prostatectomy vs radiation?

I regret having the surgery over radiation and ended up doing both only because friends who did radiation only got their sex life back , I’m not sure I’ll get mine back , almost a year now and no improvements in site despite Bimix injections, good luck

I can imagine that most surgeons wouldn’t want to try doing salvage surgery after initial radiation. But, with so many other options if there is recurrence following initial radiation, why would they even recommend surgery?

"Hope you guys are still our friends up there!"

Of course! I have friends in many countries, whether or not my government happens to get along with their government, and I think most Canadians are the same. We know the difference between the loud political bluster (on all sides) and ordinary Americans just living their lives. And in our cases, living with prostate cancer gives us more in common than our governments can set us apart.

Im also Gleason 4+3 although my PSA has for the last 12 years ranged between 0.6 and 1.1. Last test was 0.89 last month. I have a mixed morphology of acinar and ductal, the latter being more aggressive. Biopsy (urethal with TURP) did not indicate percentages. All includes contained within the prostate. Undecided but Leaning towards radiation and brachytherapy.

So with all those negative factors at work, what is your current plan of action?

Because in great % of cases it is actually curative - either 100% or delays re-occurrence for MANY years. Unfortunately those lucky patients do not come to post in forums like this. OR, they come here after 20 years of no evidence of disease (like we saw recently).

Those who come after RP are those that had micro mets already out and about and that does not mean that treatment failed. Micro mets can be dormant for years even decades.

RP also removes mother-ship once and for all so new mets are not continually emitted out. Surgery offers better analysis of the tissue and better treatment planning for the future.

All in all - there is a reason why 50 year old will ALWAYS get advice to do RP , from both radiologist and a surgeon. This fact alone was one that made our decision much easier.

@brianjarvis
I am not sure only posting my experience with this topic. I read post that say or are told you cannot have surgery if you have radiation is not correct. What my urologist, PCP, and both my R/Os from two different medical facilities is that the prostate is in such bad condition it makes surgery extremely difficult. However there are surgeons that have the skills and experience to do them.

If you have radiation and your PSA or biopsies says cancer is still there and you would like the option to have RP rather than go through radiation it is still possible but takes a very experienced and special surgeon to do so.

Per my doctors and specialist, not me, you are dealing with in most cases cancer at a celluar level not tumors, etc. If is very easy to miss areas of prostate that have cancer cells if the original radiation treatments are not done to all prostate.

It is why my Mayo and UHFPTI R/Os said regardless of the biopsies they radiate the entire prostate and margins so they do not take a chance of leaving an area of the prostate that has cancer cells that was not identified in biopsies and or MRIs.

Amen!!!!!😊

I chose to use a data-driven approach to select a treatment.
> Data indicate that recurrence rates comparing surgery vs radiation are statistically equivalent (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122), so choose the one that causes the least harm.

> Dr. Kwon (of Mayo Clinic) mentions similar numbers, the only difference being where recurrence occurs (https://youtu.be/Q2joD360_pI).

> As for pathology grade matching needle biopsy grade (though results vary slightly study-to-study), this 2019 paper out of the UK indicated that initial biopsy and pathological grade matched 59% of the time, while upgrades occurred 25% of the time and downgrades occurred 15% of the time: https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0526-9

Yes, surgery does offer better analysis of the tissue - after the fact (the numbers are similar or better 75% of the time in that study). And with all the scans, tests, liquid biopsy, genetic, genomic, and many more, sufficient data can be gathered for a good treatment plan without cutting off an appendage “just to see.”

I just think that with today’s modern radiation technologies (which continually improve) along with adjuvant therapies, there is no longer a documented need to remove that body part.

But, that’s what’s great about having treatment choices. We each get to choose the one that suits us the best and then we each get to live with that decision.

I won't actually know until my next post-surgical follow-up appointment, 7/31. I've actually pondered - without any action taken - as to why my doctor didn't move up my follow-up appointment to the week following my last appointment on April 28th? Maybe again, because prostate cancer grows so slowly, that my doctor knows that seeing him 3-months after my last appointment won't make a difference. Are there any doctors out there reading this, who want to weigh-in here? If you have a post-surgical radical prostatectomy patient who was revealed to be a pT3b level patient based on the pathology report, would you do as my doctor did, saying: "We'll need to talk about radiation during your next appointment" and wait those three months? Or...would you walk me up to the front receptionist, and say: "Schedule this patient sometime next week...make it work, fit him in." ??? What would you do?