It can be very high. Lower with lower Gleason, PSA, and clean margins. Put you results in the monogram (only valid with no ADT, radiation). As an example a Gleason 8, 20 PSA comes back as recurrence at 5 years 63%, 10 years 80% without clean margins and 46%, 66% with clean margins. At 4+3, 10 PSA clean margins it is still 30% 5 years and 50% 10 years. At 4+3, 10 PSA clean margins it is 13% 5 years and 25% 10 years.
@jim18 Hi, I have always heard that the reoccurrence rate between robotic surgery and radiations is about equal. From the Mayo clinic . “In one study, survival at 10 years was greater than 99% for men with lower risk disease who had either surgery or radiation. Even among men with higher risk prostate cancer, survival remained high, at about 96% for both treatments.”
@jim18 Hi, I have always heard that the reoccurrence rate between robotic surgery and radiations is about equal. From the Mayo clinic . “In one study, survival at 10 years was greater than 99% for men with lower risk disease who had either surgery or radiation. Even among men with higher risk prostate cancer, survival remained high, at about 96% for both treatments.”
@clevelandguy Yes. For non-metastatic prostate cancer, older research showed a slight overall survival advantage for surgery, but it was biased because younger, healthier patients were more likely to get surgery. Later randomised trials like ProtecT (2023) found 15-year overall survival to be identical for both treatments, at 97%: https://www.nejm.org/doi/full/10.1056/NEJMoa2214122
@jim18 Hi, I have always heard that the reoccurrence rate between robotic surgery and radiations is about equal. From the Mayo clinic . “In one study, survival at 10 years was greater than 99% for men with lower risk disease who had either surgery or radiation. Even among men with higher risk prostate cancer, survival remained high, at about 96% for both treatments.”
@clevelandguy Yes, the 15-year survival rate for SK was 99% for 3+4 (my mistype in post; this had 13% 5 year and 25% 10 year recurrence); that goes to 96% for 4+3 and 91% for 4+4 at time of RALP with no known cancer outside prostate margins. After recurrence usually have radiation. If it goes metastatic than ADT follows. Death rates much lower than recurrence rates. I took this to be how likely is RALP to be one and done. Even with 3+4 and favorable surgical outcomes recurrence is still significant. Older numbers are probably skewed down when RALP was still common on 3+3 cancer with a 10-year recurrence of 5%.
I suspect that moving past the aggregate numbers, the younger you are at the time of your RALP, the more likely you'll live long enough to see recurrence.
(Not based on a study or trial; just an hypothesis.)
@northoftheborder Right you are - Good and valid point... Although I cant see a direct correlation ,there is some correlation with longer life come more problems potentially . It's a very good point ! Like soem men are on ADT , ADT is known to be very hard on your heart and can complicate Cadio vascular things .... Now with Estradiol coming on stream , that may lessen somewhat ! Who knows, Estradiol may be a first line therapy one day (?) .
@northoftheborder Right you are - Good and valid point... Although I cant see a direct correlation ,there is some correlation with longer life come more problems potentially . It's a very good point ! Like soem men are on ADT , ADT is known to be very hard on your heart and can complicate Cadio vascular things .... Now with Estradiol coming on stream , that may lessen somewhat ! Who knows, Estradiol may be a first line therapy one day (?) .
@vancouverislandhiker Absolutely, though Estradiol is contraindicated if you are on blood thinners for a history of clots, as happens to many men as they age, so it won't likely replace ADT entirely.
(In my case, I developed DVT in my left calf while I was paralysed in a hospital bed, and it never recurred once I could walk again, but that still means a doctor wouldn't prescribe Estradiol for me).
That interesting . I know E2 was prescribed in pill form at one point which is not a good thing as it is too much all at once for men's body to handle and clots formed in some people, But with gel and patches I thought the blood clot issues was cleared up(?). But yes, I heard that the pill form was not recommended but the gentle flow of E2 from patch or gel is what is recommended . You had a DVT huh ? I used to get them on very long haul flights of 10+ hours of sitting. I ended up leaving the 1st officer up front while I did some walking back to galley and such for 5 minutes or so every 2-3 hours . These little clots would not be an issue , youth takes care of most of this , but you could feel you legs getting heaving , etc . I make sure I walk and such on long haul flights always now!
The most recent study (June 2025) indicates an interesting trend…BCR is based on your Gleason score going into surgery;
”8-year risks of BCR in the post-2010 era were 21% , 25% , 41% and 60% for low-risk, favorable intermediate risk, unfavorable intermediate risk and high-risk disease, respectively.”
The studies explanation for the overall BCR rate uptick is that, in the past, many more lower risk men chose surgery, who may in actuality had indolent disease and therefore experienced no BCR.
More recently men choosing surgery, typically have higher risk disease, since more indolent, low risk men are avoiding surgery and chosing AS.
Therefore, in the more recent era, with a higher proportion of men choosing surgery who actually having higher risk disease, the resulting effect is to increase the overall level of those who chose surgery to experience BCR.
@jim18 Hi, I have always heard that the reoccurrence rate between robotic surgery and radiations is about equal. From the Mayo clinic . “In one study, survival at 10 years was greater than 99% for men with lower risk disease who had either surgery or radiation. Even among men with higher risk prostate cancer, survival remained high, at about 96% for both treatments.”
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@jim18 Hi, I have always heard that the reoccurrence rate between robotic surgery and radiations is about equal. From the Mayo clinic . “In one study, survival at 10 years was greater than 99% for men with lower risk disease who had either surgery or radiation. Even among men with higher risk prostate cancer, survival remained high, at about 96% for both treatments.”
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3 Reactions@clevelandguy Yes. For non-metastatic prostate cancer, older research showed a slight overall survival advantage for surgery, but it was biased because younger, healthier patients were more likely to get surgery. Later randomised trials like ProtecT (2023) found 15-year overall survival to be identical for both treatments, at 97%:
https://www.nejm.org/doi/full/10.1056/NEJMoa2214122
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2 Reactions@clevelandguy Yes, the 15-year survival rate for SK was 99% for 3+4 (my mistype in post; this had 13% 5 year and 25% 10 year recurrence); that goes to 96% for 4+3 and 91% for 4+4 at time of RALP with no known cancer outside prostate margins. After recurrence usually have radiation. If it goes metastatic than ADT follows. Death rates much lower than recurrence rates. I took this to be how likely is RALP to be one and done. Even with 3+4 and favorable surgical outcomes recurrence is still significant. Older numbers are probably skewed down when RALP was still common on 3+3 cancer with a 10-year recurrence of 5%.
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1 Reaction@northoftheborder Right you are - Good and valid point... Although I cant see a direct correlation ,there is some correlation with longer life come more problems potentially . It's a very good point ! Like soem men are on ADT , ADT is known to be very hard on your heart and can complicate Cadio vascular things .... Now with Estradiol coming on stream , that may lessen somewhat ! Who knows, Estradiol may be a first line therapy one day (?) .
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1 Reaction@vancouverislandhiker Absolutely, though Estradiol is contraindicated if you are on blood thinners for a history of clots, as happens to many men as they age, so it won't likely replace ADT entirely.
(In my case, I developed DVT in my left calf while I was paralysed in a hospital bed, and it never recurred once I could walk again, but that still means a doctor wouldn't prescribe Estradiol for me).
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1 ReactionThat interesting . I know E2 was prescribed in pill form at one point which is not a good thing as it is too much all at once for men's body to handle and clots formed in some people, But with gel and patches I thought the blood clot issues was cleared up(?). But yes, I heard that the pill form was not recommended but the gentle flow of E2 from patch or gel is what is recommended . You had a DVT huh ? I used to get them on very long haul flights of 10+ hours of sitting. I ended up leaving the 1st officer up front while I did some walking back to galley and such for 5 minutes or so every 2-3 hours . These little clots would not be an issue , youth takes care of most of this , but you could feel you legs getting heaving , etc . I make sure I walk and such on long haul flights always now!
The most recent study (June 2025) indicates an interesting trend…BCR is based on your Gleason score going into surgery;
”8-year risks of BCR in the post-2010 era were 21% , 25% , 41% and 60% for low-risk, favorable intermediate risk, unfavorable intermediate risk and high-risk disease, respectively.”
The studies explanation for the overall BCR rate uptick is that, in the past, many more lower risk men chose surgery, who may in actuality had indolent disease and therefore experienced no BCR.
More recently men choosing surgery, typically have higher risk disease, since more indolent, low risk men are avoiding surgery and chosing AS.
Therefore, in the more recent era, with a higher proportion of men choosing surgery who actually having higher risk disease, the resulting effect is to increase the overall level of those who chose surgery to experience BCR.
Bottom Line: The higher your Gleason score going into surgery (or discovered post surgery), the higher the risk of BCR.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11370885/
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1 Reaction@clevelandguy
I keep running into people who have gone 15 20 and 30 years with Gleason nine and are still around.
I was a 4+3 and had surgery followed by radiation a few years later and I have BRCA2 and I’m still around after 16 years.
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1 Reaction@jeffmarc
Without any treatment?
@clevelandguy
After the initial treatment of Surgery or radiation.