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

Posted by quaddick @quaddick, Dec 3, 2025

I had already started scheduling for SBRT and have a date for SpaceOar. Then I got the results of my ProstoxUltra and ProstoxCFRT back and I am at high risk for grade 2 or greater late genitourinary toxicity. It's a new test and is not fully accredited yet- none of my 3 doctors have heard of it. It's based on a phase 3 MIRAGE trial of 148 patients.
I'm not sure how much weight I should give it in my decision making. It appears to be reliable based on that one study. I'd probably regret going ahead with RT only to develop debilitating symptoms that will last the rest of my life, and this test warned me of them. On the other hand, I don't relish surgery either, as they might not get it all, and then I'm left with no choice but to get salvage radiation anyhow.
Have any of you changed your decision based on the Prostox test?
My stats:
>PSA 13 bounces up down between 9 and 14 for last few years
>MRI: A 2.2 cm PI-RADS 5 lesion posterior lateral left peripheral zone at the mid gland. An additional
0.6 cm PI-RADS 3 lesion right lateral peripheral zone at the mid gland. No pelvic metastatic disease
findings
>targeted biopsy report: A. Prostate, lesion 1, biopsy: Adenocarcinoma of the prostate, Grade Group 2
(Gleason Score 3+4 = 7/10), in 3 of 3 cores, involving 45% of needle core by volume, Gleason pattern
4 comprises 15% of tumor volume. Perineural invasion is identified. B. Prostate, lesion 2, biopsy:
Adenocarcinoma of the prostate, Grade Group 1 (Gleason Score 3+3 = 6/10), in 1 of 3 cores, involving
5% of needle core by volume. Perineural invasion is not identified.
>Psma pet scan: Mildly tracer avid prostate malignancy. No definite tracer avid nodal or distant
metastases. Clinical stage T1c
>Decipher score .81 high risk
>Prostox Ultra is high risk
>Prostox CFRT is high risk

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

Profile picture for thmssllvn
thmssllvn | @thmssllvn | Feb 4 11:28am

The ProsTOX tests estimate the risk of DELAYED urinary tract symptoms of month to years. for the 3 types of external beam radiotherapy [EBRT] , i.e. , SBRT (Tx: 5x), MHRT (Tx: 20-25, and CFRT (Tx >30). The acute symptoms are about the same for any EBRT source and resolve about the same time after the series are finished.

External beam radiotherapy has to be suboptimal for prostate cancer cells as the optimal dose beamed through healthy tissue would be too injurious. Contrast that with permanent interstitial radiotherapy (IRT, seeds). These can provide an optimal dose spread over weeks or months. Originally a planning session would guide the seed placement before the 20-30 minutes out patient, one and done, procedure.

A west coast group uses an on the fly per rectum standard ultrasound for seed placement. They have over a 5,000 procedure experience. I believe Memorial Sloan Kettering [NYC, MSK] uses CT during seed placement. MD Anderson (Houston) uses MRI guided seed placement. The intra diagnostic tools (US, CT, MRI) during the procedure provide a safe margin around the urethra, etc. Any technology must be matched with the clinician's experience. A lower technology with a highly experienced clinician may be preferable to the latest & greatest at well known institutions which have deservedly stellar reputations.

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Profile picture for K. J. HOLZ
K. J. HOLZ | @kjholz | Feb 4 4:21pm
In reply to @quaddick "@kjholz , I couldn't find a link or suggestions other than that one statement you quoted...." + (show)
Profile picture for quaddick @quaddick

@kjholz ,
I couldn't find a link or suggestions other than that one statement you quoted. I was quite disappointed after my Prostox test results because after months of research I had decided on SBRT and even had it scheduled. But afer talking it over with my radiation doc, I switched to RALP and tomorrow will be 2 weeks post-prostatectomy. I figured dealing with some short term incontinence and ED would be preferable to lifelong genitourinary toxicity. I'm 67 and in good health, so I'm hoping to get many more active years.
Most men regain continence after a prostatectomy. It's been 5 days since I've had my catheter removed and continence is already improving, so I'm hopeful.
My cancer was 3+4=7, perineural invasion, cribiform, and a high Decipher score of .85 My PSMA PETscan indicated no spread outside the gland, so I wanted it gone before it did. I feel like I made the right decision.
I wish you and your husband the very best outcome possible. It sounds like you're doing your research.
All the best,
quaddick

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@quaddick My husband is 3+4=7 too. Our radiation oncologist gave us a choice of SBRT or IMRT. Problem is my husband rated himself a "5" ("almost always") on the International Prostate Symptom Score (IPSS) for "weak stream". Had "weak stream" for years. Hasn't gotten worse, stable.

When I read that radiation can exacerbate existing urinary issues (ie to a point of No Stream), I went into research mode. I found out about PROSTOX through Dr. Scholz/Alex (Prostate Cancer Research Institute).

When we told our urologist that we had scored "HIGH RISK" on both Prostox (SBRT) and Prostox (CFRT), he had the same reaction our our radiation oncologist. Hadn't heard of it.

My husband told our urologist that we were leaning towards delaying treatment and needed to order a Decipher test. The phone call went silent for a while....

Our urologist has now referred us to a surgical oncologist who will get in touch and order Decipher for us. (I hope that surgical oncologist won't lob "prostatectomy" into our lap. Sure *you* got RALP, but you, at 67, are a spring chicken compared by my 78 year old husband.

Part of me would rather gamble on IMRT than "prostatectomy".... But first we need the Decipher results just to see how aggressive a monster we have looming in the shadows.

Happy to read you're doing well, oh fellow PROSTOX Outlier!

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2 replies
Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | Feb 4 6:44pm
In reply to @kjholz "@quaddick My husband is 3+4=7 too. Our radiation oncologist gave us a choice of SBRT or..." + (show)
Profile picture for K. J. HOLZ @kjholz

@quaddick My husband is 3+4=7 too. Our radiation oncologist gave us a choice of SBRT or IMRT. Problem is my husband rated himself a "5" ("almost always") on the International Prostate Symptom Score (IPSS) for "weak stream". Had "weak stream" for years. Hasn't gotten worse, stable.

When I read that radiation can exacerbate existing urinary issues (ie to a point of No Stream), I went into research mode. I found out about PROSTOX through Dr. Scholz/Alex (Prostate Cancer Research Institute).

When we told our urologist that we had scored "HIGH RISK" on both Prostox (SBRT) and Prostox (CFRT), he had the same reaction our our radiation oncologist. Hadn't heard of it.

My husband told our urologist that we were leaning towards delaying treatment and needed to order a Decipher test. The phone call went silent for a while....

Our urologist has now referred us to a surgical oncologist who will get in touch and order Decipher for us. (I hope that surgical oncologist won't lob "prostatectomy" into our lap. Sure *you* got RALP, but you, at 67, are a spring chicken compared by my 78 year old husband.

Part of me would rather gamble on IMRT than "prostatectomy".... But first we need the Decipher results just to see how aggressive a monster we have looming in the shadows.

Happy to read you're doing well, oh fellow PROSTOX Outlier!

Jump to this post

@kjholz
You should talk to the urologist about getting a TURP in order to clear up the slow urinary issue. Then you could have radiation without the pressure of it causing future urinary problems.

The TURP is like a rotor router that clears out the prostate and resolves urinary issues for many.

You’re right having surgery at 78 is not the best idea, for everyone. I’m 78 and I’m in good shape, I run a mile twice a day and go to the gym three days a week. People never guess I’m 78. I’ve had knee replacement and hip replacement in the last 3 years and stomach surgery a month before turning 78. My blood pressure is low and my cholesterol is low. I’m not sure of your husband‘s condition but If he’s in good shape, surgery could be done. The TURP may make it unnecessary.

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Profile picture for quaddick
quaddick | @quaddick | Feb 5 9:58am
In reply to @kjholz "@quaddick My husband is 3+4=7 too. Our radiation oncologist gave us a choice of SBRT or..." + (show)
Profile picture for K. J. HOLZ @kjholz

@quaddick My husband is 3+4=7 too. Our radiation oncologist gave us a choice of SBRT or IMRT. Problem is my husband rated himself a "5" ("almost always") on the International Prostate Symptom Score (IPSS) for "weak stream". Had "weak stream" for years. Hasn't gotten worse, stable.

When I read that radiation can exacerbate existing urinary issues (ie to a point of No Stream), I went into research mode. I found out about PROSTOX through Dr. Scholz/Alex (Prostate Cancer Research Institute).

When we told our urologist that we had scored "HIGH RISK" on both Prostox (SBRT) and Prostox (CFRT), he had the same reaction our our radiation oncologist. Hadn't heard of it.

My husband told our urologist that we were leaning towards delaying treatment and needed to order a Decipher test. The phone call went silent for a while....

Our urologist has now referred us to a surgical oncologist who will get in touch and order Decipher for us. (I hope that surgical oncologist won't lob "prostatectomy" into our lap. Sure *you* got RALP, but you, at 67, are a spring chicken compared by my 78 year old husband.

Part of me would rather gamble on IMRT than "prostatectomy".... But first we need the Decipher results just to see how aggressive a monster we have looming in the shadows.

Happy to read you're doing well, oh fellow PROSTOX Outlier!

Jump to this post

@kjholz ,
I get where you're coming from on the age difference. It's my understanding that there are multiple treatments for weak or no streams. For most of us there are no black or white decisions to be made. We just got to educate ourselves and weigh which side effects we're willing to endure.
I'm glad you're ordering a Decipher test. Has your husband had a PSMA PET scan? That was a key part of my decision making also. You really have to be your own advocate. I was the one to initiate all of my tests, imaging, and second opinions other than the MRI, and biopsy. Maybe my doc would have gotten around to it, but I asked for them all as soon as I learned of them, so I'm not casting shade on the doc.
Wishing you all the best.
Quaddick

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