SBRT vs. Robot-assisted radical prostatectomy

Yes kill it with 40 sets of radiation and last 5 rapid arch for margins

Testosterone is the fertilizer for PC so get on Zolodex injections after that and PSA <.01

They took me off Zolodex and it metastases to my L2 lumbar 5 years later needing high intensity radiation to lumbar Back on Zolodex 1.2 PSA Forget sex Save your life

I am 45 years old, I have been recently diagnosed with prostate cancer.

My Gleason score is
4+3 = 7
3+4=7
3+3=6
3+3=6
3+3=6
Possible perineural invasion
I am not able to decide if I should get surgery or sbrt

Can some one please guide me through the pros and cons

I am 45 years old, I have been recently diagnosed with prostate cancer.

My Gleason score is
4+3 = 7
3+4=7
3+3=6
3+3=6
3+3=6
Possible perineural invasion
I am not able to decide if I should get surgery or sbrt

Can some one please guide me through the pros and cons

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.

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 posted this a few days ago in another thread.

I'll try….but…everyone is different and it's a very personal decision…
diagnosed at gleason 3+4, DRE and MRI showed nothing outside of the prostate, then a full body bone scan was negative for anything there. So working off that information as my doctors basically said, in prostate cancer treatment you have three choices, "watch it" / "kill it" / "remove it". Then they both took "watch it" off the table as the gleason was too high.

Being young(ish, 59 at diagnosis) and otherwise pretty healthy, the surgeon recommended RP. I left that office and went to the radiation oncologist a couple weeks later. He felt, largely for the same reasons, that his option was the best option. That being 40 radiation treatments.

Asking both dr's directly "What would you do if it was you?" They recommended their own disciplines. They were both great guys, very experienced, sit and talk for an hour if you want, I just think they legitimately believed in their own disciplines. What's a guy to do?

I went for the RP for the personal reason that I just wanted the vile tissue removed. I think there was likely a visceral reaction to the "C" word and my brain went to "get it out". My wife felt the same way. Both doctors went down the same list of side effects after treatment with the radiation oncologist adding the " there is a slight chance that the radiation could give you another cancer"

The other factoid that played into it, being a contingency planner type, was what happens when / if it returns. Both doctors agreed that if the RP doesn't get it all, it's much easier to follow up with Salvage Radiation Therapy (SRT) as opposed to working in the other direction. I was told if the radiation treatment doesn't get it all and they have to go to a surgical option later, it's a VERY different VERY specialized surgery. Having said that now, after lurking here for some time, I'm not sure that would be the next step, more likely some sort of chemo unless / until a tumor showed itself somewhere then that would likely be irradiated. (just a guess I really haven't researched that much yet).

Biochemical recurrence came to fruition as after my surgery the surgical pathology report showed that even though the margins were clear (and a lymph node taken and tested for good measure) I had some Perineural and Lymphovascular invasion. The PSA started to sneak up and I went into SRT and hormone therapy (Orgovyx in my case)

I also had a PSMA PET CT scan (with radioactive dye of some sort) that was negative as well, and in retrospect, likely expected to be. I found out from the good folks here that there's only a small change of it finding anything with low PSA, if your PSA is below 0.2, there's only a 30% chance of finding anything even though your psa is on the rise.

Current status, still on the drug for now, PSA last tested at 0.014, no lasting effects from the radiation that I can tell, the only issues from the operation are ED related. I can get semi erect, (not good enough to be of any use to my wife, you just have to be open and get creative) and can get the occasional dry orgasm. Well that was a tad blunt…

Side effects of the ADT are hot flashes, which makes sleeping difficult and "lupron belly" even though I work out and run 8-10 miles a week, and of course, "shrinkage" there are other clinical possibilities, I'll let you look those up. 🙁

One thing I might suggest, if you decide that radiation is the way to go, I might consider some type of protection like Space Oar.
https://www.spaceoar.com/about-spaceoar-hydrogel/how-spaceoar-hydrogel-works/
Best of luck to you!

Dave/Horace, I am 56 years old and had the same situation (Gleason Score 7 --> 4/3). Based on my situation (good health, wanting to minimize likelihood of reoccurrence, leave as many options open if PC comes back, etc.), I decided on a robotic assisted radical prostatectomy. My RP was done at Mayo-Rochester on November 3, 2022 (removed prostate, seminal vesicles, 6 lymph nodes). This is an invasive surgery, but it really is not a significant recovery. I would say the 1-week catheter and the referred shoulder pain (from gas used during surgery) were the most unpleasant parts of the recovery. Overall, the pain was manageable - My wife had me on rotating Ibuprofen and Acetaminophen every 6 hours. For the first week, very nice to have someone there for you. After the catheter comes out, I could handle everything if need be.
The longer term issues surrounding incontinence and erections are something each individual needs to make a decision on. However, my #1/#2/#3 priority was to get the Gleason Score 7 cancer out of my body. Based on my experience with the robotic assisted RP, I would highly recommend this direction.

Good luck with your decision and I pray all goes well!!

After this Surgery, Do you have to urinate alot more.
For instance traveling???