Treatment Decision - Radical Prostatectomy versus Radiation Therapy

More data this morning to throw into the mix. RO order a biopsy based Decipher Genomic Classifier test in support of potential participation in a clinical trial. Results indicated a Decipher Score of 0.88 which puts me in the high risk group for aggressive tumor biology. Everytime I turn around I seem to get more news that pushes the risk higher and higher. This is one crazy disease. Even the treatment decision process sucks the energy out of you.

Waiting for my RO and Surgeon to weigh back in on how this might impact options or standard-of-care going forward.

Here you go engineer..

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.

Here you go engineer..

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.

It's great that this site exists, but as I've mentioned before, use with extreme caution, because it can give you a false sense of confidence.

Combining and comparing data from multiple studies taken at different times with different participants and methodologies massively reduces the accuracy and precision, and it also can't account for other personal factors that your care team would take into accout.

The best way to use it is not as a way to decide, but as a source of informed questions to ask your care team. And pay attention only to large differences; smaller ones are likely just statistical noise.

I'm an avid cyclist and found bike riding, even three months after radiation, is still somewhat uncomfortable. I bought bicycling underwear AND wear bicycling shorts. This combo has helped tremendously and I can cycle again without discomfort. I've also been sticking to paved biking trails and avoiding dirt trails for now but it's really been good for my spirit to get out on the bike now that fall is here. If you're not biking because of discomfort, look into the underwear it might do the trick for you.

I'm an avid cyclist and found bike riding, even three months after radiation, is still somewhat uncomfortable. I bought bicycling underwear AND wear bicycling shorts. This combo has helped tremendously and I can cycle again without discomfort. I've also been sticking to paved biking trails and avoiding dirt trails for now but it's really been good for my spirit to get out on the bike now that fall is here. If you're not biking because of discomfort, look into the underwear it might do the trick for you.

Your #1 Never heard of it not healing well. I have had two different types of radiation. I never had any issues with healing, didn’t even realize I had to heal, never told there was a healing process after radiation. The first time I had radiation I had 35 sessions over seven weeks, never had any side effects of any sort. No surgery before or after. With actual RP surgery, you can also have cells left that can cause problems in the future.

#2 not heard of this being an issue. The bladder shouldn’t be touched/affected by radiation. True that a sling may not be successful after radiation. There are other procedures.

#3. I’m not sure what you mean by surgery. Sure hydrogel includes a procedure, it is done with a needle, not surgery. Removing the hydrogel spaceoar happens naturally, it is absorbed by the body and passed out through urine, again, no surgery involved. And again the markers are placed with a needle not surgery. In my case, they just put tattoos on my stomach.

Surgery almost always results in not being able to get an erection. That’s one good reason to get radiation. There are also new procedures that don’t use radiation and aren’t surgery.

Must admit, never heard of anybody else getting their prostate scraped because of urological problems, that is extremely unusual. Not sure that even makes sense, sure the urethra goes through the prostate, but you wouldn’t scrape the prostate, do you mean you have to have a TURP?

I have attended 2 hour weekly advanced prostate cancer meetings online for five years. Never heard of anybody having a scraping the prostate procedure done.

I’m not sure where you get all this information that is not accurate.

I think everyone's experience, condition and situation is different so I strongly urge everyone to find experts they trust and ask these questions of them. But for your reference on #1 I was told this by 3 urologists including a surgeon and radiation specialist. My brother experienced this and will wear two drainage bags for the rest of his life. On #2 I was told this by 3 urologists also and while the "scraping" terminology may not be common this is a very common procedure that must be done before radiation according these three highly regarded doctors. Regarding #3 I cannot speak from experience but I was told by two radiation specialists at different locations that a surgeon be required . . . however it is outpatient and I understand you not fully anesthetized. Every doctor has described this as surgery which is why I referred to as minor surgery.

I appreciate your response in that everyone should get as much information from people actually going through the experience as possible. My biggest concern with your response that because you have not heard of healing well you assume it is not a critical issue in making a decision on treatment. Not attributing blame as my first 3 doctors did not mention it when discussing treatment options. My suggestion is that you investigate further and ask experts the question and you will find that this is a critical factor everyone should consider in making their decision . . . not saying radiation treatment is not the right solution for yourself and many but it should be part of an informed decision. I hope you take my response in the positive manner intended. I spent many weeks bedside with my brother in hospitals of the last 10 years because of this issue so it gets me a bit wound up.