Connect
Radiation & Recurrence Treatment (Inside & Outside Prostate)
So a big part of my decision on radiation vs surgery is based on odds of recurrence as I know salvage is more complicated after radiation. (Diagnosed as 3+4 with 10% in 2 areas on one side of the prostate with no cribiform, intraductal and clean PMSA Pet.)
Chat GPT ( know it has limitations) estimates that out of 100 men with my profile 4 men on average will have recurrence locally and 6 men will have recurrence outside the prostate bed. From what I’ve read ….treatment is the same when recurrence is outside the prostate regardless of whether you initially had surgery or radiation.
Assuming these numbers are accurate ( or at least in the ballpark) there’s only a 4% chance ( 4 out 100 men) where salvage treatment would be different ( and admittedly more complicated) if I initially chose radiation vs surgery.
Assuming this is accurate this makes me lean towards radiation…Does this make sense…..am I making this too simplistic?
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
You have a relatively mild case of prostate cancer. And in your situation radiation would probably be just as good as surgery. The difference is that surgery would tell you if it really was a 3+4 with 10%. It could be worse it could be better. You will never know with radiation.
The thing is, the percentages you are seeing are pretty accurate and we don’t frequently hear from people that have such low Gleason Score having reoccurrence.
Getting a decipher score could really cinch it. If you have a real low decipher, then your a chance of reoccurrence is definitely in the bottom percentages.
Some more information
People who have radiation as their primary treatment have been told by doctors that surgery isn’t really an option if there’s a reoccurrence. Other options are not really mentioned..
This study shows that both salvage focal therapy (HIFU and cryotherapy) and salvage surgery were equally effective at extending the life of a patient that started off with radiation.
Those that had focal therapy had fewer perioperative complications.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2844900
-
Like -
Helpful -
Hug
8 ReactionsGood analysis — except for the assumption that salvage surgery is the only option for recurrence.
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 it’s very old-school thinking 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-school “no options if recurrence” philosophy change my primary treatment decision.