SBRT vs. Robot-assisted radical prostatectomy

Posted by dandl48 Dave @dandl48, Jun 11, 2020

Well, my last visit to Mayo didn't go as well as I wanted. I'm 72 years old and I had an Ultrasound-guided transperineal prostate biopsy and the results came back positive for cancer with a Gleason score of 4-3=7 and the Grade Group of 3 which is a Risk Group of Intermediate Unfavorable. With these results active surveillance is out and it's either radiation or radical prostatectomy . If I choose radiation SBRT is available to me using protons for 5 treatments over a 10 day period. The downside of this treatment is I will have to have a 4 month Lupron injection before radiation and that if the cancer returns removal of the prostate would probably off the table. Choosing the radical prostatectomy which would be robot assisted, comes with its own problems, infection, incontinence and impotence. Decisions, decisions, I'm open for your input.

Thanks, Dave

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Similar situation trying to figure out what to do. I was 3 + 4 Gleason but it turned into 4 + 3 by the time I acted. I actually went a little over a year before making the real decision. Went to Mayo to talk about some of the newer treatments and trials but didn't work out for me so that put the decision back to radiation or Surgery. I opted for surgery at 66 for 2 reasons that the radiation can cause complications in later years, and radiation can screw things up if you do want to do surgery at a later date. Some of that decision has to do with what age you are and life longevity after the procedure............Just had my 3 month PSA and it is now undetectable, down from over 10, so hopefully it stays there. Yes the incontinence can be a pain but it is mild now at 3 1/2 months. Don't know yet about the ED. Hopefully goes away eventually. Remains to be seen. The Dr just prescribed viagra but haven't tried it yet.

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@ronan2011

Similar situation trying to figure out what to do. I was 3 + 4 Gleason but it turned into 4 + 3 by the time I acted. I actually went a little over a year before making the real decision. Went to Mayo to talk about some of the newer treatments and trials but didn't work out for me so that put the decision back to radiation or Surgery. I opted for surgery at 66 for 2 reasons that the radiation can cause complications in later years, and radiation can screw things up if you do want to do surgery at a later date. Some of that decision has to do with what age you are and life longevity after the procedure............Just had my 3 month PSA and it is now undetectable, down from over 10, so hopefully it stays there. Yes the incontinence can be a pain but it is mild now at 3 1/2 months. Don't know yet about the ED. Hopefully goes away eventually. Remains to be seen. The Dr just prescribed viagra but haven't tried it yet.

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@ronan2011 Glad there is another person that had a hard time deciding on what procedure to do. I just know that one has to be done. It is the incontinence that is/was steering me away from surgery. Once I decide I pray that it's the right one and the stress & anxiety get reduced, realizing that it will return the closer I get to the appointment time. Thanks again for posting!

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@bruto1

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.

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Thanks for your detailed postings. It is helping in making my decision. Today is the day I want to decide.

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@dandl48

@ronan2011 Glad there is another person that had a hard time deciding on what procedure to do. I just know that one has to be done. It is the incontinence that is/was steering me away from surgery. Once I decide I pray that it's the right one and the stress & anxiety get reduced, realizing that it will return the closer I get to the appointment time. Thanks again for posting!

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It was my conclusion that there is a greater chance of serious incontinence from radiation than robot-surgery. None of my friends that has had the surgery has an incontinence problem

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@horace1818 wow, that's something I hadn't heard. All the people I've talked/chatted with said the opposite.

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I had surgery at age 67. Talked to medical, surgical and radiation oncologist and got input from each. Gleason 9 I chose surgery. 3 months after I was setting up adjuvant radiation at suggestion of surgeon. Long story, but bladder incontinence is terrible and still is.. I was told by radiation oncologist at another institution when I was talking to Doctors about the adjuvant radiation that he thought the gold standard for G9 was hormone therapy and radiation at the start. With radiation surgery, as I understand it, follow up surgery is difficult. This was several years ago so things may have changed. Just my two cents worth.

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Well, first of all I want to thank each of you who responded to the question. My decision has been made and I will be going for the SBRT 5 treatment over 10 days at Mayo Rochester. Did a ton of reading, bothered the heck out of the 2 Drs, (radiation & Surgery) and praying. Will be starting the Hormone shot next month and will be going to Mayo in 3 months if all goes smoothly.
Thanks again

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@dandl48

Well, first of all I want to thank each of you who responded to the question. My decision has been made and I will be going for the SBRT 5 treatment over 10 days at Mayo Rochester. Did a ton of reading, bothered the heck out of the 2 Drs, (radiation & Surgery) and praying. Will be starting the Hormone shot next month and will be going to Mayo in 3 months if all goes smoothly.
Thanks again

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Excellent decision. Glad you did all the research. Best wishes for smooth sailing with your treatment plan.

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@dandl48

Well, first of all I want to thank each of you who responded to the question. My decision has been made and I will be going for the SBRT 5 treatment over 10 days at Mayo Rochester. Did a ton of reading, bothered the heck out of the 2 Drs, (radiation & Surgery) and praying. Will be starting the Hormone shot next month and will be going to Mayo in 3 months if all goes smoothly.
Thanks again

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Good luck! SBRT/PBT?

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@cmartin65

Good luck! SBRT/PBT?

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@cmartin65 SBRT done with a Proton Beam

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