SBRT vs. Robot-assisted radical prostatectomy

@dandl48 I was 75 when I had a similar discussion / consult with a PCa surgeon. It was the discussion with the surgeon that was decisive for my decision to do radiation. My Proton Beam radiation at Mayo was completed in March. It was the correct decision.

@vernonkent you don't mind me asking, what did the surgeon say to you that convinced you to do radiation? Was it the 5, 20 or 40 treatments that you got?

Sorry, I thought this was clear in my response. Looking at a combination of factors -- age, progression of my cancer and likely side effects of each treatment option (surgery and radiation) -- the urologist concluded that the opportunity for a normal lifestyle for the foreseeable future for me post-radiation treatment was greater than the choice of surgery. Put differently, if you could have 5-6 years of a healthy, normal lifestyle and cancer-free post radiation treatment, knowing that as you approach 80 you will likely be confronted with new medical issues -- or even death -- that will create a new set of health challenges, would this be a good option for you? Contrast this with the same aging scenario with surgery, where you may have a greater likelihood of side-effects (e.g., incontinence, ED, etc.) that are difficult to manage in the same timeframe, only to be faced with new medical issues. Again, I don't want to oversimplify things and I don't want to diminish the benefits of surgery, for which some individuals have little to no side effects. Note that there is data available the will provide you with the odds on various side-effects from surgery. Your urologist should be able to share this with you. The treatment choice is yours based on the considerations/trade-offs I outlined as have others. Sorry, no easy choices here. Research. Talk. Weigh the risk of each approach. Weigh what's important to you post treatment. And then make a decision from there.

My radiation oncologist seemed to bounce between 5 and 28 days, implying that the choice was mine. I probed on why the shorter treatment wouldn't be everyone's choice. Less time. Same effect -- yes? Frankly, he wasn't able to provide a satisfactory answer. I was left with the impression that based on his hospital's experience, they were seeing little difference in the longer vs. shorter treatment options. Bottom line: The research and experience with the longer treatment span is extensive and proven. The shorter plan, while perhaps as effective and with no greater side-effects, is still being trialed in a fashion until they have definitive results.

Lupron is the most powerful drug I have ever taken. You will immediately feel the side-effects, the extent and intensity of which can vary from patient to patient. No fun for anyone. That said, it does immediately drop your testosterone, which is the food for your cancer cells. Probably good to start on this drug for 30-60 days prior to either radiation or surgical treatment. It also can shrink the tumor(s) on your prostate. Also, continuing on the lupron post-treatment is also advisable in my opinion for a short period time. Think of post treatment lupron as cleaning up any cancer cells that may be hiding in the corners of your prostate. Unlikely after treatment but better safe than sorry.

Feedback appreciated. Glad my post was helpful. As we both know, personal insights are important to making the tough choices regarding treatment options.

Spot on. Each individual needs to take personal responsibility for their health and related treatment decisions, whether cancer or any other disease. The hard truth: It is your future, own it.

Dave, Robotic prosectomy would be my choice. That was my option 9 years ago and even though I'm still a cancer patient its being managed fairly well. I was 69 at the time of the surgery. Make sure you have a surgeon who is very experienced at this type of Robotic surgery. My Gleason had a couple of 8's and a 9. The surgery did not, even though the margins and glands tested to be clear following surgery, get all the cancer. I do have residual microscopic cancer but kept in control mainly with quarterly Lupron injections. After my surgery I did have radiation and Chemo but my PSA never went to zero. Incontinence never a real issue, ED somewhat of a problem until I started Lupron about three years ago. My testosterone is now less than 5 so no sex drive at all. I'm now 78. The processes today have been refined and I believe more effective but of course no guarantee. I'm in good health today with no other serious issues but still always concerned that my next visit may not be favorable. I visit my oncologist quarterly and PSA has been less than 1 for last two years. I do get occasional scans and MRI's. Whatever you do make your best effort to keep your body in good shape and visit with a nutritionist to get recommended foods to eat. Glad to answer any other question you may have.

@alanr Thanks for the reply. You gave me alot to think about. Today is the day we make our decision. Hopefully my second guessing of the decision won't be bad.

I’m sure you’ll make the right decision based on your personal situation. Take confidence in the fact that you have multiple perspectives and tons of info to help you make it. Once committed, stay positive. It helps! The vast majority of prostate cancer patients have very high and good survivability rates.