What are the Odds No Cancer Ever Returns After a radical prostatectomy

@bens1. Have you decided which approach you would like to do?

My brother was diagnosed with prostate cancer in 2020 and he had a radical prostatectomy. We are very close so he talked with me about his worries and the decisions he was trying to make.

I can't answer your question because honestly I don't know. Whether you choose a radical prostatectomy or another approach such as radiation therapy you will be monitored very carefully over time as my brother is now. This is a question to ask your doctors. The biopsy will provide you with more information that you can talk with your doctors about.

Are you in the U.S.? If so, are you going to a comprehensive cancer center where all of the providers, services and procedures are coordinated? Here is a list of National Cancer Institutes where they provide treatment, conduct research, and are up on all the latest research.

-- https://www.cancer.gov/research/infrastructure/cancer-centers

Your biopsy is coming up next week. Will you come back and let us know about the results? You are getting good support and information from the members who have been where you are now.

My understanding is that the various treatments are effective AND have major side-effects, so the Quality of Life (QoL) becomes a major deciding factor.
See Dr. Mulhall's videos and book for what to do about some of the side-effects.

Problem is, you can find a good, bad or indifferent result for any of the treatments.
Do look for recent results when considering radiation, as the technology and techniques have greatly improved over the years. 15+ years ago they did it completely differently.

It's a numbers game, as doctors don't have tests or scans that can examine every cell in your body (or at least not one you survive), so how could they tell? What is available is statistics for men with similar disease, age, etc.

Please see the 2022 Virtual Conference Day 1 at the PCRI.org YouTube channel, there's lots of info and IIRC percentages for each treatment.

What I am seeing as having the best numbers for my situation is EBRT + ADT + HDR brachytherapy boost.

If getting ADT, the side-effects are nasty (it has to harm the cancer cells, after all, and they are not as different from normal cells as would be convenient for treatment) so there are mitigations you really want to do.

Thanks @naturegirl5

From the generous feedback I have received here, from what I have read and listened to that there is a real conflict industry wide as to which is best (via the doctors), internal conflicts of interest (by the doctors) and to some degree best guesses based on data. That’s not to say doctors are not doing their best only that it seems my decision may be based more on quality of life choices/comfort/convenience choices if the two general solutions have basically the same results, doctors skills notwithstanding.

I am in the US, Florida. It’s also one thing finding a surgeon who has done robotic prostatectomy many times successfully and another thing finding the right urologist/oncologist team who is skilled at making those chemical and radiation choices (given biopsy, pathology and genetic testing) that yield the best results while minimizing the side effects.

I will be back to talk about results and suggestions by the doctors and hope it helps someone.

Thank you @mrscott I will listen to that and try and get some insight

Thank you, everybody, for your various comments. They are all helpful. When I read things from the expert hospitals vs from patients who are experiencing the everyday issues, the experts sometimes have mixed messages that make it difficult to come to quality of life conclusions regarding prostatectomy vs radiation/hormone therapy. I will continue to research.

No side effects with 40 x radiations and then on Zolodex

If robotic surgery check first if cancer is near apex of bladder else they can make you incontinence which needs another operation later

With radiation, some of the side-effects occur years later. Just FYI.
Radiation still seems to be a better option (for my situation, yours may be different), especially if everything is done to minimize the negatives of ADT. Beware providers who have not stayed current (perhaps because they are swamped) and just prescribe ADT without the mitigating meds, diet and exercise. Be proactive and do what you can to get the best care -- and spreading current knowledge helps other patients as well.

In 2018 I had 40 days of radiation Then on Zolodex for 1 year I should have stayed on it longer as PC metastasized to L2 spine and T 2 and T12
I then had Intense radiation on L2 lumbar like a GPS that took out 7/8 inch of prostate metastatic cancer. I went back on Zolodex and PSA dropped from 26 to 1.2 Testosterone is the fertilizer for pc. so, forget sex The Zolodex also wore down the other spots by starving them of testosterone.
I am stage 4 but castrate SENSITIVE metastatic PC versus RESISTIVE meaning that ADT is working for me again for 2 years. If I were castrate resistive, they would put me on Enzalutamide which is chemo in a daily pill and then the clock starts to tick.

No side effects in 6 years just caution with my back which hurts if I need to go poopo as the rectum sh#t pushes on the L2 L4 etc