Radiation vs. Prostectomy (nerve sparing)

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 …

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.