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← Return to Prostatectomy or Radiation?
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The overall survival is roughly the same. The side-effects are unpredictable (many people have very mild ones; others have serious ones).
It's true that it's more difficult (not impossible) to do a prostatectomy after radiation, but also, why would you do that? Most types of external-beam radiation pretty-much fry the prostate, so it's extremely unlikely that cancer could recur there, at least not according to my radiation oncologist in 2022 (note that that might not apply to extremely precise radiation treatments like proton-beam or implanted seeds — you'd have to ask your oncologist about that).
If you see rising PSA after either radiation or a prostatectomy, it's probably because the cancer spread somewhere else.
So with all that in mind, you can drive yourself crazy trying to choose, since there are too many unpredictables. If your oncology team is giving you a choice, I suggest closing the Google tab in your browser, picking surgery or radiation, and then not looking back. You'll never know what the path not chosen might have looked like.
Best of luck!
Replies to "The overall survival is roughly the same. The side-effects are unpredictable (many people have very mild..."
@northoftheborder To be sure — many sources indicate that external beam radiation doesn’t “fry the prostate.” The DNA in healthy prostate cells get damaged just as do the ones in cancerous prostate cells.
But healthy prostate cells have repair mechanisms that can sometimes repair the damage (though not always). Cancerous prostate cancer cells usually can’t repair the DNA damage, so when they try to multiply they die (resulting in a steep drop in PSA)..
What’s left is a “healthy” prostate, 35% smaller than it was, but damaged enough that it makes salvage prostatectomy challenging (though not impossible). But, there are other, preferable salvage options.
Dr. Kwon (of Mayo Clinic) in his 2021 PCRI presentation, indicates that if there is recurrence after initial radiation, that 55% of the time it’s in the prostate. (See Dr. Kwon’s presentation about recurrence: https://youtu.be/Q2joD360_pI)
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@northoftheborder ...thanks... it's just getting closer to my surgery date and I'm freaking out with second thoughts. it's just that one site says one thing...another says diff.....thanks for your thoughts.