radiation for4+3 (unfavourable intermediate risk)? (2025)

Is the cancer only in the prostate capsule has it spread, generally what I have learned if it has said little point getting surgery, yea they may get it all however; generally you hear over and over that the cancer comes back, as to radiation, my experience was no side effectds, sexual, pain or discomfort for over two years, then I developed ulcers, strictures and calacum build up in the prostatic ureathra, follow up with incontience.

Although I need to point out that from my understanding on 6% of radiation patients have the side effects that I had. So research and try to verify were you cancer is. Good Luck to you Art

In reply to pipes-as's comment

I was diagnosed in early 2018 also Gleason 4+3 and with PSA of 52. Scans and CT revealed nothing. No PSMA available then.

As I understood at the time, despite clear scans my doc still had concern of some localized escape. He rec’d and I chose RP. Post op pathology found seminal vesicle invasion and occurrence in one local nymph node - Stage 4b.

i had a brief period of minor incontinence after surgery- a few weeks of stress leakage. No big deal

Post op treatment was 4 full years of ADT and 39 sessions of radiation of pelvic area and prostate bed. Diagnosis tools and treatment options present more options now.

The problem is we seek 100% perfection in our diagnosis when that is impossible... The MRI only can see so much, the CT, same. Biopsy only samples a very small part of the Prostate. And PET scans as good as they are still only see efficiently above .5ng and lesions larger than 4mm (almost 1/4")...

It used to be, that Surgery has a very slight advantage over radiation, especially for patients who progressed into advanced stratification with recurrence. But radiation application got a little more accurate and the addition of ADT as a multi frontal attack helped produce better results. But it's difficult to sort out which is actually better. 10 year Survival for newly diagnosed patients was almost 100% (98%) even years ago. 15yrs not far off those numbers, regardless of path (treatment) chosen. Today, studies support a slight advantage the other way, that a multi modal approach of radiation & ADT together produce superior efficacy in first line therapy. Sometimes even a third treatment arm concurrently (Triplet therapy) depending upon diagnosis that has improved patient survival significantly.

There is no differentiation between therapy in regard to side effects. All therapies have side effects. Radiation and Surgery have the same. Surgery is immediate, and radiation side effects come later, sometimes years later. Be sure, there can be side effects. I've had every treatment you could imagine. Surgery, radiation with ADT, the surgery again, chemo, more radiation, and drugs that could knock down a Moose. But through it all, my side effects were negligible. Even today, in my journey, I'm still doing pretty good (knock on wood) in regard to side effects as I have so little of them other than fatigue and maybe a brief 30 second hot flash.

Biggest and toughest decision we face as patients is separation of Morbidity and Mortality. The two are mostly mutually exclusive. But I believe most of us, chose to address Mortality over dealing with the annoyance of some side effects. I'm not making light of it as I've met some here and elsewhere that have suffered serious quality of life issues (side effects) that have immediately impacted their treatment decisions (stopped ADT). It all just depends. You won't really know until you dip your toe in the pool how warm the water is!

Good Luck and Best Regards

With a good chance of spread beyond the prostate in your particular case, radiation of some sort is a no-brainer. (The surgeons’s scalpel is limited to removing cancer within the prostate).

IMRT with HDR Brachy boost (w/wo ADT) is one very popular option at the top centers for 4+3.

Beyond that, a clear PSMA at this point really tells you nothing (given the detection threshold).

Best of luck.

In reply to Member_Goldfish9548's comment

I was 4+3 with ECE, EPE PNI and 90% positive cores.

I had EBRT and brachytherapy boost. The disease came back after about 4 years and I now have radiation induced bladder cancer.

Make sure you ask about long term outcomes if you choose radiation like I did.