prostatectomy vs radiation?

For cribriform and IDC stats and studies show advantage with RP.

For us keeping a "diseased gland" had no appeal, especially with aggressive elements that might evade radiation and became even MORE aggressive mutants , as per study I already attached.

I am sorry I can not be of much help since I am not a doctor but I just want to say that I read couple of time here on this forum that a body needs first to heal from surgery so that it can endure radiation treatments which many times are no walk in the park either. However I completely get your frustration - my husband had to wait for every singe test and every single consultations for weeks and weeks. He was diagnosed with cancer in February and will have surgery next month ...

Regarding MRILinac procedure: Since FEB of 23, how is your urinary function, bowel impact, and erectile performance? Thanks,

@tjp1958
My urinary function is normal. I never had any issue with my rectum or bowel movements. Other than a slight difference in how hard my erection is, everything is working fine. I never really had any side effects except a slight restriction after my third radiation treatment, which Flomax took care of pretty quickly.

Thx! Any cialis, viagra now or have you considered it for hardness?

Also, did they use a gel barrier (spaceoar) between rectum and prostate?

Finally, any ADT (hormone therapy) before, during or after treatments?

@tjp1958

No real need for the little blue pill or the like.

I did have spaceoar inserted.

No adt treatment at all.

This is SO HELPFUL to me! Thank you! 🙏🏻Could you please summarize your conditions going in? PSA, Gleason, MRI results, biopsy results, age, physical condition going in,

Why chose you MRILinac (or otherwise known as SMART? )
Also recovery experience - during 5 fractions and short term after, then Long term after?

Thx so much! 😊

@lcbc
Lot of questions. I had 30 rounds of proton radiation. Why? Both R/Os as UFHPTI and Mayo Jacksonville believed the low dose long term treatments were in my best interest.

I post this because the decision to go with low dose extended treatments and high dose short time of treatments should be a personal decision. The low dose long term from my PCP recently is showing some difference in the degree of side affects from those getting high dose short term. You would expect this though from getting a high does you would get side affects sooner that with the low dose (my personal opinion not a medical opinion).

Did your urologist go over the difference in photon and proton radiation? On RP I did not have so will not comment. I was 76 when diagnosed and have heart failure so was not an option for me nor would I have chose in with my dignosis of low risk from Decipher test.

I don't see you havign a Decipher test but you did get PSMA. Asked your doctors about getting a Decipher test. Most of the time they can use the same biopsies taken to do the test. Decipher test will give you and your doctors a more precise diagnosis of the risk level of your cancer. That makes a huge differences in what treatments can and will be offered to you to consider.

Thanks for the info. Surgeon and RO were great in going over pros and cons. Going with radiation, waiting for Arterra pathology test results before deciding on ADT. No SBRT due to UIRisk status. 28 sessions and hoping no ADT is needed first, but not counting on it.

I am 64, and was diagnosed in late March 2025 with Gleason 4+3, Cribriform pattern and unfavourable intermediate risk. A PSMA MRI Scan in January detected a 1.1 cm lesion with a gross extraprostatic extension on the left side of my prostate that could not be detected by a DRE or ultrasound. The biopsy found cancer in all four cores from the lesion, but not in the other 12 cores. A PSMA PET Scan found no evidence of metastasis. I am also fit, overwise healthy and am an avid mountain biker and cross country skier. I used to play squash competitively, and some of my old squash buddies are now pickleball players, but I haven't tried it yet.

Armed with all this information, I started my research. I read everything I could find from reputable sources. As part of my research, I also travelled down to the Mayo Clinic in Jacksonville Florida (from Alberta Canada) to have consults with a Urologist (surgeon) and a Radiation Oncologist. Each consult included a resident in addition to the specialist that I booked with. I also spoke to two different urologists here in Alberta. In total, I spoke with four urologists and two radiation oncologists. For my situation, all six doctors agreed that radiation and a RARP were good options that would have a good prognosis. All six doctors also told me that in my specific situation, they would opt for the RARP. The urologists were concerned that radiation would preclude the option of surgery later on. The one surgeon said that if cancer re-occurs after a prostatectomy that it is often localized and follow-up surgery can be an option in this circumstance. The radiation oncologists said they would opt for surgery because of the negative side effects of hormone therapy that would be required after radiation.

One of the urologists I spoke to was the son of a family friend who specializes in helping patients who have complications post treatment for a broad range of prostate issues including cancer survivors who have undergone prostatectomies and radiation treatments. He told me with surgery you get the bad stuff over with up front, but with radiation the side effects tend to show up ten years plus or minus down the road. He told me that if his dad was my age and in good health, he would advise him to have surgery. If his dad was 80 then he would advise to have radiation. The primary determinants were health (able to handle the rigours of surgery, age (likelihood of living long enough to experience the delayed effects of radiation) and no evidence of metastasis.

Your situation and mine have some similarities (health and fitness) and differences (age). I am glad that you are also speaking to a radiation oncologist. Ask a lot of questions about side effects of hormone therapy that I was told can linger for months or years after therapy is finished, as well as the potential for longer term side effects.

I wish you well with your journey and in making the right decision for you. FYI, I had my surgery (RARP) on Monday, July 14th, and I am writing this comment on day three of my recovery with my foley catheter bag at my side.