Surgery or Radiation?

I pulled many research papers and what i got was that its a very bad idea for agressive gleason 9 guys to go surgery

if you state that “im a sugery guy”, that tells me you haven’t done research.
For optimum cure results, yes sometimes you would be a surgery guy, but in other cases, you would be a radiation/brachy guy

I read the paper you linked. I found it deceptive. It did not fully describe the radiotherapy type and dose. There are vast differences in cure rates that depend on this.

I pulled many many research papers during my time trying to navigate out of this prostate cancer zone. I found NONE that supported the often reported mantra that two vastly different treatment techniques coincidentally yielded identical curative outcomes.
I challenge you to produce more papers. And if you do not come up with the same papers i found, if you do not produce the very easily found papers that i found within maybe an hour of internet search… i will know

The gist of the many papers i found was this… if you have an agressive grade, chances are you may have cells collecting on the prostate periphery. Going surgery may leave these behind. Going radiation (with brachy boost) can mop up these outer cells sometimes.

Look it up. Do your research

To get the low-level details you want (radiotherapy type, dose, etc.), you’ll have to research the actual clinical trials that they were reporting the results about.

I’ll leave it up you to tell the NEJM that you think their reporting is deceptive. (Don’t think you’ll get much traction with that….)

You used the word “identical” — (“….found NONE that supported the often reported mantra that two vastly different treatment techniques coincidentally yielded identical curative outcomes.” Rarely if ever will you find in scientific literature “identical” results, or even any reference to “identical” results. What you’ll find is whether there’s “statistical significance” to a result. (And, this report indicated that there is not a statistically significant difference in outcomes for localized prostate cancer.) Try to review scientific papers with a scientific mindset, not a lay mindset.

I did 9 years of researching medical literature while I was on active surveillance and more during these past 4 years since active treatment, and found many papers and many organizations and institutions reporting statistically equivalent outcomes between surgery vs radiation.

Of all the papers you said you researched, I would be interested in seeing a recent clinical, peer-reviewed paper (on par with the studies that the NEJM paper references) that indicates statistically different 15-year oncological outcomes for localized disease.

Stay strong. Surgery is not guaranteed, you’ll definitely need more thought but the results of both procedures is about the same. Take your time and ask questions. Just know that some form of ADT may also be in your future.
Good luck and all the best.

The NEJM multi-year (decade, decade and a half) study was discussed in a Prostate Cancer Research Institute webinar. I gathered that there was no statistically significant difference in outcomes between radiation and surgical treatments. I understand that if there were objective evidence (proofs) that one or the other produced statistically significant more favorable outcomes than the other, then less investors would gund the production & continuous improvement of the medical devices (e.g., robotic-assisted radical prostatectomy-RARP or MRI-guided radiotherapy) with less favorable long-term outcomes. As it is, production, sales, use and CI of devices for both procedures continue in parallel.
I hope this helps in our readers' analysis & decision-making on their treatment path.

what a tough decision.
the guys on the list have mixed opinions/research, the 'professionals' have mixed opinions/research
This sure makes it hard.
At 88 and healthy< I can imagine you wanting to make a decision that will allow more years of feeling healthy and not worrying about an aggressive cancer In my own case (I am 71) I was very torn between radiation and surgery in general, my brother had the radiation and is happy, I ended up having the surgery and am happy cancer-wise ( I am not happy with the incontinence). I have a 96-year old uncle who has had the radioactive seeds for about 40 years now. he still lives independently with my aunt and is fairly happy ( at least with prostrate cancer)
At some point, we make the best decision we can and just have to trust in the expertise of others.

As an aside, Reading this thread made me laugh a little. I find myself like many on this discussion group really getting into the research. I have even thought of writing a formal literature review on incontinence following RARP, I may do this.
I tend to think that as individuals with cancer and then actual patients that have received the various treatments, we make up a special group . I dig into the research, so I can be as informed as possible and in both the case of cancer and in the case of incontinence, I want the best outcome I can get. The science is evolving,and that is wonderful. At the same time, what is not known can be troubling. Efficacy studies, remain controversial and mixed (not like COVID, worn out knees, or skin cancer perhaps in which there seems to be pretty good agreement and efficacy support).
At some point, I had to do my best job of consuming the information and then just making the decision
I sure wish you good luck

So, you respond with lots of chit-chat, but ..
1.) you failed to report the specifics of the radiotherapy or if there was brachy boost in the single article YOU posted.
2.) you came up with no other articles

I am a fit 86 yr old who was diagnosed with three positive biopsies out of 15 at Gleason 7,8 and 9 in Jan 25. This followed a Dec 24 PSMA-PET that was negative except for a tumor in the prostate. Next week I complete a 70GY/28 fraction treatment at Mayo Phoenix. I never considered and my urologist never recommended RARP. The risks of surgery and the time to heal at our age, IMHO, just don’t warrant it. PCRI believes you have about an 80 pct chance of cure with negative PSMA-PET and in many cases questions whether ADT should be administered for 18-24 months because of quality of life degradation. Even if you have biochemical failure after radiation you can control the effects until you experience some other life ending event.

Since this thread became so long , I will repeat once more for the sake of "not missing the point" that every case should be evaluated as separate and "unique" to that person and according to pathology findings. The "one size fits all" does not exist for any disease, and particularly NOT for PC !

Age, comorbodities, gleason, Dicepher, placement of the lesion, extensions of the lesion, containment and TYPE of cancer cells present in the lesion will determine what is the best course of treatment and results do differ.

At the end, regardless of what "statistics" say, every patient will make the decision according to personal preferences that are at that point more subjective than objective and that is completely fine.

It is contra-productive to tell a person who is ghastly afraid of incontinence that RP is better and that radiation can also cause incontinence or, on the other spectrum, can cause the formation of obstructive scar tissue that can cause serious problems. For that person RP equals incontinence regardless of the small % present as a result.

At the same time it is contra-productive to tell a person that radiation is the better choice if that person can not imagine living with cancerous gland inside the body and is ghastly afraid of radiation causing secondary cancers and myriad localized problems with time (non healing ulceration, chronic proctitis, chronic cystitis, etc etc) or being afraid that radiation will not eradicate cancer in the first place since cribriform and/or IDC is present.

Also, there is a reason why 50 year old person with localized and possibly aggressive cancer will CERTAINLY be advised to have RP by oncologist and why very old person with many health issues will be CERTAINLY advised to have radiation with ADT. Why- because there IS a difference in expected lifespan.

There are about 100 "shades of gray" of PC that it is absurd to make any definitive statement about equality (or not) of effectiveness of any particular treatment since it ALL depends of the above mentioned list and ALSO depends VERY much of the skill and experience of any particular medical practitioner.

We should all be very grateful that there are so many available treatments for PC and support each other in whatever choice anybody makes.