Surgery V Radiotherapy 64yr old

Age 64. 6 tumors bi-lateral. Gleason 7 (3+4) in 2 tumors with cribriform, gleason 6 in 4 tumors. After consultations at Hartford Health Care (Joseph Wagner - my oncologist/urologist - pioneering davinci surgeon with over 4k procedures) he advised that either surgery or radiation were equipoise. I met with MSK, Yale Smilow, and Tufts for second opinions with both surgeons and radiologists - all the same - both treatments were equal and effective. I opted for SBRT under the care of David Byun (MSK/Hartford - colleague of Wagner). Five treatments, 120 days of orgovyx, early psa undetectable, some discomfort early on to pee, orgovyx side effects: no libido, fatigue - all manageable. I exercised throughout - a lot. I lost some weight (5'8" 140 normal - down to 121 during treatment). 7 months post treatment and 4 months post orgovyx - all functions are very close to normal - some fatigue, no meaningful urinary issues, libido and function fine. Do the research (which you obviously are doing), get a couple opinions at centers of excellence, have confidence in yourself and doctor, exercise - a lot, watch Dr. Scholz's youtube videos (great help), and stay positive. Many contributors on this site are a GREAT help - Jeff Marci, Heavy Phil, to name two of them. You will find the option that works for you - we are lucky to have this type of cancer vs many others and we are not kids any longer. Good Luck and Go Easy - this works out.

Thanks for posting this….. I start SBRT MR Linac on Monday. Age 60. The journey to get me to this place has been challenging.

I’m ready to start treatment and move past this disease with the rest of my life. Your post gives me hope that’s a very likely scenario

@jeffmarc
I often hear on this board patients discussing how they have no ED after radiation. I wonder if their Doctors sold their radiation option that way over surgery without the caveat, but yes in two to three years you will definitely have ED because we fried your nerve bundles. Their is no coming back from that after radiation. I personally feel Surgery gets a very bad rap about ED, because with many with localized cancer, nerve bundles spared and the Retzius sparing surgery, their ED goes away fairly quickly with use of like viagra, and for many they have resumed normal relations by 18 months post surgery even without drugs. Incontinence is even way down with the newer surgeries. I think many are living in the past when they think of prostate surgery. Will everyone have the same results, likely not, but way more today fare way better than in the past. Results between radiation and surgery for localized cancer may be the same when they measure the cancer itself being gone, but the side effect difference can be huge. So many radiation side effects including rectal and urinary issues can come two+ years later . Your ED will definitely come . I really don’t think patients realize that.

@jonathanack
I second your opinion re Jeff and Phil--two of the main "gurus" on this board, I feel!

But more generally for the OP, I'm a bit older than you, but likewise was told that my Gleason 8 could be treated equally successfully with either approach. With surgery the side effects appear immediately, then fade with time (ideally), whereas with RT, it takes quite a bit of time for them to manifest.
I chose the surgery as I figured that it would still leave the backup-option of RT if ultimately proven necessary, and really dreaded undergoing the requisite ADT as I have another condition that already causes chronic fatigue.
The biopsy after surgery actually downgraded my Gleason score to 7, which was nice, and, nine months later my continence is approaching normality, while my ED is still a work in progress (the nerves were indeed spared).
IF you choose the surgical route--and do keep researching your options--make sure you choose a surgeon who does this all the time! Mine, at a cancer center of excellence, actually does two per day, and my surgery was actually postponed by a couple of hours because he was actually doing a THIRD RARP that day. (The guy must be rolling in dough!)

@wheel1 You failed to mention that up to 40% of men who have prostate removed end up needing salvage radiation anyway when cancer returns. And if you get the wrong surgeon you will end up with ED and possibly in diapers rest of your life. Many men in small towns don't have cancer centers of excellence where the top prostate surgeons are. And might not have the money to pay for travel to see a top surgeon. So if they get rushed into surgery with an inexperienced surgeon many bad things can / will happen, short & long term! With the advancement of radiation treatments ( brachytherapy, shorter treatment duration, more precise beams, etc) RP will become more rare and reserved for very few men in the near future. It was just 20 years ago where RP was basically the only option for PC. Treatment has come a long way since then with many options. Keep in mind most surgeons will recommend RP, and many will just happen to have an opening right away to "get it out" (perhaps so you don't have time to research better options) Every case is different and 2nd & 3rd opinions a must!

Yes, that is true, but for those that eventually need it, it could be still be additional years of quality of life regained after surgery. Also always good to have that radiation in back pocket. For localized cancer regardless of potentially needing salvage radiation in the future it seems side effects between the two that you need to decide on.

@wheel1 Agree either way it's a very personal life changing decision.

@copyman
Nobody has to end up in diapers for the rest of their life. You could just get an AUS (Artificial urinary sphincter) Installed and be 100% continent or close to it, like I am.

Medicare covers it so the insurance companies.

I was 67, 4+3. Doctors said I was on the borderline - older, and they would recommend radiation; younger, and surgery would be preferred. They also said either radiation or surgery would provide a good outcome. I chose surgery because I wanted it out. The thing is, IMO, that until they get in there, they are making educated guesses as to what the situation is. In my case, the cancer was more aggressive than they had predicted which required more tissue removal. So, I don't regret choosing surgery even with the side effects.

@gently The link you provided brings you to a page about Study of Adverse Effect Profile of Parenteral Zoledronic Acid in Female Patients with Osteoporosis. Nothing to do with SBRT