Looking for input about reoccurrence rates between radiation and surgery

ron3637

First post. Recently diagnosed with PC. I am a 76 years old in good health otherwise. Results of testing: I am told I am in the intermediate favorable group with a 5.6 Gleason and 4-0 decipher. My PET scan shows no margin involvement. I am trying to get a handle on the reocurance rate between the two options surged or radiation. In other words, which has a higher one and done rate 15 after each procedure. It appears that radiation has a higher reoccurrence down the road, but I can't find meaningful statistics on this issue. Also it appears surgery gives you more options for reocurance. Thank you.

centralPA

I’ll look for the link, but the bottom line is that for both radiation and surgery, the reoccurrence rate is right about the same.

Here’s one paper, with a key quote…

https://www.nejm.org/doi/full/10.1056/NEJMoa2214122#:~:text=Death%20from%20prostate%20cancer%20occurred,0.53%20for%20the%20overall%20comparison).

At a median follow-up of 15 years, we found that mortality from PSA-detected prostate cancer remained very low regardless of whether men had been assigned to receive active monitoring, prostatectomy, or radiotherapy. Radical treatment resulted in a lower risk of disease progression than active monitoring but did not lower prostate cancer mortality. 

This paper shows that biochemical recurrence (BCR) is low for both surgery and radiation, but that mortality following BCR is slightly higher for radiation than it is for surgery.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809152

jc5549

Sloan Kettering prostatectomy prediction of outcome: https://www.mskcc.org/nomograms/prostate/pre_op

jc5549

MSK radiation information:

https://www.mskcc.org/cancer-care/types/prostate/treatment/radiation-therapy

centralPA

With favorable intermediate and at an age of 76, active surveillance is absolutely an option for you.

Marlon

Outcomes being equal, it's the recovery and side effects that are important to consider. And your projected lifespan.

My urologist confirmed that surgery can be followed by radiation if necessary, but options are much more limited the other way around.

ron3637

https://csn.cancer.org/discussion/comment/1716577#Comment_1716577

https://csn.cancer.org/discussion/328251/looking-for-input-about-reoccurrence-rates-between-radiation-and-surgery

Follow up Question

What do you all think about active waiting with my result? Thank you all

Old Salt

5.6 Gleason? Please explain.

With respect to reoccurrence rate, do you include radiotherapy after prostatectomy? The latter is frequently necessary, unfortunately.

More in general, here is a recommendation from the American Urological Association:

For patients with favorable intermediate-risk prostate cancer, clinicians should discuss active surveillance, radiation therapy, and radical prostatectomy. (Strong Recommendation; Evidence Level: Grade A)

jc5549

https://csn.cancer.org/discussion/comment/1716583#Comment_1716583

That is something you want to discuss with your Urologist. Your age, health, and expected survival over the next 10 years plays a big role in how aggressive you might be. I find these guidelines from the American urological experts (AUA and SUO) very helpful.

Clinically Localized Prostate Cancer: AUA:ASTRO Guideline (2022) - American Urological Association.pdf

centralPA

What do you all think about active waiting with my result? Thank you all

I think it absolutely has to be in the mix. The one paper I cited showed that the 15 year mortality was equivalent for surgery, radiation and active surveillance. Among the active surveillance cohort, about 67% eventually sought some sort of therapy, but that means they were able to put off the side effects for a good period of time at no expense to their mortality. It is definitely a viable option.

ron3637

Thank you all for your responses. If I get treatment it will most likely be radiation. Prior to treatment should I have had a MRI or is a MRI performed during treatment on the table so none is required before hand . Thank you.

ron3637

Also if there is a reoccurrence after radiation is ADT the only treatment? ADT really scares me. . Thanks you.

Old Salt

https://csn.cancer.org/discussion/comment/1716660#Comment_1716660

No; one still has the option of removal and there are focal treatments that can be considered.

There are relatively few urologists that are skilled at surgically removing the prostate after it has been irradiated, but it can be done.

Focal treatments (there are several) have their pros and cons as well.

Sort-term ADT shouldn't scare you. It's not a walk in the park, but many of us have recovered OK (including me).