Deciding between radiation and prostatectomy

I'm not the one you were replying to, but to add info, I started on Firmagon rather than Lupron because (IIRC) Lupron causes an initial testosterone surge and my cancer was already spreading fast.

However, Firmagon requires monthly shots, and the acute side side-effects for about three days after each injection were annoying (swelling, tenderness, rash, flu-like symptoms) so I was happy to switch to Orgovyx as soon as Health Canada approved it earlier this year. It does the same thing as Firmagon, but without the injections

Thank you very for the feedback. Other facts about me: I’m 60 years, under watchful surveillance since 2020, PSA rose from 4.6 to 12.5. Pcs localized with 5 out of 12 (3+4)

Thank you for the advice

Your decision will depend on various factors like your age, physical condition, etc. I was in a similar situation. Considering my health condition, the uro-surgeon had almost decided to do a RP, but rapidly changed his mind when my biopsy and PSMA PET scan results were out. The results indicated a Gleason score of 4+4, with local metastasis to several lymph nodes, seminal vesicles, and the bladder neck. I was put on Abiraterone and Zoladex for three months before undergoing radiation in Jan-Feb 2023. I am still continuing on Zoladex and Abiraterone, and my PSA for the last several months has remained at 0.02.

Before deciding on any procedure, make sure you've read up on all the potential side effects, so they don't come as a surprise. Not everyone experiences side effects with the same intensity. Initially, I had a tough time with Zoladex and Abiraterone, but after a few months, things became very manageable. Chin up, there's nothing to worry about. As my doctor told me, if you have to have cancer, PC is the one to have.

Thanks all for the previous advices and feedback. Other facts about me: I’m 60 years old on watchful surveillance since 2020. I have controlled high blood pressure. PCA contained in the gland, with 4 scores of 3+4, 3 scores of 3+3 and the others normal. Lives in south Florida, married with 3 college age children. Any additional feedback is appreciated, center of excellence in south Florida?? Would you recommend an oncologist or urologist??

I did HIFU on my 3+4 and they removed all of the irregular cells from one side of my prostate. This was done through the rectum. They only have so much reach through the rectum, so other ablations are needed if the lesion is too far from the rectum. Ablation generally has little impact on continence or erections, and generally can be repeated. I did have an infection which I assume was from the biopsy. I had a biopsy confirming irregular cells or cancer in 2017. I ablated the 3+4 lesion in 2023. It was day surgery and a catheter for a week. If you still are getting erections make sure to clean and lube the catheter tube. It is hard to complain about getting nocturnal or natural erections, but can be painful with dry blood on the catheter tube. The catheter tube was huge, I assume to allow the prostate to heal around it with enough room to get urine through.

Check out Dr. Klink. What is friend of mine which is prostate cancer Healthcare to him and has been very satisfied. https://southfloridahospitalnews.com/lee-health-brings-urologic-oncologist-to-southwest-florida-2/

Good luck on your journey.

The correct answer is "it depends". The issues are obvious and well-known. Surgery has a greater risk of ED and incontinence. Radiation can cause future problems (20 years) and can also cause some swelling. No one wants ED and incontinence. If you are very young, avoiding a problem with radiation 20 years from now may be a problem. If you already have problems with urinary restriction, burning out your prostate may cause it to swell and worsen that problem. There is no right answer, and both involve downsides. I went with HDR brachytherapy. At 70 I was not too worried about possible future cancers at 90 (and we may solve cancer by then). I had no slow draining issues. I'm a little slower now since my urinary tract must pass through a lump of burned-out flesh but not a big concern and getting better after a year. No ED and no incontinence with a couple of out-patient visits was the deal breaker for me. I do hear good things about new external beam radiation. That is something you might consider too.

I highly recommend robotic prostatectomy.

Given that your prostate cancer is aggressive, I personally would go with surgery versus radiation. Please note, I had no other comorbidities, was healthy, and 55 years old when I was initially diagnosed with prostate cancer (Gleason Score 7 - 4/3). There are possible complications with both radiation and surgery, but surgery allows you to physically define margins (excellent for medical team moving forward), removes all known cancer (including cancer not yet identified that remains in the prostate & seminal vesicles), and leaves more options on the table if the cancer returns (a radical prostatectomy is very difficult, if not impossible, after radiation).

I have heard the nightmare scenarios with all treatment plans (surgery, radiation, hormone therapy, active surveillance, etc.). What I have learned - Every man is unique, must evaluate their personal situation, and make a decision on a treatment plan that aligns with his life expectations. For myself, I wanted 30+ years of PC free life to spend with my wife, family, and friends. Given my health and age, the radical prostatectomy was a "no-brainer". However, given another man's situation or personal research/opinions, radiation/hormone therapy could be the "no-brainer" decision. Either way you go, you need embrace your decision, accept the consequences, and keep fighting. Second guessing only causes you stress and anxiety.

One point that is an absolute, you must go to a center of excellence for whatever treatment plan you choose (and then do research to find the best possible doctor). For myself, that was Mayo-Rochester with Dr. Igor Frank for the radical prostatectomy. Amazing doctor, staff, and hospital. Rochester was definitely not the closest option, but I am so glad I went with this center of excellence!!

Good luck and hope all goes well with your treatment plan!!!

Jim