Radiation vs. Prostectomy (nerve sparing)

Getting information here is a great place to start but get a second opinion from a qualified professional.
Try to find the best cancer center you can find. My suggestions are Mayo Clinic, Sloan Kettering or MD Anderson. I didn't have to pay much for my second opinions as I'm on Medicare, but most insurances companies will allow that. I think out of pocket expenses were less than $1000 if you don't have insurance plus travel. Just because you may like your doctor doesn't mean he/she is the most qualified. You want someone who has done it thousands of times, not someone with a new machine to try out.
Anyways, I had 4+3 and it traveled to the pelvis. I had 5 sessions for the prostate and 3 for the pelvis. Other people had longer sessions, but I'm not sure the reasons for that. I was not a candidate for surgery.
I have had no significant complications from the radiation as of yet and it's been two months.
Good luck in whatever you choose to do.
Dave

Thank you, Dave. Yes, my second opinion was with Sloan (my radiologist trained at Sloan and Cornell/Weil). Sloan recommended virtually the same procedure with only minor differences (once a week - 5 weeks vs. twice a week - both = 5 sessions). I am a candidate for removal but the recovery timeline is longer and the surgeons both said that either method has about the same odds of removing the cancer and cribriform (72-75%). Good luck to you with a continued successful recovery.
Jon

All I can add is that at age 64 with high volume Gleason 4+3 with PNI (and ‘tiny’ breach in the capsule not seen on any scan) I opted for surgery…unwillingly…the reason?
What I had - and what you have by virtue of cribriform being present - is a cancer with a high likelihood of recurrence. FORGET the surgeons and RO’s saying that their treatment is ‘one and done’ - it hardly ever is!
My cancer DID return 5 yrs after surgery at age 69 - still comparatively ‘young’ depending on who’s looking. You might be even younger if yours comes back and what then??
Ask BOTH the surgeon and the RO —“What Then?” The answers will be your best guide to making a sound decision. Best,
Phil

Today will be my third of five treatments on MRIdian; so far so good with minimal side effects. Receiving ADT as well (first depot-Lupron injection 2 weeks ago today: planned 12-18 month ADT) for Gleason 4+5, PSA 15.1 (was 3+4 with PSA 9.0) when started active surveillance 10/2021). Hoping for a favorable outcome.

In spring of 2024 I was diagnosed with prostate cancer I was considered "high risk" my decipher was 0.96 most recent PSA 12.74. Gleason score 4+4. I met with two sets of doctors from two different hospitals. I come from a Wall St background. I did realize that this was a business. The goal was to get patients, lay out their options 1) do nothing 2) have the surgery to remove the entire prostate 3) radiation treatment. I chose surgery which took place in Aug of 2024. At the conclusion of surgery the surgeon believed the cancer was confined to the interior of the prostate. The lab results proved differently there was a compromised area where the cancer cells had escaped the prostate. Within 6-8 weeks my PSA confirmed this situation. A PET scam was done which showed cancer cells in my abdomen area. I then began 6 months of homone therapy along with 2 months of radiation treatment. I have done it all. I must say at this point my PSA is .05 The consequences of the surgery and the nerve damage is that I am left castrated. The emotions and depression with this situation ( I am 67 yrs old) are brutal. The doctors where never candid about the consequences of the surgery. As you come off the homone treatment and your testosterone levels which mine were measured at a low of 15. (normal for a 60 year old male is 750-1000). My testosterone at 15 was that of a 8-10 year old boy. As the hormone treatment ended in April of 2025 and the testostrone levels slowly creep up your libido returns. At this point you realize you are incapable of having an intimate monment with you wife or partner. It is as if the surgery took my soul and manhood. It is important that you have an experienced and talented surgeon inorder to avoid perment nerve damage. These nerves which surround the prostate connect with your brain, when sexually excited send blood flow to you penis creating an erection. I have used pumps and needles in the past few months with limited success. I must say the doctors want to make you cancer free and extend your life. Your quality of life and conserquences of treatment are a secondary concern. Fighting caner is a business. I am a paying customer of the hospital where I chose to have the surgery and treatment. There is no turning back the clock. The decisions I have made I must live and die with, going forward.

@bcarey - great post buddy…you tell it like it is, no BS…thank you.
Phil

@bcarey Thank you. Your overview is very helpful and I appreciate you taking the time to lay it all out. What you describe is very similar to what I have experienced to date. I have had 3 surgeons and 3 radiologists advise me and nearly all have the same perspective with very little variance. As a guy I know that has dealt with prostate cancer since his early 50's (now 68), people think it is a hangnail and have little idea of what happens when things are worse than the usual version. Go easy and know you did what was best by those you trusted.

What a great question! Prostatectomy v Radiology. 2 different approaches. My first diagnosis left me little choice. Gleason 9. Bye by prostate. The surgeon spared me a nerve...thank goodness for that. Like someone has mentioned, we are never cured. I consider this little devil just resting, waiting to return. Hopefully not with a vengeance. Well, mine did return. The oncologist recommended exactly what he is trained on - hormones. The radiologist, different training - radiology. The oncologist said we could kill that little SOB. The radiologist just said he felt confident he could give it a jolt. I think hormones are more powerful, but they have side effects I'd rather not content with. So we gave it a jolt and have sent the PSA tumbling down. No side effects. I guess I opted for current quality of life v. longer term benefits. Bottom line - find good docs whop can lay out pros and cons. But we're the ones making the choices. Enjoy life while you can!!!

@thomasmichael 12 years ago 3 1/2 years after surgery my PSA started rising and they needed to give me salvage radiation. First, they give me a six-month Lupron shot, Which can stop the cancer from growing reduce the size of the tumors and stop the spread. I didn’t even notice any side effects from it. That was followed by 7+ weeks of radiation. Gave me another 2 1/2 years without ADT before my PSA started rising again. I have BRCA2, which is why it keeps coming back.

I’ve now been on ADT for nine years and on an ARSI for five. My cancer has been undetectable for 22 months.

With the right drug regiment, you can have long-term survival and A good lifestyle.

No one can tell I have prostate cancer, Unless I have a hot flash while they are there. I lead a normal life, doing what just about anybody else can do.

I am in the midst of SBRT (5 treatment regimen) and ADT (Lupron) for Stage IIIC, Grade 5 PCa. I am approaching my 74th birthday and have enjoyed an active sex-life until now. I worry more about the loss of libido and ED from treatment than I do about the possibility of a recurrence. Still, I am happy to know that good treatments exist and hope that I can continue to live a happy and fulfilling lifetime. I hope to successfully not allow the sexual repercussions of the treatment define my happiness and sense of well being. Time, I am sure, will tell …