Prostate Cancer Outcomes - Report Card

It surprised me that the "before treatment" percentages were higher for radiotherapy than the other forms of treatment. This is interesting information thanks for posting!

Maybe it's because of the average age (72) of those electing radiotherapy versus the average age (64) of those opting for surgery AND the fact that the radiotherapy group had 40% high risk (HR) individuals versus 20% HR for those in the surgery group, that the radiotherapy group had a higher percentage of negative sexually related pretreatment issues.

Even more surprising to me is that the surgery group, on average 8 years younger with less than half the HR percentage (as compared to the radiotherapy group), took only one year to virtually "catch up" with the older radiotherapy group, regarding negative sexual side effects and surpass their radiotherapy brothers with a significantly greater percentage of negative urinary issues.

The study indicated about 1/3 of those on AS ended up having another form of treatment within 5 years (surgery or RT) which skews the data a bit IMO when looking to compare.

Agreed. At first it seems strange that the group opting for AS would see a 22% increase in negative sexual side and higher urinary issues, one year after deciding to begin AS.

However, it may make some sense when one realizes that 1/3 of those who initially opted for AS changed to surgery or radiation within 5 years and those folks are still considered to be part of the “AS group”.

Based on the percent increase of negative side effects of those who initially opted for surgery or radiation, if a significant portion of the AS group went in that direction within one year, it may explain some of the AS group’s negative side effect uptick.

I think the report would have been a bit better, if they would have removed those who switched out of the AS group and placed them in the groups where they ended up. My guess is that it would have reduced the AS group’s death and negative side effects even further.

One thing is for sure…AS is the only decision that one can fully reverse.

Yeah. I chose surgery over anything else. I was 73. Now at 75, I just don’t know. Somehow they managed to screw up my back. Have been critical ever since. Been to Mayo and MD Anderson and a few other places with NO answers to how it happened. Best guess was that I was not supported well during the robotic surgery.
I can’t walk but a short distance any more ( the day before I walked 10 miles. Which was my
Normal distance). I have a spinal stimulator now which is marginally helpful. I guess my life is basically over

That is just terrible. Don't give up though. Have you tried physical therapy?

Oh yeah. And chiropractor. Very very frustrating. Only thing that really helped was opioids. And I won’t take those because of constipation issues. Tramadol and celebrex are what I take now with margarinal help

Handera, thanks for publishing this link. The report is one of the clearest presentations on treatment versus outcome for PCa that I've read. My particular condition falls squarely on the average: being a 72-year-old, diagnosed in October 2023 to be Stage 4a, Gleason 7 4+3 unfavorable, and PSA currently at 12. (Intermediate Risk.) The spread has been to a nearby lymph node. This report gave me much more confidence that I will see at least ten more years (and likely more) of life ahead. My appointment for treatment selection is this Monday, when I meet with my MO. My PSA five years ago was 6. It's doubled in five years to 12. I figure I have slow-growing cancer. I'm going to opt for EBRT (IMRT/IGRT) and a short course of ADT (6 months). I plan to have a SpaceOAR installed. I'll probably opt for ADT (leaning toward Orgavyx) in alternate years to keep my PSA below 4 while maintaining as healthy a body as possible. (Hoping to get concurrence from my MO and RO, (lol)). Presently, I'm in excellent health with no symptoms at all due to PCa. I'll try to make regular posts of my experiences as I embark on my own battle against this insidious disease.

Geez. I don't know then. Surprised to hear of such a complication from the surgery. Mine was in 2022 with no after effects. I'm just hoping for no BCR. I hope your back starts to do better soon. Maybe you could try a different PT. I'm in Michigan and used Pure Healthy Back center for a lower back issue unrelated to the surgery. It really helped. Stretch daily now with exercises designed for my specific back problem. From your post you sound like you're no stranger to exercise. Just need to find the right PT center to identify issue and prescribe the right exercise to relieve it. Best of luck. It's bad enough to get PCa and not to have another issue added to it.

When one is diagnosed with “cancer”, the most immediate questions and concerns are usually regarding mortality.

As you indicated, this detailed, large sample size report, indicates that even the “worst case” (high risk PCa) still has a very high probability of 10+ year survival.

Closer to home, these data indicate that intermediate risk men have probabilities that range between 97 - 99% as to NOT dying from PCa within 10 years, no matter what treatment they select AND even being diagnosed as late as an average age 76!

This is stunningly good news and virtually takes the mortality question off the table for low and intermediate risk men.

IMHO low and intermediate risk men are only left with the “negative side effects of treatment” issue.

This ends up becoming a personal decision based his doctor(s) recommendations, the treatment center available and the ability to apply what is known (by doctor and patient) regarding the negative side effects of the selected treatment to a particular individual’s PCa stage, location and propensity to later metastasize.

Personally, I am not bothered about my favorable-intermediate risk classification, as it relates to mortality, and I think the data overwhelmingly support such a conclusion.

I personally think our culture has had the word “cancer” imbedded into our collective psyche as an irreversible and often immediate death sentence. This can cause men to make quick treatment decisions out of fear or perplexing uncertainty.

That’s why I have an understanding empathy for those who feel they must choose an immediate course of treatment, even if it has a significant risk of “negative side effects”.

Of course, the data also suggest that some (or even many) will end up in the camp of low to minimal negative side effects, no matter what treatment type they select.

All that said, this report card informs as to the “odds” of the potential negative side effects, one year after treatment. So that men, in all risk categories, can make an informed decision. One important caveat of this report card is that it DOES NOT INCLUDE men with advanced/metastatic prostate cancer.

The last point I would make, from this report, is that it’s clear ADT has the longest (and most severe) list of potential negative side effects. So I think you are making a wise decision to try to minimize that part of your treatment regiment.

All the best regarding the outcome of your treatments!