Radical Prostatectomy vs. Radiation therapy?

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.

@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.

I have watched this forum for a while but have never posted anything. So here goes. I am 63 years old now. My biopsy was 3+4=7 Gleason and PSA was 5.2 at diagnosis. In my case, I chose nerve-sparing robotic surgery over radiation when I had my initial treatment in 2018 and my PSA was < .1 for four years.
I did this because my Dad was treated with radiation for throat cancer years ago and when it came back, they said surgery was no longer an option. He died six months later after lots of chemo. The other factor for me was that surgery provided a clean benchmark for success: PSA should drop to near zero. Radiation meant a drop to some “nadir” and then they watch it from there. After surgery, other treatments - radiation, PET scans, and ADT - these are all still on the table as future options to control a recurrence.
I just completed radiation last fall after a biochemical recurrence when my PSA climbed back to .23 over 6-plus years. Now, 6 months later, it is thankfully down to .04 after dropping to .07 after 33 treatments and 6 months of Orgovyx (the pill form of ADT.)
I meet with my radiation oncologist on Monday. I had a Decipher score done at recurrence - not at original diagnosis - and it was in the high risk range. Although I wish I had known that at the beginning, I would have done exactly the same thing. At age 56 when I had surgery - relatively young in prostate treatment terms - I regained urinary and sexual function within a few months. The reason I got checked for my PSA since my 30s was that my Dad got prostate cancer around age 70 and got the “seeds” therapy. He didn’t die of prostate cancer but his experience shaped my choices. My urologist and I always agree that our goal is that I die from something else - maybe with, but NOT of, prostate cancer. There are so many new and emerging treatments that are very encouraging. But I know it is my job to stay active and focused on my treatment so I can have those extra years with my family and friends. The job and the hobbies and the vacations won’t be there if I’m not there. I also remember good advice from my high school teacher: “Don’t worry about making the right choice: make a choice and then make it right.”

I have watched this forum for a while but have never posted anything. So here goes. I am 63 years old now. My biopsy was 3+4=7 Gleason and PSA was 5.2 at diagnosis. In my case, I chose nerve-sparing robotic surgery over radiation when I had my initial treatment in 2018 and my PSA was < .1 for four years.
I did this because my Dad was treated with radiation for throat cancer years ago and when it came back, they said surgery was no longer an option. He died six months later after lots of chemo. The other factor for me was that surgery provided a clean benchmark for success: PSA should drop to near zero. Radiation meant a drop to some “nadir” and then they watch it from there. After surgery, other treatments - radiation, PET scans, and ADT - these are all still on the table as future options to control a recurrence.
I just completed radiation last fall after a biochemical recurrence when my PSA climbed back to .23 over 6-plus years. Now, 6 months later, it is thankfully down to .04 after dropping to .07 after 33 treatments and 6 months of Orgovyx (the pill form of ADT.)
I meet with my radiation oncologist on Monday. I had a Decipher score done at recurrence - not at original diagnosis - and it was in the high risk range. Although I wish I had known that at the beginning, I would have done exactly the same thing. At age 56 when I had surgery - relatively young in prostate treatment terms - I regained urinary and sexual function within a few months. The reason I got checked for my PSA since my 30s was that my Dad got prostate cancer around age 70 and got the “seeds” therapy. He didn’t die of prostate cancer but his experience shaped my choices. My urologist and I always agree that our goal is that I die from something else - maybe with, but NOT of, prostate cancer. There are so many new and emerging treatments that are very encouraging. But I know it is my job to stay active and focused on my treatment so I can have those extra years with my family and friends. The job and the hobbies and the vacations won’t be there if I’m not there. I also remember good advice from my high school teacher: “Don’t worry about making the right choice: make a choice and then make it right.”

There are 3 graphs, one each for low, intermediate, and high risk. Sounds like you might be high? (Risk of recurrence after treatment).

The elipses can be confusing. I put a dot on each eclipse and drew a line to make it easier to intemperate. If you need help readin the charts get it.

You will notice that chance of cure starts well for RP but drops as risk increases. At high risk you are down to 40-50% chance of cure.
Compare that to radiation options.

@groundhogy
My Gleason score was 3+4=7 and PSA < 10 (5.2) with MRI biopsy showing positive in two sides. That made me T2C, which in 2018, put me at "intermediate risk" and surgery was a valid option given my desire to get my PSA down to zero and not down to some "low" number. My post-surgery biopsy showed no seminal vesicle involvement, no lymph nodes, no extra-prostatic extension and the Gleason score matched the pre-surgery classification. Decipher genomic classifier test was NOT standard of care at that time and therefore the test was not run. Only after hitting the magical .2 number for recurrence did they run the Decipher test, which did inform the decision to add ADT to the treatment plan for 6 months. It would be easy to go back to 2018 and say I was high-risk based on a test from 2026. When I consulted with the radiation oncologist back then - the same one who just did my salvage treatments - he told me radiation would be well-tolerated but he could also tell that I remembered what happened to my dad, and how surgery was taken off the table once I opted for radiation. He actually ordered a genomic test on my first biopsy sample- the Oncotype DX test (which is no longer used) - and it said I was "low-risk" at .08. Talked to the oncology team today and they said I could explore the genetic testing if I wanted. I am married, but don't have kids, so I asked if it would shape my treatment in any way - and, right now - it probably wouldn't.