ProstoxUltra & Prostox CFRT both high risk-switch to RALP?

Have you investigated Tulsa pro? It might wreck your life less than radiation side affects or being neutered by the rp

@wwsmith
What study are you referring to that says radiation Is that much better than RP. I’ve not seen anything like that recently, The PCRI conference last month didn’t discuss it. The studies I’ve seen have shown that both of them are equally successful long-term.

When people here mention not being able to radiate twice, they’re talking about radiating the same area that was radiated by either initial radiation or salvage radiation. That radiation is considered the maximum you can have in that area for the life. It’s a well-known fact that SBRT can be used to metastasis that are not in that area.

The study I am thinking of was mentioned on Inspire. I will get a link to it. But first you have to define equal outcomes. If by equal, you mean time to death then yes, RP and radiation yield equal time to death on aggregate. But there is a big difference between your last years dying from a distant metastasis or just dying from other natural causes. And that is the key difference between an RP and radiation. With an RP there is a greater chance of ultimately experiencing a distant metastasis than there is from being initially treated with radiation.

@wwsmith you said “ With an RP there is a greater chance of ultimately experiencing a distant metastasis than there is from being initially treated with radiation.”

There seems to be some reasoning behind this, but, Tests have shown that people that have RP’s are more likely to have better survival after having a DM. This also seems to be true in more advanced cases, not cases were the cancer as isolated to the prostate without advanced issues.

Recent studies, especially for high-risk localized prostate cancer (PCa), suggest radiotherapy (RT) may actually provide a lower risk of distant metastasis (DM) compared to radical prostatectomy (RP), contradicting the idea that RP is better; some research indicates RT-based treatment significantly lowers DM risk, while other analyses show similar overall outcomes but with RT potentially controlling progression better in unfavorable cases, though RP offers better survival after metastasis develops.

@jeffmarc

Thanks Jeff for listing different results of different studies which all point to a finesse needed in making decision on INDIVIDUAL bases.

There is just no one general guidance for every possible case. There are so many subgroups in each stage and group and it all also depends of age, comorbidities, life expectancy, etc etc. , as well as of personal preference, lifestyle and personal risk tolerance.

If we knew what we know now - that gland would have been out at 3+3 when micro mets are really non existent. We trusted our incompetent urologist who did one single biopsy in 7 years and that is why we ended in this mess of 4+5 at the end, and with all AS and MRIs etc etc , AS failed 100%.

My husband recovered so nicely after RP (knock the wood) and it was always our preferred treatment. When he got his first 3+3 we decided that he will have RP if there is any movement in wrong direction (a single 3+4 core), but alas, no additional biopsy was ever done since his genetic results showed super low risk *eyeroll.

PC is a "low risk" at that particular moment of time- in the next year or two it can become aggressive just like that , and we did not know that : (((. So, again, IF we knew what we know now - RP would have happened at 3+3 .

@wwsmith
I forgot that my own case sort of disagrees with the logic of what you’re coming up with.

I had surgery 16 years ago and 3 1/2 years later my PSA started rising so I had salvage radiation. 2 1/2 years after that I had to Go on Lupron because my PSA started rising again. Became castrate resistant 2 1/2 years later.

I’ve been on a variety of drugs since then. Five years ago I found out I have BRCA2, which is why it keeps coming back.

Two years ago a metastasis Wrapped around my L4 on my spine was zapped with three sessions of SBRT. Since then, I’ve been undetectable for the last 25 months while on Orgovyx and Nubeqa. When Nubeq Stops working I can start with a PARP inhibitor. When that stops working, I can have Pluvicto and/or chemo. I don’t think I’m going anywhere soon.

Starting off with surgery gave me 3 1/2 three years before it came back. If I started off with radiation, it probably would’ve been a lot less than 6 years before I would’ve needed to go on Lupron

Maybe I’m just one case, But with BRCA2 it’s an aggressive case and surgery her seemed to extend my survival time.

@jeffmarc Medical and biological matters are so complex and difficult to predict at first diagnosis that no one can really know what is the "best" treatment plan for any given situation. In your own case, what I am most impressed with is your ability to survive, even thrive, with a long term metastatic condition. For those of us who might ultimately evolve to that situation, you are a great example of how life can still be good and long even with a distant metastatic condition.

What I wonder about in situations like yours when you were first diagnosed and you had the opportunity to either go with surgery or with a comprehensive radiation plan combined with ADT, could the radiation to both the prostate gland and the greater pelvic region kill all the cancer that was present and possibly prevent any future recurrence? Of course, if undetected cancer had already spread further than the pelvic region then that approach would not have worked either. Also, if your cancer was so aggressive and so persistent to live that even high dose radiation with ADT couldn't kill all of it then you would still have had a recurrence leading to eventual distant metastasis.

We can always wonder about all kinds of what ifs after the fact, but for many facing these issues right now they and their doctors have to analyze all the historical statistics and also give some consideration to current anecdotal information to come up with what they believe is the best plan. And there will usually be no obvious best plan.

@wwsmith
Like other people who have advanced cases, my BRCA2 problem is something that cannot be fixed by radiation or surgery alone. Back then, IMRT was the only type of radiation available. Yes in San Diego they were doing proton radiation, but there was no easy way to find out about that. They didn’t have the communities they have today that tell people what possibilities there are. Because my cancer was so isolated they probably would not have treated the prostate bed and lymph nodes. The BRCA2 can restart the cancer by making DNA errors, Like it did to give it to me in the first place.

We still hear about people whose cancer didn’t spread beyond the prostate that have reoccurrences. Doesn’t matter which treatment they had, It comes back.

If only there was a simple solution. Someday there will be.