Intermediate Risk Prostate Cancer Treatment Decision

I am glad you are pleased with your decision so far. I hope things continue to go well for you!

I elected RP in a similar situation at a similar age. I also feel pleased with my decision so far. I am now 3 years plus out. They did find cancer at the margin ("positive margin") when they did the pathology, but so far nothing has come of that. I am grateful.

BTW, I am not sure where you got your stats about incontinence and impotence, but I think many would disagree with those statistics. I have had the opportunity to read and research much more extensively in the three years after my surgery than I had in those very quick, rapidly getting up to speed weeks between initial (renewed) concerns about prostate cancer and the decisions that had to be made then.

tk192,

what have you decided? my numbers are similar. I am looking at HIFU or Cryo at center of Excellence.

Going to Mayo in FL to meet with them regarding v Tulsa Pro on the 26th. I’m leaning to radiology vs radical surgery if and only if I don’t qualify for Tulsa Pro

tk192,

OK, good luck in FL. .

I have a video call with Mayo MINN tomorrow. I'm not sure what types of Focal Therapy they do................HIFU, Tulsa, Cryo??? I have researched them all. But my first question will be" Does the high decipher score point you to certain therapies or are Focal options still on the table?
Second question: what are long term probabilities of recurrence for Focal Therapies? My research shows (approx. ) 25% recurrence with Focal vs. 6% recurrence with Radical Prostatectomy and Radiation. I'm going to ask Mayo if there is any way to get that 25% number lower. Age, health, family history, MRI/imaging advances, ......... etc.

Third question: If recurrence, ........ex. after 4 years, .........will the recurrence be in the prostate or will it have spread to outside the prostate? Is that where the Decipher score is telling? That is the big question.

Good Luck again,

INCONTINENCE - only about 5% of men experience permanent incontinence 12 mos post robotic RP

Just to make stats correct here .

If you ever see higher number it is referring to a period immediately post surgery. As the time passes there is great improvement in continence as well as in ED.

Also - most of the time with localized cancer "everything is on the table" and available, it is just the matter of one's preferences and one's risk tolerance and statistical results.

Anecdotally…
Radiation can be just as destructive or more so than surgery. It wasn’t the prostatectomy that nearly ruined my life, it was the salvage post-surgery radiation required if the surgery doesn’t get it all and PSA rises.

Post-radiation >>> Impotence, incontinence, urethral stricture, Hemorrhagic bladder, urinary retention, anemia. Hard to stop the bleeding. Sorry if this sounds frightening , but we are all truly between a rock and a hard place. I hope your decision turns out to be the right one for you.

My research indicates recurrence rates for RP at 5 yrs 10-25%, double that for 4-3 Gleason vs 3-4, 10-20% for radiation but half that with ADT hormone therapy added, Focal therapies are 20-30%. All of these have similar outcomes at 10 years add 10%-15% to the 5 year risk rates, but some focal therapies don't have 10 year results yet (Tulsa). My call with Mayo nurse is tomorrow. Meeting doctors 26th.

Good luck

It is not anecdotally, it is A FACT.

One have the same possibility of the same side effects and even some more with radiation, it is just that they appear later and with RP you can possibly have ED and incontinence initially but than incontinence improves over the course of one year and ED over the course of 2 years with proper rehabilitation.

Why is nobody mentioning those facts is beyond me.

Yes, there will be cases with zero side effects in both groups but the same goes for cases who do have side effects - they are present also in BOTH groups.

According to Zero and NIH

Overall, studies show that about 20–40% of men will have a recurrence at some point after surgery. For example, one large study found that 27% developed biochemical recurrence (a rise in PSA) after prostatectomy, with 5- and 10-year recurrence rates of 21% and 29%, respectively. Long-term, the risk of recurrence can reach up to 32–40% over 15–20 years

Thanks Jeff - did they say for what gleason ?

Do you have stats for RT ?

I mean, for us RP is a must, but for the sake of other members here it would be nice to have some links for RT and RP and possibly done in more recent years and for the same gleason score.

Thanks in advance 🙂