time to decide and I'm stuck....

@surftohealth88
The RO I went to at a center of excellence for a second opinion suggested the Aleve experiment. My local urologist agreed to it. My local RO wants me to have 6 months of ADT. My urologist says I don't need it and the 2nd RO says if my PSA after Aleve is < 10 then I'd be in the favorable intermediate risk category and could forgo ADT.

@suzdog
You should’ve looked further into Surgery. After they took the catheter out, I had no incontinence at all, and I’ve heard from many people that have the same experience. A percentage of people have incontinence problems for a short time after surgery.

Burning While urinating and Having multiple bowel movements is not a problem with surgery.

If they are able to save the nerves, Or even half the nerves, Most people can get an erection after having prostate cancer surgery.

It’s too bad you didn’t see a doctor that was knowledgeable about surgery, You were really misled when told you needed to wear a diaper after surgery, and you wouldn’t be able to get an erection. There are many people in this forum that could disagree with that, after having surgery and neither of those problems, at least for more than a short time.

@quaddick

It all might make sense if you did not have Decipher 0.81 . You have very aggressive cancer regardless of PSA level according to all papers I ever read. Maybe you can remind them about that fact ? Doctors are very busy and sometimes forget all of the findings that are listed in patient's profile. I caught them numerous times overlooking some details. Six mos of ADT is really very short time and can add a lot of benefit but of course you will decide what looks more manageable to you 👍.

Wishing you the best possible outcome and complete eradication of cancer 🍀🍀🍀 with whatever you decide !

@rbtsch1951

Agreed : ))). However if gleason goes down that makes no difference in choosing a treatment but if it is actually higher , treatment might be insufficient and that could be a real problem.

I can only speak from personal experience - we are very happy that we had RP since my husband had cribriform and IDC . My husband has minimal incontinence just 9 weeks post surgery (1 tsp in 24 hours) and ED recovering nicely. Only about 3-5 % of patients have long term trouble with incontinence according to all research papers.

Unfortunately BOTH methods can have long term side effects - the same % of patients have long term toxicity damage to bladder, urethra, anus etc. after radiation, secondary cancer can appear and even incontinence and ED .

No approach is perfect, nor it can be. We are dealing with cancer and I think that people sometimes forget what is the purpose of all of those techniques and methods. It has to be done and one can only choose what looks the best for every particular case taking into consideration also an age and general health status of every patient.

Both RP and RT have the same success and the same amount of side-effects. The choice is personal, basically. ONLY in case of very aggressive cancer (with large cribriform and IDC) RP gives better long term success. Also, for young patients (50 ) RP is almost always the first choice of treatment since RT can cause secondary cancers in following decades and also since life expectancy is longer younger patients need to have second chance for cancer eradication - salvage radiation.

@jeffmarc I disagree. I did look into the surgeon's facts and here is what I found. I understand the guys that report no problems but you won't have the guys saying, Hey I can't have sex anymore. They would keep that quiet. So here is the stats. The number of men who cannot get an erection after prostate surgery varies, but studies show rates can be between 30% and 80% within the first two years, with many men experiencing significant improvement over time. For example, one study found that after 18 months, nearly 60% of men could not get an erection, but this number dropped to about 42% after two years. Recovery rates depend heavily on factors like the surgeon's experience, whether the surgery was nerve-sparing, and the individual's age and overall health.

As far as wearing a diaper goes here is the stats on that. Most men will need to wear a diaper or pad for at least a few weeks after prostate surgery, and many will continue to have some leakage for up to a year. While nearly all men experience some degree of urinary incontinence immediately after surgery, the need for a diaper decreases over time, and long-term incontinence is a concern for about 5–15% of men.

So those stats told me to stay away. Your synopsis doesn't reflect this data so not sure where you are getting yours from except for maybe reading only the positive reviews. Those stats aren't made up.

@suzdog
Did you ever read those stat :

"Approximately 50% of men develop erectile dysfunction (ED) after prostate radiation, though rates can range from 25% to 70% depending on the study and follow-up time. This can be a gradual process that may begin within six months of treatment, with recovery to baseline function possible for many over two to three years".

As I mentioned in my previous post - both RP and RT have the same amount of side-effects. Difference is that for RP they are immediate and they tend to recover over time and for RT they are somewhat delayed.

Also, it is not true that patients are quiet about ED - here we have very honest and open discussions about it and you will find numerous posts about that issue.

Yes, I was responding to the poster that said I should have had surgery because it carried very little chance of side effects. My surgeon was honest and my research backed it up that there was a good chance of being impotent after the surgery and I have read many reviews here from guys have had to wear pads and/or diapers as well. Most men are not going to post their erectile disfunction problems and I get that. Some will but I bet most don't as the stats say a lot are going to have that issue after surgery. I hate my side effects but will put up with them versus the alternative.

@suzdog
I’m not only gone by stats, but on peoples experience and both of them have shown me that the numbers you are quoting don’t match newer experiences.

If they are able to save the nerves, Something that has relatively recently been done, Then there is a really good chance of being able to get an erection. Maybe not immediately, but within a few months. Even people who have had half the nerve spared have been able to get erections. Is this something the doctor that you talk to discussed with you?

Most men have very short periods of time before their leakage stops. Some like me don’t have any. Those that have serious problems may go out to a year, but those are not the usual case, very low percentage is according to surgeons I’ve heard from in recent online conferences. After years of being on online forums I have not heard that much. I attend nine online advanced prostate cancer forums every month And hear complaints from a lot of people. I must admit that five years after having radiation and almost 9 years after surgery I did start to have incontinence problems. That combination of treatments is going to cause future problems for many people.

@quaddick FWIW, my urologist also recommended NO ADT for salvage radiation; new studies showed that if recurrent PSA was < .7 you could avoid it. Mine was 0.18…
However, my RO at Sloan Kettering agreed with my gut feeling that I should have it - and I did with no regrets.
I realize your situation is different than mine since yours is primary treatment. But I just want to remind you that all these studies, scales of aggressiveness, and gradations of the Gleason Score (ie favorable low/unfavorable high, etc) are human interpretations of mathematical results; even AI at this point is based on human data.
My point is to err on the side of caution; ADT will absolutely make your PCa more responsive to radiation. While that is no guarantee of success, it does improve your chances.
I had 6 mos. ADT and while annoying, it was not a hardship. Many things in this life are much worse and last a lot longer! Best,
Phil

My biopsy showed 3-cores out of 12 cancerous 1)G6, 2)G7, 3)G8, opted for proton radiation in 2022. PSMA/PET March of 2025 absolutely no avid tracer in the prostate. Cancer destroyed, RO sez prostate is now “COLD”. You possibly might consider my experience.