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[Airhead2]

sudden PSA rise on follow up after having biopsy two years prior. Low Gleason score, I chose robotic surgery to hopefully rid myself of cancer. Scheduled for Jan 9th & trying to get better educated about situation. Thanks

[Tall_Allen]

Why did you wait 2 years - were you on active surveillance? Did a follow-up mpMRI suggest progression?

" I chose robotic surgery to hopefully rid myself of cancer." Surgery has no better chance of ridding you of cancer as radiation, but active surveillance may still be possible if there has been no progression.

[Airhead2 in reply to Tall_Allen]

Yes, I was on active surveillance. Recent MRI showed growth X3 over the two year period. The Urologist is Duke educated and did his residency there and taught robotic surgery at University of Tennessee; he is highly recommended. He did give me the choice of continuing monitoring with another biopsy and Gleason score or radiation. I have an innate fear radiation. I’m a generally healthy 69 yr old, non smoker ex boozer who runs, does yoga, weights etc.

[Tall_Allen in reply to Airhead2]

You might want to see a psychotherapist to help you get over your unreasonable fears that are getting in your way. I did, and learned some valuable techniques that I still practice.

[Airhead2 in reply to Tall_Allen]

I’ve had some very successful surgeries in the past: heart ablation for afib, knee replacement, wrist, not to mention kidney stones & hernia. Maybe, I have great confidence in the surgeons; it’s obviously the reason I can still run, golf, lift weights and more. I don’t believe it’s an unreasonable fear. Do you for some reason not recommend surgery? I have a few friends & acquaintances that have had great success with surgery and a friend that went the radiation route that has some leakage problems although he is so far cancer free. Do you perceive greater risk? I’m only a layman, but I’m thinking greater chance of peripheral damage and chance of other cancers caused by the radiation. Am I that far off base? I’m only a retired airline pilot and fairly recent EMT, don’t think I’m that phobic although I’ll admit it might be from preconceived opinions.

[Tall_Allen in reply to Airhead2]

The side effects of prostate radiation are milder than surgery, so, yes, your fear is unreasonable. Permanent incontinence occurs in about 20% of men having primary surgery vs about 2% of men getting primary radiation. ED among previously potent men is permanent in about 65% of men getting nerve-sparing surgery vs about 35% of men getting primary radiation. Second cancers caused by radiation, if they occur, are on the order of 1 in 1000. Both have salvage treatments (radiation is salvage for both) that usually work if the primary treatment fails, which is rare.

I'm not against surgery, but there is no rush to get treated, so take your time, and talk to specialists in each therapy. Until you do, your best stance is to decide not to decide, and to get rid of your preconceived notions.

[ron_bucher in reply to Tall_Allen]

Can you provide sources for those numbers you cited? They don't look representative of the cases and studies I've seen.

[Tall_Allen in reply to ron_bucher]

Yes I can. Can you provide sources for the numbers you've seen? There's a lot of bad info out there.

[ron_bucher in reply to Tall_Allen]

Please do share.

[Tall_Allen in reply to ron_bucher]

I never quote figures without proof. If you have seen something contrary, let's see it. I come on here to help people, not to belabor them with data.

[ron_bucher in reply to Tall_Allen]

If you share references for numbers you share, then your numbers would have credibility. We know you have a wealth of knowledge, but it raises a yellow (or red) flag whenever anyone (especially without MD credentials) refuses to cite any references for such statements.

[ron_bucher in reply to Tall_Allen]

my.clevelandclinic.org/heal...

hopkinsmedicine.org/health/...

[Tall_Allen in reply to ron_bucher]

I don't refuse. I just asked to see what you where your misunderstanding came from first, so I don't waste my time getting data that is not questioned. As I supposed, you had only seen the public statements of some hospitals that have a stake in misrepresenting the data, not actual trial data.

The actual trial data is this: On incontinence (see Table 1) and on erectile dysfunction (see Table 5):

prostatecancer.news/2016/09...

Those Tables are from these two sources:

nejm.org/doi/full/10.1056/N...

nejm.org/doi/full/10.1056/N...

[ron_bucher in reply to Tall_Allen]

Thank you

[Derf4223]

Being an APCa patient myself, doctors like to offer us options depending on our grit.

Grit is the ability to face down howling fears and make objective decisions. Grit is to know that none of the options guarantee anything. Grit is being willing to take treatment risks because you have loved ones relying on you.

TA rightly pointed out it is frequently the case RP does not cure and if so, RT is next anyway. As an ex-pilot, you are probably well aware you have accumulated a higher lifetime radiation dose anyway. Ask yourself, do aircrews get high rates of secondary cancers? That dose hits everywhere in your body. In contrast therapeutic RT is very tightly controlled and planned in terms of laying down a 3D-shape-conforming total dose to a volume of even only a few cubic mm. The best RT machines use real time MRI to track even small motions of target volumes, allowing even tighter control.

Good luck. Making decisions based on fear is probably not what pilots are taught to do.

[pakb]

Have you consulted with an oncologist who does not specialize in that surgery? It is usually a good idea to meet with a radiation oncologist and a medical oncologist along with a surgical oncologist. This was you can get a clear picture of options. If it hasn't spread and you have low gleason- you may also want to ask on the prostate cancer group on this site. This group is advanced prostate cancer- meaning metastatic and/or high Gleason or high risk aggressive. Either way- good luck with whatever you choose!

[pakb in reply to pakb]

Just re-read your one comment- I'd consult with the oncologists I mentioned before having anything done with a urologist.

[Oatmeal2]

I’m with the other commenters here. Take your time and make an informed decision. Radiation such as IMRT is much more precise and advanced than it was even 10 years ago. Even with the surgery there is no guarantee that it hadn’t spread outside of the prostate, then you would have to deal with salvage radiation.

[ron_bucher]

Advantages of Prostatectomy that hardly anyone ever talks about:

- surgery pathology report provides a better understanding of the state of the cancer

- PSA becomes a pretty reliable indicator of cancer progression

- no more risk of BPH

- no more "factory" for normal prostate cells to mutate into PCa

- no more biopsies

[Bethpage in reply to ron_bucher]

My husband had a simple and (sadly) a salvage. I've been wishing he'd qualified for RT. He had very extreme BPH so RT was not advised. I'd not thought of these 5 advantages of prostatectomy. Thank you!

[Airhead2 in reply to ron_bucher]

Most doctorsTrusted Source believe that the treatments are equally effective. Surgery may offer a slightly higher long-term cure rate than radiation. But several factors influence the success rate, including the grade and stage of the cancer and your age and medical history.

A 2022 reviewTrusted Source of 23 studies found that people with localized prostate cancer who received external radiation had lower overall survival than those who had surgery to remove their prostate. But the study also found that combining external radiation with brachytherapy (internal radiation) had a similar success rate to surgery.

American Cancer Society study, very recent. I appreciate all the advice but I’m leaning much more towards surgery than radiation. Evidenced based especially, doesn’t really help telling me I need psychotherapy, fear-nonsense or radiation follow up anyway. Either way, it’s a leap of faith.

[SilverSeppi in reply to ron_bucher]

sorry but these are ALL incorrect, no idea where you got your false information.

[groundhogy]

Rate of cure for surgery vs radiation is in these graphs.

prostatecancerfree.org/comp...

[groundhogy]

It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

[SilverSeppi]

You REALLY need to explore all your options before jumping into surgery; there is no rush. Make sure you speak to a radiation oncologist, today's radiation is far more advanced than years ago and just as effective if not more than surgery. I also see WAY too many cases where surgery was performed and then not long after salvage radiation was needed, so they should have just done the radiation in the first place. That of course is just my opinion, you need to do your research then decide what is best for you. Good luck.

[ron_bucher]

"should have just done the radiation in the first place" - a radiation oncologist told me that a few minutes after my urologist told me I had BCR after my prostatectomy. I felt like grabbing him by the throat, but instead I promised myself that I would NEVER second guess any treatment decision made by any patient.

[ron_bucher in reply to ron_bucher]

p.s. and I'm still glad that I had the prostatectomy because the benefits have far outweighed my side effects.