Radical Prostatectomy vs. Radiation therapy?

@jonathanack When you said, " The risk of incontinence and intimacy issues is present in both treatments", I think that statement needs to be qualified a bit. There is WAY less risk of incontinence from a radiation treatment versus an RP and the same goes for ED and sexual function.

@wwsmith
"After reading many others' experience on recovery from RALP I have never heard of anyone being fully continent the day after surgery. Also, I am sure that you had weight limits imposed for awhile on what you could lift."

No one is incontinent until the Foley catheter is removed.

Of course I did Kegel exercises before surgery. During the 7-day post-op exam, before the catheter was removed, 120 ml of saline solution was poured into the catheter, & then the catheter was removed. The test was to see if I could control urination (I could) & then urinate the same amount (I did). I wore a pad the day of the post-op but never needed it.

I'm glad you are sure I had weight limits. Attached are my post-operative, 7-day, & 3-month post-op visit instructions, which don't mention it.

Dr. Walsh's book does not mention weight limits; he just says to take it easy, but long walks are allowed (even preferred to avoid any blood clots).

Remember, most people come here because of issues, so ranking surgery vs. radiation based on complaints here, is a non-scientific way to assess results. One needs to have an objective study of a controlled population in order to make such assessments. I first came here out of curiosity, 4.5 years after surgery & one year after completing hormone therapy.

@wwsmith
Yes, that is in line with what all of my docs advised. A significant issue for me in deciding on SBRT (with 120 days of ADT/orgovyx. It was all manageable and the side effects are not what I would characterize as significant.

@wwsmith
I had my surgery 16 years ago. Had to wear the catheter for 14 days. Never thought about the fact that I might have incontinence after. They pulled out the catheter and I didn’t have any incontinence problem, until about nine years later, Which was about six years after I had salvage radiation.

@readandlearn Ok, so while you have a catheter in place you are not in a recovery period and can do all normal physical work? Of course not, so there is a recovery period involved with an RP.

Like yourself and myself, we both came to this forum not because of any problems we were experiencing, but to learn and share our experiences for the benefit of others. But certainly there are also those of us who came to ask about problems we are experiencing. If incontinence and ED problems were equally distributed between RT and RP guys, we would see just as many complaints about incontinence and ED from both sets of men. But clearly on this forum and others like Inspire, we see incontinence and ED complaints far more from men treated with an RP versus men treated with radiation.

@jeffmarc Surgery and radiation are a double whammy against continence. An RP surgery typically leaves you with only 5-10% of the sphincter muscle needed for continence. This handicap can be overcome but still has high chances for not having normal continence. You got six more years of continence after radiating the residual sphincter muscle you had after your RP. So many men go into salvage radiation already with incontinence problems. I wonder as a general rule do incontinence problems typically get worse quick for men who have salvage radiation after an RP?

@wwsmith "Ok, so while you have a catheter in place you are not in a recovery period and can do all normal physical work? Of course not, ..."

The catheter was in place & I did all the work that a 76 year old man in good health would do. As I said, the surgery was a non-event. The catheter was a minor annoyance & did not bother me when I took long walks, drove a car, or did volunteer work assisting with COVID vaccinations, outdoors in freezing weather. It happened to be a convenience in cold weather: Rather than unbundling to get by my zipper, I just put one foot up on the toilet rim & opened a valve.

Of course, if you are at the beach in a swimsuit in the summer, you may not like the look of a catheter. 🙂 Probably you should not play beach volleyball, either.

I'm sure younger men that have a robust physical life are advised to "take is easy".

As for "If incontinence and ED problems were equally distributed between RT and RP guys, we would see just as many complaints about incontinence and ED from both sets of men", but as I said, that would be true in a controlled population study, not here in a forum where members are self-selected. If problems were equally distributed (your hypothesis) but about 2/3 of prostate treatments were surgery (as is the case), you'd expect to see more surgery complains. That's just basic math & science.

@wwsmith
"An RP surgery typically leaves you with only 5-10% of the sphincter muscle needed for continence."

Apparently that's enough, since 90% of men regain continence after surgery (source: Google). We're relegated to using the same muscles that women have, but which we have not had a lifetime to train.

Why am I beating this drum so loudly? Because I came on this forum to describe my experience per Mayo's Guidelines) with surgery & hormone therapy. I have little knowledge & zero experience with radiation (I do have some knowledge of the physics of radiation from my time at Caltech). I don't describe what it's like to have radiation & its issues (despite having friends that have had radiation treatment), because that's not my experience & don't know all the details.

But when someone comes on the forum & starts laying down what surgery is like without experiencing it, I wonder what their agenda is.

@readandlearn The original poster (OP) is a self proclaimed workaholic that does a lot of physical work moving heavy objects at times. I don't think telling a guy like that there is no recovery period after an RP and that he can do all his normal physical work with a catheter bag strapped to his leg with no problems immediately after an RP is accurate or helpful. I don't think there is a single RP guy on the forum who would agree with you that there is essentially no recovery period needed after an RP.

Also, a guy like the OP is in immediate need of good info to guide his decisions. Perfect scientific controlled studies are not always available or current pertaining to the questions at hand. Anecdotal experiences are extremely valuable in situations like this. I know that when I had to make my decision between surgery or radiation, it was easy to recognize that something like 90% of the complaints on incontinence and ED came from RP patients.

@readandlearn It sounds like your agenda is to promote that an RP is a piece of cake with no recovery period and that the harsh side effects of an RP are overblown. My agenda is to help new prostate cancer patients recognize that urologists are most often surgeons and that they often try to influence patients to go with an RP while understating the chances of recurrence and the harsh side effects of an RP. Both radiation and RP procedures have their place in prostate cancer treatment and every patient should work hard to fully understand the pros and cons of each treatment so as to make the best decision possible for their own unique situation.