SBRT vs. Robot-assisted radical prostatectomy

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!

Dave see my prior posts on this decision. I had exactly the same numbers as you and after agonizing review, chose DaVinci prostatectomy. I do not regret it. Any time you can cure cancer with surgery, you should do it. If you have been reading the recent posts on this site about the side effects of Lupron, radiation etc, you will know the situation. There are downsides from surgery but they are manageable. ED is certain but can be boosted with drugs; there is some leakage on coughing and I have some low level pain in the urethra (rare). But I am now 4 years post surgery with a PSA of zero and retain a healthy libido and function. One thing you should do is to have the Prolaris test done to determine the degree of aggressiveness of your cancer. Best of luck.

I was similar to you as well. Stage 3, 4+3=7 Gleason. Since it had spread (stage 3) it was deemed inoperable because I would still need radiation. I was told radiation on an area after an operation could be harmful. I went on Lupron then had High dose brachytherapy and 25 external beam. I was on Lupron for 24 months. If you stay active and communicate with your doctors - 4 months would not be too bad.

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!

@horace1818 Horace, Thanks for your input and advice. Sometimes I wish Mayo wouldn't give you options, Just say to me "You have cancer and we will get it out by doing xyz."

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!