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Decipher risk: prostatectomy RP vs radiation.
Hi everyone,
I was considering radiation therapy vs. surgery, so my radiation oncologist ordered a Decipher test. My Decipher test results came back at .61, which crosses the threshold from intermediate risk to high risk, meaning radiation would include six months of hormone therapy.
Since I was deciding between RP radical prostatectomy vs. radiation, it seems to me that I definitely need to get the cancer out via surgery vs. doing radiation first. I can't imagine starting with radiation as first course for treatment for me at age 63 in otherwise good health, with 3+4=7 contained Pc.
It sounds like it is rare for most to have Decipher test information prior to a RP since it is a tool for accessing radiation options. . But, my guess is that means the surgeons will be more aggressive in surgery with that knowledge of high risk cells.
Big question: Do you know what I can expect from surgery if they are more vigilant with removal since they would know in advance that the cells are more aggressive?
Guessing nerve sparing is less likely. Not sure if that extends to the bladder neck and stuff like that?
Side note: A big factor I look at in my decision making for surgery vs. radiation is if there is recurrence, what are the salvage treatment options. If I have surgery, than I retain the option for salvage radiation (which looks like it would include hormone therapy). If I do radiation first and there is recurrence, than it's lifelong hormone therapy, which sounds like it doesn't blast the cancer, it just delays it. So, that tells me that surgery is my best first option.
Thanks for your help!
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@jonathanack Hello-I am new to the forum, just got my PET scan results and they are 4+3, so I am at an intermediate risk level. So, the urologist gave me 2 options; I am leaning towards the DaVinci robotic assisted removal, as besides the 3 cores that have the non-cribriform type of cancer structure, I have at least one more area that looks suspicious. I would just like to clear the seed bed for the cancer by removing it vs. continually chasing new spots that show up. I don't like the radiation beads idea either, as they can honeycomb the gland making it more difficult to remove it later.
@tuckerp You're tougher than me. Funny thing....as a long time photographer type, I have actually photographed multiple surgeries...including robotic laparoscopic surgery and been just fine......but when it comes to my own body...I don't want know what there doing in there to my plumbing. 🙂
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1 Reaction@drcopp
A lot of it depends on how old you are. If you’re on your mid to late 70s then five sessions of SBRT could take care of it. They also work if you were younger, and the results are just about equal to surgery. A lot fewer side effects at the time compared to surgery.
Are they able to spare the nerves if you do surgery? If not, then getting an erection is a real problem. There are Solutions, but you definitely want to ask the doctor if they can spare the nerves.
While large cribriform is A real problem were any of these found in your biopsy, intraductal, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.
Did you get a PSMA PET scan? That could tell whether or not the cancer has spread beyond your prostate and needs to be handled differently than surgery.
I found out I was a 4+3 after surgery and it gave me 3 1/2 years before my cancer came back. I have a genetic problem, so that’s why it reoccurs.
If you want to know if yours is going to reoccur, you should get a decipher test and an Hereditary, genetic test. Those two can narrow down the possibility of you having future problems.
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3 Reactions@drcopp
Welcome to Crew!
I am far less well informed than many of our cohorts here, but happy to help answer any questions. I can honestly say that a couple things are more important than I had initially thought: Exercise consistently, Your wife or partner, and understanding that though our situation is not ideal... a lot of people have a much more grim issue.
What Jeff M has noted below matches what my docs advised.
I am a big advocate of second / third opinions as well. Also, I Jeff also mentioned, a decipher test. That test had a lot of influence from my oncologists perspective (Joseph Wagner - Hartford Tallwood Mens Health). Wagner was one of the first to use the DaVinci...he was very candid with me re: the cribriform... So, so far so good.
My SBRT treatment came along with 120 days of Orgovys (just finished). My psa test was this week and ... undetectable and less than .1 (mine was never all that high 4.7 tops).
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2 Reactions@jeffmarc
I am still young enough to handle a surgery or radiation-mid-60's. I was checked for genetic things on two studies and nothing came up, but my brother had the same thing that I do, with a 3+4/7 and no cribriform for either of us. He has a 0 PSA score and no return now past 5 years.
I got the PET scan and no metastasis, so thank you; I will ask about the Decipher test.
I did send off for the PROMISE testing and nothing showed up. My fusion biopsy showed another suspicious area on the opposite side of the cancer, besides the above adenocarcinoma in 3 of 15 core samples.
The surgeon is the best and has the most cases under his belt in our entire large metro region, has been using the DaVinci for some time now. The device can miss the nerves and I was told that the operation takes about 3 hours.
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