Prostatectomy or Radiation?

@bobby1313 Waiting and choices are hard. I never experienced that, because I was in medical crisis and they had to rush me into the operating room to stop the metastasised tumour from continuing to crush my spine. After that, a prostatectomy wasn't an option (you don't generally do it when the cancer has already left the prostate), so it was just radiation to the spine, radiation to the prostate, ADT, and ARSI (so far so good, 4 years later 🤞).

I never went through the decision anguish most forum members have experienced, because things were happening too fast.

@brianjarvis hello....my decision to have surgery was that myPeT scan showed my cancer hasn't spread to other tissue and such. So I figured to remove the source before it did spread was a better option. But I'm second guessing it now.

@northoftheborder .Hello..I'm sorry to hear that. It seems your decision wasn't really your decision. I am glad to hear your doing well 4 yrs later. I wish you all the best. Thank you for sharing your thoughts.

@davederousseau ...Hello..thanks for sharing your story. I'm just getting cold feet. I've just read so many different things on so many different sites. I just don't know if my situation really needs surgery. Thank you for sharing.

@bobby1313 I made one very important decision back in 2021: when they told me I likely had only a few years to live (and many/most of those likely in a wheelchair), I told them I wanted to fight, hard, and I'd do whatever it took. Knowing my wishes encouraged them to give me then-new, cutting edge treatments like doublet therapy and radiation to the metastasis and the primary. They also got special permission from the health ministry to put me on Erleada (Apalutamide) before it was in the Ontario formulary.

I didn't know what all these threatments meant back then, but I had made it clear what I wanted, and I was lucky to be at a top Canadian cancer centre (entirely by chance), where they were up on the very lastest research.

I've been in functional remission ever since, and walking for most of that time.

@bobby1313

If you haven't been to another doc, preferably a well known one like Mayo, for a second opinion, you should do that. It is an easy process and detailed here in other chat threads. Laurie, a volunteer mentor, posted this earlier this month:
“You can also contact Mayo directly with your questions:
Start your appointment request use this link http://mayocl.in/1mtmR63.
Your request will be reviewed and a time will be set up to discuss with an appointment coordinator to assist you with the process.”

@davederousseau Did you have any great issue with urinary side effects after surgery? I worry that I may be in the 5% that experience this as a more longer term issue.

Based upon your comments, I understand that you have chosen surgery and are now having the usual understandable second thoughts.

My input is that the quality of the treatment is important. Once you have chosen surgery, a patient needs to ensure that you are getting the best possible surgeon operating at a prostate cancer center of excellence with a documented history of 1K+ prostatectomies resulting in a high percentage of continence (>90% within 6 months) and sexual function (comparable to pre-surgery within 18 months, assuming nerve sparing).

If you have chosen a prostatectomy expert, I recommend accepting that the pre-surgery apprehension is normal and focusing on actions you can control, such as pelvic floor muscle training and getting educated as best as possible on actions to be taken post-surgery.

If a surgeon with this expertise is not available, many patients choose radiation therapy from a prostate cancer center of excellence, performed by a team with demonstrated expertise using recent-generation equipment that minimizes damage to healthy tissue. As others in this forum have often described, newer generation proton therapy and MRT guided photon therapy provided by an expert team have history of effective prostate cancer treatment with a high percentage of minimal continence and sexual function side effects.

@bobby1313 hey pal, if your feet weren’t frostbitten you’d be abnormal!
I had similar pathology but was G4+3. I opted for surgery (kicking and screaming) because I was 64 at the time and wanted to have a second chance to hit it again if need be with radiation.
Turns out to be one of the best decisions I’ve ever made since my cancer did come back five years later and I finished salvage radiation just about a year ago today – in fact, exactly one year ago today.
My PSA’s are currently undetectable so it’s all good for now, but who knows what fun and thrills the future will bring? Always gotta keep your options OPEN!
Phil

@bobby1313
Don't feel like you are not feeling what most of us felt. Too much information can be overwhelming. Also what others did or experienced are not necessarily what you should do or will experience.

Mayo Community Connect it to provide a forum for posters to post their personal experiences. Just know again that this is our experience. A lot of us our decision making takes in our mental health aspect with what we pick as treatments and why. Thus you may not want to chose what others did.

Have you gotten a second opinion. That really helped me chose to hear from two different medical experts on PC. Also getting additional test like Decipher can really help more accurately define you risk level that you and your medical doctors can discuss.