Prostatectomy or Radiation? Lot of stress over which to choose

@jeffmarc — just signed up. Thanks!

@bobby1313 I'm sure we were all were concerned before surgery. I had mine a year ago and it turned out well. Based on my research, radiation and prostectomy can have similar results at the 10 year mark. There appears to be indication of greater return at the 20 year mark with radiation vs RALP, but that also depends on multiple factors - my research focused on Gleason 7 (3+4) contained within the prostate. The variables matter. I was 53 at diagnosis and my friend who is an oncologist opined that I was too young to rely on radiation. His opinion had weight with me, but we all need to make our own decision - as tough as that may be.

@climateguy
"Yes indeed." Bottom line: There is NO PERMANENT CURE for prostate cancer. I KNOW that my urologist said that I should have the prostatectomy because "it is 100% curative." When I challenged him on that he said: "I never said that." I said: "you most certainly did say that...why would I say that you did...where would I have come up with that?" He repeated: "I never said that." He was already covering his butt, because my surgical pathology report came back with, among other things, "surgical margins" to which he had to admit that he "didn't get all of the cancer" out of me, because I had EPE. Despite left seminal vesicle invasion, and the fact that he removed the entire prostate, both seminal vesicles, and both vas deferens, my pT3b classification because of the left seminal vesicle invasion means that a LOT of men just see their cancer return "within" five years post-op. The more that I read, and the more that I read here, the more I am convinced that there is no permanent cure for prostate cancer despite prostatectomy and radiation, and even the dread ADT hormonal therapy. Each is just "the next" treatment modality to hopefully give you several years to maybe a decade or more of life, BEFORE it comes back. It always seems to come back. Granted...this Mayo blog is a subset of men with problems with their cancer. The men who have successful prostatectomies with no later issues, never write here...they don't need to. They were "100% permanently cured" I guess. But I do not know those statistics...how many men have prostatectomies and never have any later recurrence requiring anything more in treatment like radiation or ADT hormonal treatment? I'd sure like to know that statistic. Dr. Walsh even states in his book, that traditional outcomes are the same whether you have immediate "Adjuvant" radiation therapy, or you have "Salvage" radiation therapy 6 months or later post-op. We read of countless men here who had the prostatectomy, and they were good for years or a decade or more, then...it came back. Then they had radiation, and they were good for a couple years or more. Then...it came back. I want to know why the hell it comes back? How can a man with a full radical prostatectomy with both seminal vesicles and both vas deferens removed with or without EPE see that cancer come back after the fact? How can that same man who then undergoes a course of radiation therapy, be good for so long, then it comes back. This is why physicians say that they "practice" medicine, because it is imperfect...nothing is ever a complete cure. They just do surgery and treat to delay the inevitable. The only good news is that it is mostly a slow growing cancer, that gives us the humorous luxury of saying that "most men with prostate cancer will die of something else." That is hardly humor. I have had a very "A+B always equals C" life. I was a clinical laboratory director. I ran and controlled the production of the very labs that run and report the PSA tests and every other test that can be done on the human body. You would not believe what labs do to validate the accuracy and precision of lab test methods on instruments, and what is done if the exceedingly tight limits of quality control and calibrations are exceeded. Yet, we can get this prostate cancer, and turn our bodies over to surgeon urologists...basically "human body mechanics" to remove the cancer...but they fail every time. They leave some cancerous tissue behind, that comes back to face other treatments with horrible outcomes while "hoping" to kill "all" of the cancer once and for all. But...ooopps...it doesn't...so we go to the next step of treatment and hopeful cure that never happens. I should have gone the route that my dad did: he lived to 99 years and 10 months "WITH" prostate cancer. He never had the prostatectomy or radiation or anything. He suffered greatly his last five years with monthly urinary tract infections due to his massive enlarged prostate. They were often fungal in nature so he had to be admitted to the hospital for I.V. administered anti-fungal meds (there are no pills for that). But he never suffered the surgery, the recovery, the follow-up radiation, the follow-up ADT hormonal treatment, etc. Can you tell I am angry about my post-prostatectomy cancer? It isn't over: my physician knowingly left cancerous tissue in my body that WILL GROW, unless I am exceedingly lucky and the cells die due to their blood supply being removed. So now I am talking to a radiation oncologist who will put me in a diaper for the rest of my life (20 years more I hope), and kill my sex life making me permanently impotent with erectile dysfunction. What kind of "quality of life" is that?

@diveinnow, will you be having surgery soon for prostate cancer? How are you doing?

@colleenyoung I'll be scheduled for surgery to remove the prostate gland in the new year. I'm feeling better, more positive, confident about it because I am more informed and have a clear path ahead. All the best, Sean PS I'm hoping to get the surgery delayed a bit so I can race a cycling race in early April, we'll see.

I used the info here to make my decision. I think the current thought is SBRT is as curative as RALP . I just finished 5 SBRT treatments at Mayo and will see what time brings me !

Miradx Co. produces the PROSTox tests. A simple mouth swab and you will receive a LOW (5%) or HIGH (15% risk report of DELAYED urinary tract symptoms >Grade 2. The test can be both for SBRT or IMRT. Test cost $500 for one and $900 for both tests, The acute symptoms are the same for both SBRT or the IMRT variants and resolve with time.

Prostatectomy is not an option. I finish this week with radiation therapy. My preference would have been proton beam. However, the closest proton beam for me is in Loma Linda and in San Diego, California. I suggest that you read books by Dr. Mark Stohs:
Invasion of the Prostate Snatchers
The Key to Prostate Cancer

His Prostate Cancer Research Institute (PCRI) has a free Helpline and Support Groups. He continues to post videos at YouTube.

While going to radiation therapy, I have met radiation patients who have had a prostatectomy. One patient had the prostatectomy in June 2025. The surgeon’s explanation was that the prostate must have spilled some prostate cancer cells during surgery. This patient must now do 38 days (fractions) of radiation therapy.

A second patient had a worse experience with prostatectomy. The cancer metastasized up to his cheeks. He is facing 38 days of radiation therapy plus Orgovyx. If the cancer in the cheeks does not disappear because of ADT, then he will need an additional 24 days of radiotherapy.

Simply search for the probability of cancer returning following prostatectomy. You will discover that the probabilities are at least 20% to 40%, depending on your Gleason score.

@paulsheldonfoote
Pretty sure you are talking about Mark Scholz

During the PCRI conference a couple of years ago this was said

Seeds for metastasis were already there when surgery was done, waiting to grow.

@jnj, I moved your post about choosing between surgery and radiation to this related discussion:
- Prostatectomy or Radiation? Lot of stress over which to choose https://connect.mayoclinic.org/discussion/prostatectomy-or-radiation/

Did you have the biopsy? How are you doing with choosing which treatment is best for you?