Risk prostate cancer. It showed equivalent survival rates. A prospective study for High-Risk prostate cancer, however, is unavailable. Only retrospective studies are available.
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It seems we have a national passion for prostate biopsies. A million men are biopsied every year. Two hundred thousand of them will be diagnosed with prostate cancer and about half of these with Low-Risk disease, a condition that can be safely monitored without immediate treatment. Even so, more than half of these men with Low-Risk will undergo prompt, radical treatment. Sadly, irrational fears rooted in the electrifying word “cancer” drive most men into taking immediate action.
The term "adjuvant" means treatment “added to” the primary or initial treatment. When the primary treatment is surgery, even when all detectable disease is removed, there remains a statistical risk that the cancer will return due to microscopic cancer cells left behind. Men with high-risk features such as extra-prostatic extension or high Gleason score face a higher risk of recurrence.