Radiation vs RARP for IDC prostate cancer with high Decipher?

unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i have IDC-p present in 3 cores and Decipher score of 98.

Im looking for an aggressive treatment plan, but just getting standard treatment options. One recommendation is to skip the RARP altogether and go straight to hormone/radiation. I gotta believe yanking that thing out is step one. Also, i see early studies that show that IDC doesnt always respond well to hormone/radiation. it appears that there IS no aggressive treatment option for IDC, and a lot of early work is going into trying to identify better treatment options.

Anyone who has any similar experience and/or intelligence they can share would be greatly appreciated.

With those cells and high Decipher score, I would advocate for surgery first. You have to get that gland OUT. Surgical pathology, lymph node analysis will give a better idea of where you really stand.
But if you are in your late 70’s or early 80’s, ADT + radiation might be less traumatic and just as curative considering your expected life span

thanks for the input. im 70 so borderline.

unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i have IDC-p present in 3 cores and Decipher score of 98.

Im looking for an aggressive treatment plan, but just getting standard treatment options. One recommendation is to skip the RARP altogether and go straight to hormone/radiation. I gotta believe yanking that thing out is step one. Also, i see early studies that show that IDC doesnt always respond well to hormone/radiation. it appears that there IS no aggressive treatment option for IDC, and a lot of early work is going into trying to identify better treatment options.

Anyone who has any similar experience and/or intelligence they can share would be greatly appreciated.

Hi, my husband has IDC and some cribriform in one single core, so I did bunch of reading. IDC, cribriform and PDA are just recently recognized as special entities with different predictive implications. There are a bunch of studies now done but none have definitive answers YET . One thing that is sure is that all have unfavorable effect and that is because those variants have a lot of mutations present and those cells even possibly form self protective micro environments. All in all , there is a study that supports RP and we will follow that study. Of course there are some studies that show no specific benefit of RP but we will choose RP. Why - because those cells often evade standard therapies due to so many mutations so by using pure logic physically eliminating those lesions might help. I mean, what is person to do at this point ? There is consensus that those cohorts of patients need novel approach but no new or personalized protocol exists at this point. The ONLY concrete study that showed definite result was in comparison of different ADT drugs and conclusion was that Abiraterone is superior to Docetaxel as first-line treatment for IDC-P . I am completely new to this murky world of PC so I have zero knowledge about ADT protocols and I hope others will jump here to explain what Abiraterone is and how it differs from regular ADT.
BTW - this study also mentioned that 28% of IDC-P positive cases on needle biopsy were actually IDC-P negative at the time of RP (?!?????). WHAAAAA Somebody just shoot me already ...

believe me, most of us feel your pain! PC is incredibly complex with multiple solutions, and no clear path to the promised land! Find the best people you can to help sort out the pros and cons. I agree there seems to be no treatment regimen in place for idc, which is shocking.

im going with RP as some retrospective studies show IDC may not be as receptive to hormones and RT. (no clinical studies). plus, i want the pathology that will help map the path forward. can also check lymph nodes and seminal vesicles. and it leaves radiation as an option if necessary.

Hi, my husband has IDC and some cribriform in one single core, so I did bunch of reading. IDC, cribriform and PDA are just recently recognized as special entities with different predictive implications. There are a bunch of studies now done but none have definitive answers YET . One thing that is sure is that all have unfavorable effect and that is because those variants have a lot of mutations present and those cells even possibly form self protective micro environments. All in all , there is a study that supports RP and we will follow that study. Of course there are some studies that show no specific benefit of RP but we will choose RP. Why - because those cells often evade standard therapies due to so many mutations so by using pure logic physically eliminating those lesions might help. I mean, what is person to do at this point ? There is consensus that those cohorts of patients need novel approach but no new or personalized protocol exists at this point. The ONLY concrete study that showed definite result was in comparison of different ADT drugs and conclusion was that Abiraterone is superior to Docetaxel as first-line treatment for IDC-P . I am completely new to this murky world of PC so I have zero knowledge about ADT protocols and I hope others will jump here to explain what Abiraterone is and how it differs from regular ADT.
BTW - this study also mentioned that 28% of IDC-P positive cases on needle biopsy were actually IDC-P negative at the time of RP (?!?????). WHAAAAA Somebody just shoot me already ...

Yes, I forgot to mention that - analysis after surgery will hopefully give us extra insight about "margins", actual gleason, and involvement (or not) of lymph nodes. The comforting thing is that researchers are now finally looking into IDC-P and other variants and are trying to find better treatment protocols. I can not even blame them since there are also so many sub-variants and many differ not only on morphological level but on molecular one too.

I’m laughing at that, surfer, because reading about all those molecular processes and which enzymes donate x amount of electrons in one instance, but not in others if a mutase in an acidic milieu is involved, is what made me finally throw up my hands and cry “Uncle”!!
This cancer - like all of them - is like something from a sci-fi movie that you can’t kill, won’t die and adapts to anything you throw at it.
ATOMS are involved in its pathogenesis and teams of brilliant PhD’s can only scratch the surface on trying to figure out what makes it tick.
And even IF the biochemistry is understood, it doesn’t mean that the cancer cells will respond in a predictable way. It becomes like shooting craps in an alley, wearing a starched white lab coat…Best,
Phil

Not sure if you saw this study, but it discusses the problem with patients who have cribriform And then have SBRT radiation. In a very high percentage of cases, there is a reoccurrence, They actually did a radical prostatectomy for a bunch of these people to see what Was going on after radiation.
https://www.sciencedirect.com/science/article/pii/S0893395222002629#bib27
Then there this discussion which covers cribriform risk as well.
https://www.urotoday.com/video-lectures/a-journal-club-for-patients-with-prostate-cancer/video/mediaitem/4452-unfavorable-histology-classification-aims-to-reduce-unnecessary-treatment-journal-club-jesse-mckenney-cornelia-ding.html
Docetaxel is chemo therapy. If a patient has a lot of Metz then they do triplet therapy with ADT, Abiraterone and CHEMO. Otherwise they do doublet therapy with ADT and Abiraterone.