Prostatectomy or Radiation? Lot of stress over which to choose

@climateguy hello... you've gone through much of what I'm going through now. I've had all the tests..starting with psa... ultrasounds... biopsies..my doctor told me I've got stage 2b prostate cancer. In his opinion surgery was my best choice. However I've been researching all of the treatment options... including proton .. photon..brachy seeds....but now I'm going for 2nd opinion at Vanderbilt hospital...my biggest concern about radiation is the possibility of damage to other tissue and organs. My biggest concern about surgery is the pain,the catheter...so as I said, I'm going to see another urologist soon to weigh the options.. i just don't know... I've also heard that if I choose radiation first and it doesn't work or cancer comes back that the risks for surgery becomes a lot higher. But if surgery fails I would still have options for radiation therapy.... I'm just going crazy stressing about this. I had 12 biopsies .... Gleason scores of 6and 7s... Grade group 1 and 2s...so anyways...thanks for your input....

@bobby1313 I had surgery . It appeared contained in the prostate. Post op confirmed containment. 6 yrs now zero PSA. No medications no treatments. Surgery was a piece of cake except maybe coming out of anesthesia. catheter was cumbersome to sleep in but that was a piece of cake. Told me to wait 6 weeks to do any lifting but I felt great at 2 weeks. my issue was incontinence and ED. ED was probably fixable but I waited 5 years to work on it. 5ml of trimix fixes it now. I keep my testosterone at 600. Incontinence is my scary spot. Thinking of AUS. But either way I think there are some fixes to normalcy. Not ideal but life can go on.

I did the MRI and found that i have cancer. The cancer is still in the prostate and has not spread. PI- RADS 2- assessment 4. and going to do a biopsy. The cancer has not left the prostate and the research i have done is to take it out or have radiation done. I don't know if one is better than the other. The radiation does not work it is hard to do a surgery. Both ways will stop you from having sex?

How do you know you have Cancer if you have not had a biopsy? Was your MRI a Pirads 2 or a Pirads 4?

Note that an MRI only indicates the probability of having prostate cancer, and indicates that probability by assigning a PIRADS score (1 - 5). An MRI-guided fusion biopsy needs to be performed for a definitive prostate cancer diagnosis.

A PIRADS 2 means that it is unlikely that clinically significant prostate cancer is present.

Typically, a biopsy is not performed for a PIRADS 2, but it will be done if requested.

Depending on whether or not the biopsy finds prostate cancer, you’ll have a number of options to choose from.

You’re thinking about treatments way too soon. However, IF you do have prostate cancer, and IF you do choose external radiation as initial treatment, and IF you do have a recurrence (that’s a lot if IFs),
choice of salvage treatment would depend on the nature of the recurrence; there are other salvage options preferable to surgery - focal therapy (e.g., cryo), brachytherapy, SBRT, and yes even re-radiation in some cases.

(I had 28 sessions of proton radiation + SpaceOAR Vue + 6 months of Eligard with no impact on sex life. There are precautions that can be taken to minimize the risk.)

@brianjarvis it says high suspicion for malignancy pi- rad score of 4. i don't know much about this but it sounds bad. also states it in just in the prostate. i am 68 years old

@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.

@jnj When you indicated “PI- RADS 2- assessment 4”, I didn’t quite understand what that meant.

If it’s PIRADS 4, that indicates “ High (clinically significant cancer is likely to be present).”

But, that is still not a diagnosis of prostate cancer - it represents a statistical probability. (Many of us had PIRADS 4 (or PIRADS 5); I was 65y when I had treatment for that.)

You still need the biopsy for a diagnosis.

After seeing a community urologist for interpretation of my rising PSA and getting an MRI and a PET scan, I made a decision to get surgery. This 1st opinion guy made an appointment for me to see a radiation oncologist to make sure I heard the case for radiation. For a second opinion I saw a urologist at an NCI designated cancer facility. Both of these urologists presented the surgery/radiation decision as my choice. They said the outlook would be very similar either way.

The 2nd opinion doc booked an appointment for surgery, but he spent some time making sure I was convinced that I would consult the radiation oncologist that he was going to refer me to.

Then I read his clinical note. He wrote, in bold type, that despite his recommendation, I had chosen surgery.

I couldn't understand why he didn't tell me this to my face. I lost my trust in this doc, and told him so. I said I needed a doc who would level with me.

I re-read both urologists clinical notes. In the 1st opinion clinical note I now saw that although this doc had cheerfully agreed to do surgery, he predicted a "multimodal" approach might eventually be required. Given that the 2nd opinion doc had recommended radiation in writing, I decided that I would see several radiation oncologists with a very open mind, instead of going to these RO appointments because a surgeon wanted me to check a box.

I guessed that although the surgeons had no positive evidence my cancer had metastacized beyond the criteria acceptable for surgery and hence had booked surgery, they were not confident of success, i.e. cure. A point both ROs made was if you get surgery and it fails to cure, you will then do RT, and consequently you get to experience the side effects of both types of treatments. If you do RT alone, you just get RT side effects. I decided to get RT.

I don't regret the decision to not do surgery. But, I felt, after agreeing to 20 days of EBRT and 2 years of ADT, that I was not fully informed about my choice of what type of RT to get. I have told the RO who came up with the treatment plan that I would like a referral to a doc with extensive experience with brachytherapy boost, i.e. 20 days of EBRT + ADT + brachytherapy boost. No one had mentioned brachytherapy to me in any of the consultations I had had.

So, welcome to the rabbit hole that choosing a treatment for prostate cancer is. I keep hoping that at some point I'll be comfortable with my choices and I can try to resume some sort of normal life that isn't oriented almost completely around navigating through a fog of information I know I do not fully understand, in an effort to make very serious decisions that will affect me for the rest of my life..