Odds of Reoccurrence after Surgery

I wanted to do a separate thread from my "My Story" one that contains my whole history.

I just had a prostatectomy on 10/21/24. My pathology was a mixed bag with stage pT3A and two EPEs but I have clean margins and no lymph node involvement. (See signature.)

I've heard various figures of how often reoccurrence happens after surgery - everywhere from 20% to 33%. I'm curious if there have been studies that narrow that down based on the staging of the post-op pathology. For instance, patients whose cancer did not break through the prostate skin compared to cases like mine where it did. Or cases of positive margins versus negative margins.

I've gone through many accounts both here and at other sites and there are a distressing number of cases of reoccurrence. There are also positive accounts of guys remaining undetectable but I do wonder if we hear more often from those who have relapses.

Anyway, again, just wondering if the reoccurrence rate has ever been broken down based on the specific pathology. Thanks.

Jason B - I think you are making a mistake by using a forum or forums to base any statistical analysis or conclusions on. My guess is that forums represent way less than 1% of all PCa patients and tends to attract those with more difficult situations and those who like forum participation in general.

The overall statistics for prostate cancer diagnosis survival are good like near 100% at 5 years, 98% at 10 years, and 95% at 15 years per JH which is irrespective of treatment method. Keep in mind that this is based on all treatments done in the last 5-15+ years, not today.

Clearly, recurrence risk goes up with the Gleason score and staging but there are the other items you have such as family history, high Decipher score, cribriform pattern which are not included anywhere in the statistics and some are newer criteria.

My Dad had recurrence at 13 years and my wife at 17 years which means you are never free from recurrence risk with cancer. There are a number of men on the forum with cases that most would not expect a recurrence to happen with but here they are. Cancer is a diabolical enemy and quite unpredictable with time on its side unless you die from something else.

There are many sources of the information you are looking for. The most well known but older were the Partin & Han tables from JH:
https://www.hopkinsmedicine.org/brady-urology-institute/conditions-and-treatments/prostate-cancer/risk-assessment-tools/han-tables

Cleveland Clinic, MSK, and others have similar charts, graphs, and/or calculators but they are generalities and to not apply to any one person. A 1% chance sounds low unless it is you.

Jason, don't project too far into the future. When I look back at the secondary treatments guys in here were talking about 10 years ago, compared to what they are talking about now, it's a whole different world.

10 years from now, who knows what will be happening?

Plus, you have a lot of living to do--so go live it. Yes, get your PSA done regularly--probably every 3 months for the first year, every 6 months for the 4 years after that, and annually therafter. If something happens, deal with it then. You've got a strong chance of making it 15-20 years with no issues. Embrace THAT/

Jason,
You have a lot of scenarios running through your mind right now, and that’s normal. I did the same thing and I imagine many/most guys do it too. It’s probably better than trying to just ignore the issue, which plenty of guys do as well. Almost certainly things will settle down and you will become more comfortable for accepting that your life has changed forever. Like the guys said, you will go on living your life.

The other thing mentioned by the other posters is that you have time on your side as treatments continue to advance. For me, just a simple change in the sequencing of anti- androgen drugs will hopefully continue to keep me alive for years to come. Researchers are already running Pluvicto trials on castrate sensitive guys. Also, I know you questioned whether or not you would ever submit to ADT. I felt the same way, but when we have “do it or die” staring at us, most of us quickly change our minds.

If you don’t already have a handle on the way you feel about things, it will come and you will go about your business much like you always have.

Hang in there, it gets better.

Thanks for the further insight.

I guess I'm just adjusting to the new normal. My anxiety about what to do about my prostate cancer has now shifted to a different type of worry. After the initial excitement of finally doing something about my condition, the reality has hit that my body is altered and now I must play the waiting game. This entails waiting to get sexual function back as well as a general feeling of wellbeing along with waiting for the PSA test that's still over 2 months away.

It's natural to want to put odds on things but I realize there is little that I can do to affect them at this point. I think some of the anxiety will dissipate once I'm back doing more normal things. I admit that I perhaps wasn't expecting to feel this depressed about the situation but I'm trying to not let it affect my interactions with family members and others. Today is the 4 week point and I expect to make significant progress in the weeks to come.

JasonB,

If only to rule out a big miss from surgery weeks earlier than if you wait the full 3 months, many of us who had surgery were psa tested at 6 weeks to see how things are going. (i was).

The definitive test is the later one, but if you have persistent psa at 6 weeks, you will likely have it at 12 and you can start lining up tests/drs/strategy in the unlikely case of a miss.

Knowledge is power.