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ADT first then Radiation? Or Surgery?

Prostate Cancer | Last Active: 2 days ago | Replies (7)
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@heavyphil

I can see why the ADT before treatment would be helpful; it would serve to shrink the prostate cells encroaching on the bladder wall and give more separation for whatever will be done.
At age 65, surgery is a good first choice IMO. A very skilled surgeon can dissect the cancerous tissue away from the bladder and if you need SRT down the road it should not be a problem.
However, radiation therapy, although extremely precise, does involve a margin of anywhere from 2-5 mms depending on the machine used (Cyberknife vs MRI
Guided. So bladder damage might be inevitable if all the cancer is to be eradicated. And if treatment fails, your options become limited.
I chose surgery at age 64 (kicking and screaming) purely to get a second chance if needed…and it was.
Phil

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Replies to "I can see why the ADT before treatment would be helpful; it would serve to shrink..."
brianjarvis | @brianjarvis | 2 days ago

What I found as I was reviewing resources back in 2019/2020 (for my 2021 proton radiation treatments) was that if the treatment failed, all the options were still available (depending on the nature of the recurrence) —> focal therapy, brachytherapy, SBRT, and sometimes even re-radiation (depending on how well the rectum was protected during initial radiation),

Then, at the 2023 PCRI mid-year conference, I heard Dr. Rossi say pretty much the same thing in his presentation: starting at 4:53:00 (Re-radiation) at https://www.youtube.com/live/WTqPnSRYtW4?feature=share

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