Why would my doctors recommend surgery over radiation?

Permanent loss of sexual function after radical prostatectomy is not inevitable. Orgasm is controlled by a different neural pathway and is possible almost immediately after surgery, even of it is not "nerve sparing". For those who have nerve sparing surgery, a study in 2011 showed the combination of rehabilitation with cialis-type drugs AND use of a vacuum erection device ("penis pump") restored sexual function after 9-12 months - defined as successful vaginal penetration, and intercourse to orgasm - in 92% of men, compared to less than half who only used the cialis drug.

Search "penile rehabilitation after prostate cancer surgery" for more information.

The question that is often not asked is; what is the frequency of recurrence for radiation and surgery? From my research surgery has a recurrence rate of 20-30%. There are a variety of radiation methods that have a recurrence rate ranging from 4-10%.
The frequency of incontinance and ED is higher for surgery.
Following surgery the pathologist can determine the risk of recurrence. This can also be done by genetic testing of your biopsy samples.
The comment that if you have radiation you cannot have a follow up surgery. Reviewing the comments in this forum those that have a recurrence are typically treated with radiation and ADT.
The number of treatments for radiation depends of the method. I was offered 28 treatments at one radiation center. At Mayo I had a choice of 5 proton sessions over 2 weeks or 2 HDR treatments over 2 weeks.

It would seem likely that radiation is more effective . The nature of the agent is more variable. Tech changes in radiation delivery are awesome.

'Experimental Treatment'. A few more thoughts. (Again, my treatment was proton beam (5 treatments at Mayo Rochester).
Labeling a treatment modality as experimental may be a way of biasing a patient towards the treatment that the physician offers. A reasonable question would be "does this medical facility offer that treatment".
The Prostate Cancer Foundation (different org that Prostate Cancer Research Institute) has a guide to prostate cancer. I have a particular annoyance with their guide which devotes a skimpy paragraph to proton beam treatment labeling it as "experimental", suggesting it may be expensive, and that it may cause bowel injury. Given that Loma Linda has been doing proton beam treatment for 20+ years and that Mayo has a proton beam facility in both Rochester and Scottsdale (I think building one in FL), Seattle Cancer Care Alliance also has a proton beam facility. Seems unlikely that all these places are misguided.

So, lets just say a label of "Experimental Treatment" should be questioned.

Can you link this study you are referring to?
Thanks!

Here's the article I referenced:
https://www.dcurology.net/wp-content/uploads/2016/01/Pump-Paper.pdf
Here is a search page with other related info:
https://duckduckgo.com/?q=effect+on+Sexual+Function+of+a+vacuum+erection+device+post-prostatectomy&t=osx&ia=web

As you can see from the comments received, there is a plethora of alternate views on treatment. It is my opinion, one treatment plan does not meet everyone's wants/needs/etc.

For myself, I was diagnosed with PC 1 1/2 years ago, 56 years old, Gleason Score of 7 (4/3). I did a lot of research and talked to people that had different treatment plans. In the end, I decided on a robotically assisted radical prostatectomy at a center of excellence (Mayo-Rochester). For me, this was the only logical choice, I did not want all of the side effects associated with radiation and hormone therapy, and wanted to have a procedure that allowed for physical examination of margins. Technology has come a long way, but scanning tools are not perfect and I was unwilling to bet my life on an imperfect scanning tool. I chose to find the best possible center of excellence and the best possible surgeon at that center of excellence.

I cannot understand why any doctor would tell you that active surveillance is a viable option at the young age of 64 (unless you have other life limiting issues). And even more perplexing, why would a doctor ever recommend for you to wait 1-3 years and then address the cancer. If you have known cancer in your body, address it immediately. Letting any cancer in your body only increases the chance of metastasis. As anyone will tell you, when PC metastasizes, your life is changed forever.

My personal recommendation (based on my set of circumstances - relatively young, healthy, positive attitude and wanting to live 30+ years PC free), I would recommend getting a radical prostatectomy at the best center of excellence you can find and taking the time to find the best surgeon at that center of excellence. Don't let a 4-5 hour drive or 2-3 hour flight sway your opinion. A minor inconvenience today will have a profound impact on the quality of life for the rest of your life.

Best of luck with your treatment decision!!

Jim

My oncologist gave me the Prostate Cancer Foundation brochure to read after my biopsy came back positive and before we had our first face to face to discuss treatment. Prior to the visit I had read a lot online and also a book describing the various treatment modalities. To say I was somewhat surprised the Prostate Cancer Foundation labelled Proton Beam Therapy as experimental, especially when other sources rated its ability to kill the tumor as effective as photon radiation without the attendant side effects. I chose Proton Beam Therapy because I did not want to undergo surgery and from what I have read, the side effects short term are minimal compared to photon radiation. My treatment was completed in November 2022 so not enough time has passed in my case so that I can make a definite statement on effectiveness of the PBT, only time will tell.

Where I live in Vermont they only offer photon or surgery. The doctor told me the photon had a better success rate and did a better job. I don’t want surgery either, but it seems the best of both options to me. If all goes well I m ok in a month or two.

Thanks my opinion also. Surgery scheduled Feb 15th. Robotic surgery. The doctor has done over 300 procedures, very good. No issues