Looking for input about reoccurrence rates between radiation and surgery

ron3637
ron3637 Member Posts: 14 Member
in Prostate Cancer #1

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.

Comments

  • centralPA
    centralPA Member Posts: 341 Member
    edited July 14 #2

    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
    jc5549 Member Posts: 58 Member
    #3

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

  • jc5549
    jc5549 Member Posts: 58 Member
    #4

    MSK radiation information:

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

  • centralPA
    centralPA Member Posts: 341 Member
    #5

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

  • Marlon
    Marlon Member Posts: 127 Member
    edited July 14 #6

    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
    ron3637 Member Posts: 14 Member
    #7
    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
    Old Salt Member Posts: 1,530 Member
    edited July 14 #8

    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
    jc5549 Member Posts: 58 Member
    #9
    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
    centralPA Member Posts: 341 Member
    #10

    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
    ron3637 Member Posts: 14 Member
    #11

    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
    ron3637 Member Posts: 14 Member
    #12

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

  • Old Salt
    Old Salt Member Posts: 1,530 Member
    #13
    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).

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