1. < Prostate Cancer

Intermediate Risk Prostate Cancer Treatment Decision

Posted by jt14 @jt14, Jun 10 11:08am

I have perused comments in these discussion areas and thought I'd reach out for thoughts on the decision of prostatectomy vs radiation therapy. Thank you in advance for your thoughts.
I am 70 years old in good physical condition (no heart, metabolic or obesity issues). Biopsy showed 5 out of 13 specimens positive ranging as below:
all on one side
Group 1 to Group 4
Gleason 3 + 3 to (just one) 4+4
one with "ductal features"
Most recent PSA 4.8
PET scan negative
I believe from a couple of opinions (top notch institutions)
that mine is fairly aggressive and needs treatment not surveillance.
Except for one surgeon who was adamant that his open surgery would be the best option I have heard that I could rationally choose either radiation or surgery as treatment and I am in that the process now of determining best road forward.
I initially leaned toward robotic surgery ("get it out," benefit of pathological report on the prostate cancer, no long term treatment as with radiation and ADT) but after a recent opinion from a surgeon the thoughts of potentially months of urinary incontinence and much larger chance of ED issues has me rethinking this.
On the other hand weeks to months of radiation treatment and ADT along with the side effects of that and 24-36 months of no/low testosterone and no ability for sex, fatigue, osteoporosis, etc. have me likewise hesitant.
My guess is there is no "right" answer in my case but would very much appreciate feedback from personal experience. Thank you all.

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retireditguy | @retireditguy | 11 hours ago
In reply to @surftohealth88 "Thanks Jeff - did they say for what gleason ? Do you have stats for RT..." + (show)
@surftohealth88

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 🙂

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Hi Surftohealth88. Here's a reference to a (free) Sloan Memorial Kettering database on 10,000 of their patients history after proctectomy. You enter your information and it gives the percentage of BCR. You can play with it and it shows how much the percentage increases due to certain factors (gleason, grade, positive margins, etc):
https://www.mskcc.org/nomograms/prostate/post_op

REPLY
1 reply
surftohealth88 | @surftohealth88 | 10 hours ago
In reply to @retireditguy "Hi Surftohealth88. Here's a reference to a (free) Sloan Memorial Kettering database on 10,000 of their..." + (show)
@retireditguy

Hi Surftohealth88. Here's a reference to a (free) Sloan Memorial Kettering database on 10,000 of their patients history after proctectomy. You enter your information and it gives the percentage of BCR. You can play with it and it shows how much the percentage increases due to certain factors (gleason, grade, positive margins, etc):
https://www.mskcc.org/nomograms/prostate/post_op

Jump to this post

Oh - imagine THAT !!! : )))

Thanks so much for that link < 3

I will try it out tomorrow after I drink some Valerian and Mint tea to calm my nerves ...

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jeff Marchi | @jeffmarc | 8 hours ago
In reply to @surftohealth88 "Thanks Jeff - did they say for what gleason ? Do you have stats for RT..." + (show)
@surftohealth88

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 🙂

Jump to this post

Here is the answer using the query below in google

Approximately 20% to 30% of men experience a recurrence of prostate cancer after radiation treatment, typically within five years following the initial therapy. The likelihood of recurrence can vary based on factors like the extent and aggressiveness of the cancer, according to Johns Hopkins Medicine. Some studies indicate that recurrence rates can range from 15% to 70% after definitive radiation therapy.

You can use this search to find answers by adding for example SBRT before radiation to get the more specific results for that type of radiation
“what percentage of people have reoccurrence after a radiation treatment for prostate cancer”

REPLY
pdcar4756 | @pdcar4756 | 24 minutes ago
In reply to @matthewdore "tk192, OK, good luck in FL. . I have a video call with Mayo MINN tomorrow...." + (show)
@matthewdore

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,

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If you are able to get answers to your questions if you would, please share with us what you were told. You have some very good questions. I had TULSA-PRO at Mayo in Rochester in October 2024. These questions apply to me as well. Thanks much!

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