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Trying to choose between radiation and surgery
Diagnosed 7/15/26, 2 of 12 cores 3+4 on both 20% and 30%involvement t1c, have oncologist appointment on 8/20 and Urology surgeon on 9/28, asked my main urologist for a decipher test hopefully it reaches the oncologist before the appointment. If it comes in lower considering optional treatments without adt but if not probably will proceed to nerve sparing surgery also if that was the case I was hoping I could get a lower groin hernia fixed at the same time.
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The deciding factor which could sway me more towards optional treatments is
the decipher score if that comes in somewhat low to intermediate range I
will feel more confident in choosing optional treatments besides surgery.
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Hug
1 ReactionI want to continue to ride bikes after surgery…. What saddle do you recommend to use after my surgery.
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
Thanks thas good information
I'm not sure I'm a avid bike rider also and have not thought about it yet.
@ginger38314
Hi,
Surgery after radiation is possible but more difficult. You have to find a doctor who has done that type of salvage surgery many times.
Dave 3+4
With the information you provided, I would definitely take a look at Tulsa Pro, a focal therapy that is done in an MRI environment. Low risk of side effects, an d all treatment options remain on the table if cancer returns. Click on my profile for my Tulsa experience.
OHSU in Oregon performs those surgeries but your reoccurance has to be
confined and can cause more urinary and rectal symptoms than if you
originally had prostate surgery.
@chuy10
Someone posted this information
Bicycle seat that works well with AUS and prostate cancer patients
https://www.hugeoaks.com/products/hugeoaks-width-continuously-adjustable-bike-seat-comfortable-prostate-friendly-bicycle-saddle-for-mountain-bikes-road-bikes-city-bikes-exercise-bikes
@ginger38314
I am in the process of getting ready for treatment. Have been making the decision of RP vs Radiation. I am 61, so younger than you. I have RP scheduled for September 16th. This is over 1 year from initial biopsy in 2025.
Some thoughts:
1. From your information, you do not want to rush a decision. With current information, I would not worry about taking 6-12 months to make a decision.
2. Most important decision is finding (if you haven’t already) a very good Surgeon, Radiation Oncologist, and treatment center.
3. For the surgeon, you want retzius sparing RA surgery. My surgeon converted to this procedure over 2 years ago.
4. To evaluate radiation options, I would want a center and doctor(s) very skilled in SBRT and HDR. I “think, but do not know” Doctors and Centers good at HDR, will be good at IMRT, SBRT, and other versions of Radiation.
5. Piece together as much information possible. Every person is different and unique. You have to understand, best possible, your information.
-PSA velocity over the past few years. Understanding a low PSA may be seen with significant cancer and a high PSA with no cancer.
-MRI imaging. Do you have visible lesion(s)? If so, Pirads rating. My initial biopsy tested at 3+3, but MRI lesion was Pirads5, this led to more tests and 2nd MRI biopsy showing 4 cores of 3+4. Your MRI image may indicate you may likely only have a small percentage of gleason4. With a small percentage of 4, your case may be closer to 3+3.
-MRI imaging to help understand location of lesion. Is lesion (if seen on MRI) showing symptoms of Extracapsular Extension or any other indication of risk profile for cancer escaping the prostate prior to treatment.
5. I sent my information to TULSA Pro treatment center. Due to size and placement of my lesion, I am not a candidate for TULSA Pro. It was a relatively simple process to be evaluated. You want to do understand your options for focal treatment.
At 61, I have chosen RP. Prostate cancer is slow growing. Looking back at yearly PSA results and the size of lesion, my cancer probably started 15 years ago. Cancer starting in my mid 40’s or at least early 50’s has played a role in my selection of RP over radiation.
I have felt, If I was closer to 70, I would be choosing radiation. However, Each person and decision is unique.
Another good tool is to join ANCAN group. They meet twice per month for low and intermediate group. https://mailchi.mp/ancan/ancan-low-intermediate-prostate-cancer-group-august-10th-8-pm-est
Next Meeting is this next Monday night. Join a few minutes early and tell them you are new.
Best wishes as you learn and go through this process.