Radiation instead of removal (surgery delayed due to illness)

Number One: Meet with the RO.

I had a 4+3, and a 3+3 and had SBRT with a boost to the primary lesion and Orgovyx ( 6 months) for ADT.

No physician here, but 3+3 very likely will not involve ADT. "Higher" dose RT, SBRT is now indicated and accepted for all localized prostate cancer.
RT has the opposite urinary result as RP, in that IF you have a side effect it is likely to involves urinary retention and or difficulty vs incomitance. Short term I had a couple days of urinary urgency and GI constipation/mucus/a little blood....all known and in my case minor side effects. I am now 9 weeks after my last SBRT and I am hard pressed to remember/feel as if I had anything done.

Rt can cause problems years down the road.......urinary retention, GI problems, bladder cancer. All theses have in my opinion a low enough incidence that it was acceptable to me. I am 68, if you are significantly younger some will suggest RP over RT. Additionally in the case of recurrence RT takes RP off the table. Again, acceptable to me as I am confident new treatment modalities will be available IF I ever have a recurrence.

See your RO, prior to that look at this forum and other forum. Continue asking questions and educate yourself.

Stay Strong Brother.

Radiation therapy has improved significantly over the past 15 plus years. The beam for photon radiation has an entry and exit point. The proton beam releases the radiation when it hits the target. The technology for radiation is very precise and the risk of damage to healthy tissue is minimal. I would look for a center of excellence for treatment, they not only have experience but the facilities as well. From the studies I have reviewed radiation also has a lower recurrence rate than surgery.

robo45vt: I finished my 5 hypo fractional treatments in February of last year. It was with a narrow margin built in MRI linac machine. I chose the specific machine as there are real differences in the type of radiation machines used and it seems difficult for doctors to discuss the differences as they relate to quality of life and the specific machine except on a limited basis. My margins around the prostate were 2 mm. Most other machines are 3-5 mm. Protect your healthy tissue. The narrower the margins and exposing the healthy tissue to radiation, the less likely to have quality of life side effects. Mine were minimal with some urination flow issues but they were quickly corrected with Flomax.

I spoke with 5 RO's 3, from centers of excellence. I had 3+4 gleason, took the Decipher test to look at modes of treatment and aggressiveness using my biopsy material and had spaceoar inserted for my radiation treatments to protect the rectum. Doctors do use the Decipher test, which indicated one mode of treatment was the way to go. I had no hormone treatment.

I chose the specific MRI Linac machine for a number of reasons over a Proton machine. You will read about many success stories on this site about both choices. I wanted minimal healthy tissue exposure, real time imaging (what you see in real time, you treat) not fused images, automatic shutoff, dynamic mapping in case my organs moved and more.

Proton is another type of radiation where a physicist calculates the depth that the Proton beam goes into your body. There is some scattering but the pencil beam proton has had much success.

If I had a biological re-occurrence, I would find the same machine I used before (and I had access to the machine I chose and Proton locally in Florida) and be treated again.

I recommend a discussion with a medical oncologist that specializes in prostate cancer to walk you through the treatment options, the 3-5 year post treatment data (recurrence, incontinence, ED, etc) on radiation versus surgery (your age at time of treatment is a consideration) and consider reviewing the online PCRI.org and PCF.org information for Gleason 6 patients. Talking through that data with an oncologist that is not a surgeon or radiation oncologist can be helpful.

With a Gleason 6, you have time to carefully consider the different treatments. If your Dr is a surgeon , they seem to want to do surgery.
I like to use PRCI to gather information (prostate research institute) and talk to other people who chose a treatment and what their experience was.
I’ve rejected surgery so far due to fear of incontinence . But I have to be honest- I fear toxicity and side effects of radiation also. I’m still trying to figure it out.
I’m Gleason 7 (3 of 12 were positive )and one was 4+3. My PSA recently dropped back to 3.6 from a high of 6.7. I have more questions than answers and find it difficult to find advice that isn’t shaded with a bias for their own craft.

Robovt45, before you decide surgery vs radiation, watch this video:

Also, understand that choosing the best treatment for YOUR prostate cancer should involve YOU evaluating your treatment choices. And it sounds like that's exactly what you're doing.

To help you make an informed decision, I highly recommend "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" (5th edition): https://www.amazon.com/dp/1538726866?psc=1&ref=ppx_yo2ov_dt_b_product_details

Best wishes.

I’m in the midst of biopsies and MRIs.
75 yo, Gleason 3+4, Decipher high risk.
Getting a 12 sample biopsy Mar 7 at SW in San Antonio.
Given my age, he recommends radiation only, not surgery due to very high risk of prolonged incontinence due to age. And 24 sessions, not fewer high dosage sessions.
Our relative small city has a reputable radiation oncology group, but I can also have it at Mayo, AZ. I have a place to stay there in AZ. What to do…stay home and have it locally, or go to Mayo? I’m guessing Mayo would be most of your recommendation.
Thx for any comment.

From my own experience Mayo is fantastic. I have been going to Mayo for all my healthcare, since moving to Arizona in 2014. In February I was diagnosed with prostate cancer and will be treated at Mayo. I guess you have to measure the convenience of San Antonio vs staying in Arizona. Obviously there are more concerns than travel. As far as treatment, Doctors, nurses and staff are way better than any other hospital.
Mayo hospital is located in north Phoenix just off the 101.
Anyway this is one man’s opinion
PS Check to make sure they take your Medicare plan

That's kind of the $64K question (hopefully, I haven't dated myself too much)...lots of good points already made above, particularly the comment about how options will continue to improve in the future. I'll add: every PCa should be considered unique and treatment modalities chosen to correspond to yours; my initial urologist said he'd get RT if he had my PCa; another urologist, who is nationally known, recommended (his) RP, although, after my Decipher was intermediate, he said his recommendation was neutral and I went with RT.

I was talking last weekend with a retired urologist who treated Andy Grove, former Intel CEO. Andy had told him that he used all his skills and vast resources to analyze the various PCa treatment options that were available to him at the time. However, in the end, he went with his gut. That is pretty much what I did, but, doing the research on my own.

I did the five-proton treatment at Mayo Phoenix. It was a Monday-Wednesday-Friday-Monday-Wednesday. My three- and nine-month PSA were undetectable, and I am 74. You don't state your age which would be a factor in which treatment you would choose. I was a 4-3 Gleason in two cores and 3-4 in two cores all from the area of a seven mm lesion. I had a 30 core transperineally fusion guide biopsy due to my 120-gram prostate and my PSA was 2.9. I chose radiation because of my age, and it has the same results as removal. If I get 15 more years it makes me 89 and I don't want to go into a nursing home.