1. < Prostate Cancer

What are the Odds No Cancer Ever Returns After a radical prostatectomy

Posted by bens1 @bens1, Oct 22, 2022

I had an MRI and it showed a lump in the prostate. My biopsy is November 1st. I have a friend who had a radical prostatectomy 22 years ago, is 72 and cancer free. I read in some of the posts that cancer has, or may have returned after a radical prostatectomy. Has anybody seen a number indicating the cure rate with a radical prostatectomy with no future treatments necessary? I admit I am looking for some glimmer of hope that it is a longer term solution. I am almost 70 and otherwise healthy.

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

mrscott | @mrscott | Nov 3, 2022
In reply to @bens1 "Thank you, Kevin. Part of the conundrum is even if everything is confined to the Prostate,..." + (show)
@bens1

Thank you, Kevin. Part of the conundrum is even if everything is confined to the Prostate, is radiation/Androgen therapy a better decision than prostate removal. Since you wrote this my brother called from NYC and said he has prostate cancer and is going with a radioactive insert placed between his prostate and adjoining areas and his cancer is confined to the Prostate. Its almost as if one is deciding on which side effects and processes are more or less appealing, general effectiveness notwithstanding.

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There are many effective therapies; the author of "Key to Prostate Cancer" Mark Scholz MD said outright on a video that for low and intermediate Risk PCa it's a choice between side-effects and convenience. And, for those lucky enough to be Gleason 3+3=6 and below, Active Surveillance may be the best option (no side-effects).

Androgen Deprivation Therapy has serious side-effects BTW; have a look at Dr. John Mulhall's videos:
https://youtu.be/u4TN9mCHlg4

I'm reserving ADT for if I really need it. Turns the muscles involved in an erection into collagen or fat ...

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bens1 | @bens1 | Nov 4, 2022

I was looking at the Mridian MRI guided radiotherapy capabilities for my upcoming choice of radiation vs prostate removal. The feedback from various people on this Mayo support site have helped me lean in this direction. I understand the unintentional bias Dr's may have in using there own "stuff" but even over proton therapy, which is also near me, doesn't it make sense to use the radiation device that has the greatest targeting capability to limit damage to good tissue, may only require 5 doses and minimizes side effects?

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1 reply
paulchen | @paulchen | Nov 4, 2022
In reply to @bens1 "I was looking at the Mridian MRI guided radiotherapy capabilities for my upcoming choice of radiation..." + (show)
@bens1

I was looking at the Mridian MRI guided radiotherapy capabilities for my upcoming choice of radiation vs prostate removal. The feedback from various people on this Mayo support site have helped me lean in this direction. I understand the unintentional bias Dr's may have in using there own "stuff" but even over proton therapy, which is also near me, doesn't it make sense to use the radiation device that has the greatest targeting capability to limit damage to good tissue, may only require 5 doses and minimizes side effects?

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My thoughts exactly. I’m 55 years old Gleason 6 wondering how long I can endure my anxiety on Active Surveillance. In the meantime doing the research on treatment. Proton therapy seems to make the most sense for someone with cancer that hasn’t spread beyond the prostate. What is everyone’s point of view on this?

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mrscott | @mrscott | Nov 4, 2022
In reply to @mrscott "It's a numbers game, as doctors don't have tests or scans that can examine every cell..." + (show)
@mrscott

It's a numbers game, as doctors don't have tests or scans that can examine every cell in your body (or at least not one you survive), so how could they tell? What is available is statistics for men with similar disease, age, etc.

Please see the 2022 Virtual Conference Day 1 at the PCRI.org YouTube channel, there's lots of info and IIRC percentages for each treatment.

What I am seeing as having the best numbers for my situation is EBRT + ADT + HDR brachytherapy boost.

If getting ADT, the side-effects are nasty (it has to harm the cancer cells, after all, and they are not as different from normal cells as would be convenient for treatment) so there are mitigations you really want to do.
https://youtu.be/6duRbpY-WkI

All I can say for the treatments is that they beat dying.

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I have reconsidered ADT (for borderline-Unfavorable Intermediate); starting to better understand the side-effects. They include e.g. (not sure how long it takes) collegenating the muscles involved in erections or turning them to fat; irreversible at the current state of the art. Which beats dying, and there are penile implants, IF that's the choice you are up against.
ADT is not something to choose casually, although the recurrence numbers are better. As with all the PCa therapies, over-treatment costs you.

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mrscott | @mrscott | Nov 4, 2022
In reply to @melcanada "In 2018 I had 40 days of radiation Then on Zolodex for 1 year I should..." + (show)
@melcanada

In 2018 I had 40 days of radiation Then on Zolodex for 1 year I should have stayed on it longer as PC metastasized to L2 spine and T 2 and T12
I then had Intense radiation on L2 lumbar like a GPS that took out 7/8 inch of prostate metastatic cancer. I went back on Zolodex and PSA dropped from 26 to 1.2 Testosterone is the fertilizer for pc. so, forget sex The Zolodex also wore down the other spots by starving them of testosterone.
I am stage 4 but castrate SENSITIVE metastatic PC versus RESISTIVE meaning that ADT is working for me again for 2 years. If I were castrate resistive, they would put me on Enzalutamide which is chemo in a daily pill and then the clock starts to tick.

No side effects in 6 years just caution with my back which hurts if I need to go poopo as the rectum sh#t pushes on the L2 L4 etc

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Different word choices? When I talk about side-effects, I was including "Testosterone is the fertilizer for pc. so, forget sex" and the other results of not having testosterone. Maybe you call those "effects"?

The effect I want is at least as good and long of a life as I would have had without PCa. Everything else is a cost for that desired outcome.

Of course what I REALLY want is indefinitely long life in excellent health at, say, physical age 25. Don't think I'm going to get that one, though.

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bens1 | @bens1 | Nov 4, 2022

Another question is if the MRI guided therapy is better targeted but the radiation still passes through the tumor and beyond, how does that compare to the Proton therapy side effects that are supposed to stop at the depth of the tumor as set by the technician.

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1 reply
melcanada | @melcanada | Nov 5, 2022
In reply to @bens1 "Another question is if the MRI guided therapy is better targeted but the radiation still passes..." + (show)
@bens1

Another question is if the MRI guided therapy is better targeted but the radiation still passes through the tumor and beyond, how does that compare to the Proton therapy side effects that are supposed to stop at the depth of the tumor as set by the technician.

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When they GPS ed my L2 lumbar that is all they hit I saw on the live x-rays

4 years earlier when I had 40 days of radiation they targeted the prostate only as GPS On last 10 days they di rapit arch where the radiation included the margins outside the prostate Rectum was not affected

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1 reply
bens1 | @bens1 | Nov 5, 2022
In reply to @melcanada "When they GPS ed my L2 lumbar that is all they hit I saw on the..." + (show)
@melcanada

When they GPS ed my L2 lumbar that is all they hit I saw on the live x-rays

4 years earlier when I had 40 days of radiation they targeted the prostate only as GPS On last 10 days they di rapit arch where the radiation included the margins outside the prostate Rectum was not affected

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Melcanada: that sounds positive. Thank you.

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pamperme | @pamperme | Nov 19, 2022

I had an RP in September 2022 and the 6 week PSA was <.02. While I was informed everything is good some of the biopsy of the prostate bothered me. The biopsy of the prostate said the tumor focally approaches to margins at right bladder neck and peripheral margin at right mid. Cautery artifact precludes definitive evaluation of margin status. It also says extraprostatic extension present extensive at right anterior , lateral and posterior, apex to base and left posterior, mid. The tumor was 30% Gleason pattern 4 cribform identified. I am now waiting 3 months for next PSA. Should I be looking at anything else. It was rated 3a

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2 replies
melcanada | @melcanada | Nov 20, 2022
In reply to @pamperme "I had an RP in September 2022 and the 6 week PSA was <.02. While I..." + (show)
@pamperme

I had an RP in September 2022 and the 6 week PSA was <.02. While I was informed everything is good some of the biopsy of the prostate bothered me. The biopsy of the prostate said the tumor focally approaches to margins at right bladder neck and peripheral margin at right mid. Cautery artifact precludes definitive evaluation of margin status. It also says extraprostatic extension present extensive at right anterior , lateral and posterior, apex to base and left posterior, mid. The tumor was 30% Gleason pattern 4 cribform identified. I am now waiting 3 months for next PSA. Should I be looking at anything else. It was rated 3a

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Get on Bartilutimide and then Zolodex injections ASAP to stop testosterone the fertilizer of pC NOW

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