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Surgery or Radiation?

Urologists and a surgeon suggested Radical Prostatectomy to treat PC (PSA 11.9, Gleason 3+4=7, Intermediate Level).

Been preparing myself for major surgery; however, after consultation with an Oncologist today I learned radiation is a viable treatment option.

I am a bit overwhelmed by the choice of treatments and would appreciate advice and wisdom from other community members.

  1. I had about almost the same diagnosis about two months ago 3+4 and psa 12.7, age urologist from beginning was leaning toward radiation. I believe for the newly diagnosed men who have the options to choose between two treatment there are many factor for surgery vs radiation which need to be considered and looked at such as your age which you haven’t mentioned here, your life style, side effects and availability of any of these treatment option near and close by and of course how important the possible ED side effects are important to you and risk factors… so as probably you already know with the early stage of PC you have some time to educate yourself and there are lots of available research and published data out there regarding each treatment to help you decide.

    When I joined this group about two months ago couple of PC contributors and coaches in this forum thought me to ask lots of questions and research. If you decide with radiation there are multiple options with your diagnosis which you can consider, one of the contributor in this forum provided the following link for radiation options

    1. some how the last paragraph of previous reply was chopped…I was saying also got good fed back from on this forum who has gone through both Surgery and Radiation.
      After discussion with my oncologist I’ve decided with external radiation and currently in my third week of treatment, I’m posting my experience under “Sharing My Radiation Therapy Experience” thread with very good inputs and links from other members.
      All the best for your decision and treatment

  2. None of this is easy ... If the cancer is contained you most likely can do surgery or some form of radiation. The impact of surgery on loss of urine control and lack of erections are immediate. I did regain both over 6 months. Over time ( average appears to be 5 or so years) radiation can have similar impacts to surgery. The issue is we all react differently so you do not know how you will react to any of the treatments

    Based on conversations with surgeons is quite difficult to do prostate surgery after radiation due to effects of treatment on the impacted tissue. I decided on surgery and when my cancer returned 5 years later I was able to do radiation plus hormone therapy. My current PSA is 0.02 or undetectable.

    In the end it all boils down to personal choice. Once your decision is made there is no going back. I think the best choice is to take a deep breadth and go in the direction you feel most comfortable with. After that move on with living. I am coming up on 9 years post surgery with a Gleason 9 and the cancer was described ... confined to the prostate. ... Dennis( TEAM)

    1. Tough decisions for sure. I was diagnosed 3+4 Gleason last June. Went through both options with my doctor and really couldn't decide. In the end, after the PSA jumped two more points in November 2021 I decided on surgery. If the ED and incontinence were something I could experience with either treatment than I reasoned the remaining side effects of surgery outweighed the radiation side of it. I felt my age (56) and activity level - cycling and softball coaching - this was a better option for me in the long run. Recovery has been good - longer than my brain expected but, overall, not nearly as bad as my shoulder surgeries or my cervical fusion. PSA is currently .01 3 months after surgery.

      1. Glad to hear you are doing well 0.1 is great some 3 months after surgery

    2. Decisions are the toughest choices - Is that ever an understatement! At 63 yrs old, and several rising PSA scores (up to 5.3) my urologist said it was time for a biopsy, which resulted in a high risk Gleason 9 score. Was told by a surgeon at my community hospital that at my age and being in good health, I should consider surgery, but he was requiring I get a 2nd opinion. I live by a nearby a University/National Cancer Center; so I went there and had 3 (2nd opinion appointments). First one was with urological oncologist who referred me to a very experienced surgeon, and my 3rd visit was with a radiation oncologist. In addition to these additional 2nd opinion consults, I spent countless hours on the internet researching and also talking to friends who went thru the PC journey. My point is that there is no right answer and everyone is different. The key for me was that I had done enough legwork that in the end I knew what was right for me, and did not want to be second-guessing later. Side-note; I did have the robotic surgery in March of '21 (as for side-effects; threw the depends away 6 weeks later, and at one year found an ED solution)

      1. After 1 year how did You get the help you needed for your ED solution. I am where You were. no erection. Advice would be helpful.
        Thank You

      2. @
        So at 3 months post surgery; I went back to the urological oncologist and explained that the pills no longer worked, and he suggested that for ED that I continue with pills combined with a VED* and a constriction ring. I had some "very limited success" with this combo for the next ~6 months.

        At the one year point had another discussion with this same urological oncologist, at that point he felt my next step should be Trimix injections. So he ordered a script and one-week later he taught me how to inject in his office and sent me home with guidelines on carefully and gradually adjusting the dosage. This turned out to be a very good solution for the next 2 years (until this fall when I finished salvage therapy with 38 radiation treatments).

        *Side-note on VED (vacuum erection devices): Used on a regular and responsible way, these are a proven and recommended method of maintaining penile health (and size loss) after a Prostatectomy.

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