Surgery or SBRT PSA 4.4; T1c.

Posted by jaygk @jaygk, 4 days ago

Hello, I am a 65 Year old male, ALL 12 sections biopsy positive. 11 sections Gleason 6, 1 Gleason 7 (3 + 4). Clinical state T1c. The 7 is on the outside. Cancer has not spread outside of the prostate and is no perineural invasion.

Met with the surgeon (uses robotic da Vinci) who prides himself on nerve sparing. However was told my changes of nerve sparing are decreased since all 12 sections positive.
Met with radiologist for SBRT (CyberKnife) consult. I would need the space OAR gel . I also have severe diverticulosis and generate approx. 15 polyps per year on my annual colonoscopy. So, I am worried about the radiation bleed over into the rectum and its effect on any future treatment I would need regarding those 2 conditions. Meeting with my gastroenterologist next week to get his option.

I understand both methods are very effective 90%+ so that is a blessing. I am a good candidate for both...also a blessing.

I am concerned about urinary continence and ED and am on the fence about which treatment to select.

My question is what have been your Dr. recommendations and what have been the experiences you have had for surgery (da Vinci) and radiation (SBRT CyberKnife) in particular and what have been your ED and urinary continence results.
Thanks, Jay

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thmssllvn | @thmssllvn | 1 day ago

…CCOE for those on MEDICARE be aware that July 1st is when new residents start training. There is an old saying “ Earn while you
learn” Accreditation and ethics
prevent deferral to the unprepared. Notwithstanding, patients may opt out of training less experienced residents.

I helped a colleague through a process to repair an abdominal
aneurysm at the number 1 US hospital. Night and day between
two surgeons, both competent. One did the endovascular procedure the other did not but
said he did “…but you are not a candidate” Similarly IMRT shops don’t say SBRT is not equally effective, your not candidate!
Also OS spread the myth that once you have radiotherapy you cant’ have surgery. Please review the pcri.org video by Mack Roach MD c. 25 APR 2025 he has written over 200 papers on PC.