radiation versus surgery

Hi Augus


Like you this is my first time using a cancer forum and noticed your post. We have a lot in common. Like you I restore old cars, 78 years old, newly diagnosed with Stage 3 prostrate cancer with no symptoms and no spread outside of the prostrate with a Gleason score of 8. So I am in stage 3.


I live in a relatively small town with no fancy cancer center or cancer support teams. I had to solve this puzzle by myself. Like you I am active and have no other medical issues. Here is how I went about it.


I used the internet and plain old Google and Google Scholar and started searching. I stayed away from any sponsored site on Google. It took a while to sort this all out but you may want to start with a search like “treatments for stage ? Prostrate cancer” also visit the American Cancer Society web site to get a good overview.


In addition I will make a car analogy which may help you. If you ask a guy who has owned Fords for years what the best car is it should not come as a surprise that he tells you it is a Ford. Well I found this true in having to deal with individual specialist doctors. If he was a surgeon the solution was surgery or if she was radiologist the answer was radiation. They all have a bias.


One thing I found out in my research was both procedures are equally effective and radiation had fewer downsides. Also that men over 65 had a tendency to just trust their doctors for various reasons - lack of knowledge, confusing and frustrating, etc. In addition if you are 70 plus there are few studies published that deal with guys like you and I. Most cancers today are diagnosed in younger men who have lower stage cancers. I guess we statistically have such a short time remaining it is not worth researching us. Yes there is ageism in cancer research.


All that said I eliminated surgery in my case based on recovery time and possible side effects. My wife is handicapped so I could not afford a lot of down time. Next month I meet with a radiation doctor to discuss my options. Internal or external radiation with or without hormone replacement therapy or some combination of the preceding.


Not sure if you are married but my wife was a super help. She started talking with her friends from all over and before long she had set up me up with five telephone interviews with guys in their 70s who had either surgery, radiation, etc. One even had surgery that failed and then had radiation that failed followed by chemotherapy. So I got to hear his story. One of the guys had surgery because he just wanted the cancer gone. These guys all went through this process and were really willing to help the next guy.


Just hang in there and remember it is a process that we all have to go through it. It takes time and effort and there is no silver bullet and there is not one size fits all solution. You have to determine your own criteria so you can evaluate the options based on the stage of cancer you have and that takes time, patience and research.


Funny but I still remember the feeling I felt when the urologist would go over a report on a procedure that I had done like a MRI, or some other test, etc. Most of the time I was in shock initially. There never seemed to be any good news or what does that really mean moments. I would leave with my paper results and then have to research what this really meant. Every session seemed to be just shock and awe and my mind would go blank.


Hope this helps and good luck on your journey. There is light and calm at the end.

Hi . Your confusion is definitely understandable. It is great that it seems that your cancer is contained to the prostate. This opens up many options.
First, let me note that, like said, surgeons tend to want to cut and radiation oncologists tend to want to radiate. If you can find a doctor who tells you your best option is something other than their specialty they may be a keeper (note: I don't mean this as negative as it may sound - just human nature to focus on what they invested their training and career in).
I can tell you that it can be helpful to discuss your short-term and long-term concerns and goals. Some surgery side-effects, such as erectile dysfunction, tend to happen early and potentially subside with treatment and time. Whereas, the ED side effect can come on years later after radiation (see: https://www.pcf.org/about-prostate-cancer/prostate-cancer-side-effects/radiation-side-effects/#:~:text=These%20may%20include%20proctitis%20(rectal,of%20these%20can%20be%20managed.)
With radiation, it is important to note that there are different types and you would need to choose what best fit your needs. This article gives an overview of different radiation options: https://prostatecancer.net/treatment/radiation-therapy.
It may also be useful to ask about the risk of progression with your cancer. There are tests, such as the Prolaris, which can help with this (see: https://prostatecancer.net/research-diagnostic-tests). Hope this information is helpful and others chime in with their experiences. Best, Richard (ProstateCancer.net Team)

Thank you for your reply, & the web site addres, I will check them out. It apeares the cure for this cancer is left up to us to make the best choice we can from the information we can get from different people, doctors, & internet. I have the information from the prostate nurse which is given everyone when they are diagnosed with prostate cancer, But hearing from others like yourselves does make it easier, to come to a treatment option that's not pushed on us by doctors. The experience of others going through the same cancer & their information as to how they handled it gives me more confidence in making a choice as to how I want to treat the cancer.
I will keep in touch & let you know how I go, Thank you again for the help.

Sorry to learn of your diagnosis that said prostate cancer is quite common and a lot of men (200,000 or so annually)have faced the same questions you raised here. In my case I had a high Geason score of 9. That said my cancer caught early and was only found in 2 samples of the 12 cores taken. Follow-up scans suggested it had not spread.


My choices like yours were radiation or surgery. Given the high score I chose surgery first just in case the cancer came back which happens to about 30% of men. Mine did return some 5 years later and ... because I had surgery first ... I was able to be treated with radiation. The reverse order does not work as well and men often have significant quality of life issues with leakage.


One day after robotic surgery I was on my way home and had no issues climbing a flight of stairs to the bedrooms. Ten days later my catheter was removed and 4 weeks later I was once again riding my bike 15- 20 miles several days a week.


While my personal experience may not mirror yours I lead a support group of over 20 men and almost all report similar outcomes. As with all things in life there are always exceptions. Unfortunately none of us know in advance how we will react to any treatment.


I would ask your oncologist to clarify your Gleason score and discuss the possibility of treating a returning cancer. I would would ask if he suggests the need or use of hormone therapy in conjunction with radiation. I would ask about Proton therapy and also if you are a candidate for seed therapy. You have some time with this diagnosis as PCa is slow growing. Ask lots of questions and by all means get a second opinion on choices available to you. Do hope you keep us posted on your next steps. Dennis(ProstateCancer.net TEAM)