So if you had the choice of doing surgery or radiation which would you do for intermediate favorable prostate cancer. I've done so much research on both my head is about to exploded. No matter what both come with side effects. So looking for your help on what you had done and why. I'm 61 years old in pretty decent shape. Thanks
Surgery vs radiation for prostate can... - Prostate Cancer N...
Surgery vs radiation for prostate cancer.
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After consultations in US and England on most methods, knowing faced likely risk my intermediate cancer was already out, I chose RP based on: mpMRI findings, desire to remove tumor burden, capability to have <0.010 as post RP nadir bullseye and have salvage RT in reserve. Nine years ago last week was the procedure - no regrets and doing very well even though RP did not get it all.
Some in this forum trash RP and consider me an anecdote. I never disparage another man's treatment path. All the best with your decisions.
Well put, Nano. I also had the RP due to my family’s history of the BRCA2 gene mutation. I was very pleased with the outcome. However after 1 year, PSA started rising, and I had a biochemical recurrence. Disappointing, yet 6.5 weeks of radiation therapy took care of those microscopic cancer cells. I’m cured now. Thanks for your comments.
That's great. Nice to hear the "C-word" here every once in a while. We just don't hear it often enough!
You will find lots of different views on this but here is one persons take. It depends on whether you think the cancer has escaped the prostate or not. If you have a small amount of Gleason 6 or 7 without any bumps felt on the prostate then I would suggest surgery (with an experienced surgeon at a center of excellence) since there is a good chance you can get it all out. And if you don’t you can always get adjuvant radiation. Yes, there are side effect risks (incontenance, ED) but for the vast majority who have surgery it is not that bad. If, on the other hand, you have a high Gleason and large volume and bumps felt, you might go with radiation/brachy. This is because if only a few cells have escaped, the wider focus of radiation may get them.
What did I do? I was torn as I was in the middle ground. I had a high Gleason (5+4) but very little volume (5% of prostate) and no bumps. So I chose a trial door number 3. I avoided radiation, I had surgery, but also 6 months “intensive” ADT to kill any escaped cells. So far, so good. 4.5 years after surgery no recurrence.
I too was diagnosed intermediate/favorable. I chose RP. I also recognize it was largely an emotional decision, based on the experience of a patient (I'm a retired dentist) who had RT, then recurrence, then surgery. His experience was terrible, but I understand it's become more possible to do surgery in irradiated tissue, and it's highly unlikely surgery would have been done after RT in any case.
I am out over 6 years now an as yet no recurrence. I am NOT unhappy with my choice, but I certainly would have looked further into RT as an option.
Bottom line--you have 2 acceptable choices, which is better than having none, even if it makes your decision more difficult.
Good luck!
Thanks
AT 57, that is exactly the decision I was faced with. Here are some questions to ask yourself:
prostatecancer.news/2017/12...
In the randomized ProtecT trial, in terms of cure rates, prostatectomy and RT are equally curative, but potential for side effects is much worse for prostatectomy:
Diagnosed at 53 with Gleason 3+4 (20% 4) and PSA 31. My Dad was diagnosed 4 years earlier with PSA 7. He went RT due to his age and appeared to be in the low-risk category.(SBRT Cyberknife with OAR Spacer and fiducial markers - no side effects and PSA stable to this day 6+ years later)
I went with surgery primarily so I could have salvage RT as a backup plan for a second chance at a cure, AND because I'm young enough, if I don't cure it, there's a high chance I'll live long enough to die from it. Now if you are within 5 years of the average male lifespan versus 20-25 years, treatment decisions could be very different than someone much younger.
I think the big fact that many may risk undervaluing in their decision is you don't know what you don't know. You're basing decisions in many cases on probabilities not certainties. In our attempt to avoid overtreatment and the accompanying side effects, we risk in reality undertreating because there were things we couldn't verify. The technology is not there yet.
So to me, aside from the age factor, the big question is, do you want to maximize your chance for a cure but at the same time also increase the risk of overtreatment or do you want to go by the statistical probabilities and reduce the risk of overtreatment but potentially lower your chance of being cured. It's a personal balancing act decision. I think if you read what many of these people here have to go through for years at an Advanced stage, you might want to error on the side of potential overtreatment when catching it an earlier stage.
If you're young, and have access to an expert surgeon at a center of excellence, surgery to me was a no brainer just to have the second chance with salvage radiotherapy if surgery didn't cure me because there was undetectable cancer outside the prostate. I was lucky to have bi-lateral nerve sparing but was prepared to live with unilateral which would pretty much destroy my erectile function. (Decision was made during surgery by the surgeon by what he was seeing.) I had no positive margins, extracapsular extension or seminal vesicle invasion and 14 lymph nodes removed which had no cancer so he did a good job. But it still doesn't guarantee I won't need salvage therapy.
Admitedly, if I was 3+3 with PSA < 10 and only a couple positive biopsy cores, it would have been a much closer decision and I may have went with SBRT. But there really is in my opinion very minimal long-term side effects with bilateral nerve sparing surgery with an expert at robotic surgery. Some people just don't like the idea of having something cut out of them (especially if it has severe short-term side effects.) Some people are more scared of radiation. Try to take pre-conceived emotional responses to the mode of treatment out of your decision making process and focus on the facts and THINK LONG TERM.
Radiating the prostate and pelvis was not an option up front, or considered too extreme given your diagnosis?
It was but I decided I wanted up to 2 shots at a cure than one shot. Also I consulted with Chiefs of Urology and Radiotherapy at the 3 of the top centers in the West (UCLA, UCSF, and UWash/Fred Hutch) and they all were in agreement due to my age and negative PSMA PET scan outside the prostate, and decent tumor size that surgery was preferred. Also surgery has the benefit of giving you more accurate pathology details as opposed to relying on biopsy cores. You get confirmation of how extensive the cancer is in and around the prostate and with pelvic lymph node dissection if there was small amounts of cancer there that the scan couldn't detect You don't get that additional and more accurate info after RT.
You should look at it predominantly from a different viewing angle: Do you have access to a place where frozen sections intra operational biopsies are the norm plus you will be operated by a surgeon that has been performing 300 procedures per year for the past 20 years, or to a place that employs the latest linac (Elekta Unity) and version of planning/control software, plus the star-radiation oncologist will be around to supervise the implementation of the super-dupper plan they have been boasting about and won't leave it to the discretion of all these fabulous technicians. You most probably don't, but, you get my drift: Select on the available options laying in front of you and not decide based upon general statistical data. You are not optimising for the elderly male population of your state/country, but for your SELF.
Going to see a surgeon that's done over 17,000. Prostate removal next week then the following week going to the Moffitt Cancer center in Tampa Florida to see radiation oncologist. They do have an Mri linac .
It is ultimately the decision of the therapy physicist as to whether or not the “star” radiation oncologist’s plan is implemented.
Yep! The unsung hero of radiation. He/she hides in a back room plays with formulas, etc and they let them out for lunch and to go home.
Oh do not forget the techs that setup and run the machine and the visiting technician who makes sure it is fixed and calibrated to specs.
That RO is simply the “front man” in a band. Do not judge a book by its cover.
Well said. You've done your homework. I'm planning on Elekta Unity for salvage when needed.
What I have found out from places having one, is that they are reluctant to employ it for typical salvage RT. It is an expensive piece of kit, plus salvage RT is still widely regarded as a blind irradiation endeavour, so older linacs fit perfectly the bill . They prefer using it in cases where specific targets have to be aimed at .
I’m seven weeks out from Unity Electra MRI guided RT five sessions SBRT no fiducials no SpaceOAR, empty rectum empty bladder …..no side effects normal bowel urinary function Very active sex life…..no downtime at all….To be I honest I think the beam wasn’t even turned on…..treated at MSK
I was intermediate favorable with a very large prostate gland. I chose robotic surgery; I was convinced radiation would make my already troublesome urinary symptoms even worse. Both neurovascular bundles were spared, virtually no incontinence and erections returned but it took some time and work. In my city, there are a few guys who perform 400+RP's per year. I visited two of them and was not tempted, felt like I'd be part of an assembly line. Eventually, I found a surgeon who had performed thousands of RP's and I believed in him. That was 6.5 years ago and life is very good. Thank the Lord we have options. Good luck.
I’m not here to recommend one treatment over the other, as both approaches have very similar success rates when it comes to a cure. Personally, I chose RT with HDR brachytherapy boost, along with 4 months of pre-ADT and 9 months of post-ADT. I’m a Gleason 4+4 with no metastases as confirmed by the PSMA scan.
When I was deciding, I found myself in a similar position to you. My urologist strongly advocated for surgery as the best option. While I appreciated his expertise, his rather aggressive approach to scheduling made me feel a bit uncertain. For instance, although he mentioned being booked for three months, he suddenly had an opening in three weeks, which left me questioning his motives. It could have been an unfair assumption, but my wife and I both felt the need to explore other options.
After that, we consulted with a radiation oncologist who gave us a comprehensive and balanced view of the treatment options, including potential side effects. He didn’t pressure us but instead helped us feel informed and empowered. With the addition of HDR brachytherapy, we felt confident moving forward with RT.
Part of my decision was influenced by stories I heard from others. A friend who underwent RP 11 years ago faced incontinence and needed an Artificial Urinary Sphincter. While he’s still alive, the quality-of-life impact was significant. Another individual I know had a recurrence three years after RP, leading to additional RT and subsequent complications. These experiences made me realize that while no treatment guarantees 100% success, advancements in RT have significantly improved outcomes over time.
From what I’ve learned, RT has evolved remarkably in recent years, offering better precision and outcomes. In contrast, robotic surgery seems to have reached a plateau in terms of advancements over the last decade.
Ultimately, whatever treatment you choose, embrace it with confidence. Stay positive, trust your decision, and never give up hope. If I’m still here 20 years from now, I’ll know I made the right choice—and I hope the same for you. You’ve got this!
I was faced with the same question a year ago. I chose RT and the reasons are in this post:
healthunlocked.com/prostate...
I'm very glad I did. One year on I've had the RT, which was relatively easy, undetectable PSA, no side effects. I am on ADT which causes some SE's such as muscle ache. I had a friend who had an RP and then developed a pain in his hips two years later which turned out to be from mets. He now greatly regrets his surgery.
RT has come on in leaps and bounds in the last 10 years whereas RP has stagnated.
I assume your friend's nerves were not spared during the surgery. He could have easily still gotten Mets with RT. But I am guessing your point is probably If he was going to get mets no matter what treatment he would have preferred to have preserved his erectile function. If only there was a way to detect 100% of prostate cancer cells throughout the body.
I don't think he would have got mets with RT. The urologist consultant was the same one who initially saw me. He was dismissive of the possibility of spread to local lymph nodes - "your scan is clear" - although that scan was a straight CT not PSMA PET. He just removed my friend's prostate. I had RT of the prostate, bed and lymph nodes as my oncologist calculated the risk of Lymph Node Involvement was significant.
Mark I did the same as you. So far so good. I honestly think that young RO was trying to overcome a shoddy work and had my best interest at heart.
My GP told me to trust that RO. My GP is a former Navy flight surgeon and after 20+ years as a military flyer I have learned to totally trust them. They treated me and my entire family.
I had both. This is extremely common. Surgeons love to tell patients that RP will ‘get it all’ and usually declare confidently that they did. Recurrence after RP statistically is 30% and that includes all the low volume, 3+3 who have no need to treat.
The notion that any doctor can tell you your odds of avoiding salvage treatment after RP by how the prostate ‘feels’ or even your Gleason score is completely erroneous. So is any claim that the vast majority of men who get RP do not have lasting side effects, especially ED. ED and changes to the size and shape of the penis are extremely common. Incontinence is less common but not rare.
I went to a major center of excellence and was given no hard sell on RP but ‘getting it out’ by removal just made sense to me. As it does for so many. I needed subsequent aggressive additional treatment and another surgery for extreme incontinence.
Radiation has come a long way in the last 20-30 years, as has been noted. RP has not. Regardless of stage if I had to do it again it would the radiation that I ended up needing anyway.
My husband chose radiation therapy plus 2 years of Firmagon injections because the PSMA scan showed that there was a small lesion in the pelvis. He had a higher Gleason score. Have you had a PSMA scan? You really need to know if there has been any spread and sometimes it always doesn’t show and then you need salvage RT after the surgery. We had decided that if there was already a lesion in the prostate, why do the surgery knowing that he would also have to do the salvage and probably have significant side effects after both. Remember a surgeon is always going to recommend surgery.
An excellent, ethical surgeon will always recommend what is the best treatment for the patient, all things considered--not what increases his bottom line. My surgeon recommended that I have RT and not surgery. So I would have to disagree with you--not every surgeon recommends surgery.
Yes this is a common misconception in my estimation that good Urologists that do surgeries are biased towards surgery. I think this opinion is common from patients having regrets in hindsight when their surgery wasn't curative or they experienced more severe long term side effects than they were told to expect.
There are a multitude of factors specific to the individual patient to be carefully weighed. Age can make a huge difference in surgery outcomes for example. It's a mistake to simplify things to assume your outcomes will be the same as someone else's.
Yes I agree with you but I guess our experience wasn’t quite the same. My husband’s urologist kept telling him he was an excellent candidate for surgery even though his scan showed the questionable lymph node. When we questioned him with the medical oncologist and radiation oncologist they kept asking him if he would able to remove the lymph node with the surgery to which he said no. So I said why would we do the surgery knowing he would then have to do the 38 radiation treatments. The medical oncologist told us that the best treatment option was not the surgery but the radiation treatment and ADT. I felt like he was pushing the surgery for business so I guess I became a little cynical in the process.
Another agreement - the urologist who diagnosed my PCa did not recommend surgery. He felt being over 70 with some comorbidities ruled it out. His suggestion was to pursue radiation treatment, but he provided me with no guidance on how to go about doing that. Luckily I have a good friend who is a senior radiation tech at a local cancer treatment center (at a teaching hospital), and he guided me to an excellent radiation oncologist (his boss) who took over the treatment. I also found a medical oncologist via a local user support group - he'd been to one of their meetings to talk about advances in immunotherapy (his field of research at a major medical center/school.)
peterattiamd.com/tedschaeff...
Strongly recommend this podcast with Peter Attia & Ted Schaeffer. I was in a similar situation as you & opted for high dose brachytherapy 1 year ago. Lots of great intel here on sbrt, brachy, and RP.
There's a long term retrospective study by Amar Kishan at UCLA that I think went back 20 years showing brachy + ADT has statistically better outcomes than RP or RT + ADT. But you have to keep in mind if there is disease far enough away from the brachy seeds (ie lymph nodes) that was too small to show up on a scan, no local treatment will be curative. Low risk and low favorable I think would be at a high risk of over treatment doing whole pelvic RT. If I had elected brachy I may have asked to add SBRT to my lymph nodes (ENRT not WPRT) or pelvic lymph node dissection to be as aggressive as possible with low risk for severe additional side effects.
It depends on the luck of the draw. With surgery, you may be looking at incontinence. With radiation, the process is painless; but somehow, stressful because of the daily rountine. You may be looking at bowel and/or bladder damage. Or you may walk away from both or either one with little negative effects. The skill and experience of the doctor offers some insurance, but the outcome is never guaranteed. No one will have the same journey. Anecdotical information can sometimes be more confusing than helpful. If you trust your doctors and feel they sincerely have your interest at heart, let them guide you. You have to feel good about your decisions. At the end of the day, all any of us have is hope.
Good points. You can get a pretty good estimate on incontinence based on several prognostic factors
Long term significant incontinence is not common for most patients electing based on these factors to have robotic surgery. You can have continence issues at an older age without prostate cancer or having not had a prostatectomy. Age, extent of the surgery, type of surgery and surgeon skill, along with if you are obese and not physically active all play a factor on likelihood of long-term effect on continence based on studies.
So it is important to not generalize about this side effect without acknowledging the multiple risk factors that play into the probability of long term side effects.
There is never no effect as you are removing 2 of the 3 valves. So it is common for an extremely full bladder to be a bit more painful or have infrequent minor leakage when you are putting a lot of pressure on a somewhat full bladder.
For example I took a spill snow skiing and the way I fell put extreme pressure on my bladdee and I probably leaked a tablespoon or two during the crash. Otherwise my day to day continence feels the same as pre surgery.
But my experience is not going to be the same for someone else necessarily, it's just one example. If I had pre existing continence issues or was 70 or older I probably would not have gotten surgery.
Couple of weird comments to hopefully lighten this discussion.
1. Did you ask your friends and office mates for their opinion on whether you should marry “Sally” or “Peter”. Why not!
2. Did you marry knowing you had actually had a back up plan? Divorce!
I was diagnosed at 69 with Gleason 9 ( 4 +5 ) organ confined PCa. Treated with RP + IMRT + ADT for 2 years. For 10 years now no recurrence, PSA remaining at < 0.008 I am happy about the combined treatment I opted to undergo.
Statistically, the outcomes are the same. You can verify that on your own. So to quote my top flight , New York City, Sloan Kettering radiation oncologist: “If you could have two procedures to treat your cancer, one was invasive, and the other one was not, why would you choose to have the one that’s invasive?” I’ll leave you to ponder that. I did not have a good answer which is why I ended up going with SBRT, LINAC MRI guided RT. Good luck.
To me this is both laughable and a demonstration of unprofessional bias or at least negligent oversimplification by the doctor.
"Following radiotherapy for prostate cancer, there is a 1 in 5 chance of recurrence where the cancer returns inside the prostate."
prostatematters.co.nz/prost...
We can argue the actual percentage with today's RT treatments but if the diseas is 100% confined to the prostate and seminal vesicles, which are removed at surgery, only surgery insures you'll have no recurrence in those places.
Laugh all you want, conversely there's: nejm.org/doi/full/10.1056/N...
I think you misunderstood my point was that the Radiologist (apparently) fails to acknowledge that in certain circumstances RP may have a higher cure potential.
His statement per your post was
“If you could have two procedures to treat your cancer, one was invasive, and the other one was not, why would you choose to have the one that’s invasive?"
Notice he used the word TREAT not CURE.
My answer to his question if you still have the chance of the treatment being curative would be "Because even if the cancer is 100% confined the radiation does not guarantee a cure and if it recurs in my prostate or seminal vesicles, subsequent surgery post RP is high risk with long term side effects likely more severe than doing surgery initially. In addition, I'm young enough that even if the RT kills 99% of the cancer i can still live long enough for it to come back and kill me "
But that's me. Another patient might have different circumstances and goals. Their answer would be different.
One interesting question to pose to Prostate Cancer patients is, can you envision having a different set of prognostic features, including your age, that would have changed your decision between RT vs RP? Anyone answering NO is not fully aware of all the factors that should be considered.
I can list a combinations of factors that would have lead me to RP and others combinations that would have led me to RT. I did not let my general emotions about the mode of treatment, a single doctor's bias, a single study, or anecdotal reports of other patients effect my decision. I went by multiple studies and opinions from 6 different doctors with different experiences and specialties.
None of them were stupid enough to pose that kind of oversimplified question to me since I had potential of a cure and it's just not that simple. They explained all the different factors to weigh.
It would have been a big mistake in my opinion to dumb it down to that oversimplified question which in my opinion indicates an obvious bias based on his specialty.
If gaving RP post RT had no more severe side effects than doing the RP first I would have definitely chosen RT. But unfortunately that's not the reality.
You don't get a "do over" if RT fails and your cancer isn't metastatic.
Any physician that will give you 100% is not to be trusted. That's just Trumpism. But, to each his own. I didn't go to one physician who used the word cure. Besides, this is a forum where we share our experiences to try and help one of our PC brothers asses treatment options. It's not a debate.
Providing treatment decision history without full complete context involving all the factors in play is unhelpful at minimum if not dangerous. Some people can mistakenly place too much importance in anecdotal reports by individuals.
You’re making a mountain out of a molehill. I’m finished here. Good health to your sir.
is it fair to assume Dr Z, who is no longer at MSK, was your radiation oncologist ? If so, he’s a rock star and the best in the business. A world renowned leader in the field. Stay well !
You are correct. I’ve been following up with his associate Dr. McBride, who appears to be a rockstar in his own right. You be well also.
Surgery ensures no such thing. Maybe not recurrence in the now removed prostate but in the prostate bed or where ever else this disease may have spread to and was undetectable at the time of RP surgery.
I agree. I suggest reading the book 'Invasion of the Prostate Snatchers' by Dr Mark Scholz.
RP surgery the most invasive option. I chose neither.
I went with HIFU.
One needs to weigh your bio to understand why you chose that treatment. Your bio is far different than the OP and indicates you were never really attempting a cure and your choice (I bet a good one) was largely influenced by having previously had TURP surgery. Your low PSA at that age indicates you can probably delay the cancer until you die of something else without more invasive treatments.
Why would you say "you were never really attempting a cure." We, unless grossly metastatic at the time of diagnosis, are all hoping for a cure. There's nothing in my case to indicate otherwise. Clean scans. No sign of metastasis yet anyway and it has been 8 years. Other than my prior TURP surgery why would you say my "bio is far different than the OP"?
thomasahleringmd.com/wp-con...
thomasahleringmd.com › uploads › 2022/05
by AS Kibel · 2012 · Cited by 169 — Results: The adjusted 10-year overall survival after radical prostatectomy, external beam radiotherapy and brachytherapy was 88.9%, 82.6% and 81.7%
NOTE: The above article was 2012!
I then looked for something to compare recently since 2012 was quite a while ago. (We now have PSMA-pet, Orgovyx, etc. I could only find this article:
EAU 2023: Survival after Radical Prostatectomy vs. Radiation Therapy in Clinical Node Positive Prostate Cancer Patients: A Multicentric Study
Agreed, localized vs node positive is not a good comparison, yet I would suspect that the outcome for the node + would be worse. In this:
“…it appeared that the biochemical recurrence-free (86% EBRT versus 76% RP, p=0.15) and metastasis-free (97% versus 83%, p=0.051) survival rates were non-significantly better in the EBRT arm. Conversely, overall survival rates (97% versus 87%, p<0.001) were significantly better in the RP arm, likely a reflection of a selection bias for better overall comorbidity/performance status in the RP cohort at time of intervention.
My take-away, from the research that I’ve done is I think (and I could be wrong) that as time goes by the RT + ADT (and in my choice, brachy boost) beats (from a survival POV) surgery, and adverse effects. I suspect as the years go by surgery may drop as a % in the treatment of choice.
I also believe that in 3-5 years AI will come hugely into play, and I think that will move the % away from RP.
So much depends on just what you want. (If you have a choice, practically speaking). But, often I see RP as a choice because, “damn it, cut it out.” I get that, but all too often, not “all” gets cut out.
It is difficult, and researching it can be awful (if you’re that sort of person). Best of luck.
Thank you
The AI can help give more information to the decision making but I think there's no clear rationale at this point to say it will swing people one way or another. Time will tell.
Because just as it could help give a more higher accuracy that the cancer is not locally confined it can do the converse and give more accuracy that it is locally confined.
If it shows it's less likely to be locally confined then less surgeries. If it does the opposite, especially if the patient is younger it could increase surgeries. Some have false belief that if you irradiate the prostate there is zero chance any cancer remains in the prostate or seminal vesicles. If AI can give more definitive indication the cancer is 100% local RP for relatively younger patients is clearly the better choice if you want to insure maximal chance of a cure.
I want to preface by saying my case was an outlier, but surgery made my life much worse and permanently so. In addition, I had to get salvage radiation less than 2 years later.
My robotic prostatectomy was botched and required a major surgery at a much larger city in another state to get any quality of life back. I was close to suicide and wouldn't be here today if not for that reparative surgery. I am not against surgery, but vet your surgeon very carefully! I thought I did, but I was wrong.
My salvage radiation was a bump in the road but stopped the cancer for only about 3 years. None of the treatments available are without risks or consequences.
I was dignosed at the age of 56. PSA 7. It took me time to decide what to do. I opted for surgery. Lots of doctors or urologist told me that was the best option for me. For me to be honnest the best solution was : doing nothing. Side effects are allways a risk. If i choose radiation i had to undergo ADT. Some urologist told me that side effects from radiation are sometimes visible only 20 years after treatment. Anyway the argument to do surgery was : the only non toxic way to cure, or at least start to cure this cancer. I was may be lucky because i had good surgeons. (3 operators). They could spare both nerve bundle. Biopsy was 3+4 and one core 4+3 but at the end the Gleason score was 3+4 = 7 on the path report. Negative margins at the path report. Incontinence after surgery was very short (1 month), normal after catheter, but after a short time no problem anymore, even with effort. Impotence is ok, with help of pills sometimes. Having sex now is different but it s ok. I cant know how it would be if i didnt had this surgery. One more plus is : i dont have problems with a too narrow urethra or prostate pusing on the urethra, what i had before surgery sometimes. How this problem would be now without surgery a cant konw it.
Now : PSA 0.03 after surgery (more than one year now). Hope it will stay like this.
Good luck. Take your time, dont stress. For me the biggest deal was psychological, bacause no surgeon would care and speak about your life. They care about having the tumor out. So try to speak with other patient (like here for instance).
What you will choose you have to accept the "consquences". Goal is no tumor and a good quality of life.
Christian (from Switzerland)
I would strongly suggest that you consider whether you would need to endure ADT and for how long when deciding on a plan of treatment.
I had RP over 6 years ago, Gleason 7 (3/4). PSA undetectable since so I’m cancer free , that’s the good news.
The not so good news, immediate and permanent ED. Also mild stress incontinence requiring men’s pads .
I’ve had several friends choose radiation therapy for PCa and have had very good results in most cases. I would seriously pursue the radiation option if I were to get a do over.
Good luck!
in 2018 I had a prostate tumor on an mri and biopsy determined that it was cancer 3+4. I did a mistake and had a laser ablation in florida My PSA started to go up and no mri showed any tumor. I was told two things by the doctor that performed the ablation that were not true. The first was that I had the option RP in future and I could repeat the laser ablation with a minimum expense charge. The doctor wanted $25k again and not surgeon wanted to perform the RT due to the ablation. I flew to Dallas to the UT southwest hospital and they did a biopsy and recommended SBRT with spaceoar. The did a PSMA pet scan and did 5 sessions of radiation My psa after 3 month was 0.58. UTSouthwest did everything by schedule and I no complain or any side effects
Lots of confirmation bias in some of the answers here.. it's not immediately obvious, but it shows up with "I had XYZ treatment instead of ABC treatment, and it worked for me, so it should work for you." "And I made the RIGHT decision with XYZ treatment." There are a few "don't do what I did.." posts to balance those out.
I believe the original question wasn't a wrong one (what did you do and why?) - it's simply impossible to pick one of the treatments discussed and say it's the "best".. why? EVERY case of PCa is different in some aspect. What worked for me may not work for you unless you have an identical disease and health profile, and genes to mine. I'm not going to suggest my treatment for you since we are different people with different diseases.
TA gave you a few papers to read - I'd suggest reading them, then consider if they apply in your case. When I was making my decision there were several studies that strongly influenced my decision. Since I was Gleason 9 (or 10, depended on the read) there were less studies done for cases like mine, and especially less studies of the A vs B format (different treatments done on similar men with similar disease)... but one or two caught my eye and greatly influenced my decision.
If your head still feels explody after reading the papers TA suggested, I would suggest that you reach out to him personally and ask if he has any other guidance he might provide. He has been quite generous in that when I've approached him. He does present fact based suggestions rather than anecdotal stories. He's excellent at digging out the facts and ignoring the crappola "studies".
Your bio does not state the PSA, Gleason, etc.
In my case, I have neither and my PSA was 6 over 9 years ago, crept up and have still luckily have no symptoms fortunately. I did completely change my diet, and exercise and never got a biopsy- and just accepted this roll of the dice. Most of the studies that I have seen ignore diet and some don't take into account alcohol consumption, obesity, smoking, lifestyle, etc.
Key part of the NEJM 15 year study, is there are not 2 but 3 options including active surveillance. Which such a study will never likely be repeated as where will funding come from since all the procedures, drugs and treatment is a money train for the system.
"Death from prostate cancer occurred in 45 men (2.7%): 17 (3.1%) in the active-monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the radiotherapy group (P=0.53 for the overall comparison). "
It's all a gamble, comparing 2.7 vs 3.1 vs 2.2% seems to me that doing nothing medically is an option. If you read the huge amount of side effects posted here- you will see a diverse set of results.
Psa 5.12 Gleason 3+3=6 core was 20%3+4=7 core was 20% . Intermediate favorable.
PSA is a bit high but not alarming, and Gleason 3+3 is being strongly pushed to be relabeled as NON cancer. 3+3 "treatment" is generally "active surveillance.." Going full on treatment at this stage is like swatting a fly with a sledgehammer. The fly may be smashed, but chances are so is everything else around it..
Relax. Look into modifying your diet- Johns Hopkins had a recent paper about diet. Study, read all the scientific papers, get to the acceptance stage that you have something out of your control- and decide if you want to turn that control over to someone else. Don't ignore but rather read all the treatment risks and horror stories here on this forum, as they woke me up to make my decision. There are quite a few videos talking about over treatment as well. Your comorbidities- if any, take those into account also. In my case, I lost 60 lbs, taking numerous supplements, eat foods with lycopene (Tomato products) and sulforaphane (Brocolli, Cauliflower), curcumun (tumeric), and removed most high sugar or high fructose corn syrup products (No more soft drinks), stopped eating all milk, dairy, bread, pastas, processed foods packaged and meat (including chicken filled with hormones) and now no more blood pressure pills, feeling great, and cholesterol dropped to normal. I also don't have the usual side effects some experience with urination at night and last checked PSA was 25. Will my PSA increase, will it double soon? Who knows, maybe my tumor will shrink, maybe it won't, maybe it will stay put, maybe it will escape (ECE). Whatever happens, happens. My quality of life is great now, and don't want to risk it. I refuse to be damaged by submitting to the mass opinions of treatment- YMMV- as everybody has different levels of severity you will find. I know it's mind numbing reading and reading, and contradictions, and opinions are all over the place from draconian- cut it all out to doing nothing.
Late to the game but.....I elected RP due to knowing my chances of having any disease outside the prostate was negligible. Also, my physical condition, age, no comorbidities, etc. My thought process was; 1. Access to an excellent surgeon (not my uro) that had a track record to present. 2. Multiple MRI's over 18 months and 40+ cores removed from my prostate over 3 biopsies so again, my faith that I did not have alot of volume of disease(only 1 core found) and that it was contained. 3. I favor the PCSM rates of RP over RT and a bit less complication of secondary treatment (but more possible SE's) and no ADT(G8 diagnosis). 4. I had terrible urinary issues that only one of my 3 RT consults said she could remedy, "probably". The other 2 recommended RP due to existing urinary issues. My surgery was a breeze. I have no ED, incontinence, penis shortening or any other issues and I'm a bit over 3 years and still <.02. , <.01 at a different lab test. My only issue sexually is that I miss my ejaculate more than I thought I would! Wife has no issues with the lack of a mess but I miss that feeling of it. After dribbling urine for 4 years and sleeping 90 minutes at a crack I cannot tell you how GREAT I feel now! This might sound odd but here goes; I used to hide in a public bathroom because I was embarrassed of how long it took to void and the sound of my dribbling. Now I feel like leaving the main door open so everyone in the building can hear me water-jetting the back of the urinal!!
All this and I do NOT advocate for RP...sounds weird but when my friends ask about advice I tell them to look into RT but it is their choice!! I have just read too many stories of folks having cancer outside the prostate already and/or having some hack operate on them that their chances of not having effective treatment/proper surgeon leads to early BCR, incontinence, ED and advanced disease. Also the gains of RT delivery over the last 5-8 years is huge and you cannot ignore it.
I'm 100% satisfied in my choice of treatment for ME. But no doubt, I took some chances for sure and got lucky statistically.
Good luck OP!
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