ProstoxUltra & Prostox CFRT both high risk-switch to RALP?

A guy I know that has a 3+4 and has decided to do nothing after the Prostox test, Decipher and ArteraAI All came back showing very low likelihood of anything reoccurring. He’s talked to multiple doctors about it and had his biopsy reviewed by. Dr. Epstein, who he talked with at length. They all felt he could use active surveillance for a while. He is getting retested every six months.

You made a decision because of high results and he made a decision because of low results.

Surgery does make a lot more sense since you can then have radiation if it comes back.

Have you had a genetic test to rule out a genetic anomaly, causing your high risk?

I don't understand the aversion to surgery. I had a RALP & woke up with five tiny bandages the size of a dime, & NO PAIN (then or later). The next morning they disconnected a couple tubes & told me to get dressed & leave. I walked out of the hospital. I opted for non-nerve-sparing, & had no incontinence.

As you note, there is no guarantee that some hadn't already escaped to a lymph node (as in my case), but at least you got rid of the main source quickly, without all the drama of radiation. I had a friend who did radiation, & they had to temporarily pause it due to bladder issues caused by the radiation. He doesn't stray far from his house these days. That's all you need is side issues & more delay, in my opinion.

In my case, I subsequently had hormone therapy, which was also a non-issue in my case.

That Decipher score really jumps out at me. Can’t advise you what to do but perhaps radiation may not be totally effective in eradicating it?
I was dead set against surgery 7 yrs ago - no way was anyone doing that to me! I had no Decipher score to guide me back then, but my G4+3 told me that it was more aggressive and could recur; if I opted for radiation as my primary treatment, what then??
So I bit the bullet and opted for surgery which was successful according to pathology standards - negative this, negative that, etc.
However, the cancer DID recur, and I had SRT/ADT which I completed exactly one year ago.
My decision worked out in my case, yours may be different- NOBODY knows, no matter how many AI inspired tests you take.
I understand your concern for incontinence - don’t we all?- but your primary focus should be the eradication of the cancer, and secondarily, what you can do if it comes back, which your Decipher hints at.
I think you need to draw out a flowchart of treatments vs outcomes, along with all the benefits and risks, before you do anything. You DO have time to do this, based on your pathology. Don’t rush into anything until YOU are totally comfortable with your well thought out decision. Best,
Phil

https://botimageai.com/prostatid/ is an AI 2nd read of the MRI images. The MRI second read AI may also guide in selecting other areas to biopsy in addition to the obvious targets identified on the eyeball read. It should be noted that prostate tissue and cancerous tissue look similar, The human readers have 73% accuracy rate ['interobserver reliability'?] the ProstatID is at 95%. The AI method compares thousands of images of known disease with your MRI images, It works with dye enhanced or simple MRIs of the prostate, It is not covered by insurance. It is well worth the fee whether it alters or confirms the findings on the first read.

PS: It is also recommended to have biopsy slides sent to secondary read at a center of excellence. ARTERRA is an AI secondary read of slides.

PPS: https://www.dotmed.com/news/story/63474 (November article on ProstID)

I would not wait too long since your Decipher is so high : (.

My husband had surgery and it was really not a big deal for him and he was 69. I do not know what is your age but if you are reasonably "young" and in good shape you will recover in no time. He is now about 3 and a half mons post surgery and is doing more than great. What future holds - nobody knows - we can only work with what is known and available and looks the best for us at certain moment in time.

I was thinking - can radiation treatment be adjusted in cases like yours ? My knowledge is measly in that area but I swear I read somewhere that radiation can be done in more days with less intensity and have the same results ? I also think that IMRT is milder than SBRT ? I really hope that members who are more knowledgeable about radiation protocols and types will jump in and help.

Can you go to radiology department in some other center with doctors who DID hear about Prostox and ask for advise ?

@surftohealth88
When I had my salvage radiation 12 years ago I had 8+ weeks of IMRT radiation. They try to do the same thing today in around 20 sessions. If somebody has serious side effects, they can reduce the amount of radiation and extend the number of sessions.

They cannot use SBRT for salvage radiation. It covers a wide area of the prostate bad and lymph nodes.

For a primary radiation treatment SBRT can be used, but it has much higher amounts of radiation per treatment since it’s usually done in five treatments.

The same as with salvage radiation, if IMRT is Used for primary treatment with around 20 sessions, but it is causing too many side effects, they can reduce the amount of radiation and increase the number of sessions.

I too had a 3+4 from a Pirads 5 lesion and two Pirads 4 lesions with Decipher 0.81. Using both my local doctors and MD Anderson in Houston, I went with 26 IMRT sessions obtained locally and one HDR Brachytherapy session as a boost to the prostate in Houston along with one year of ADT. It's the high Decipher score that drives the need for ADT and extra radiation. I will be one year post ADT in February 2026. Testosterone has recovered along with full sexual function. Never had to use ED pills and never had any incontinence. An RP is way more risky in terms of long term side effects and also more risky on the chances of recurrence.

Never had a Prostox test and never considered SBRT because IMRT is better for treating the entire pelvic region.

@wwsmith

I am sorry, but you have wrong information.

For low and intermediate cancer the chance of BCR is the same for RP and RT, and for high risk PC RP gives better results (longer period before BCR ) .

Of course, every case is different and all also depends on skill of a surgeon and /or radiologist - but statistics in multiple studies show above stated facts.

One can always find isolated study that shows something different, but there is consensus of multiple studies that show that patients with low and intermediate PC can have equally good results with either RP or RT , with a caveat that if BCR happens, than RP patient has an option of having RT as a "second chance" for eradication , while initial RT patient can not irradiate the same area twice.

That is why young patients are always advised to do RP because their life expectancy is higher and chance of having BCR is than greater . For the same reason RT is not preferable as initial treatment in very young patients because chance of developing secondary cancer due to RT is a possibility if patient lives for 10 or more years after RT.

All in all - there are so many factors to consider it is not easy nor simple decision, nor it should be done in a haste.

I think the newest studies underway will show lower chances of recurrence with modern radiation and ADT use than with RP treatment. You can already see it on an anecdotal basis by just counting how many RP posters on the various forums have a recurrence versus those that started with radiation.

It is also incorrect to say that initial radiation treatment precludes future radiation treatment. You can see numerous cases on this forum where SBRT is used multiple times because it is so precise.

If a patient has significant risk factors before initial treatment, an RP is in most cases ill advised because follow-up radiation is almost guaranteed. Why go through an RP when you know recurrence and future radiation is almost certain?

The primary problem with an RP is that it only deals with cancer contained within the prostate itself. All of the recurrences you see after an RP came from microscopic escapes of cancer cells from the prostate gland that could not be detected before the RP was performed. This happens with far greater frequency than what the surgeons advise patients.

With radiation treatments, if there is any suspicion that some microscopic escape of cancer has already occurred, radiation can target not only the gland itself but also the greater pelvic region such that those as yet undetected microscopic cancer cells can be killed.

@wwsmith
We can not rely on "anecdotal" data on this site since it is anecdotal. Actually just this year there were several cases here of RT patients (and 2 with proton radiation) that had BCR and were scared to death and asking for guidance since there were not many options on the table. Also, no, you can not radiate prostate again - SBRT is used for recurrence in the areas around the gland or other places where mets appear after initial RT. If there are new methods indeed than imagine what toxicity second round can cause on the same place ?

Why have RP - for some cases it is a better method that provides much better results. My husband had IDC and cribriform and those formations sometimes show resistance to RT and actually post RT examination in those cases in some studies found mutated cells that were even more aggressive in nature.

He might have BCR anyways in 5 years , but any year without ADT and possible RT side effects that can be debilitating and long term is a plus for him. He is very active in sports and works full time and has 2 startups on top - brain fog, low energy, cistitis, proctitis, secondary cancers etc etc were something far less appealing to him than surgery and he is very happy with his decision. He had consultations with both surgeon and radiologist and BOTH in his case advised RP to him in the top center for PC treatment . And that is "why".