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Decipher risk: prostatectomy RP vs radiation.
Prostate Cancer | Last Active: Mar 14 11:09am | Replies (75)Comment receiving replies
@fritzo I am not aware of a similar nomogram prediction on recurrence after radiation treatment. I think such a nomogram would be more difficult to create because there are so many radiation types (IMRT, SBRT, LDR brachytherapy, HDR brachytherapy, and combinations of these) along with various time lengths of ADT involved. As an example, in my own case I had 26 IMRT sessions, one HDR brachytherapy session and one year of ADT.
The side effects from an RP are harsh, immediate, and often long lasting. Those of us choosing radiation as a primary treatment want to avoid those severe side effects and typically choose an aggressive radiation plan such that the odds are good that primary radiation is the only treatment we will need for life. But even if that didn't happen, as @brianjarvis mentioned there are numerous treatments that can follow radiation if need be, even radiation itself. SBRT can be used as spot radiation multiple times where ever needed. All the focal therapies can be used on metastatic spots as well. What can't be done twice is wide area radiation across healthy tissue that has already been radiated. But a recurrence after radiation as a primary treatment is not likely to need that. And if a systemic treatment were needed for a recurrence after radiation as a primary treatment, there are the new drugs like Nubeqa and new procedures like Pluvicto. According to @jeffmarc there are also numerous new treatments under development right now that will be even better than what we have today. As such, I think it is an outdated knock on radiation as a primary treatment that follow-up treatments are limited.
And yes, joining the Inspire cancer forum is very worthwhile. It allows for lengthy blogs as you can see mine here https://www.inspire.com/m/williamwattsmith/about/
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@wwsmith
Thanks so much William! Opening my eyes that radiation may still be an option. My big concern was recurrence treatment options. Now I know that while you can't re-radiate the entire area, spot treatment options are viable, as well as new drug possibilities.
This is big-thank you!
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@wwsmith Instead of nomograms, men might even have to seek out one-by-one individual clinical trials like COMPPARE, PARTIQoL, ProtectT, FLAME and many others that look at each of the treatment types or treatment methods, compares them, and then publishes the data. That may entail looking through dozens (hundreds?) of clinical trials for the one(s) that might apply to one’s specific diagnostic situation.
As just one example, in 2023 the results of the ProtectT trial (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122) came out comparing external radiation (IMRT w/ADT) against both surgery and active surveillance, and found that survival rates comparing surgery with radiation are statistically equivalent no matter what treatment chosen (and that active surveillance was actually only statistically a little worse), and that the treatment decision is mainly decided on side-effects and quality-of-life (or as that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).
And even the ProtectT trial results I would supplement with more research because ProtectT looked at men who were treated between 1999-2009, well before today’s next-generation imaging techniques, and modern diagnostic tools and treatments were available. (I first heard about that report on the evening news (https://www.nbcnews.com/news/amp/rcna74512), and then had to do some serious digging to find the trial report: ProtectT.)