Treatment Decision - Radical Prostatectomy versus Radiation Therapy

Radiation would be a good choice, especially since Mayo RO felt it would be a good option. Ask the oncologist if they could combined SBRT with IMRT which could cut down the number of IMRT session you would get. It is a pretty common technique these days. The SBRT is done to the prostate and then the IMRT to all the tissue around it.

This usually protects your ability to get an erection in the future.

Have you had genetic testing? it would be good to know if you have a genetic anomaly before you have either treatment. Has Mayo recommended that? I would suspect they did. If not, you can get a free genetic test at the following website..

Www. prostatecancerpromise.org

Just make sure you don’t select that you want your doctor involved or they won’t send you the spit tube until talking to them. They will have a genetic counselor talk to you about the results. Takes three weeks usually.

Have they mentioned putting you on ADT before radiation or surgery? That can prevent your cancer from spreading and growing while you’re waiting to make a decision.

They have discussed the combination of different radiation therapies. I have not had genetic testing other than the pending biopsy genetic testing (Decipher). Thanks for the information on that. We have also discussed the option of ADT with both approaches. There is also a potential clinical trial that might be an options depending upon the outcome of the Decipher test. Thanks again for the input!!!

There's no guarantee that surgery gets rid of it — overall survival is comparable for both approaches. I suggest looking at the side effects of each treatment to help with your decision.

Best of luck!

@dougharris
First don't feel you are unique. Almost all of us had to made decisions on what to do and getting a lot of information to digest. It can be a very difficult time but just know you are not alone in your feelings, anquish, anxiety. WE all went through it. I had some extra help as I sought help at the Psychological Section of Mayo Jacksonville. I already had PTSD which developed into Anxiety/Panic Disorder.

You mentioned the Decipher test pending. That test will determine if your cancer is low risk, intermediate, or high risk. That has great impact on the type of radiation you would get, surgery, and getting hormone treatments.

Did you get a PSMA? Did you get a bone scan? Those test also help with treatment options.

A great pro to you is that you are at an outstanding clinic Mayo Phoenix. Can't get much better than Mayo. I went to Mayo Jacksonville for testing and diagnosis but got proton radiation at UFHPTI as Mayo Jacksonville did not have proton radiation treatments just photon.

One poster said surgery does not guarantee removal of all. That is why Decipher, PSMA, bone scans are so valuable. You are talking about cancer at celluar level and if outside the prostrate surgery will not prevent it from growing elsewhere.

Some chose surgery, some chose radiation, some chose to have hormone treatments some do not. It is why those test mentioned are so valuable to your urologist, and R/O and more important you! This decision is yours not your surgeon, urologist, R/O and not anyone on MCC.

Just know surgery carries a lot of side affects. Radiation does too but a lot less. Try to do research at all the major sites like Mayo, Cleveland Clinic. I recommend contacted UFHPTI and asking for their information pamphlet hand out. In that FREE package will be two books by authors who have gone through prostrate treatments as well as a urologist. It is free with the information pamphlet and will give you a ton of independent information on making decisions.

Good luck, keep us informed about what your Decipher tests comes back as.

There are clinical trials that have you take one drug, but the second drug you may not get because you are the generic side of the trial. You also won’t have any idea you are taking the generic instead of the real drug.

There have been recent test that have not really looked good for the patient because they don’t give the most effective combination of ingredients.

If you’re considering a trial, come back here and ask about what people think of it

Yes, a good example of that is the TITAN study for metastatic castrate-sensitive prostate cancer (mCSPC) — there was an experimental group taking ADT + Apalutamide (Erleada) and a control group taking ADT + a placebo.

A couple of years into the study, they realised that the the ADT + Apalutamide combo was so effective at delaying or preventing cancer progression that they had to unblind the study for ethical reasons and offer the placebo group the opportunity to switch over and start getting Apalutamide as well.
https://pubmed.ncbi.nlm.nih.gov/33914595/

This is what I learned:

The more advanced the cancer is the more RT is preferred over RP, but that does not mean RT is not a good choice for less advanced cases.

One doctor (surgeon) said with RT you trade early side effects of RP with late side effects of RT.
With RP, there is no ADT, with RT it depends on the risk (T stage, GS, PSA, decipher).
If you get RP and there are "positive margins" (= cancer detected on the edges that were removed), you will need RT anyway.
If you get RP and it is locally advanced they will remove lymph nodes and biopsy them (possible RT needed)
RP you can have "salvage" pelvic RT if it recurs (RT you can as well to some extent)
Salvage RP after RT is difficult due to tissue damage but possible (specialized surgery)
In some case people are not good candidates for surgery, so need to get RT instead.

As said above, most of us went through this (mine was easier, surgeons also recommended RT in my case).

Good luck with the decision.

@dougharris there are different kinds of radiation machines with different side effects. I had the MRIdian linac machine that has a built in mri so what they see in real time they can treat dynamically. This means the margins (the areas outside of the prostate that radiation exposes you to) is less. Most radiation oncologists will treat the entire prostate PLUS a margin. The MRIdian was a 2 mm margin while most others are 3-5 mm. The Elekta Unity machine is another built in mri radiation machine. If you have not read the Mirage study, you might want to. It was a randomized trial comparing MRI guided real time radiation to non real time radiation machines. It showed a MAJOR difference in side effects and toxicity.

Your responses to your situation are SEVERAL. I d say the end result , no matter what route you choose will be the same. My age and pelvic node cancer involvement made my decision easy. RT. PSA < .01 since 2022. Stage 4 aggressive. Expect a lot of Fatigue in your future. I m ok , just take a nap daily. Bye guy!

@dougharris,
I'd say radiation is your best bet. You might start the dreaded ADT orgovyx before radiation to try and shrink the tumor away from the apex of the prostrate. If you decide on radiation the MRIdian Viewray has the best margins. One to two centimeters less than other radiation machines. MRI guided is best. If you have the five fraction, the treatment is less expensive and easier. I would recommend contacting UCLA's Amar Kishan https://www.uclahealth.org/providers/amar-kishan?utm_source=google&utm_medium=Yext
At least look at his UCLA videos.
Best luck