Prostatectomy or Radiation? Lot of stress over which to choose

Hi there.

No huge time intervals wwith me - uncontrollable pain after Pluvicto # 2, did Botox, Colonoscopy (thankfully no cancer, pollups, but they did 'discover' the ulcer and confirmed the fissure. Recommended solution to removing irritant from the areas was colostomy; divert the waste and give the ulcer and fissure chance to heal. That was 6 weeks ago. Still experiencing considerable pain and pressure, and their only solution is more drugs more often. Pallitive Care folks want to do what they do - peddle drugs. Surgeon wants to cut. Oncologist is very fuzzy and I now have a colostomy, etc. and no reduction in pain or pressure. Thanks for your energy, and I pray for healing daily (for myself and other men battling this). Part of my 'issue' is other medical things going on in me - I have Prostate cancer which has metastasized, and a lung condition also requiring much medication. Thanks again and blessings, Michael

@michaelbryan6998
I am really disturbed by what you are going through. The side effects are just way more than acceptable and I really extend to you my sympathy. I just hope you have some relief soon.

Am I misunderstanding what you have said? You seemed so negative about radiation that I thought that’s when you got the fissure. Did you get it there and it was aggravated by Pluvicto, Or did you actually get it from the second Pluvicto treatment?

4 plus years into Prostate Cancer experience. Had three chemo treatments, two year interlude, radiation directly to. prostate (20 treatments) three years ago, and in February 2025 took Pluvicto - two treatments. Radiation irritated (caused?) fissure and ulcers in rectum. EXTREME pain and pressure. NO relief. Oncologist sent me to colorectal sturgeon to remove irritant (stool passing over fissure and ulcer and irritating them) and of course the surgeon recommended surgery - divert the bowel and eliminate the problem. So, I submitted to a surgery five weeks ago and now have a colostomy bag, etc. for the rest of my life. STill have pain, pressure, and extreme discomfort and pressure.

Problem is that they are still 'practicing,' and two things: (1) they do NOT tell you all the side effectss, and when confronted, the radioactive docs deny any responsibility while (2) every article on the net and in medical communication says that radiation proctitis is a direct result of more radiation, and is irritated by the same drugs they prescribe to manage the pain. =

Instead of curing the problem which they created, the system prescribes more strrong narcotics, more frequently, and the docs get their prescription kickbacks, etc. and patients suffer.

My two cents: remove the prostate and never let them radiate you. There are many pleasurable ways to make love, not just one, and it sounds cold, but consider their situation. The docs cannot do anything that the insurance. ompanies won't pay for, or do it in the prescribed sequence, and NO ONE HAS THE PATIENT'S WELL BEING AS FIRST PRIORITY.

For months now all focus of my treatment has been on pain managment and keeping me drugged - meanwhile, the cancer grows and spreads and we talk about 'will this work?' "Lets try this?'

Praying you have wisdom, a doctor not interested in only making money and tikking off boxes. but in seeing you healed fully, and a strong support system for you. "Fight, fight, fight.'

@michaelbryan6998 So sorry you are going thru this- it sounds absolutely awful. I do have a question, however; why does this colostomy have to be permanent? Can’t it be reversed once the fissure and rectum heal? That should happen but the timeline varies for each individual. Best,
Phil

I chose the prostatectomy in major part because the scans suggested I might have EPE. So I wanted to nail that down. In the event the prostatectomy pathology report said there was none, that my Gleason was 3+4 (my biopsy suggested it'd be 4+3) no positive margins; no affected lymph nodes; no cribiform or intraductal; no metasis etc. But there was +PNI
I felt I was home but a year later I had BCR. And I've been dealing with it ever since. Apparently it was the +PNI that was the culprit in its escape.
I'd still choose the prostatectomy because of all the definitive info I got up front that then made my salvage radiotherapy much more well informed.
Another reason-
the adage I had drilled into my head over half a century ago at Ft Benning training as an infantry lieutenant for Vietnam-
"Lieutenant-always bring the boss bad news first.
Good news takes care of itself."

Good luck!!!

Hello everyone.... I'm very grateful for all of the comments, thoughts and experiences that this whole community has shared. As expected,there were sooooo many different experiences.So a quick update on my next steps.... I'm going for a second opinion at Vanderbilt. The Doctor I'm going to is a specialist.... His education is from Mayo Clinic....A Fellowship at Mayo... Masters in Science...and last but not least...an Assistant Professor..... I really think his opinion could help me in many ways.....won't see him until Dec.17th. Will keep y'all posted.Once again, thank you all.