@heavyphil

Not sure where your 30% failure rate, for definitive treatment, comes from; but the 2024 research I cited earlier indicates that the BCR rate, 8 years post RALP, varies significantly, based on biopsy determined risk category, from 21% to 60%.

I’ve heard Dr. Matt Cooperberg (UCSF) indicate that if he has a Gleason 3+3 patient decide anything other than active surveillance, he feels he has not adequately informed him of the true nature of his disease.

IMHO, under the current way of labeling “prostate cancer”, it’s two different diseases…based on risk category, regarding its life threatening nature.

That’s why I think evidence based, patient controllable interventions, are primarily for managing “low risk” PCa men, defined either as being diagnosed with Gleason 3+3 or having a low risk Decipher score.

Higher risk PCa should be actively treated, even though additional treatment(s), down the road, is(are) more likely to be needed.

What I wonder is how many men with low risk PCa go forward with active treatment and then attribute their “remission” to the active treatment, when in fact they may have done just as well….possibly many more years without potential side effects….if they had no active treatment and/or had waited until higher risk disease had been confirmed.