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Trying to choose between radiation and surgery
Diagnosed 7/15/26, 2 of 12 cores 3+4 on both 20% and 30%involvement t1c, have oncologist appointment on 8/20 and Urology surgeon on 9/28, asked my main urologist for a decipher test hopefully it reaches the oncologist before the appointment. If it comes in lower considering optional treatments without adt but if not probably will proceed to nerve sparing surgery also if that was the case I was hoping I could get a lower groin hernia fixed at the same time.
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What is your age? That is important to a decision.
I'm a big fan of surgery. Had a RALRP in Feb 2021. Woke up with five tiny (1/2") bandages across my abdomen, & no pain (then or ever). Walked out of the hospital the next day & resumed normal activities for a 75 yr old man. No incontinence, then or now.
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1 ReactionJust turned 69 and in otherwise excellent health besides diagnosis
I'm leaning that direction but I'll wait for the decipher score and see how that comes in, the, just concerned about less options with reoccurance with radiation.
With your 2 cores that are 3+4, what % were “4” cell types?
They rarely recommend ADT for a 3+4 unless there are other risk factors. (See attached NCCN guidelines for favorable intermediate risk group).
> do you have other risk factors: cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma? (If not, that’s good.)
(At 65y with similar numbers, I had proton radiation.)
Your mild case could be treated with focal therapy, Surgery or radiation.
If you had focal therapy and your cancer came back you could have surgery or radiation. It’s a lot less invasive than the other two options. Ask the doctors about it, There are multiple different types of focal therapy.
Getting a hernia fixed at the same time is something they will do under certain conditions.
Here’s some information from the Mayo Clinic about those choices
https://www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/prostate-cancer-treatment-surgery-vs-radiation/art-20592862
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2 ReactionsNo seminal invasion or cabriform patterns one 3+4 10% the other 30%,
declined active survalance.
That's why I'm getting a decipher test done to see how my risk is in deciding on therapy.
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1 ReactionThanks. That's very helpful.
@ginger38314 Many surgeons can do a prostatectomy after radiation these days, but if the recurrence is outside the prostate anyway (as is often the case with radiation, and always with a prostatectomy), there would be little point.
If you already have undetected local spread now that will eventually grow to a detectable level, the prostatectomy won't get it, but the radiation (if not too narrowly focused) might, either as your first treatment or as your second. But as I understand it, it's not really as if doing a prostatectomy first gives you two shots at the same thing.
Disclaimer: not a medical professional, etc.
Best of luck!
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