Radiation vs RARP for IDC prostate cancer with high Decipher?

At 70 years old, you are right on the border of surgery versus radiation. Have you had a PSMA pet scan to see if the cancer has spread anywhere else?

If it has not, and you are in good health And it’s a toss up. You should be able to make it through the surgery without any issues. And if it comes back, like your decipher score implies, you can have radiation.

If you have SBRT radiation There are issues that happened 10+ years after you have it with possible cancers, and problems with urinary and rectal issues. But it is just as effective as surgery.

Those aren’t the only choices, however. With a 3+4 You probably would also be able to get other types of treatments like Focal Therapy, NanoKnife, cryotherapy, HIFU, TULSA-PRO, etc, which don’t use radiation, and allow you to use radiation in the future if it comes back.

I you can’t get meaningful answers you need to go get a second opinion. Maybe consider switching your treatment to a center of excellence. While a 3+4 it is usually slow growing, you want to have Doctors you work with I can give you more information and can Help you make a choice.

Did you mean to write 4+3? Asking because you said intermediate unfavorable in your title.

I am 52 and torn btw RT and RP. At your age I would definitely go for RT.

thanks for your reply. following up, could i start with radiation and then go to focal, hufu, tulsa etc if it comes back? or how about proton? mine is pretty well spread in the left side, so dint think focal would work.

Those techniques have to be first. They can process the whole prostate. Tulsa-PRO would probably work. A few guys in this forum have had that maybe they can respond.

I can only give you my experience. Six years ago, age 64, I was diagnosed Gleason 4+3 Unfavorable. I do not have any info on the surgical pathology other than it remained G4+3.
I chose surgery because the cancer had a higher risk of coming back even without a Decipher score (there wasn’t any back then). You, on the other hand, have a Gleason close to mine AND a scary (your word) Decipher score.
Even though my cancer was contained, no nodes, negative margins, etc., the cancer came back 5 yrs later. Just completed salvage radiation and 6 mos ADT🤞
In my mind, which takes a somewhat pessimistic bent, you almost have to assume your cancer has a good chance of recurring.
NOT saying it will - no one knows! - but the odds are skewed that way.
If you choose radiation as your primary treatment your options become very limited if your cancer returns. Not going to go into all of that now but you can find that info on any reputable center of excellence website.
My motto is: He who fails to plan, plans to fail. It’s not a panacea but at least you know you’ve done everything in a step-wise logical way. After that it’s just a matter of luck. Best regards with whatever you decide.
Phil

unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i have IDC-p present in 3 cores and Decipher score of 98.

Im looking for an aggressive treatment plan, but just getting standard treatment options. One recommendation is to skip the RARP altogether and go straight to hormone/radiation. I gotta believe yanking that thing out is step one. Also, i see early studies that show that IDC doesnt always respond well to hormone/radiation. it appears that there IS no aggressive treatment option for IDC, and a lot of early work is going into trying to identify better treatment options.

Anyone who has any similar experience and/or intelligence they can share would be greatly appreciated.

The results are about the same with either RARP or Radiation, But how old you are could be a factor in what’s the best decision?. Radiation has a chance of causing cancer in other places 10 to 12 years after you get it. If you are in good shape surgery works into the 70’s. If you have radiation, make sure they do nerve sparring surgery, if possible.

There may be options other than surgery, Focal Therapy, NanoKnife, cryotherapy, HIFU,, TULSA-PRO. Not sure if they will be acceptable with IDC, but the doctors would know. You can have radiation after having that, Even surgery.

With IDC, If positive surgical margins or extraprostatic extension are found after prostatectomy, radiation to the prostate bed can reduce recurrence risk.

It would probably make sense to go on hormone therapy after surgery or radiation. You have a type of cancer that Causes reoccurrence. Hormone therapy will almost definitely stop anything from growing for a while. After you are undetectable for a year, you could consider going on holiday. Ask your doctor about these issues, I am not a doctor just things I’ve heard.

One thing you should realize is that there is prostate cancer in your bloodstream. This is one of the things that can lead to reoccurrence and why hormone therapy makes sense.

I’ve read that radiation and hormone therapy drugs are not effective against intraductal and cribriform. Is there any truth to that or is it nonsense?

ive read in a clinical study that adt may not be as effective vs IDC. not sure about radiation. just not a lot of proven idc treatment that i can find.

What you hear appears to be true.

SBRT is an excellent option for most localized prostate cancers, but for tumors with a cribriform pattern, the risk of recurrence is higher and SBRT may not fully eliminate the cancer. These cases often require more aggressive or combined treatment approaches, and decisions should be made in consultation with a specialist. As a result surgery is recommended for localized cancer.

EBRT is also recommended with a little bit higher dosage than without cribriform.