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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Mayo Clinic Connect
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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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To be brief- Gleason 9 here. Seminal vessel invasion. Lymph nodes too. Age 74 at time of discovery. Had ADT/ 28 RT SESSIONS. PSA < .01 since January 2025. After RT I told oncologist I felt the cancer growth on the seminal vesicle -FALL OFF- while I was laying in bed. The RT seems to have cooked it dead. lol. Feel fine today at age 77. Only need a nap in the afternoon. Don’t forget to watch 77 SUNSET STRIP on old TV when your fatigued- cookie cookie lend me your comb. How’s your MEMORY? Take care.

It seems weird to see anyone make a statement "there is probably no chance of a cure". The Mayo Clinic has a webpage up entitled "Prostate Cancer Recurrence" that states: "For every 10 people treated for early-stage prostate cancer, studies show that 3 to 5 have a prostate cancer recurrence."
https://www.mayoclinic.org/diseases-conditions/prostate-cancer-recurrence/symptoms-causes/syc-20592131
There are different words the docs use to describe future outcomes. Biochemical Recurrence Free Survival until you die of something else describes what most newly diagnosed patients would believe means "cure".

I was astonished when I realized that some docs consider different treatments roughly equivalent if patients survive afterward for comparable lengths of time. One treatment might have a much higher rate of early disease recurrence compared to another, but because there are so many followup therapies that can be applied that keep patients with recurrent cancer alive, the overall length of time of survival after undergoing the two treatments may be described as equivalent.

A patient may not see things this way once they realize what has happened.

If treatment A offers a higher likelihood of disease free recurrence than treatment B, a patient should clearly understand this before making a decision. Other factors will influence the decision such as how do the side effects compare, or how hard is it to access the treatment, etc.

Mack Roach addresses the common perception that if you get surgery and the cancer recurs you can get radiation, whereas if you get radiation first you can't get surgery in this video:

The idea that “if you choose radiation first, you cannot have surgery later” has some truth to it (if you only want surgery for some reason), but is very old-school and doesn’t consider modern treatment techniques.

If there is local recurrence after initial radiation, choice of treatment would depend on the nature of the recurrence; there are other options - focal therapy (e.g., cryo), brachytherapy, SBRT (because they’re all very targetable), and yes even re-radiation in some cases. I personally know two guys who had their prostate recurrence re-treated with SBRT, because the recurrence was a single spot.

So, I wouldn’t let the old “no options if recurrence” philosophy change my initial treatment decision.
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@climateguy
While the study shows three out of five have prostate cancer reoccurrence, when you consider a case of Seminal vesicle invasion, I suspect you would find that the reoccurrence rate is much higher.

That three out of five figure is including everybody, Not just people that had aggressive issues.

I know in my case it was 3 1/2 years after surgery before it came back. I’ve run into people that have gone 10, 20 even 30 years after surgery or radiation before it came back. You know those people are really frustrated finding that out.

@jeffmarc

I have to agree, after all that I saw and read so far (and it is a ton), my opinion is that if you live long enough it will reoccur. 🙁

Since most patients are older man and 20 or 30 years "down the road" never happen to them, good % of patients have "no recurrence" for that reason IMHO.

BUT, who is to look into teeth of a gifted horse ??? !!!! : )))

"Prostatectomy or SBRTw/ADT?"

The answer is yes. 🙂

It's actually pretty amazing that we have multiple excellent and pretty-much equally-effective options (there's also Tulsa Pro). There are differences in possible side-effects, but you don't find out which (if any) side-effects you'll end up with until weeks, months, or even years later, so in a sense, it's out of your control either way.

The statistical comparisons you'll see are largely splitting hairs, especially when they're comparing numbers from different studies with different methodologies, which makes the margins of error swamp any claimed "advantage" of one over the other. The only things worth paying attention to are head-to-head clinical trials that applied the same controls to all participants, but they're relatively rare.

The websites that try to extrapolate from those for things that weren't specifically investigated — e.g. if you're 67, have South Asian ancestry, and your cancer is Gleason 3+4 with no BRCA mutations, treatment X is 15% more effective than treatment Y — are are statistically questionable.

@ecurb yep..77Sunset Strip and Hawaiian Eye..along with Route 66..black and white but so what..we were young ! didn know a prostate from a protestant !