Although some men appear to have clinically localized cancer, there’s a good chance that their cancer has spread beyond the prostate (see table 3.3).
For these men, the combination of radiation and surgery might sound like a promising option. However, it is not yet certain whether radiation after prostatectomy is ultimately helpful. Note: Radical prostatectomy is definitely not very successful in men who have undergone radiation treatment, and in the minds of many urologists, surgery after the fact is not an option. However, men who have undergone radical prostatectomy can go ahead and have radiation therapy later.
Some surgeons recommend hormonal treatment to shrink the prostate (and, they hope, the tumor) before radical prostatectomy, believing that this will make the cancer more curable. But, as one Johns Hopkins scientist explains, “hormone therapy is not a vacuum cleaner—it can’t suck the cancer cells back into the prostate once they’ve escaped.” There is no reason to believe that hormone treatment before radical prostatectomy will make it possible for surgeons to retrieve and eliminate cancer cells that have strayed from the prostate. Also, this approach may mislead a surgeon into thinking the cancer picture is rosier than it actually is, and thereby encourage a less-aggressive cancer operation.
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