Do you regret having had a prostatectomy vs. radiation, or vice-versa?

I was diagnosed in 2014. Stage 4, season score 9. I chose a prostatectomy. I’ve since had radiation twice, 7 weeks and later 5 weeks. I’ve also had SBRT radiation 3 times. In addition I’ve had Lupron and Eligard shots and have been on Zytiga. All my treatments have been at Mayo Rochester after being diagnosed at my local doctor 3 hours away. I’ve never once regretted going to Mayo or my choice of treatment.

Somewhat similar story with me. I had local metastasis so surgery was not an option. I have radiation proctitis and I have "boxed it into a corner" through treatments with a gastroenterologist, diet control (avoid palm oil, nutmeg, ultra processed foods, and limit dairy in my diet) and mushroom tea.

I wish I had known about this. Thank you

In 2010 I had a PSA of 4.8 and after a course of antibiotics it was 3.7. Now which one am I going to believe? I was a hospital doctor and ran into a urologist the next day. I said I want a prostate biopsy. He said OK come to my office on Friday. The biopsy was equivocal so they sent it to Mayo Clinic, who said "positive for cancer cells". Oh they are just covering their but. I don't really believe it. But I went to Vanderbilt for robotic prostatectomy.

My father died at 94 with metastatic prostate cancer. He had a high PSA at age 84 and had 10 years of hormone suppression therapy.

Studies I read seemed to indicate similar results and side effects from surgery and radiation therapy, but if it recurs and you need more RT it has to be restricted, whereas you can have full dose radiation if it recurs after surgery. So I chose robotic surgery by a very experienced surgeon. Pathology after surgery showed 10% of the prostate was cancer but well away from the margins and I did not need to have any lymph nodes resected. However, I was a little bit surprised to have all the usual side effects including quite significant incontinence.

Three years later I had an AMS800 artificial sphincter placed. The sling can only be used for mild incontinence. At first it worked well, but by 3 more years it was failing due to atrophy of the urethra, where it was constantly being compressed. They changed from a 3.5cm long cuff to a 5cm long cuff. It didn't work 100% and after 5 years it's tubing migrated through the skin of the scrotum and had to be removed. Last week I had my third one placed at Vanderbilt, this time located a 4cm cuff placed high up at the base of the bladder. Lets hope this one works better. This time they used a surgical approach through the perineum behind the scrotum, which reminds me of an episiotomy. Much less pleasant than the approach through the scrotum, but the surgeon says he can get closer to the bladder, and claims it is less prone to infection, despite being right next to the anus.

See my post about the reason for the penis shortening immediately after surgery.

My PSA=0 after 15 years, and with a positive family history I do not regret having robotic prostatectomy. I would probably make the same decision again.

I had my prostatectomy in December 2010. Fortunately, my prostate cancer was still localized as it was detected early. I became worried when my erection slowed down without reason. When the PSA was done, it was high and kept going up. Over time, there were no side effects that raised much concern, as I have no incontinence, the erection was satisfactory, although not 100%, and with some meds, I could perform. This year, the erection raised the alarm again, and the PSA was also fluctuating. I did the PET scan, and the recurrent localized prostate cancer was detected. I was recently put on hormone therapy, enzalutamide and leuprolide.
I'm not quite sure how this hormone therapy treatment will treat me, as I started it recently. I'm also not sure if it was the right choice. I'm struggling with whether I should do radiation instead of hormone therapy or whether to do both.

Just want to, as originator of this discussion, thank everybody who has responded so far!
Lots of very thoughtful, honest, revealing, and often vulnerable comments, and I'm so happy for those who have had positive results--for either approach--as well as truly sorry for those who have regrets for the path chosen.
Thus far it seems pretty 50-50 with RP or RT, and I think I have decided to go with the RALP, given that:
1. I feel still young and vigorous enough (What?! You're in your eighth decade of life!! Obviously in denial...) to do okay with fairly major surgery (it's only "golf ball sized", right?)
2. Although radiation is apparently equally effective and has improved, I would also apparently need hormonal therapy, and that has some big potential downsides. For example, fatigue for me is already an issue due to Long Covid.
3. I like the idea of it being (potentially, I know) "one and done". That is, I'll be immediately confronted with some of the unwanted effects that will HOPEFULLY subside, as opposed to a delayed reaction of side effects from radiation that typically take months or even YEARS to manifest. Also it offers immediate analysis of the actual current cancer state.
4. If one process is chosen but proves ultimately unsuccessful, or only partially successful, it's much "easier" to get RT after RP than the converse.

I still have a CAT scan upcoming, which might potentially put things in a different light, although the radiation oncologist, interestingly, thought that unlikely. Fortunately, I happen to live in a city with a large university that has an NCI approved cancer treatment center, so I'm in good hands with both treatment approaches, and both doctors described quite good results with their many years of respective experiences. In addition to the radiation oncologist and the urological surgeon, I've consulted with a very senior urological oncologist.
Meanwhile, I am trying to be religious in my observation of the Ritual of the Holy Kegels, with the help, thus far, of a charming Australian lass on YTube.

So again, thank all of you so very much, my Prostate Pals-in-arms, and let's keep this discussion going since I'll certainly be paying attention, plus it might benefit others wrestling with The Decision!

It has been my experience, just from support groups that there is a higher rate of regret with RALP. But I think this is generally because people weren't fully informed at the time. I think that men who have gotten a number of opinions, reviewed all options, and decided on RALP are generally happy with their decisions.

Often a urologist will default to surgery because that is what they know. And too often people think "doctor knows best" and don't explore other options.

i was just thinking about this this morning,
71 had RARP in January am incontinent (and hate it) I likely have a hernia that will require additional surgery.It has been six months and likely could be another six months of "licking my wounds'
Would I elect for surgery again: absolutely
I believe ( there are no guarantees) that in my case my survival rate/longevity
increased
My brother had radiation, I really hope he has a good outcome
I have a 96 year old uncle who has the seeds and he is living independently so that was a good choice for him at the time ( probably 40 years ago)
I hate the side effects but I would not want to worry about choosing something that did not give me the best odds of survival

Consider that these are most popular procedures hence the most popular feed back. Suppose there is a X procedure/technology that is superior for your particular case. Would you hear about it? Would your team of experts know about it? Do you trust your advisors? Are they current with recent research,advances and technology? Advice: be more knowlegable high level point of view... you are general contractor, they are the subcontractors. Not an easy decision.
>Thus far it seems pretty 50-50 with RP or RT

I had SBRT and I’m happy with my choice. You talk about delayed reactions- I’ll add something else. The day I started SBRT one of my closest friends had RALP.
He had no idea of his Gleason score, was wearing Depends for a year, hasn’t had an erection in 2 years.
You know what? HE IS HAPPY. NO REGRETS . His PSA is undetectable. He’s playing golf, hanging out with his grandkids.

Me- none of the complications. But I’m 21 months out. Had a PSA bounce which is nerve wracking. And haven’t hit a nadir after 21 months.
And IM HAPPY.
If you are informed and make your choice, it’s easier to live with what comes next.