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Prostatectomy vs Photon radiation vs Proton Beam Therapy

Posted by bdouglas67 @bdouglas67, Nov 11, 2025

I’m 58. Gleason 7 (mix of 3-4 and 4-3) 9 out of 12 cores. Stage 2. Intermediate unfavorable. Scheduled to have Petscan and will ask about Decipher.

Being seen by a Urologist which is part of a group. Will schedule a second option with Radiation Oncologist but all this in the insurance and medical world is slow time. I would go tomorrow but that’s not how healthcare works.

Quality of life and the cancer treatment. I have read re radical Prostatectomy good outcomes here with some experiencing little incontinence or it self correcting over time. Others not so much. Ed seems widespread.

Proton beam therapy on paper sounds like in the short run has less side effects but limits or rules out RP in the future if re occurrence. Photon also seems to be statically beneficial but seems higher with possible other unintended cancers due to its exit need.

I’m simply lost and still gathering information. The Petscan will help. And having a RO give their opinion will too.

My question is for those in my age range what has been the pluses or minuses of RP. And for those that did conventional Photon radiation. And finally any proton people here. What is short term and longer term 5 - 10 years.

Yes cancer is different for everyone based on genetics, age, other conditions and the cancer type itself. Insurance companies steer people to the standard treatment such as RP and maybe Photon. But I have read unless you have great insurance or Medicare (which I’m not on) they deny.

I’m active and in good health otherwise. Just looking for some mental calm. Thanks.

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jeff Marchi | @jeffmarc | Nov 15, 2025
In reply to @kikito1 "@jeffmarc I've seen others, though I can't remember where, quoting about a 1 in 1000 men..." + (show)
Profile picture for kikito1 @kikito1

@jeffmarc I've seen others, though I can't remember where, quoting about a 1 in 1000 men who have IMRT / SBRT get another cancer. In any case, Brachy is almost exclusively hitting only the prostate will little over spray. IMRT / SBRT must pass through normal tissue to get to the prostate. We know that the prostate can withstand radiation at much higher doses than normal tissue. That's another reason why I think Brachy, either LDR or HDR, is the best choice. It's not practised as much here because it takes more effort and doesn't pay nearly as well as other modalities of treatment. Mark Sholtz has a segment about that aspect also.

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@kikito1
When quoting this “ about a 1 in 1000 men who have IMRT / SBRT get another cancer” you have to subtract from that percentage how many would’ve gotten another cancer even if they didn’t have IMRT/SBRT. That was the point made by the Stanford study that getting other cancers was not isolated to those having radiation.

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Colleen Young, Connect Director | @colleenyoung | Nov 15, 2025
In reply to @climateguy "@ketter1 Re: does Medicare over proton therapy? I haven't had proton therapy or attempted to get..." + (show)
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@ketter1 Re: does Medicare over proton therapy? I haven't had proton therapy or attempted to get Medicare to pay for proton therapy so I don't know. Your RO could be correct, but it also seems to be correct to say Proton therapy can be covered by Medicare.

I found this on CMS.gov Search for the page using this term without the quotation marks: "LCD - Proton Beam Therapy (L35075)"

"PBT is considered reasonable in instances where sparing the surrounding normal tissue cannot be adequately achieved with photon-based radiotherapy and is of added clinical benefit to the patient."

Also: "Prostate Cancer: Coverage and payments of proton beam therapy for prostate cancer will require: Physician documentation of patient selection criteria (stage and other factors as represented in the NCCN guidelines);
Documentation and verification that the patient was informed of the range of therapy choices, including risks and benefits."

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@climateguy, here is the link I believe you wished to share with @ketter1

Proton Beam Therapy coverage https://www.cms.gov/medicare-coverage-database/view/lcd.aspx

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