Why would my doctors recommend surgery over radiation?

Robo45vt,
Best of luck on your surgery!
1. I'll suggest doing Kegel exercises before surgery; there seems to be some evidence that doing so helps recover urinary continence more quickly after surgery.
2. If post surgery surgery sexual function is important to you (sexual function means being able to achieve an erection capable of being sustained with penetration) you may want to review various literature. The article cited above suggests that the use of medication (like Cialis or Viagra) and the use of a vacuum erection device may help recover sexual function.
I would suggest that just expecting recovery "after a while" is probably not the best approach.

I thought this video of an interview of a Mayo urologist clinician on recovering sexual function was interesting :
https://www.youtube.com/watch?v=CaPwnxlpp6w

Best of luck with your surgery - I hope all goes well and margins come out negative!!

Thanks. Last check was 3+3. MRI showed lesion had grown a little but still contained. Doctors said I could stay on Active surveillance for probably another year, but elected not to with family history. Rather deal with it now than later

Smart move on your part. Who knows what the situation will be in a year from now. If you are in good health for undergoing surgery now who is to say what next year will bring. The situation today is a known and who knows what the future will bring with it. Insurance/medicare may get better or it may get worse, your M.D. may move and you will need to find another. If you have made your decision for surgery and all is good for it, why wait?
Best of luck.

Well, looks like you've made up your mind about having surgery. At a 3+3 my personal feeling (having gone thru surgery for a 4+3) would be to go with CuberKnife. Yes, yes everyone is gonna scream at me for saying this - especially since we all know how hard it is to make a treatment decision - but the side effects of surgery are very impactful no matter who performs it since every patient is different. I am still impotent and sometimes incontinent and I had one of the best surgeons in the world (supposedly!!!)
But it is your LIFE which carries the most concern, not the side effects, right? When I had my surgery 5 yrs ago at age 64 (I now have recurrence and am facing radiation and ADT) a study had just come out which compared the 10 year outcomes for surgery vs Cyberkife: they were exactly the same! In other words, your chances of success and failure were equal.
I chose surgery because as most have pointed out, you CAN have radiation after surgery but the reverse is not really true. So a recurrence would mean hormones and possibly chemo for the rest of your life. However, I did NOT have the benefit of genetic testing at the time ad my only criteria was the Gleason score. Today, there is the Decipher test (which most hospitals can order) which uses your biopsy sample to determine how aggressive your cancer really is and if it is the type that will metastasize. Don't know if you've had this test but if you have not, I URGE you to have it so you can really make an informed decision.
I personally know two people who've had biopsies (one of them a 4+3) and on the basis of their Decipher score, Sloan Kettering recommended Cyberknife - and they are a very conservative institution. I was really reluctant to weigh in on your question because of the anguish involved in the final decision but I decided that the more you hear, the better.....your surgeon is not going anywhere and at a 3+3, neither are you - HA!! Best of luck with whatever you decide!!

AL

Just received my biopsy results today, 23 cores 6 had 70% cancer, Gleason 4+3=7 3 cores had 40% Gleason 3+4=7 and 14 cores benign prostate tissue. I had previously had a pm MRI Pirads 4 showing 12mm lesion and I had a 4K score of 95% so it was spot on. PSA was only 6.625 but had just jumped from 4.47

Now what to do? Urologist at Mayo is leaning towards surgery, so your post is very helpful

You may want to read through this to help you in your decision with your medical team NCCN Guidelines Version 4.2023, Prostate Cancer.

Kevin

So glad you are working with a center of excellence and looks like you are approximately where I was at - Gleason 7 (4+3). As you found, PSA alone is not a definitive indicator of PC, doubling time and slope of increase are also very important.

As you have seen on this and other forums, no procedure will absolutely guarantee the prostate cancer is gone forever. The medical community has developed a lot of indicators/tests/etc., but nobody knows if the cancer has been contained to the prostate, even if a full pathology is performed post radical prostatectomy. However, in my view, the best indicator is a physical examination of the prostate, seminal vesicles, lymph nodes, and any other tissue removed. Scanning tools and biopsies are good indicators for the existence of cancer, but at this point in time, can't define margins as accurately as a physical pathology. Also, when the prostate, seminal vesicles, and several lymph nodes are removed, all known cancer is out of your body.

I am always skeptical of statistical data used to justify less invasive procedures for addressing prostate cancer. These studies almost always use a 10-year outcome/survival rate/etc. to justify their procedure. What I always ask myself, what if I want to live longer than 10 years? I use the the analogy of laying out landscaping in your yard. My wife and I are meticulous and have in the past laid out the placement of trees/shrubs based on maximum size defined on the grower's label. Every time, the plantings would grow together. It took us two 10-year cycles to realize that the maximum sizes are based on 10 years of growth. So, when we laid out our landscaping based on the grower's label, the plantings ultimately grew together. This is a silly analogy, but shows the limitations of a 10-year study.

Bottom line, do as much research as you can to ensure the treatment procedure aligns with your life goals and expectations. i.e. If impotence is something you absolutely cannot live with, then maybe a less invasive procedure is worth the risk. For me, 30+ years of cancer free life was #1, #2, #3, with continence #4, and erectile function #20. Fortunately, up to this point (only 1.25 years post RP) I have been blessed with good outcomes on all of the above. I chose a center of excellence (Mayo-Rochester), went with the best possible doctor at that center of excellence, and did all of the physical therapy required pre and post surgery.

Good luck and hope all goes well for you addressing your prostate cancer!!

Jim

You were so thorough on your comments. Good job on educating all of us. My husband, Jim, is set up for the pacer surgery on 3-14-24. He will do a CT and MRI scans on 3-15-24. I'm presuming that Proton Beam therapy will begin the following week. After reading everything on hormone therapy, he has decided not to have it. They are recommending 18 months of Eligard. He thinks that the potential side effects of possible stroke and heart attacks for all the hormone medications is not worth the risk. He hasn't informed the radiologist yet. Has anyone done the proton Beam therapy without hormones? He was originally going to have a RP but the surgeon said that his prostate is on the large side and he couldn't guarantee that he wouldn't have major urine challenges. The surgeon is the person that recommended radiation. He is 73 and in very good health otherwise.

I did the five at Mayo and my 3 month and 9 month PSA's were both undetectable and I am 74.