Newly Diagnosed: Removal vs Radiation

@gently @survivor5280
This is very helpful information from @gently. A lot of great advise here.

The side affects of having surgery really need to be told to you as can be very different with every patient. As @gently mentioned the great improvements in radiation treatments has really changed how the cancer can be treated and lessoning damage to surrounding organs and tissues.

You can have sugery after radiation it just requries a very skillful surgeon and thus you get the feedback from most urologist about the hestation of sugery after radiaion.

I would not label myself as the most experienced prostate cancer survivor. I had 30 rounds of proton beam radiation and yes did have some minor side affects that amost all are gone 1.5 years later.
Again hats of to @gently he gave you some really great advice.

@survivor5280
The comments by others were good but I would like to add that I too, had the Mridian Linac radiation machine. As @gently relayed, the margins used in radiation, and therefore side effects make a difference. The Mridian uses 2 mm (maybe the Elekta machine as well) versus 3-5 mm margins for other types of radiation machines because the Mridian has built in MRI so everything being treated is in real time, no fused images. Read the Mirage study to see how that makes a difference.

My side effects were minimal, no pain, no bleeding, urinary functions diminished briefly but Flomax helped overnight. Sexual function diminished but not for long. I would do it again.

The use of the word cure medically, seems to be different than the layman's definition. We all still have to have our PSA checked no matter what solution we choose.

I went through all the emotions you're describing and I had a mini-"nervous breakdown" where I was crying and screaming and thought about ending my own life. You're not alone in this. Whether you choose surgery or radiation it's life changing.

I found a prostate cancer mentor through Zero (a prostate cancer info and support site) and he has talked me off the ledge multiple times both before and after treatment. I also see a psychologist weekly and started taking Wellbutrin, an antidepressant that doesn't have sexual side effects so it shouldn't interfere with my sexual recovery when ADT ends. This web site is also the best online support I've found.

I still have times I'm really down and have crying jags. Some of them are from being on ADT but others are just from having cancer. It's good to just let it all out and cry when you have to--you will feel much better than keeping your feelings bottled up.

Most side effects can be treated to some extent and not everyone gets every side effect. It is a tough road, but it sounds like you do have some support already and there is plenty of other support out there.

As someone who always wanted to be in control of things, it was hard to let go and accept the support of others when I was usually the one providing support but, once I did, things began to feel better. Don't go it alone.

Prostate Cancer Foundation (PCF) lists one PC center of excellence in Colorado (Aurora): https://www.pcf.org/patient-resources/patient-navigation/treatment-centers/

I chose surgery in August of 2022 at 60 years old I also was a Gleason 4 + 3. Learning that you have cancer is devastating but we are blessed to be living in an age where there are multiple treatments for it. I always tried to fall back on that when I was spiraling down with worry. I chose surgery as I was young (lol) and liked the idea of removing the cancer. I used the same surgeon who removed a third of my friend's kidney 15 years earlier for cancer. He had performed over 1500 RALPs by the time he did mine. I'm 6 ft 3 in and weighed 220 lbs. I decided to drop 20 lbs as I heard this improves your odds of having less complications, even though my surgeon said it wasn't necessary. It gave me some feeling of being in control of the situation though. You could also start performing kegels before your treatment decision. I started kegels after surgery. 7 weeks after surgery. Need time to heal. I can honestly say I never had any pain or incontinence issues after surgery. I was relieved to get the surgery over naturally after having all the pre-surgery tests to make sure it hadn't spread. I took a full 8 weeks off from work to heal mentally as well as physically. I have a job where it requires lifting so no hurry to rush back. I had nerve sparing surgery so everything feels the same. You'll get through this just fine like your kidney surgery.

I'm glad I could be of help. I was in the same mental state as you... pretty freaked out. 50's is too young to go through this (60's too). I had to be logical and let the facts determine what I needed to do. Then I sort of turned off the "what if" noise. Otherwise, I think you could drive yourself nuts. Make a decision based on the best information you can get. Do your research. Then don't look back.

I am both a realist and a pragmatist and am immersing myself in as much education about all the possibilities as I can. The info provided by all of you has helped to alleviate some of my worry about maybe there being a better quality of life after this than I originally thought, but it's hard to turn off the what-if noise as I know everyone is aware. Needless to say I didn't sleep last night, even with pharmaceutical assistance. I've been reading these forums and, honesty, it's hard to find much bright side in all of this, it seems like most accounting of the experience and/or life after is absolute misery, but perhaps it is a vocal minority that I've been reading.

First, a positive attitude is the key to fighting cancer. Support is also a key weapon, and you can get that here and with your loved ones.

I chose surgery because if you have radiation, that removes the surgical option in a majority of men. Yes, there is the rare case of a successful surgery after radiation, but you might want to consider that radiation most of the time removes that from your selection of choices.

I chose the surgical option because the doc told me that even if I had surgery I would need radiation because of possible lymph involvement and the cancer leaving the prostate. I wanted to be able to go with the 'tiple anitbiotic' method: surgery, ADT, radiation. MRI/Surgery proved the surgeon correct in the lymph involvement.

I had my surgery 6 weeks ago, and there is no misery. The incontinence is much better, the pain is almost totally subsided unless I try to lift something too heavy, and the sex part is sill undetermined, but at 71 I'm not too concerned about it.

Yeah, I know that lost and depressed feeling all too well. You're definitely not alone in that. I still get pretty down sometimes (especially if i wake up in the middle of the night) and I definitely overthink things on a regular basis. But overall my mental state has gotten better over time. I think it's great you're getting some help; you're smarter than me. Whichever treatment you end up selecting, you should be sure to ask your prospective provider about your odds for incontinence and ED. When I asked the surgeon about me specifically, for my case, he said I had a 90% chance of being continent at 1 year and 70% of having erections at 1 year (assuming I had them before). Those numbers were way better than I was expecting, and for some reason hearing my surgeon say them really helped me settle down. Now those were his numbers, but I believe most providers at a recognized cancer center of excellence should know their numbers and have some idea what you can expect. It's great that you have access to a recognized cancer center of excellence. Also, depending on what you hear, don't hesitate to get a 2nd opinion from another cancer center of excellence. These days many of them will do a remote 2nd opinion just looking at your test results. I didn't, but frankly I felt pretty good after I met my surgeon. If I hadn't, I hope I would have gotten another opinion or two before selecting the treatment and getting it done. Best wishes.

Are there moments of misery, yes, but most of those, for me, were early on before treatment and during the height of ADT. However, if I look at things objectively, 80% of my life is the same as it was before: I still enjoy my job, I have fun hanging out with friends and family, I go to the gym, I walk my dog four miles every day, I mix and make original music, I read books, etc. Sex hasn't been great but it's been adequate and I trust it's going to improve with time. My therapist compares it to a pizza. I still have seven slices of delicious pizza when I had eight before, so why waste time thinking about the missing slice (easier said than done sometimes).

Edit: it took me months to reach this mindset. I felt exactly the way you did, that everything was going to be pure misery. Thanks to therapy, my mentor, my support group and the fantastic people here my opinion has changed. Don't expect yours to change quickly but it WILL change if you let other people help you.