Cancer in Prostate and Seminal Vesicles: Prostatectomy or SBRTw/ADT?

Providing as much information as possible will allow for more feedback.
-What is your age?
-PSA history and trend?
-More detailed MRI info? Pirads score of lesion(s)?
-Family History of prostate and other cancers?
-Decipher score?
-Other health issues?
Etc.

Best wishes

For starters, there is probably no chance of a cure, Long-term remission is the most likely thing to happen. If you have surgery, they can follow it with radiation. If you have radiation, they can follow it with focal therapy, Something that is quite successful, but the doctors don’t mention. If the surgery isn’t 100% successful and cancer comes back then you would have radiation but then you would probably need ADT.

In the case of seminal vesicle invasion, it might be better to have IMRT radiation, Which would take at least 20 sessions, Because it can radiate the prostate and the seminal vesicles, lymph nodes and the prostate bed. IMRT using VMAT would be good if available.

Seminal vesicle Invasion is pretty aggressive. Even with surgery, it might make sense to have six months of ADT to see if we can suppress the reoccurrence.

You might get a decipher score to see What the chance of reoccurrence is?. If the decipher score is low, then you don’t need a lot of ADT.

I’ve had prostate cancer for 16 years and I’ve been on ADT for the last eight years. My cancer was reoccurring four times but I’ve been undetectable for 28 months because the drugs are so good. Prostate cancer is a chronic disease for most of us not a deadly disease.

Just some options to think about. You might want to get a second opinion from a center of excellence, Only having one place to get your treatment decisions may not be sufficient. You have an aggressive case of prostate cancer so it really would make sense to ask someone else their opinion.

I am sorry that you have more than initially thought you would have to deal with.
I am a Gleason 3+4, decipher .46. Still deciding Surgery vs Radiation. 74 years old.If you haven't looked into and been advised of any nerve sparing procedures you may want to.Ash Tewari, MBBS, MCh, senior author of the study, chair of the Department of Urology at the Mount Sinai Health System. He uses as other Dr's are trained with this procedure, the hood technique. I wish you the best going forward. Ray
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| @vittles13 made their first post to Prostate Cancer Support Group.

Their discussion:
Cancer in Prostate and Seminal Vesicles: Prostatectomy or SBRTw/ADT?
A couple of months ago, I was diagnosed with Prostate cancer (Gleason 6/7) and was given the choice of prostatectomy or SBRT radiation. I chose SBRT. Had the MRI, which showed some spots the radiologist and my oncologist dismissed as artifacts. Still, to be sure, I had a PET scan, which revealed cancer in the seminal vesicles. Now, my treatment option is: prostatectomy (with a 50/50 chance cure rate), or SBRT with an 18-24mo. ADT (90% cure rate). My oncologist suggests doing the surgery because it retains the SBRT as a 'backup'. This makes sense to me, but I would love to hear other opinions. I know some have a rough time with the after effects of each, and then there are some who skate through with minimal after effects.
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