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Intermediate Risk Prostate Cancer Treatment Decision

Posted by jt14 @jt14, Jun 10 11:08am

I have perused comments in these discussion areas and thought I'd reach out for thoughts on the decision of prostatectomy vs radiation therapy. Thank you in advance for your thoughts.
I am 70 years old in good physical condition (no heart, metabolic or obesity issues). Biopsy showed 5 out of 13 specimens positive ranging as below:
all on one side
Group 1 to Group 4
Gleason 3 + 3 to (just one) 4+4
one with "ductal features"
Most recent PSA 4.8
PET scan negative
I believe from a couple of opinions (top notch institutions)
that mine is fairly aggressive and needs treatment not surveillance.
Except for one surgeon who was adamant that his open surgery would be the best option I have heard that I could rationally choose either radiation or surgery as treatment and I am in that the process now of determining best road forward.
I initially leaned toward robotic surgery ("get it out," benefit of pathological report on the prostate cancer, no long term treatment as with radiation and ADT) but after a recent opinion from a surgeon the thoughts of potentially months of urinary incontinence and much larger chance of ED issues has me rethinking this.
On the other hand weeks to months of radiation treatment and ADT along with the side effects of that and 24-36 months of no/low testosterone and no ability for sex, fatigue, osteoporosis, etc. have me likewise hesitant.
My guess is there is no "right" answer in my case but would very much appreciate feedback from personal experience. Thank you all.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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retireditguy | @retireditguy | Jun 18 8:49pm
In reply to @surftohealth88 "Thanks Jeff - did they say for what gleason ? Do you have stats for RT..." + (show)
Profile picture for surftohealth88 @surftohealth88

Thanks Jeff - did they say for what gleason ?

Do you have stats for RT ?

I mean, for us RP is a must, but for the sake of other members here it would be nice to have some links for RT and RP and possibly done in more recent years and for the same gleason score.

Thanks in advance 🙂

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Hi Surftohealth88. Here's a reference to a (free) Sloan Memorial Kettering database on 10,000 of their patients history after proctectomy. You enter your information and it gives the percentage of BCR. You can play with it and it shows how much the percentage increases due to certain factors (gleason, grade, positive margins, etc):
https://www.mskcc.org/nomograms/prostate/post_op

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1 reply
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surftohealth88 | @surftohealth88 | Jun 18 9:58pm
In reply to @retireditguy "Hi Surftohealth88. Here's a reference to a (free) Sloan Memorial Kettering database on 10,000 of their..." + (show)
Profile picture for retireditguy @retireditguy

Hi Surftohealth88. Here's a reference to a (free) Sloan Memorial Kettering database on 10,000 of their patients history after proctectomy. You enter your information and it gives the percentage of BCR. You can play with it and it shows how much the percentage increases due to certain factors (gleason, grade, positive margins, etc):
https://www.mskcc.org/nomograms/prostate/post_op

Jump to this post

Oh - imagine THAT !!! : )))

Thanks so much for that link < 3

I will try it out tomorrow after I drink some Valerian and Mint tea to calm my nerves ...

REPLY
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jeff Marchi | @jeffmarc | Jun 18 11:45pm
In reply to @surftohealth88 "Thanks Jeff - did they say for what gleason ? Do you have stats for RT..." + (show)
Profile picture for surftohealth88 @surftohealth88

Thanks Jeff - did they say for what gleason ?

Do you have stats for RT ?

I mean, for us RP is a must, but for the sake of other members here it would be nice to have some links for RT and RP and possibly done in more recent years and for the same gleason score.

Thanks in advance 🙂

Jump to this post

Here is the answer using the query below in google

Approximately 20% to 30% of men experience a recurrence of prostate cancer after radiation treatment, typically within five years following the initial therapy. The likelihood of recurrence can vary based on factors like the extent and aggressiveness of the cancer, according to Johns Hopkins Medicine. Some studies indicate that recurrence rates can range from 15% to 70% after definitive radiation therapy.

You can use this search to find answers by adding for example SBRT before radiation to get the more specific results for that type of radiation
“what percentage of people have reoccurrence after a radiation treatment for prostate cancer”

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pdcar4756 | @pdcar4756 | Jun 19 8:05am
In reply to @matthewdore "tk192, OK, good luck in FL. . I have a video call with Mayo MINN tomorrow...." + (show)
Profile picture for matthewdore @matthewdore

tk192,

OK, good luck in FL. .

I have a video call with Mayo MINN tomorrow. I'm not sure what types of Focal Therapy they do................HIFU, Tulsa, Cryo??? I have researched them all. But my first question will be" Does the high decipher score point you to certain therapies or are Focal options still on the table?
Second question: what are long term probabilities of recurrence for Focal Therapies? My research shows (approx. ) 25% recurrence with Focal vs. 6% recurrence with Radical Prostatectomy and Radiation. I'm going to ask Mayo if there is any way to get that 25% number lower. Age, health, family history, MRI/imaging advances, ......... etc.

Third question: If recurrence, ........ex. after 4 years, .........will the recurrence be in the prostate or will it have spread to outside the prostate? Is that where the Decipher score is telling? That is the big question.

Good Luck again,

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If you are able to get answers to your questions if you would, please share with us what you were told. You have some very good questions. I had TULSA-PRO at Mayo in Rochester in October 2024. These questions apply to me as well. Thanks much!

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2 replies
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jcf58 | @jcf58 | Jun 19 9:27am
In reply to @pdcar4756 "If you are able to get answers to your questions if you would, please share with..." + (show)
Profile picture for pdcar4756 @pdcar4756

If you are able to get answers to your questions if you would, please share with us what you were told. You have some very good questions. I had TULSA-PRO at Mayo in Rochester in October 2024. These questions apply to me as well. Thanks much!

Jump to this post

Likewise! I had my Tulsa Pro July 2024.

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tk192 | @tk192 | Jun 19 3:46pm

Sloan Kettering Prognosis algorithm calculates your odds of recurrence after RP. This is at least a tool to help, based upon their results for 1000's of patients. There may be one for RT I didn't dig around.
https://www.mskcc.org/nomograms/prostate/post_op

REPLY
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matthewdore | @matthewdore | Jun 20 11:56am
In reply to @pdcar4756 "If you are able to get answers to your questions if you would, please share with..." + (show)
Profile picture for pdcar4756 @pdcar4756

If you are able to get answers to your questions if you would, please share with us what you were told. You have some very good questions. I had TULSA-PRO at Mayo in Rochester in October 2024. These questions apply to me as well. Thanks much!

Jump to this post

Hey guys,

had the video visit with Mayo MN yesterday.

Here is recap of my Numbers: Gleason: 3+4 , 1/12 CORES POS. small lesion 1MM. 30% 4. No Cribriform, No intraductal.
MRI: pretty clean, not much diffusion. PI-RADS 2.
Decipher : .80
Prostate size: 34 cc
PSA holding pretty steady around 2.0 to 2.3 for last two years.
Health: good, very fit.
Visit with Mayo surgeon, thought I was scheduled with the Focal Dr. My mistake. (lots of appointments these days, getting hard to juggle). So, a little bit of a waste but Mayo is a class operation. Dr. was good communicator. I did not get a lot of Focal Info. I have a new appointment at Mayo with Focal Dr. Not until Sept.
I did get some info off the Mayo surgeon though. He had done 1700 RARP total. 2/week lately. ( I think he is probably pretty skilled. I have experienced surgeons near me in Chicago also)
This what he said:
If you are healthy and have solid baseline urinary cont. and erection scores at surgery the RP Numbers are as follows :
BCR: at 5 years 1-2% (sounds low)
Erections: (w/wo help (no pumps but pills or needle) 70% prob. after 1year
Continence: 90% after 1 year.

I didn't ask about Focal too much. He did say my high decipher means I should give a little more weight to surgery option. Also: if BRCA-2 (?) gene is present you should probably NOT do active surveillance.
So, I am still thinking about Focal of course. Big HIFU Dr. in Chicago says 25% non-recurrence with HIFU.
webinar by Dr Klotz (famous in Urol.) you Tube. " Is Focal Th. right for your Prostate Cancer" 8/31/2023. very informative. Talked about results for HIFU and Tulsa and Cryo. Minute 39:00 talks about o Visible vs. Invisible Tumors and MSLK NY study. Metastatic outcomes down the road ( ? years) higher in 'VISIBLE 'tumors than INVISIBLE tumors!!!!! (on the surface , that makes sense, larger, visible tumors are probably going to Metastasize over time, but, it does give some insight on the small invisible ones we all fear so much. So, unseen tumors are not as threatening as believed. he said: 'it really turned some Dr.'s heads around on Focal strategies'. Also his thoughts on the similarities of treatment timelines between breast cancer and prostate cancer. (early in the video?) watch video yourself to form your own opinion.

I would like to say to all those who have more serious situations than myself, hang in there, we are all thinking of you, and rooting for you. things get better every day.

REPLY
1 reply
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jeff Marchi | @jeffmarc | Jun 20 1:02pm
In reply to @matthewdore "Hey guys, had the video visit with Mayo MN yesterday. Here is recap of my Numbers:..." + (show)
Profile picture for matthewdore @matthewdore

Hey guys,

had the video visit with Mayo MN yesterday.

Here is recap of my Numbers: Gleason: 3+4 , 1/12 CORES POS. small lesion 1MM. 30% 4. No Cribriform, No intraductal.
MRI: pretty clean, not much diffusion. PI-RADS 2.
Decipher : .80
Prostate size: 34 cc
PSA holding pretty steady around 2.0 to 2.3 for last two years.
Health: good, very fit.
Visit with Mayo surgeon, thought I was scheduled with the Focal Dr. My mistake. (lots of appointments these days, getting hard to juggle). So, a little bit of a waste but Mayo is a class operation. Dr. was good communicator. I did not get a lot of Focal Info. I have a new appointment at Mayo with Focal Dr. Not until Sept.
I did get some info off the Mayo surgeon though. He had done 1700 RARP total. 2/week lately. ( I think he is probably pretty skilled. I have experienced surgeons near me in Chicago also)
This what he said:
If you are healthy and have solid baseline urinary cont. and erection scores at surgery the RP Numbers are as follows :
BCR: at 5 years 1-2% (sounds low)
Erections: (w/wo help (no pumps but pills or needle) 70% prob. after 1year
Continence: 90% after 1 year.

I didn't ask about Focal too much. He did say my high decipher means I should give a little more weight to surgery option. Also: if BRCA-2 (?) gene is present you should probably NOT do active surveillance.
So, I am still thinking about Focal of course. Big HIFU Dr. in Chicago says 25% non-recurrence with HIFU.
webinar by Dr Klotz (famous in Urol.) you Tube. " Is Focal Th. right for your Prostate Cancer" 8/31/2023. very informative. Talked about results for HIFU and Tulsa and Cryo. Minute 39:00 talks about o Visible vs. Invisible Tumors and MSLK NY study. Metastatic outcomes down the road ( ? years) higher in 'VISIBLE 'tumors than INVISIBLE tumors!!!!! (on the surface , that makes sense, larger, visible tumors are probably going to Metastasize over time, but, it does give some insight on the small invisible ones we all fear so much. So, unseen tumors are not as threatening as believed. he said: 'it really turned some Dr.'s heads around on Focal strategies'. Also his thoughts on the similarities of treatment timelines between breast cancer and prostate cancer. (early in the video?) watch video yourself to form your own opinion.

I would like to say to all those who have more serious situations than myself, hang in there, we are all thinking of you, and rooting for you. things get better every day.

Jump to this post

Sounds good and you definitely could consider active surveillance. Do you have BRCA2? You are getting tested?

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2 replies
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brian5837 | @brian5837 | Jun 21 8:45am
In reply to @jeffmarc "Sounds good and you definitely could consider active surveillance. Do you have BRCA2? You are getting..." + (show)
Profile picture for jeff Marchi @jeffmarc

Sounds good and you definitely could consider active surveillance. Do you have BRCA2? You are getting tested?

Jump to this post

Jeff, did you see the surgeon's comment: "He did say my high decipher means I should give a little more weight to surgery option."

Anyone else heard a surgery recommendation based on decipher results alone?

REPLY
2 replies
Profile picture for jeff Marchi
jeff Marchi | @jeffmarc | Jun 21 10:13am
In reply to @brian5837 "Jeff, did you see the surgeon's comment: "He did say my high decipher means I should..." + (show)
Profile picture for brian5837 @brian5837

Jeff, did you see the surgeon's comment: "He did say my high decipher means I should give a little more weight to surgery option."

Anyone else heard a surgery recommendation based on decipher results alone?

Jump to this post

I must admit I have not heard that before, You should check with the radiation oncologist and see what their opinion is.

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