Recently Diagnosed - Surgery or Radiation?

At one month past SBRT and while still on ADT I had no problems doing any day-to-day activities. I did have SpaceOAR gel and had no rectal issues, but some people do get diarrhea from radiation. I just needed Flowmax.

I did get depressed from ADT but when distracted I was OK. Most people I know who took ADT didn't get depression but did get hot flashes (which I didn't get). If it were me, I would go on the cruise as long as there was a ship doctor or nurse. I probably would have needed an occasional nap.

I think it's good to set expectations that way. Then, on the days when you find you *do* have enough energy for a walking tour or bus trip, you'll feel like you're doing better and it will be a celebration, rather than its being a disappointment when you can't.

Bon voyage (and may there be many, many more vacations ahead, for both of us).

Hey pctm, I’ve had both -surgery and 5 yrs later radiation. Surgery is far, far more invasive and life changing - at least it was for me. Only reason I chose it was the ability to do radiation later if necessary - and it was. All the comments made here are rock solid and there is NO best treatment.
Your biggest obstacle, as I see it, is that you are locked into the VA health system - not a shining center of excellence in the past. There have been many vets who’ve not gotten optimal care.
But starting with the Obama administration they started turning things around and the care - as well as the doctors in the system - has vastly improved. Your real task is finding either the BEST robotic VA prostate cancer surgeon OR the best radiation oncology team with the most up to date equipment and software.
EITHER of those are equally able to remedy your cancer (barring any aggressive findings on PET). You may have to travel to get the best, but it is well worth it, because if you do not, then the question becomes:
“What will destroy me more - a badly botched surgery…. Or a poorly administered course of radiation?”
You see, we all agree that “successful” outcomes are the same for both, but no one ever talks about which “failures” are the worst for either.

Sorry to welcome you to the forum, it's the one place that nobody wants you to be but welcomes you with open arms because we don't want to be here either. Sort of like the DMV but with hugs 😉.

Nobody here is qualified to tell you the path to take, it is for you to be your own advocate. We can, however, share our own experiences.

I am a couple months since RARP (surgery) and at 54 years old I was told by 9 doctors to do surgery. There wasn't even any vacillating on the topic, from radiation oncologists to medical oncologist to urologists: surgery. Their reason for this was that at 54 I was strong enough to recover from surgery and young enough that I could see the negative side effects of radiation in my natural life - where someone 20 years older may die of natural causes before they see that so radiation could be more of an option.

The other benefit is that RARP is the only way to get a 100% pathology on your cancer, where they know precisely what you had and if they should consider more treatments. Not just the prostate itself, but while they are in there they can evaluate your bladder neck, lymph nodes, surrounding tissues and more. Because you have some spots that are far more aggressive (4 and 5 grades) you may end up with both surgery and radiation but you will at least know exactly what was impacted.

It's very easy to find reasons not to do surgery because of the perceived side effects, but that perception is skewed a bit by the fact that the people who had issues from RARP are more likely to stick around and talk about the problems, whereas people who don't have issues have no reason to stick around to tell people about the positive outcomes. I'm the latter of these two. Zero issues, it's not a unicorn, it is real for some guys.

I personally am glad I got surgery, the cancerous gland is out of me - sure it may have metastasized and I might have to deal with that later but the "mothership" popped smoke and is gone (another vet here, didn't use the VA). Even with radiation it's not uncommon for "salvage surgery" to occur later anyway.

Thank you. Happy you are doing well.

I’m a 55 year old navy vet. I was diagnosed in 2022 had surgery in December of 22. I did not do any radiation or chemo. My only side effects have been incontinent since and have been unable to have an erection. I had in June of 24’ proact ballon’s implanted and gas helped with the leakage. Nothing so far to help with getting an erection.
Just this past moth had a psa test that was .36 first reading above zero in over two years. Now looking at having to do radiation for a nodule on my left lymph node. So I wish you luck I’m ok with having my prostate removed I have wanted to stay away from the radiation and chemo just because I’ve seen the side effects with friends and other family. Hope this might help

@pctm I had the mridian radiation machine that had a built in MRI so the margins were 2 mm instead of other types of radiation machines that use 3-5 mm. Because of that, my side effects from the 5 hypo fractional treatments were little to none. I had restricted urine flow for a couple of days but flomax took care of that right away. I also had spaceoar gel inserted to add more space between my rectum and prostate, so I think that helped as well.

There are solutions for getting an erection. You can exercise your penis with a penis pump. Get it used to being enlarged. You can get bimix or trimix injections, From a urologist. You inject it directly into the penis with a very small needle and it gives you an erection for a while.

And then there’s penile implants, Supposed to have high satisfaction.

Yes, radiation treatments can result in radiation cystitis; practicing the proper full bladder, empty bowel routine greatly minimizes that risk. Radiation can also result in radiation proctitis; using a rectal spacer greatly minimizes that risk. Most side-effects from radiation can be minimized/avoided by some precautionary practice.
Be sure that not only is your radiation oncologist (RO) experienced, but also everyone on the radiation team. The RO is like a team manager/captain; it’s all the others who are doing the heavy lifting. Ask about them as well.
Also be sure that you’re reading about modern radiation as you’re researching this; modern radiation technology and techniques are vastly different than they were 15-20 years ago.
Fortunately, I was on active surveillance for 9 years (initially diagnosed in April 2012 at 56y) and used those 9 years to get referrals and dive headlong into the nuances of all treatment techniques. When I finally decided to start treatment (on 19 April 2021), I had 28 sessions of proton radiation, plus 6 months of hormone therapy, and SpaceOAR Vue. I only had 1 day of side-effects - my RO told me that was probably due to an inflammatory response to the radiation. (Resistance-training exercise is the key to minimizing/avoiding most hormone therapy side-effects.)
Prostate cancer treatment is usually successful (meaning that you’ll likely succumb to something else - cardiovascular disease, for example - rather than prostate cancer), so you have every reason to stay positive. Though it’s diagnosed quite often, the prostate cancer mortality rate is actually quite low compared to other cancers. You’ll be fine.
For me, proton radiation was the right call because I was looking to (1) successfully treat the disease, (2) maintain my quality of life, and (3) have the most options available should there be a recurrence.
Now 4 years later, I am on no medications. PSA is remaining low (between 0.35-0.55). It’s as if nothing ever happened - just walked in a revolving door, got treated (28x), and walked out the door…..it’s practically back to the way it was before the prostate cancer journey started. (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.)

Good luck with your decision.

My only comment that helped me decide surgery vs radiation is if you choose radiation without good results, if I understand correctly most cannot then have prostate removed. Unfortunately in my and many others surgery didn’t get it all and I ended up with 6 weeks of radiation after all. Sometimes being in my late 70”s I wish I threw the dice and hope that something else would cause my death before cancer , I’ll never know