Surgery or Radiation for Intermediate Prostate Cancer?

Hello @robermizek
I had a PSMA Pet Scan at Dana Farber last week which showed no progression beyond the prostate, my doctor said these are about 85% accurate. So that is good news. Met with a surgeon today at Mass General who has been doing Robotic Surgery for prostatectomy procedures for about ten years. I am most concerned about being continant after the procedure. He said it takes time, one to two months to get back to a more normal daily urinary process. He said Keagle exercises and good core strength are key to bladder control. I also met with a Dana Farber doctor about radiation last week. They use the Ethos machine which seems to be state of the art. It uses precise MRI positioning, and they update the MRI information at every treatment date. Treatment will be 20 sessions over four weeks, along with 3 months of ADT. Still unsure of what road to take to a cure.

Hi and thanks for the update.

The results of your PET-PSMA scan are hopeful! I’ve had two of these scans and been told that they typically don’t detect lesions smaller than a half inch which is probably where his 85% number comes from.

Have you had a decipher test or considered getting one so that you understand how aggressive the cancer is? I asked for one when I was originally diagnosed and was denied. Had I received one back then that showed the aggressive high risk cancer I’m dealing with now I would’ve initially opted for surgery as primary therapy and dealt with short term incontinance issues. My care team told me that generally speaking if “Plan A” is surgery and cancer returns, radiation can be “Plan B”. If however radiation is “Plan A” and that fails more radiation is often off the table and surgery is off the table too and other therapies may be necessary.

Anecdotally, I had salvage RP this past January at age 68. I was 90% continent within a week of having the catheter removed. I then used one lightweight pad each 24 hours to catch small leaks. I never came close to soaking a pad. I was extremely concerned about both the catheter and leaking urine and neither was much more than a short term inconvenience. I strengthened my pelvic muscles with easy to do Keagle exercises three weeks before surgery and continue to do those exercises even now even though I no longer need a pad and don’t leak.

Last thought, the second time around my case was reviewed by a tumor board consisting of both radiologists and surgeons who collectively recommended that my treatment involve surgery, then long term ADT, and “clean up” radiation. That made my decision an easy one.

Hope you are comfortable with whatever decision you make!

- Bob