Biopsy results

I am 3+4 with 10% pattern 4 but I have a lot more 3+3 and bilateral disease although no other risk features. My decipher was .49 and despite a favorable baseline in terms of metastasis free survival at 10 years, after all my consultations I decided on 6 months of ADT and SBRT regardless of what ArteraAI says. I’m concerned about the ADT but even if it improves my odds a little I’m willing to do it.

I would get a decipher test done and that could clarify the situation alittle bit more. In my case had I had only a .8cm lesion 2 cores 3+4 10% component on each but high decipher. If the score was low I definitely would have chose sbrt without adt which adt would only add an extra 5%, so to me that's not worth it. So opted for surgery because if reoccurance happens can always do radiation later. Surgery scheduled for mid February.

@ginger38314 that was sort of my take until the RO said "there is an absolute benefit and the toxicity from a 6 month course of ADT is temporary". The Decipher studies that show a 8-10% benefit of adding ADT lump intermediate and high risk decipher scores into the same bucket. And its impossible to tell within that bucket who is getting the bigger benefit and who isn't. The study does show an absolute benefit and in his mind even with a strong baseline it is worth the temporary side effects of ADT. My baseline is a 95.3% chance of being metastatic free in 10yrs. I was initially resistant to that but now I'm more accepting of that philosophy and trying to intervene to avoid the worst ADT side effects.

My 10 year metastasis was not that far off yours at 4.7% mine was 6%, with
high decipher thanks to favorable features. Like I said originally was
going with sbrt and no adt but that was with low decipher which was 90%
cure rate without and 95%with adt. I figure if I have to I will do adt
later if reoccurance happens with radiation, hopefully it won't. I'm hoping
my daily walks last 10 years of 10 miles daily and lifting weights 5 days a
week will help keep reoccurance at bay. Good luck.

Did you get a chance to speak to a radiation oncologist to decide whether that was a good option? Five sessions of SBRT radiation is commonly used with the early prostate cancer you have.

If you do have surgery, you want a doctor that can do nerve Sparing surgery. That is something you need to discuss with the surgeon. There is also Retzius Sparing surgery, which greatly reduces the chance of incontinence. If you can find a surgeon that can do both that is ideal.

brown4644
I have posted about my experience with Retzius Sparing and Nerve Sparing on this board and I don’t know when you were doing your research regarding surgery you may have come upon it. Existing members that have viewed my posts regarding this can disregard reading any further if they wish as it is all repeated information.

Regarding nerve sparing, definitely be aware that may or may not be possible depending on the severity of your cancer spread and the cancer being out of the capsule. There are two nerve bundles, one on each side. Again depending on circumstances, a skilled surgeon can avoid and save the bundles 100% or sometimes 50% or more. He might save both sides 100%, one side 100%, one side 50%, one side 100%, one side 0%, 50% each side, none at all. This is all depending. What is important is just because you hear the Surgeon say “I will do nerve sparing”, you need to ask to what extent or percent he expects to save of the bundles from his review of your MRI and biopsies. He generally has an idea based on the MRI and biopsy where at least the cancer that had been identified is, well within the prostate, on the edges affecting possible margin cutting outcomes and nerve bundles. Don’t just believe by his statement regarding nerve sparing surgery that you are in the clear and then be terribly disappointed afterwards with the results. It is better to know upfront what can be possibly saved. As I just mentioned this depends if the tumor is deep in prostate or was on just one side or tumors on each side. The point is that there are limits due to the extent of your cancer in what surgeon’s are able to do regarding this and be prepared regarding nerve sparing and your expectations when you do hear they will do nerve sparing. You need to ask. Some patients hear nerve sparing and just believe that keeps them from ED issues.

It is important to note that nerve sparing can be done with both surgical techniques of a regular RALP and Retzius sparing RALP, but Retzius sparing cannot be done with the standard RALP

Now for Retzius sparing RALP, again different from nerve sparing, cannot be done by a typical surgeon performing a RALP. It actually now has it’s own acronym within the medical field as it has gained wider surgical availability as more surgeons become trained due to it’s advantages. It is RS-RALP.

The significance of Retzius sparing is the non cutting of the Puboprostatic ligament tethering the bladder. This is going to substantially improve more immediate continence. This procedure has a longer learning curve for surgeons so you definitely want an experienced surgeon in this technique not a newbie. There are also two surgical techniques related to the Retzius space done by surgeons trained in one of those two techniques to improve continence. One is called the Anterior approach, referred to as a Hood’s technique to protect the Retzius space ( different from Retzius sparing) and the other Posterior approach which is actually the only one referred to as Retzius sparing surgery to completely avoid the space. The surgeon comes in behind and underneath the bladder. The posterior approach the surgeon actually looks at your anatomy in reverse.

I had Retzius sparing. The anterior approach gets called the anterior fascia sparing while Retzius sparing is called Retzius sparing. It is again something to be cognizant of the differences, but in both those approaches the Puboprostatic ligament is not cut to improve continence.
I am happy to say I recently passed my two year surgery date and on my 2 year PSA was non detectable. I went into surgery a Gleason 8 and came out a Gleason unfavorable 7 (4+3) after the pathology. I was totally continent immediately and ED was minimal and resolved by 6 months with viagra. I am currently 73.
It seems things have moved quickly with surgery scheduled very fast. Don’t rush, you have time to obtain second opinions.