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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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Except your radiation backup oiption is called “SALVAGE” for a reason. Its a last ditch very low chance option.
Your chance is NOW.
Go here and compare your probability of cure vs the major treatment pathways
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
Don’t use cellphone use a computer.
There are 3 graphs, one each for low, intermediate, and high risk. Sounds like you might be high? (Risk of recurrence after treatment).
The elipses can be confusing. I put a dot on each eclipse and drew a line to make it easier to intemperate. If you need help readin the charts get it.
You will notice that chance of cure starts well for RP but drops as risk increases. At high risk you are down to 40-50% chance of cure.
Compare that to radiation options.
Get Dr Scholz book where you can stage yourself.
You need to learn to survive.
This zone is flooded with bad information. You will hear different stats from every damn doctor. Im sorry but the cancer is not the most dangerous thing here. Getting steered wrong is just as deadly.
Read read read
I would be eyeballing bracytherapy options now.
Sounds like one chance was wasted. You may have a second chance?
@groundhogy I will agree that brachytherapy, especially when it’s combined with other forms of treatment, is excellent and has a high success rate.
But radiation can fail too, right? Yes, you are treating it internally and externally but sometimes this F***er just won’t die…
It strikes me that surgery with follow up SRT and ADT is probably equally effective when compared to Brachy+EBRT+ADT done all at once.
You’re still gonna have men whose cancers recur after both of these treatments.
Phil
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5 Reactions@heavyphil Exactly. As @jeffmarc mentioned in another thread, if some cancer cells have already escaped the prostate and are dormant elsewhere in your body, they can wake up and start growing a tumour any time — 3 months, 3 years, or 3 decades.
There is no medical technology (yet) that can detect individual dormant cancer cells hiding in your blood, organs, bone marrow, or lymph nodes, and there is no procedure — prostatectomy, external-beam radiation, or brachytherapy — that can guarantee the cancer won't recur some day. 😢
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5 Reactions@heavyphil
I have no idea how it came to be that patients started to believe that RT patients do not have BCR ??? O-o
It happens about 10% less in RT BUT one can not irradiate the same spot twice and salvage surgery is almost impossible.
Also, RT patients are inherently older cohort in general and many die from other reasons than PC which removes them from study, so real % of total BCR happening is skewed.
RT for aggressive cancer is even more iffy with results (about 36% have BCR in 15 years according to the latest JAMA article 2023).
The famous "Steve" case with cribriform surviving brachy was a tipping point for me (for my husband brachy was never even "in the picture" lol, he was "take it out guy" from the 3+3 stage). He is especially happy now that he has a second chance to eradicate it IF it really proves to be BCR.