Prostatectomy or Radiation?

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!

This depends on your Gleason score. How extensive the prostate cancer is. Has it spread outside the prostate? How old you are. Is there a genetic cause of your prostate cancer, I have BRCA2, which causes mine to keep coming back. There are a few other factors, let us know Where you stand.

It’s really not possible to give opinions without more information.

I had surgery at 62 three years later it came back and I had radiation. Since then it has come back three more times and I’ve been on multiple different drugs over the 16 years. My brother got it at 77 and had five sessions of SBRT radiation and he’s been just fine for the three years since that happened.

Different results for different cases.

@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.

@jeffmarc ...thanks....my Gleason scores are mostly 6 with a few 7s...cancer is contained to prostate... hasn't spread...sooooo...I'm freaking out as my surgery date gets closer...just nervous I guess... thanks for comments.

What criteria and method are you using to decide between them? How are you comparing one against the other? Once you have your methodology defined, the decision-making process is much easier and will be less stressful.

It sounds like you made an informed decision after much research and I suspect discussions with doctors. I did the same in this year and had my surgery in October. While I did the research and agreed with the doc, I was still nervous before the surgery. It is natural to be concerned and to even question your choices. My Gleason was higher, 10, and I am 62. Post-op pathology confirmed high risk for spread. I believe I made the right decision and am working through the post-surgery issues- all of which were detailed in my research. All of the options have their own set of issues. Good luck. Keep coming to this forum and talking through things here and with family and friends as you face and overcome all these challenges that we all here faced and met as life goes on.

@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)

@bobby1313
At 64 surgery can give you the option of radiation in the future. If you were to have radiation, then it would not be possible to do a second time in the same place, but radiation could also give you long-term Remission.

Because you are only a Gleason 7 frequently the surgery can put you into remission for the long-term. It’s hard to call it cured because it does come back for a significant percentage of people.

Was your Gleason seven a 4+3 or 3+4? When I had surgery, I was only a 3+4, but after surgery they found I was a 4+3. I know people that were Gleason seven before surgery and are Gleason nine after. Surgery will tell a lot about what’s really going on with your cancer.

You should request a decipher score. That will tell whether or not there is a possibility of you’re having a reoccurrence. It varies a lot.

As I found out the hard way... the more you read. the more you worry yourself over nothing.
We absolutely want to be as informed as possible about what to expect.
But remember that you're reading about the experiences of a lot of different guys.

One thing to bear in mind: These are things that *may* happen to you.
Or they may not. Reading about it doesn't guarantee that will be your particular experience.

Repeat radiation depends on the type you had the first time. According to my radiation oncologist, I'd be allowed to have radiation to the same spot in my spine a second time if I ever needed it.

That's interesting about the prostate sometimes repairing itself after radiation. Maybe just low doses or highly-focussed radiation (like proton beam)? And presumably, a self-repaired prostate would be easier to remove, since it would no longer be hard and rubbery, no? I still have only dry orgasms, which suggests to me that my prostate hasn't repaired itself yet 3½ years after 60 gy of radiation, but I have no special expertise to evaluate.