Connect
← Return to prostatectomy vs radiation?
Discussion
Comment receiving replies
Short/quick answer that others that may echo: When discussing my options after biopsy revealed my cancer, my urologist said that you never want to do radiation "first" if you have the option for prostatectomy. He said that radiation turns your prostate into "concrete". If the radiation does "not" work, you are no longer a candidate for prostatectomy. A radiation therapy treated prostate is not suitable for prostatectomy. He said "you have no choice...I am taking your prostate."
So...I had my DaVinci robotic assisted radical prostatectomy. While there are several unpleasant outcomes to radical prostatectomy, I was glad I had the surgery. Here is why:
I was diagnosed in January after December biopsies revealed: Gleason 3+4 = 7 with only 10% being 4's. My urologist assured me that I'll be alive in 15 years. But...I think urologists fall into the trap of "since everyone's prostate cancer grows slowly, we can wait a couple months for surgery and/or radiation." And of course, nothing is known after biopsy except Gleason score. It was only after surgery that my surgical pathology report revealed slight invasion into my left seminal vesicle (both seminal vesicles and vas deferens were removed as part of the surgical procedure). I was one of the unlucky 10-20% that have "surgical margins" (cancerous tissue left behind by the surgeon). I also had cribriform glands. Taken together I am classified as a "pT3b" with a much poorer long term outcome. I've gone from a "sure thing 15 year or greater survival, to something that the literatures says is more like 5-10 years. Even though the prostate, seminal vesicles, and vas deferens were removed, a pT3b cancer just always seems to "come back." "Lucky me."
Replies to "Short/quick answer that others that may echo: When discussing my options after biopsy revealed my cancer,..."
The idea that “if you choose radiation first, you cannot have surgery later” has some truth to it, but is old-school and doesn’t consider modern treatment techniques.
If there is local recurrence after initial radiation, these days choice of treatment would depend on the nature of the recurrence; there are other options - focal therapy (e.g., cryo), brachytherapy, SBRT, and yes even re-radiation (w/rectal spacer) in some cases. Dr. Rossi answers a question about this in his presentation during the 2023 Mid-Year PCRI conference: https://www.youtube.com/live/WTqPnSRYtW4?feature=share
—> Starting at time: 4:53:00.
(I personally know two guys who had their prostate cancer recurrence re-treated with SBRT, because the recurrence was a single spot.)
So, I wouldn’t let the old school “no options if recurrence after initial radiation” philosophy change an initial radiation treatment decision.
So with all those negative factors at work, what is your current plan of action?
Connect
@rlpostrp
I have read and been told it is very hard to find a urologist who can do surgery on prostate after radiation and cited the reasons you did.
However they are out there but very hard to find as takes some exceptional skills to do it.
I think MCC posters will agree the statement of urologist that you will die of something else or you will be alive in 15 years and assume everyone cancer is slow growing. They should just be honest and say we will do everything to keep you cancer free.
Can I asked did you have the Decipher test done after your biopsies? That test gives a more precside diagnosis of the risk level of your cancer.
I had proton radiation done (30 rounds) in 2023 with a PSA of .10 just done 2 years later.
Has your urologist referred you to a R/O? Can they not do radiation on the others areas where cancer is.
I know if my cancer would come back I would look at new treatments even clinical trials. I know Mayo is working on a type protein that attaches to prostate cancer cells only and kills them leaving healthly cells alone. I am unsure if in clinical trial basis yet.
I think what a urologist and R/O should give is the options for treatments and the pros and cons of radiation and RP.