Adjuvant Radiation Therapry (ART) vs Early Salvage radiology

Thanks for posting your question and your experience since we are in a similar conundrum regarding RP and not so favorable findings after RP. I wish I have an answer for you since we (my husband and me) just got pathology and we are still grasping the meaning of it all.
My husband was not offered any therapy yet, actually nobody mentioned any since maybe he is still just 7 days post op. but we are becoming aware that some kind of adjuvant or even salvage therapy after RP might be beneficial or even necessary.
I will closely follow your case and I am wishing you great success in complete eradication of PC 🍀🍀🍀

It can take time to get continence back after surgery, Having radiation Can make it worse, but your long term survival depends on you getting treated soon.

You have to realize that between cribriform, intraductal and ECE The risk of recurrence is very high as your decipher test indicates. It is .93 not 93. Top of the scale is 1 which at least one person has reported in the last few months. There is always a solution for a serious incontinence problems, the AUS.

Cribriform patterns are linked to increased risks of metastasis (cancer spreading to other parts of the body) and disease-specific death, particularly in men with Gleason score 7 (3+4) prostate cancer, and yours is 4+3 even more risky. @surftohealth88 has found that her husband’s Gleason seven was changed to a nine because of intraductal and cribriform after surgery. You may be in the same boat.

Would you please share a link to neoadjuvant therapy that you found promising ?

Thanks so much in advance .

I had my prostatectomy on 5/22 with very similar results as you, except I had positive margins. The surgical team basically told me that I would need radiation once I healed from surgery. I started ADT 2 weeks ago, and had a meeting with Radiation Oncologist today to choose my radiation plan.

thanks for your no BS input. im sure my gleason would be upgraded as well. no one likes to give bad news.

on another topic, do you have any data points on MRI guided radiation? seems like a better mousetrap than ct-guided.

so you are having adjuvant radiation in the near future? so sorry, i feel your pain. i dont know about adt, but assume i will soon be following suit. im curious about what plans you are offered. would you mind sharing your options? would be good to get some advance knowledge. are you at a center of excellence?

will send to you shortly. it was a history of art vs salvage clinical trials over the last 15 years or so. pretty informative.

of course still looking for other recent clinical trials.

if i find anything, will forward. im sure youre googling madly like i am.

also, i am looking for a CoE for a second opinion. Anyhospitals/ ROs you would recommend?

Starting Adj radiation in about 3 weeks. I am treated and the University of Rochester Wilmot Cancer Center. I was given 2 plans to choose from. A less aggressive plan where they treat everywhere that showed up on PSMA PET scan vs. a more aggressive plan where they hit everything in my pelvis including pelvic lymph nodes. I choose the more aggressive plan and my RO agreed with that. I want to be aggressive as possible because I have a very aggressive case, and would like to address it before it gets any worse. After radiation, I plan on discussing docetaxel with my MO, but she indicated that it’s not called for unless there is metastasis. My POV is that we should not wait to do things that we can do now. But on the other hand, I didn’t go to school for oncology.

Yes, MRI guided is supposed to be better but other radiation oncologist have said that CT guided is just as accurate, Of course that’s what they use.

From 2024 conference

MRI guided radiotherapy is a promising new technique and may reduce the risk of certain side effects of prostate radiotherapy (urinary, bowel, sexual) within the first 2 years after treatment
• MRI guided radiotherapy still needs further study, the MIRAGE trial was a small clinical trial done at a single center
• It remains unclear whether it is the technology (MRI-Linac) or the smaller volume around the prostate that was treated in MIRAGE which results in fewer side effects

If you are really concerned about the side effects from radiation, then you should take a look at proton radiation.

Proton radiation therapy definitely causes less secondary cancers than other radiation therapies. They prefer to use it in children to avoid secondary cancer risk over their lifetime. Proton therapy machines have been extremely expensive to build or treat patients, which is why it is so much more expensive and less used. They have finally been able to get a proton machine built in one and two rooms, which will greatly reduce the expense. Eventually, it seems proton, will probably be equal in priced to other techniques and will be used much more often.

So sorry, I have terrible luck with doctors, this is why my husband ended like this : (((. I can only give you advice where not to go - UCSF.