My father-in-law, age 65, was recently diagnosed with prostate cancer (pT3 N0 M0). Some evidence of extracapsular and seminal vesicle spread via biopsy and transrectal ultrasound, no evidence of bone or lymph involvement (via CT and bone scan). Biopsy revealed 12 of 12 cores positive, Gleason scores of 8 and 7 (4+3) for most samples. Last PSA measurement was ~6. He is otherwise healthy.
We're trying to decide between surgery and combination therapy (hormones/radiation), and the evidence favoring either direction isn't definitive. The combination therapy approach suggested is Cassodex + Lupron followed by HDR brachytherapy followed by IMRT for 5 weeks. Surgical approach is radical prostatectomy.
Any thoughts on the consideration set of tradeoffs? We're told that continence and sexual function tend to be better preserved via radiation, although hormone therapy does drop levels to castrate. Long term survival rates don't seem dramatically different in either course, nor do rates of recurrence.