Surgery V Radiotherapy 64yr old

Apologies and thanks, copyman, I found this video while searching for the MRI guided video. It's pretty interesting, too. https://www.youtube.com/watch The link i meant to send https://www.youtube.com/watch, mainly for the portion starting at 21:24, showing how much the prostate moves during treatment.

@gently
Thanks, appreciate that.

@marlon
First time I heard somebody being told that at 67 they shouldn’t do surgery. I know an awful lot of people that have done it in their early 70s. One’s health could be a factor.

Your experience with it being found worse after surgery is not uncommon. I was a 3+4 before surgery and a 4+3 after. I know a few people that found they were 4+5 after being told they had lower Gleason scores before surgery. A biopsy only gets about 1% of your prostate, Hard to figure out what’s in the other 99%.

Lots of good advice posted by the very knowledgeable crew here.

My decision process boiled down to this: My doctors said that since both radiation and surgery had similar 10 year outcomes for someone with my profile (3+4=7, contained) that I should choose based on which side effects profile are the least agreeable to me.

To me, that is the wrong question. My decision was based on which procedure gives me the best options if there is recurrence. This is cancer and recurrence is a very real reality. For that reason, I chose surgery. It leaves open all the options for radiation and hormone therapy.

Now, with that, you've got to find a surgeon who has done more than 250 surgeries and centers of excellence are your best bet. You want a surgeon familiar with the latest techniques.

I had my made my decision, but I did explore radiation. I got a Decifer test, which showed my cancer was somewhat agressive (.61), which meant the radiologist recommended ADT therapy with the radiaton. That sealed the deal for me toward surgery. I did not want ADT unless absolutely necessary.

The question in my book; "Based on my imaging and cancer profile, which procedure provides the best options for followup treatments if there is recurrence."

I had surgery 3 1/2 months ago and progressing well. The post surgery pathology was very, very good. I am fortunate. My incontinence is so much more manageable. My ED response is very promising.

Quick bits of advice: If you do surgery, get signed up with a pelvic floor therapist. Even though my incontinence is not terrible compared to others, the therapy has been incredibly helpful. Also, get signed up with a sexual function/ED therapist as well. My ED recovery is WAY ahead of schedule. Still a ways to go, but, having good advice and a treatment path has also been super helpful.

My surgeon didn't offer these automatically, but as soon as I asked, he wrote out both referals with no delay. You just have to ask....so make sure you ask and set these up BEFORE surgery so that you don't get delayed by scheduling issues (another story).

I will say this, post surgery incontinence is largely stress incontinence (leakage on exertion), but because of bladder irritants, I deal with urge incontinence. I find the urge incontinence to be much worse. I'm no expert, but what all the doctors told me is that radiation induced incontinence is largely urge incontinence, which I feel is very challenging.

Tough decisions, but you're smart and whatever way you go, embrace the choice and know that it is the right one for you. There is always second guessing, but getting educated and then just own it. You're on the right path.

Thanks so much for the advice and I have taken all on board. I'm definitely leaning towards surgery as I think it leaves all options open. Thanks for the replies and hearing about others in the same situation has helped greatly. Tim.

Thanks for all the good advice. Tim.