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Outcomes and impacts from SBRT and/or Robotics Radical Prostatectomy
Hello. You may know me as JohnnyZ and I am facing the decision for a recommended SBRT by my radiation oncologist, or robotics surgery to remove the prostate. I am concerned about long term impacts from the treatments. It would be very much appreciated and helpful to hear first hand experiences from those who have had either SBRT or Robotics RP. Radiologist says no ADT, and if recurrence comes along down the road, then Brachytherapy with some ADT. My numbers are: PSA b/w 10.8-13, MRI shows two lesions; 1.0 and 1.9. with second being AFS. I have had 7/15 positive cores, 3+4 in 6 cores, one 3+3. Pattern 4 is <5%, overall cancer volume is <10%. Pathology shows no IDE or EPE, no lymph node or seminal vessel invasion. There is however some "low" volumes of Cribriform. My hope is to get treatment this fall, and have priorities for cure, then least amount of quality of life impacts: hoping for minimal to no ED, and minimal incontinence. I am currently working on health and doing Kegel exercises. Please respond if you can with any insight from your experience with one of the treatments.
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My brother had small cribriform And was treated with five sessions of SBRT radiation at UCSF with Dr. Roach. He had that three years ago and he’s now 80 and doing fine. I know other people that have been treated by him, One guy with a Gleason eight treated 15 years ago had ADT for a short time and has never had a reoccurrence.
I had an RP And I’m still around 16 years later, even though I have a Genetic problem that makes it more aggressive. 3 1/2 years after my RP I had to have salvage radiation. I’ve been on ADT for nine years and at 78 It’s not really a big deal Since I have no fatigue.
There’s a new surgery technique that makes incontinence a very short term thing and the same with erectile dysfunction as long as you can have the nerves spared. Here’s a couple of links discussing it.
https://connect.mayoclinic.org/comment/1548188/
https://www.mdanderson.org/cancerwise/how-retzius-sparing-prostatectomy-helped-a-prostate-cancer-patient.h00-159538167.html
@jeffmarc Thanks for your response Jeff. I appreciate you in depth experience on these matters! I will review your link and circle back. Can't believe how tough the decision is. My two brothers had radiation two years ago and are happy with results. I just don't know which way to go yet...
My 2 cents....
I was doing the radiation vs surgery thing, too.
Reading about them, I found that surgery often results in incontinence & ED pretty much immediately (although they do resolve later).
Radiation (which I didn't choose) can result in bladder incontinence AND bowel incontinence.
ED doesn't immediately appear as a problem, but can show up later.
Bowel incontinence was a hard no, for me.
But if continence & erectile function are important to you, surgery is not your friend.
https://www.differencebetween.net/science/difference-between-surgery-and-radiation-for-prostate-cancer/
Other opinions incoming.....
In brief, diagnosed Gleason 4+3 at 59 in Dec 2025. Retzius, single incision RALP Jan 2026. I chose the surgery for a few reasons. I am working and radiation would be most disruptive for work and I would need ADT with my risk being higher at 4+3. Wanted to avoid ADT. Otherwise, I would likely have had radiation. Surgery was very successful. Currently undetectable. No real lack of continence, except a bit of stress incontinence which resolved in less than two weeks after catheter. Natural return of erectile function progressing 7 mos post surgery. Utilize Trimix for sexual intercourse. I have zero regrets and am very grateful!