Newly Diagnosed: Removal vs Radiation

My experience with the emotions, mind racing off, etc., are similar to yours. IMO, if you don’t feel these things you really aren’t paying attention. Don’t worry about that but I applaud your reaching out for counseling - never a bad thing.

I was 66 when I had my prostatectomy last Sept. I followed all the docs and surgeon’s recs. I read Patrick Walsh’s and Vanita Gaglani’s books (hers is on “life after prostatectomy”). Both were very helpful to me.

My suggestion is to feel the emotions then move on to your decision making. Once you make your decision about radiation vs surgery, go all in. Don’t look back. Pros and cons to each and nothing is absolute - your results may vary - and all that. My friend here, Michael, advised me when I expressed doubts to go all in with positive thinking and not to look back. Best advice and just what I needed to hear.

One year later, I’m continent with the occasional bout of “stress incontinence” - no bid deal my wife advises 😁. ED was slow (for my preferences) but no biggie. Dry orgasms are the new thing and I sure don’t mind. Having the belief (prayer) that I got the cancer out is worth it to me anyway.

Best of luck to you - whatever you decide is best for you. Keep coming back here for there are amazing souls reading your posts.

I can only tell you what I did. After researching and getting 3 opinions, (1 was surgeon , 1 was RO, 1 was Oncologist ) I went with radiation.
My main concern was incontinence and ED. Seemed to me I had a bit better chance with side effects if I stayed away from surgery. I felt surgery was very invasive and was willing to risk radiation.
I’m 2 months post radiation and side effects are minimal. Occasional bowel urgency. I’m only 5 weeks post ADT and so it will be months before I get that out of my system.
It’s a difficult time trying to navigate the decision process. I got three opinions and was glad I did.
I also spent immeasurable time reading and watching podcasts by experienced doctors in the know.
One resource I favored was Prostate Cancer Research Institute. They have some very good videos that I accessed thru YouTube.
Once I chose a treatment, my anxiety went way down as I felt I had done a good job of getting informed. Best wishes on your journey.

I chose to have a prostectomy without even thinking about radiation. I was told if radiation didn’t work, removal would be very difficult. BTW, I was 71 with two cores of cancer, one at 3+4. Removal went well. However, my pathology report showed cancer was at 4+5 and a high decipher score. Before and after the surgery I did Kegel exercises religiously. I had ZERO incontinence issues. I attribute that to the Kegels and a very skilled surgeon. So far, I have had 4 PSA tests come back at < 0.01. Hoping for more of the same. IMO, I would really consider the pathology results as something to consider when making your choice. Best wishes! PS. Next week will be one year since my surgery.

survivor 5280,
Sounds like you and I are in very similar place. After having a partial nephrectomy in July at Cleveland Clinic in Ohio, I had an MRI after having a slow but consistent rise in my PSA from 1 to 5 over seven years. With the MRI revealing a .6 cm PI-RADS 4 lesion, I then had a transperineal biopsy revealing four of nine positive cores (two at 5%, one at 15% and one at 35%) and all at Gleason score 3 = 3 =6 Grade Group 1. I then opted for the Decipher test given family history of aggressive prostate cancer and got the results last night showing a high risk at .78. Will be circling back with my surgical oncologist although I suspect he will recommend surgery given the high Decipher score. As you mentioned, I somewhat feel like I went from likely active surveillance to almost certain surgery or radiation in one day.
Am trying to remain positive, learning as much as I can about options; and although I have great confidence in my surgeon, I will at least consider consulting with a radiation oncologist for a second opinion and will push for PSMA and bone scans to rule out spreading.
Would greatly appreciate hearing more about your situation and from others who might have thoughts or comments.
All the best as your explore your options and select your treatment.

A number of doctors were trying to change Gleason six to non-cancer. Many doctors don’t feel it necessary to do anything with someone who has a Gleason six. Yes, your decipher score was high, but you could go on active surveillance for another year or more and avoid all the problems caused by treating prostate cancer. Checking your PSA every three months at the most could show when your PSA actually starts to rise noticeably. From one to 5/7 years is not really much of a rise at all. That’s a doubling time of more than one year.

Urologists are surgeons they make A lot of their money doing surgery.

I also explored if my kidney cancer was related and they said if it was then it would have shown up in the biopsy tests, so in my case it was totally unrelated.

After consulting with a number of doctors, there is literally not a single one that recommended anything other than a prostatectomy - but some of that was based on me being a bit younger than a lot of prostate cancer patients so your recommendations may vary.

I was reading through responses so far and there are very good points and ideas, so I will just provide my thoughts on the basic question and my experience.

I would vote for removal. I was diagnosed on the younger side (48y) and fortunately had access to excellent resources within a reasonable distance at Johns Hopkins. They offered a multidisciplinary panel that would review your medical file, scans etc. and then you would meet with the panel later in the day to review options. The late, great Dr. Partin was part of this and ended up being my surgeon. I chose the RP mainly for piece of mind, in retrospect easier treatment plan vs. radiation, but most importantly to leave open the radiation option for down the road. My father had Prostate cancer as well and due to his age, decided on radiation therapy initially and when it returned, his only real option was Lupron. He succumbed to prostate cancer.

I was diagnosed as 4+3=7 in the Dominant Nodule and 3+3=6 in a Secondary Nodule. Margins were negative. My PSA was 3.7 that had increased over 300% in less than a year. I realized there were going to be ED and other issues, but still felt getting that bugger out of me was the best course of action. I had the usual leaking for a few months (wore pads), initial issues with ED that improved over time especially with the use of Cialus, then eventually good on its own. I was able to get back to somewhat normal life, the libido and ED continued to improve and celebrated each anniversary of being cancer free. That was 8y and 3m, up until yesterday. I met with a Radiation Oncologist since my PSA was no longer undetectable. It was hovering around .34 for a while and then doubled to .7 in best we could tell a 2y period. Missed PSA's in between so please stay vigilant! Course of action now is MRI Prostate, PMSA and Decipher. Starting 6m treatment on Orgovyx and 7.5 weeks of radiation therapy.

But this doesn't change my mind that the RP was the way to go back in 2016. The availability of the Decipher test is very useful it appears. Best of luck on your journey!

It is interesting when I read you saying

@robj67 said “I chose the RP mainly for piece of mind, in retrospect easier treatment plan vs. radiation, but most importantly to leave open the radiation option for down the road. My father had Prostate cancer as well and due to his age, decided on radiation therapy initially and when it returned, his only real option was Lupron. He succumbed to prostate cancer.”

It is interesting to see someone who made exactly the same decision I did for exactly the same reason.

My father died of prostate cancer also. He had radiation and when it came back, he went on Lupron. I remember the day he told me Lupron stopped working. At that time, there was nothing else for further treatment. I decided that since he took radiation and it didn’t work that I would start off with surgery, giving me the option to have radiation 3 1/2 years later when it came back. That was in 2010. Since then, there are a lot of new drugs we can take to hold prostate cancer off

I realize that a forum like this one doesn't have a lot of folks who had outstanding outcomes hanging around, because it tends to no longer be needed (although there are always those that want to spread the positive word so this is not always the case), but it sure is depressing to read how many people have a recurrence of the cancer after just a few years and end up having to go on radiation or hormone therapy. That honestly scares the crap out of me, to think I go through this nightmare only to have to start a whole new nightmare a few years later. It seems like most of the accounts I read of the cancer returning are only after a few years.

When I was first diagnosed, I was really scared about how long I would live. I thought a lot about how my father had prostate cancer for many years and after Lupon failed he died.

My first decision to have surgery was based on that. But things have changed so much in the years since I was diagnosed in 2010. We’ve got so many different drugs that can keep us going for years, With only some annoying side effects. I’ve had four reoccurrences and each time there was something to do next. I Still have something to do next actually three different things I can try one after another.

In the next few years, there should be some really good development in prostate cancer treatment. Don’t worry so Much about the future, You’re probably gonna live many years and medicine is keeping up, to make you live longer.