Sure, wish you had started a new thread with this information. Would be interesting to hear what’s going on in the future with your treatment, Definitely have a lot of decisions to make.

Are they worried that using SBRT would be a problem because of swelling which would require catheterization. Would this really be a permanent problem or would it only be short term?

Have you looked at the other treatments that don’t use radiation or surgery? HIFU , Cryoabalation , NanoKnife , TULSA PRO, HoLEP are some alternative treatments.

@psychometric, regardless of your decision, visiting with the folks at MD Anderson will give you confidence in your choice.

For my benefit, did you happen to answer a questionnaire about lower urinary tract symptoms? It goes by two names, but its the same questions: AUA Prostate Symptom Score or International Prostate Symptom Score (IPSS). It's a 7 question quiz concerning urinary symptoms that allows the patient to rate the level of severity of the particular symptom from 0 (None or Never) to 5 (Almost Always). Your answers give a composite score of 0 - 35. If you did take that quiz and know the outcome, would you mind sharing it? In several radiation studies I've read, they use that composite score as one determining factor in deciding whether that particular radiation treatment would be a good or poor choice for a patient. I will add that the IPSS threshold was not the same in all studies I reviewed.

Thanks and keep in touch!

First of all, sorry you are having to go through all of this. Just about all of us have been through the same ordeal.

I was diagnosed at age 68 with G8 with no evidence of spread or ECE on MRI. I was fortunate to be a physician and was pretty good friends with the Chief of Oncology (he was a MO specializing in prostate and bladder cancer, BTW) at a COE. He invited me to visit and set up appointments with their most experienced RO and Urologist. After I met with them I went to his office for a discussion. He said there was no bad choice; the 2 options had about the same long term survival.

The side effects from surgery are more immediate-short term incontinence with some possibility of permanent incontinence (from my understanding most younger men regain continence fairly quickly). ED and the usual 1-3% complication rate associated with surgery and anesthesia.

The potential side effects from radiation are longer term and more delayed. Chance of incontinence and ED. Potential radiation injury (unusual) to the rectum or bladder.

I elected for RP. I wanted the cancer out and in the pan. The surgery was uneventful. Having a catheter in for 10 days was an annoyance. I was back to work in 2 weeks post surgery. I also wanted to hold radiation treatment in abeyance should I need it in the future. With radiation as the primary option, later surgical intervention is iffy and has a high complication rate due to the scarring from the radiation. Depending on the initial dose to the prostate additional radiation may not be an option.

As fate would have it, I got to experience radiation treatment after all. I developed a solitary met at T8 six months after surgery successfully treated with SBRT. In another 4 months PSMA PET detected a positive pelvic node after rapid doubling of my PSA. Time for the MO! I found an experienced, aggressive MO at JH and had triple therapy followed by whole pelvic radiation with a boost to the node and the prostate bed. PSA went undetectable after the second chemo infusion and has remained so for 2 1/2 years. I'm off all meds (except T) and I am currently on TRT as my T didn't sufficiently recover after a year on Lupron. Feel great.

I agree with others on this board to visit as many ROs, urologists and MOs as you need to feel comfortable. I flew to Baltimore to get my treatment every 3 weeks. I've flown a lot farther for vacation trips, I figured a plane flight is nothing to potentially save my life.

Make the best decision and don't look back and second guess yourself. That's the last piece of advice my Oncology friend gave me at the end of my visit. Sound advice. Good luck to you!

That was my thinking as well. There are many long-term treatment options with RT, depending on the nature of the recurrence. The recurrence may be distant from or very near the prostate, for which there are many treatment options; the recurrence may be local to the prostate, bringing treatment options like focal therapies (because the dose can be specifically targeted), brachytherapy, SBRT, and sometimes even re-radiation. (There is rarely a medically-necessary reason for surgery. Most men do surgery only because they “can’t bear the thought of….”)

Side-effects from hormone therapy have been demonstrated to be minimized by rigorous resistance-training exercise. Following what I read and heard about resistance-training exercise, I hit the gym immediately after every radiation session (and for as long as I was on ADT) for weightlifting, as well as alternating days of running 5Ks or swimming laps for 35-45 minutes. I never experienced fatigue; my only side-effects from the hormone therapy were mild warm flashes, muscle atrophy, and zero libido (but never experienced ED).

My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. The short amount of time that I was gone each day for treatment were no different than any other time when I simply left to go shopping or to the gym.

Today, almost 4 years later, everything has gone as hoped. We’ll see what the future brings…….