Surgery vs radiation for prostate cancer.

[RBSW1]

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

[NanoMRI]

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.

[RBSW1 in reply to NanoMRI]

Thank you

[Tony666]

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.

[RBSW1 in reply to Tony666]

Thanks

[dentaltwin]

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!

[RBSW1 in reply to dentaltwin]

Thanks

[Tall_Allen]

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:

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

prostatecancer.news/2016/09...

[jazj]

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.

[Justfor_]

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.

[RBSW1 in reply to Justfor_]

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 .

[Jpl506 in reply to Justfor_]

It is ultimately the decision of the therapy physicist as to whether or not the “star” radiation oncologist’s plan is implemented.

[allie2020]

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.