Prostatectomy or Radiation? Lot of stress over which to choose

I had this very same dilemma. I ultimately decided on radiation. Happening in a week. Why did I chose that option? It came down to qualify life. My cancer is early stage 2 and either surgery or radiation would provide the same benefit. I’ve had surgeries before and I just didn’t want to go through the healing process. I didn’t want to wear man diapers and and the idea of cutting around my man parts had me feeling less than enthusiastic. I just asked a ton of questions and kept track using an ai tool o just adding questions and response and finally looked at the pros and cons. Whatever decision you make will be right because you made the decision. You need to do what’s best for you. You’ll hear many stories but this is a personal journey. God bless my friend. We all in This together

I understand your dilemma and feel your anxiety, as I faced the same one three years ago.

It was very difficult for me to weigh the options as I received conflicting guidance depending on which doctor I consulted (urologist suggested active surveillance, surgeon surgery, and radiation oncologist - yep, you guessed it, radiation). Ultimately, I picked surgery, but if I had it to do over again I'd probably take another path.

An extensive study published in 2023 in NEJM opened my eyes to the fact that it doesn't really matter which treatment option one picks for men with relatively low-grade prostate cancer. Unfortunately, as a new member of this forum, I'm unable to post the link to the article, but if you google "Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer", you'll find the article.

I wish you the very best of luck in making the decision that's right for you.

@abinoone
Actually, the fact that the results are the same whether they’re having radiation or surgery are mentioned a lot in the 10 pages previous to your comment. Too bad you couldn’t put in the link yet, but many of us are aware of it and tell people about it.

I’m not sure you noticed that the original question was December 2 and there were 10 pages of replies. Pretty sure he’s decided by now.

I picked surgery in 2010 and 3 1/2 years later it came back so I had radiation and it’s come back three more times since then but I’m still alive and I’ve been undetectable for the last 25 months. Surgery gave me 3 1/2 more years than I would’ve gotten with radiation since I have BRCA2, which causes my cancer to keep coming back. Didn’t find out about that till five years ago. For younger people surgery can make a lot of sense because you can have radiation after and the recurrence rate is pretty high.

Yes, I noticed the OP date, and read the 10 pages of replies, but the study I referenced was worth noting, plus it's always helpful to share one's personal experience.

@abinoone, IYou will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe. Allow me to post it for you:

- Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer https://www.nejm.org/doi/full/10.1056/NEJMoa2214122

@colleenyoung That report even made the U.S. national news. I recall when it was reported in a March 2023 NBC news report: https://www.nbcnews.com/news/amp/rcna74512

In my case, I was advised against a RP based on the fact that I am obese (BMI > 30). I went through the 44 sessions of EBRT, with no issues and since my radiation treatment ended during May 2024, my four PSA readings have been less than 0.01 ng/dL Nothing to complain about, however, the duration of the ADT is another matter, but I will leave that for another post.

@juanmoczo There was a paper published on this topic earlier this year titled, “Impact of obesity on prostatectomy outcomes: Insights from a large prospectively maintained cohort.”
> https://www.sciencedirect.com/science/article/abs/pii/S1078143925000183

Their conclusion was, “z
….we found that radical prostatectomy in obese patients had a higher likelihood of positive margins, longer operative times, higher blood loss, and increased complications. While this reflects the increased technical difficulty familiar to surgeons, the chances of biochemical recurrence and metastasis were not significantly worse for obese patients, suggesting that BMI in and of itself does not portend worse or more aggressive disease after surgery.”

I agree with westphillyguy215. I did not want to deal with the after-effects of RP. I am 68, so wanted the shorter recovery time. My urologist also cited the studies on recurrence essentially being the same between SBRT and RP, but my Decipher score was also low risk for reoccurence. I am 32 days post last treatment and pretty much back to normal. Will have my next PSA in February so praying for good news.

"I did not want to deal with the after-effects of [RALP]."
WHAT after-effects? I had ZERO pain, & no incontinence. I had ED, but that was because I chose "non-nerve-sparing" as a surgical option.

"I am 68, so wanted the shorter recovery time."
WHAT recovery time (I was 75)? I drove the day after, & walked my usual two miles a day later. At the ten day mark, my catheter & drain tubes were removed without incident.

Everyone's experience is different. My best friend didn't want any more children, but refused a vasectomy because he "didn't want to be under the knife." It's a local procedure! (His wife did her procedure as a result.) I know several men that are fearful of ANY surgery. Women, not so much.

I know some here will think I am a broken record on this issue, but this is not 1925. In fact, it is not even 2010. Both the surgical & radiation options are much better than 15 years ago. And that last sentence will be true again in another 15 years!