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Would you recommend proton therapy vs surgical removal of prostate?

Posted by seekingclarity @seekingclarity, Dec 2 2:06pm

Looking for positive feedback. I am 59yr AA male, diagnosed with prostate cancer. My PSA has been 4.86 to 5.46 over the last 6 mths. My Gleason score was 3+3=6, 3+3=6 group 1, with one score reading of 3+4=7. I recently spoke with my urologist and we meet on 22 Dec 2025. I have been working with 2 separate Urologist to confirm diagnosis. Now that I have the confirmation I need I am really not in favor of the invasive robotic removal. I have done my research into other less invasive treatments of which were not initially brought up by the doctors. One is Cybernife radiation treatment and the most recent is Proton therapy treatment. I would like to if anyone has heard of any good results for men just under 60 to have proton therapy or cyberknife and what type of feedback was recieved. What were some side effects if any at all? Why aren't the doctors recommending these options outside of the cost. I have been told by some doctors if you do radiation first that they will not do a removal if the cancer returns. Why is that. My final thought is if PSA is not the sole determining factor for someone to have cancer why is it looked at that way. Finally what is the possibility that cancer has been present for ones entire life and has only become a discussion due to a biopsy.. Why cant it continue under surveillance? Help me unravel my thoughts. However I am leaning more towards trying the the Proton therapy. Please share feedback thank you for listening and I apologize for any confusion.

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Profile picture for jc76
jc76 | @jc76 | 5 days ago
In reply to @stldadof4 "@seekingclarity thanks for this post and the great questions. I will be following this thread as..." + (show)
Profile picture for stldadof4 @stldadof4

@seekingclarity thanks for this post and the great questions. I will be following this thread as I am in a very similar situation, but a few months behind you. I had my first biopsy on 12/2 and it showed two G6's and one G7 (3+4). I am still waiting on my decipher results. I'm 57 and am going to take the next several months to research my options (surgery & if so where, tulsa pro, ongoing active surveillance, etc.), unless the decipher results indicate something potentially more aggressive than the "favorable intermediate risk" the dr. believes I currently have. To your question about PSA results, like the others have said, I think they consider it more of an indicator and not necessarily anything definitive. Also, it is quick, easy, and cheap, so it makes sense that the doctors would start with PSA. After several elevated PSA readings and a negative MRI a few years ago, my dr. recommended Iso PSA, which ended up being unusually high. From there we went to an MRI which was pirads 4, and most recently a biopsy with the results above. I think this is a fairly normal progression, even though I'm on the younger side. The one redeeming fact about prostate cancer is that it's fairly common and also usually slow growing. There's a lot of data out there, and most of us have time to weigh options and make decisions.

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@stldadof4
Your post indicates you are very attuned to doing what is best for you and the available treatments out there.

Good luck!

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wwsmith | @wwsmith | 4 days ago

I am a big advocate of radiation treatment (RT) over radical prostatectomy (RP). An RP causes a lot of damage that is hard to recover from. The surgeons talk about new nerve sparing techniques but the reality is that nerves are always damaged with an RP. You can easily become permanently incontinent after an RP as the prostate provides the bulk of the sphincter muscle to control urine flow. Regardless of how good your surgeon is, and no matter how many Kegel exercises you do, if you are lucky enough not to have permanent incontinence, you will still very likely experience urine leakage when you cough, sneeze, lift heavy objects or run. Permanent ED and very compromised sexual function is very common after an RP. As you read through cases on this forum, you will see that RP guys have a lot of incontinence and ED issues, far more than what RT guys experience.

In addition, the RP guys also experience a lot of recurrence causing them to have to use radiation as well. RP guys have a 30% recurrence rate overall but that climbs to 50% and 60% when the patient has Gleason scores of 8 and 9 respectively. Most surgeons simply do not emphasize enough how likely a recurrence is after an RP. Enter your data in the MSK nomogram here https://www.mskcc.org/nomograms/prostate/pre_op if you would like to see your odds of recurrence after an RP.

I believe that the reason that there is such a high recurrence rate after an RP is that there are microscopic escapes of cancer cells outside of the prostate that occur before the RP is even performed. These small cancer cell escapes can't yet be detected by our best scans like the PSMA PET scan. It is still too easy for some cancer cells to lurk in lymph nodes or seminal vesicles without being detected. This is especially true when you have a genetic predisposition like BRCA2, high Gleason scores and/or a high Decipher score. Extracapsular extensions and lesions broadly abutting the prostate capsule also increase the risk that some escape has occurred.

Having so called "clean margins" after an RP is really not much assurance that all the cancer was removed. With radiation treatment and possibly some ADT treatment if needed, cancer in the prostate gland itself and cancer as yet undetected in microscopic escapes can be killed both in the gland itself and the greater pelvic region.

Ideally, we all want to have a treatment plan that let's us be one and done with the least side effects possible and never have to deal with prostate cancer again. There are occasional side effects from radiation and there are some recurrences as well, but overall, as you read through scores of cases on this forum, I think you will find radiation yielding the best overall outcomes in terms of fewest side effects and less recurrences of cancer.

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