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Would you recommend proton therapy vs surgical removal of prostate?
Prostate Cancer | Last Active: Dec 31, 2025 | Replies (51)Comment receiving replies
@wwsmith I have to disagree with some of your comments. I had an RP after learning I had two cores of cancer, one at 3+4. When the pathology report came back at 4+5, I was glad I chose RP. Also, I did Kegels religiously for the month prior to my surgery and after my catheter was removed. I am not out over two years since my surgery, and ZERO incontinence issues. My surgeon said I was one of the lucky 10%. Your summary of your experience certainly is helpful, but as we know, not everyone is affected the same way.
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@kjacko Whew! Going from a 3+4 to a 4+5 is a very unwelcome surprise as it puts your probability of recurrence much higher now. If you enter your data both for a 3+4 case and a 4+5 case into the MSK nomogram here https://www.mskcc.org/nomograms/prostate/pre_op you can see the probabilities of recurrence after an RP for each Gleason score scenario.
Such situations happen fairly frequently but it actually reinforces the potential benefits of going with radiation as the initial treatment. Obviously, a recurrence after an RP happens outside the prostate since it is no longer there. If this were to happen, it means that there was some small escape of cancer even before the prostate was removed. If radiation is used initially, both the prostate gland and surrounding pelvic areas can be radiated. This would greatly decrease the chance of recurrence from some small escape of cancer from the prostate gland itself.
Ultimately, as technology improves these microscopic escapes of cancer cells might be detectable in the future and there would not be so much guessing involved on whether escape as already occurred or not. Whenever escape as already occurred, then an RP is not the best choice.