Deciding between radiation and prostatectomy

This is an excellent, unbiased, informative post. I was going to wright a more lengthy reply but I couldn't have said it better.

I will just add that many people downplay the potential complications of Radiation Therapy and emphasize the surgical ones. The pros you list for RP are well stated. Radiation Therapy SE are usually delayed by many months or a few years. Radiation can also result in ED and incontinence. Also, bladder and rectal irritation and significant bleeding which, is a very small number of patients, can be difficult to control.

So, I absolutely agree that there is no one solution. The decision is individual. People that say don't have this procedure because I had such and such a problem are speaking anecdotally and doesn't apply to the population as a whole.

Good luck to all in your journey.

@cjp63 I already commented on this question, but one other addition that I personally think is important is specifically looking at the different types of radiation machines. Not all radiation is alike in terms of how it’s delivered. In my opinion, it is not discussed enough. If you go with Radiation, as a treatment choice, take a good look at the machine that they are using both in terms of real time imaging and the margins and exposure of that radiation. It does have an impact on side effects.

I talked to Dattolli over the phone and was impressed. Also with is partner. I would have needed to relocate so didn’t end up with him.

Im not seeing agressive in your stats, but if it is agressive, surgery is the worst choice for those men, if you are seeking cure.
The first step is to determine if you are in the low, intermediate, or high risk category. This refers to risk of recurrence.

Also, it is widely told, but surgery and radiation pathways do NOT in most cases have equal chance of cure.
The book by the famous hopkins surgeon is good. Also read a book about radiation from Scholz maybe. He has one that will help you stage yourself.

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

And, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Many of them are more dangerous than the cancer.

Great chart. Would like to see them breakout external beam radiation as it does not address the difference in results from external beam machines vs mri guided as shown in the mirage study.

(This a general reminder for everyone, including myself, not a criticism of any specific forum participant).

I suggest that we laypeople be very careful about making our own charts and doing our own data comparisons from different studies with different methodologies, because we don't know what we don't know.

For example, most studies track *overall* survival (OS). Since the majority of prostate-cancer cases (not mine, sadly) occur late in life and develop slowly, many of the people in advanced stages might not have had 10 years left in any case, so the OS numbers are going to skew low.

Now, what if aggressive treatments like surgery are more common for younger patients than for elderly ones? That would mean that their OS numbers might come in higher even if the two treatments are equally effective, because the younger person is less likely to die from other causes in the next 10 years.

Researchers probably apply different statistical models (and some WAGs) to try to adjust for this, but if we laypeople just pull numbers haphazardly from different studies into a single table or graph, we won't have that benefit, and the results might be very misleading (as we saw with much of the amateur research during the COVID pandemic).

I used these charts to make my decision to go for LDR brachytherapy when I was first diagnosed with low risk (Gleason 6) cancer in 2020 as it showed a better outcome to remain disease free than surgery. Four years later with a recurrence of high risk Gleason 9 Stage 3 N1 disease I wish I would’ve opted initially for surgery.

As someone that used data extensively in an arguably successful engineering career I can safely state that data always tells a story however the story it tells may be based on an amalgam that includes data that may be irrelevant to a given and specific situation. Caution is always warranted to make the best possible decision.

Best wishes to everyone on their journey with PCa.

I had proctectomy April of 2023 in Rochester with gleason score of 4+5. at the age of 69. I was recommended by 2 different doctors to have proctectomy because they thought it was contained in prostate. Surgery went well and so did recovery. Year later my PSA is undetectable, < 01. I am doing my everyday life as usual with no complications. I do believe with an excellent surgeon and being in good physical shape that I made right decision.
I have not needed any other treatments to this date.