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Deciding: Surgery vs. Radiotherapy 64yr old Gleason 3+4

Posted by tm1a @tm1a, Jul 31 2:44pm

Hi, I've been diagnosed with Prostrate Cancer Gleason 3+4. Not suitable for focal therapy as growth on left side but 1 out of 6 positive on right side too. I've been told I'm fit and am suitable for surgery or radiotherapy but cannot decide which is the best option. I'd be grateful for any advice, Thanks, Tim.

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Setters and Birds | @jonathanack | 20 hours ago
In reply to @wheel1 "@jeffmarc I often hear on this board patients discussing how they have no ED after radiation...." + (show)
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@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.

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@wheel1
There are a lot of factors. Any patient that does their research will find that it varies widely by patient. My surgeon (Joseph Wagner - pioneer robotic urolgost and my radiologist - David Byun Weil/Cornell/MSK) aren't selling anything. Their counseling is clear that ED is not an inevitable outcome with SBRT. Second and third opinions at Smilow and MSK confirmed the same on direct inquiry to ED and incontinence for both procedures. All confirmed that if function at time of treatment is unencumbered and easily achieved and with no other complicating factors this part of life is not an inevitable part to give up. If you are fully functional the odds are on the patient's side that he will age as normal.

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