(1) That is a small positive margin. I think you would get different opinions from different specialists as to whether immediate adjuvant radiation was necessary. I don’t think anyone can tell you with certainty what is “right” or “wrong” in a case like this.

(2) With respect to the quality of care issue, what is important is the skill and experience of the treatment team. Radiation to the bladder neck needs to be done with great accuracy to minimize side effects. If I was going to have such radiation therapy, I would want it done by a radiation therapy team that had done this many times before, using the most accurately targetable equipment available.

I recently wrote a piece which you can find on my Yananow web site to help men focus on the issues that might impact on survival. I had a positive response and a number of men said they found this useful.

“The prostate cancer mortality rate was 33 per 1000 person-years during the first 15 years of follow-up (95% confidence interval [CI], 28-38) and 18 per 1000 person years after 15 years of follow-up (95% CI, 10-29). The mortality rates for these 2 follow-up periods were not statistically different, after adjusting for differences in tumor histology (rate ratio, 1.1; 95% CI, 0.6-1.9). Men with low-grade prostate cancers have a minimal risk of dying from prostate cancer during 20 years of follow-up (Gleason score of 2-4, 6 deaths per 1000 person-years; 95% CI, 2-11). Men with high-grade prostate cancers have a high probability of dying from prostate cancer within 10 years of diagnosis (Gleason score of 8-10, 121 deaths per 1000 person-years; 95% CI, 90-156). Men with Gleason score of 5 or 6 tumors have an intermediate risk of prostate cancer death.”