Surgery? Radiation? Can I have an independent suggestion?

I am 68. I have been reading a lot the past two weeks, as well as watching oncologists on videos. Your post is among the more helpful ones that I read.

Given all the information that I have gathered and given deep thought, I chose Robotic-Assisted Radical Prostatectomy. My oncologist will give me the earlier possible day, between the two Toronto Ontario hospitals where she does RARP. Her assistant indicated that it could be by end of March 2025; I said earlier than that, if possible; I want to eliminate or reduce the possibility my PC can spread outside the prostate before surgery.

Others may choose a different treatment that they think fits them. Whichever treatment they choose, I wish everyone well in this our journey. In due time, I will update you of my progress.

I just read this thread now; this info is too late for Hans.
There are two MR-Linacs (MRI-guided) in Toronto: at Princess Margaret and at Sunnybrook. However, these are a limited resource, reserved for patients who need more accuracy (less margin) in their radiation treatments. I was treated in one of the many Elektas (earlier version) available for most patients -- MRI-guided for radio planning but not real-time MRI-guided during actual treatment. However, my care team did a mini-CT scan before each treatment, comparing with the simulation images to make the necessary adjustments before starting each SBRT treatment.

@vircet I am not sure of the earlier version of the Elekta Unity but the current Elekta Unity mri guided radiation machine is in real time, before and during treatment. Here is a link to the Elekta web site for more information.
https://www.elekta.com/products/radiation-therapy/unity/

I am In the same position as you except I’m 4+3=7, 2 of 11 samples positive. Locally, surgeon said surgery, radiologist said radiate but I elected to go to Md Anderson for 2nd opinion and BOTH surgeon AND radiologist say that surgery gives me a slightly better chance of long-term success. At 10 yrs it’s a “coin flip” and probably ok either way, but I’m 55 and otherwise healthy which they say tips the scales slightly toward taking it out. Scared to death to go through that but bilateral nerve sparing should be an option in my case so just hoping/praying I’m making the right decision. Best of luck to you on your journey.

My humble opinion. I had proton radiation which was completely successfully and destroyed the cancer in my prostate. 3-cores of 12 cancerous one core 4+4, another core 4+3, third core 3+4. PSMA/PET three years later showed no uptake in the prostate. The only side effect I have experienced is somewhat of an extra urgency to urinate. Spacer gel utilized to avoid rectal issues and I have none. So that is my experience. I had 34 fractions of proton. Good luck and blessings with whatever you choose.

What I referred to as ""earlier versions of Elekta" is "not an earlier version of the Elekta Unity." For example, Elekta HD, mistakenly indicated by AI as no longer in use. There are several of these non-MR Linac machines at Sunnybrook, and they didn't retire them all when Sunny installed the first MR-Linac in Canada. The Wing of the building I was treated on, there's a huge sign MR-Guided Radiotherapy. I came to understand that it meant MRI-Guided treatment for a few patients needing more real-time accuracy (e.g., patients who cannot ha e fiducial markers) and MRI-Guided simulation/planning for most patients who get a mini-CT scan before each SBRT treatment (comparing the mini-CT images with the planning images, and the care team making adjustments before each treatment). At least, this is my understanding -- and this is probably be more accurate than AI's statement that Elekta HDs are no longer used at Sunnybrook.

My Sunybrook radiation oncologist started me on Orgovyx March 26. I had my fiducial markers (gold seeds) embedded the same day. My SBRT Treatments were from April 9 to 21. Today I start my last month in Orgovyx. My PSA was 0.36 in early July (was 10.5); my next PSA test is in early October. Aside from loss of libido, I had practically none of the other side effects that I had prepped my mind I would deal with post-SBRT/ADT. I will se what happens after I stop Orgovyx, or if I will have a recurrence within the next couple years, I hope not. My RO told me, "I see so many patients, I am not worried about you."

In 2023 I had a PSA of 32, Gleason of 3+4 on biopsy. Cribriform present. Lesion in one side. PET scan showed no metastasis. I elected RARP. Post-surgical pathology was a pT2 tumor confined to the prostate. Post surgical PSA testing has been undetected. No other treatments. It took seven and a half months to totally regain continence. I would elect surgery again, There are more treatment options if it were to recur at some point.

Still undecided between robotic surgery and radiation (the 28-visit type, as Cyberknife is unavailable through my insurance in central Ohio) for my 3+4 Gleason intermediate stage PC. We ordered a Decipher test 4 weeks ago, still waiting for the results, but when they come, I am wondering if the score may dictate whether surgery or radiation makes more sense. Cannot find useful info on the Internet about that question and curious whether anyone knows.

I was PSA 7.1 and Gleeson 4+3 = 7 in one core out of 12 or so. I had no interest in wearing urinary catheters for days/week, drains and the higher chance of post surgical side effects (incontinence and impotence).

My research suggested outcomes and prognosis for robotic proctectomy and radiation were about equal. So I chose a three pronged treatment plan of 5 weeks IMRT + one session of HDR + 6 months Orgovyx ADT.

I am now 2-3 months post treatment and the only minor complaints are increased urinary frequency and occasional short bouts of fatigue. I would choose the same program again