Radical Prostatectomy vs. Radiation therapy?

@wwsmith " ... urologists are most often surgeons ..."

Source? Where is your source for your other stats, like "90% of the complaints on incontinence and ED came from RP patients"? Compiled from this forum???

My AGENDA is to provide one example of an excellent result. I am by no means the only one on this forum that has a story like mine. I don't argue against radiation because as previously stated, I have no experience with it. I do know what worked for me.

As for what urologists recommend, the one that diagnosed my cancer gave me John Wash's book, told me to read the pertinent chapters on radiation & surgery, & let him know which I wanted. I took the book's recommendation & found the area's most experienced surgeon (at U. Wash. / Fred Hutch Medical Center), who recommended radiation in my case. So personally, zero for two urologists recommending surgery.

Have you read John Wash's book?

You cite a lot of claims with no sources, & as I've already stated, your math is fundamentally unsound. I just don't like unsupported statements like "An RP surgery typically leaves you with only 5-10% of the sphincter muscle needed for continence." Given my source for "90% of men regain continence after surgery" (https://pmc.ncbi.nlm.nih.gov/articles/PMC3034651/ from the National Institutes for Health), I find your claim not creditable.

People can make of that what they wish.

@wwsmith
I’m a little puzzled by your 5 to 10% statement. Men have two sphincter, unlike women who only have one.

Men lose the internal urethral sphincter (or bladder neck sphincter) during a radical prostatectomy, as it is removed along with the prostate gland. While this involuntary muscle is lost, the voluntary external urethral sphincter remains, and it is strengthened to regain bladder control.

The external Sphincter can get damaged during the surgery, That’s what causes the problem with incontinence. Apparently, it doesn’t happen to everybody.

I have to agree with @readandlearn .

I spent tons of time here and I was reading posts by almost every RP patient here. Only fraction came back after RP and mostly because they had some annoyance to ask about , like irritated skin, or some redness on incision site, etc etc. Very rarely there was a case with some extreme pain or what not - I know of only one case actually and after I wrote "post of support" next day that patient declared that pain is almost gone. Rarely there is hernia report.

Regarding incontinence, actually there WERE a few with immediate continence. Very, very rarely there were cases of full incontinence that lasted up to a year and that can be fixed by different surgical methods. According to UCSF - 95% of patients regain FULL continence by 12 mos post op ( 60% by month 4).

ED - some patients like "survivor" here had erection while in the hospital next day after RP, the rest needed some time to recover. For nerves to recover it takes up to 24 mos. as was the case for "retiredguy" - he regained normal erections after 2 years. Most regain it before that time-frame.

All in all 95% of post RP patients will regain continence by year 1 and 50-60 % regain erections IF they do penile PT. The rest uses different methods to deal with ED as all other men do in general population - Cialis, Viagra, injections, implants - array is wast.

My husband was 69 years old at the time of surgery. He was able to resume full time job and 2 startups 2 weeks post op ! ZERO pain after 2 days, zero difficulties, even zero irritation or discomfort with catheter. I had to remind him all the time not to carry heavy things and to slow down. He was fully functional and full of energy, happy as a clam. Fully continent at 4 mos. ED half way there and we did not even try Viagra yet.

Bottom line, if he had to choose "method of eradication" again, he would choose RP .

PS: Man have 3 sphincters that control urine flow, 2 get cut out during surgery and one that is left is one that females have (we are born with only one ).

@wwsmith
Sir, by God's grace, my husband had no incontinence at all after catheter removal. I have heard of others who had the same experience.

@readandlearn After you have read hundreds of case histories across multiple forums, patterns, trends, and percentages start to burn in to your memory. The 90% number of incontinence and ED complaints coming from RP patients versus RT patients is one such number. If I were to tally the actual count, I think it would be likely higher than 90%. Anyone can just do their own small sample tests on case history posts and see what I mean.

Concerning urologists often being surgeons, that too is a trend I picked up from reading so many case histories. So, of course, not every urologist is a surgeon and not every surgeon will recommend an RP for every case. There are certain circumstances where an RP or radiation is clearly the better treatment. However, a trend that I saw repeatedly was a patient being "railroaded" down a certain path, and most often down the RP path. Patients would often admit that this happened to them without them realizing what was being done. The advice from many such patients was to do your research, talk with as many patients and doctors as possible, and get as many perspectives as possible. As I began to do this myself, I came to the opinion that radiation would have been better for many cases that been steered into an RP. Of course, each case is unique and often either approach would often work well so it is not a cut and dried decision.

In my research, many patients complained that RP side effects are underreported in official statistics and that when you talk amongst many RP patients you get to see what the real statistics are on incontinence and ED. Reading accounts on the forums are a great way to do that.

Even today, the current statistics given by google on how long a man will typically live once diagnosed with metastatic cancer are completely wrong. Google will say something like 5 years to live is typical and yet virtually every metastatic guy on this forum will tout all the new drugs like Nubeqa that has let them live far longer than that. Not to discount the current studies, videos, and books, but the best information comes from real patients talking right now on forums.

@wwsmith The old adage “When all you have is a hammer, everything looks like a nail” can be applied to almost every area of medical expertise.
Unfortunately, many, many specialists feel that THEIR chosen field holds all the answers - which is what attracted them in the first place. RO’s are gonna push radiation, Urologists - surgery…it’s only natural.
Since most men are usually seen first by a urologist, poked by the Uro, sent for scans by the Uro and biopsied by the Uro, they tend to bond with the Uro favor what he/she tells them and that is surgery.
Of course, there are Urologists who work closely with ROs in centers of excellence or big teaching hospitals and they may refer - and DEFER - to the RO, but I don’t think that’s common.
Without any evidence to back it up, I’ll go out on a limb and speculate that the more educated patient, or the more financially successful one will seek out second and third opinions after his urologist’s.
The less informed or those relying heavily - or totally - on medical insurance or Medicaid don’t have the time or luxury to educate themselves on all the options open to them. They trust and blindly follow, thinking that ‘Doc’ has their best interests at heart…ergo, probably more surgeries done by a lot of mediocre Urologists who do a few (?) per month leaving incontinence in their paths…JMO
Phil

You've identified the stinky part of surgery as ED and incontinence. This is true.

The stinky part of radiation is ADT where your testosterone level is dropped severely. Depending on how you respond to ADT, your strenuous activities may be compromised.

Gleason 3+4 does not immediately call for ADT. With a Decipher score of 0.96, your doc may prescribe this. Decipher is an old test that may not be relavent in 2026. A newer test called AlterAI does the genomics test differently and may give you a better answer.

Using rough numbers, it is said that 10 men must endure ADT so that 1 receives the benefit.

@jeffmarc I had to find the old post where I first saw those numbers and now I realize that what the poster was trying to say was that only about 5% of the internal urethral sphincter muscle was left after an RP. As you point out, the external urethral sphincter muscle is left after an RP, although sometimes damaged, but it requires a lot of voluntary control work learned through kegels to regain continence that was once handled without thought by the internal urethral sphincter muscle.

@heavyphil As you point out, it is only natural that these specialists have a bias towards the treatment they provide. And in most cases, it is an honest bias where they truly believe what they are advising is in the best interests of the patient. Unfortunately, it does take a patient with some time and financial means to seek second opinions and visit different institutions. But for those that do so, better outcomes are far more likely.

Hi all, time for a gentle reminder about the Community Guidelines https://connect.mayoclinic.org/blog/about-connect/tab/community-guidelines/. Please review.

As someone who manages this patient forum, I completely agree that great information comes from patients/caregivers supporting patients/caregivers as they journey with prostate cancer and navigate their health and care.

However, forums can give an unintended bias. People who do not experience side effects are less likely to post on a forum or once resolved may discontinue participation. We're lucky here in the Prostate Cancer forum that many members stick around to share their tips and recovery stories.

Drawing conclusions and statistics from online forums does not represent a patient population objectively. Forums can however reveal themes that can be used as a starting point to discover research questions that can and should be explored in objective, randomized controlled studies.

All information shared by members on the Mayo Clinic Connect is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have read on the community.