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dandl48 Dave (@dandl48)

SBRT vs. Robot-assisted radical prostatectomy

Prostate Cancer | Last Active: Jul 9, 2020 | Replies (37)

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@bruto1

I'm pleased with your results, Horace, including the minimal side-effects. Like you, I was faced with the same agonizing decision — surgery or radiation. I spoke with several urologists, along with patients who had experienced both forms of treatment. Most were successful. The side-effects of surgery tended to be more pronounced in the near-term — incontinence, ED, etc., which in some people, continued to last more than 24 months after surgery. The impact of radiation on patients was dramatically less so, though the data suggests that the side-effects for radiation are more often seen in the long term, principally due to radiation effects beyond the prostrate itself. At 73 and with Gleeson scores that ranged from moderate to aggressive, I was stuck in the middle on making my treatment decision either way. The tipping point for me was a conversation I had with a young urological surgeon. Typically, surgeons will always lean toward recommending their skillset — cutting. And, like any good surgeon, he confidently predicted I would have successful prostate surgery based on his many operations. That said, he said that his father was my age, 73. He then said that if his father's cancer was the same as mine, he would recommend that he undergo radiation treatment. Why? Put simply, he said that at his father's age why risk the near term surgical side-effects that m I describe above and possibly continue to suffer from them for a longer period of time/end of his life? Moreover, the data indicates at 73 he will likely suffer another, separate medical event that may have serious consequences, making his life even more uncomfortable when dealing with surgical side-effects. Successful radiation treatment would assure a higher quality of life for the foreseeable future. Future consequences aren't inevitable. Remember, this advice is coming from a urological surgeon who has witnessed the side-effects of more than 1,000 surgeries/patients firsthand. This conversation was the tipping point for me. I opted for radiation. Put simply, it was a lifestyle choice based on my willingness to possibly pay now (surgery) or pay later (radiation). I successfully completed 28 days of radiation therapy in late May. It's an extraordinary benign experience. I will remain on ADT (lupron) though September. I anticipate the cancer will be well behind me by then and that only periodic check-ups will be needed. Survivability rate for this treatment protocol is in the 90th percentile. My choice is not an argument against surgery. I understand its virtues. I also understand why individuals may make the opposite choice of my mine. However, my experience may help your decision-making either way. Should you go with radiation, I would question the advisability of a high dose, 5 day treatment vs. a longer period at a lower dose. There is no good evidence that the high dose/5 day treatment is more effective. Challenge your MD for an answer. Finally, I suggest you visit the website for the Prostate Cancer Research Institute (PCRI). Excellent information and data, along with some great, short video opinions/insights. Good luck!

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Replies to "I'm pleased with your results, Horace, including the minimal side-effects. Like you, I was faced with..."

I understand your situation. I was 74 when I had the surgery in 2016 and in very good shape (work outs, walk the golf course, no other diseases etc) and so it turned out fine. I also have 4 friends who had similar numbers and opted for surgery and all came out very well. It is a personal choice. The relief to have the cancer gone is high and the worst was over recovering from the surgery in 2-3 weeks. I did not want to have the drug/radiation side effects and planned to have a long life. Hope it comes out well for you.

@bruto1 Thanks for your detailed response. A question or two if you don't mind. Was the radiation done at Mayo? Did you have Lupron prior to radiation? Thanks for reporting your interaction with the surgeon. If I choose radiation, it is his response that swung me over to that.

@bruto1 This is a superb post. Thanks for taking the time to write it.