Deciding between radiation and prostatectomy

CJP63…First, I’m sorry to know we have another member of this club no one wants to belong to. The good news is that there is lots of support and knowledge (and opinions) here. Unfortunately, there is no simple answer to your question as it’s very personal and case specific. You need to provide the group some specifics about you - your health, stats, etc. In the meantime, I’ll offer my thoughts…

I was 66, in good health otherwise when diagnosed last Spring. I, like many here, spent months talking to anyone who had an opinion and reading all I could to help me reach my decision. I’d recommend Dr. Patrick Walsh’s book, Guide to Surviving Prostate Cancer, as a good starting point. Debate pros and cons with your urologist and anyone with personal experience (lots here, of course) to learn how they decided what was best for them. I had 3-3, 3-4, and 4-3 hot spots with no evidence of spread outside the prostate. It appeared I was fortunate to have caught the PCa early.

As I said last Summer, I’d be lying to say I was fully confident in my decision to have a Prostatectomy (September 14). I received encouragement here to have faith in my decision-making process, accept the path I’d chosen, and focus on being positive. All good advice!

Nothing but good news so far. My first two post-op PSAs were undetectable levels. 🥳

Whatever path you choose, find the best surgeon or radiologist team you can identify. Go to a “center of excellence” like Mayo if you can as experience matters. Side effects are just that….side effects, imo. I chose to focus on getting rid of the PCa as best I could, then addressing the side effects - they exist but are manageable. I have 4 grandkids so far and watching them grow up as long as I reasonably could was a priority.

Whatever you choose, brother, be positive and commit to “do the work” as you’ll have plenty to work on, as you’ll learn. Good luck to you!

Welcome to the forum. We’re here to help. May I ask you a few questions before I weigh in?

How old are you? How is your overall health? Is there a history of prostate, breast, or ovarian cancer in your family? Have you considered Having a decipher or similar genetic test done on your pathology to better understand your risk of aggressive disease?

(Layperson writing)

Overall survival is the same for radiation and radical prostatectomy, according to my onco team, so (in my personal opinion) it's mainly a question of trading off different possible side-effects and assessing your ability to tolerate surgery under general anaesthesia.

For people with advanced prostate cancer, radiation is almost always preferred to surgery, because the cancer has escaped anyway so why do any unnecessary cutting (plus, I think, radiation spreads a bit and can kill cancer just outside the prostate as well).

Good luck!

Good comments being posted by everyone! I have a Gleason 8, Stage cT3b, and ranked very high risk. I am schedule for RARP at Mayo on Monday. I spoke with a radiation oncoligist at Mayo and was informed that to get the equivalent results from radiation, I would also need to be on hormone replacement therapy for at least a 18 months. I was also told that since I have coronary artery disease, the hormone replacement could be quite detrimental to my health. Additionally, she said swelling in the urethra from radiation would severely aggravate my already present BPH, so she recommended that I have RARP. I still have concerns about surgery but believe it is the best of two undesirable options. One way or the other I have to get treatment moving because I too have grandchildren that I'm not ready to leave yet!

My biopsy was quite similar to yours. In my case after exhaustive research and talking to a number of Doctors, I chose radiation. I was 74 at the time and ultimately felt that since the results of each procedure were almost identical in treating the cancer that avoiding unnecessary surgery was the best choice for me. Side effects exist with both approaches and are an inconvenience to be sure, but are ultimately manageable and just become part of your live-how bad they are and how much they bother you is a personal issue. Wish you the best and know you have lots of company in this fight.

I'm a patient at Mayo - Phoenix. Are you talking about taking either Lupron and/or Orgovyx? I'm on Orgovyx because of my coronary artery disease. According to data, Orgovyx has substantially fewer adverse effects for those of us who also have coronary artery disease.

There was not a specific HRT discussed, just that there was a concern. To be honest, I think the real concern is that there's a high likelihood of reoccurrence with the aggressiveness (I'm rated at very high risk) of my cancer and they're saving salvage radiation & HRT for later in my treatment if/when reoccurrence takes place.

@cjp63 I had the same numbers as you did 3+4 and I had 10.2 PSA with my cancer contained within my prostate. if you choose Radiation, the type of machine matters. Most of the radiation machines use margins of 3 to 5 mm which is the space used around the entire Prostate. we chose the Mridian radiation machine for many reasons but it had 2 mm margins, built-in MRI in real time so no fused images and I did not have any hormone Therapy.

I spoke with five radiation oncologists, three from centers of excellence and the other two trained at centers of excellence. As of my last blood test a few weeks ago, my PSA was .73. I completed my 5 treatments in February 2023.

I also had spaceoar inserted to protect my rectum. Margins and radiation exposure are really important to minimize side effects. My Side effects were minimal with a reduction in urination for a little while but nothing else. No blood no pain.

Excellent comments by all! My gut reaction is to go with radiation but the hormone issue with your coronary artery disease is a pretty big concern. If it was a four or six month regimen it wouldn't be a problem but 18 months is a long time to expose an already compromised arterial system to the detrimental effects of hormones. I would suggest talking to your cardiologist and getting a good workup before you decide. There is an excellent video (don't remember the name of the doc) on YouTube on effects of hormones and the problems seem to come mostly from excessive weight gain, hypertension and diabetes. But if these factors are controlled by diet or medication, there usually is no problem.
Yourreally gotta do some homework on yourself before you plunge in since surgery is no picnic either!

I am 75, diagnosed Gleason 8, had surgery. Walked out of hospital next day . Some incontinence. Several sessions of PT .

Rereading this note , it wasn’t this easy but not as bad As I anticipated.