Radiation VS. Prostatectomy? Looking for advise on which best for me.

grywolf: I too had gleason 7 with 10.2 psa. 69 last year when discovered. Had prostate mri, biopsy and then decided on the mridian viewray radiation machine. Spaceoar was inserted to separate the rectum from the prostate. 5 treatments completed in February of this year. PSA went from 10.2 to 4.6 to 3.9 since then. Did not want to remove my prostate. For me, too many side effect risks. Kept reading about biological recurrence happening more often than I expected. Radiation first can make having my prostate removed later on more difficult but I am good with my decision. I narrowed my radiation decision down to proton therapy (Mevian) or the mridian (viewray) linac photon. Protect your healthy tissue from radiation. Mridian uses 2 mm margins vs every other radiation choice, including proton that uses 4-6 mm. Get more than one opinion outside your local network of doctors, preferably a center of excellence. Read the discussions on this site as you have been. LOTS of experience.

Here are some sources to check out:
Nccn.org: Many doctors follow their guidelines, and it is there for doctors and patients
Decipherbio.com:Takes a slice of the biopsy which helps evaluate aggressiveness and modes of treatments
Viewray.com: MRI/Radiation machine combination mri and radiation built into one machine. The only one out there. auto shutoff and real time mapping.
Mevian.com: Proton therapy. radiation stops at the prostate. Smaller beam.
PCRI.org: The Prostate Cancer Research Institute helps men and caregivers research their prostate cancer treatment options. Many helpful videos.

Good luck. Keep asking questions of everybody. You are dealing with experts that are human with strengths and weaknesses.

Prostatectomy or radiation & ADT are the primary choices.
72 yr old; I chose RP for cure potential w/ salvage radiation & short term ADT as backup.
Would make same choice again.
Personally, I believe that so much radiation discussion results from the many different radiation machines and protocols.
I chose an experienced surgeon at a center of excellence 1 1/2 hrs away.
Good luck to you in your decision.

I'm a 62 y/o with 3+4 on active surveillance (offered prostatectomy, EBRT and AS), PSA 4.6. Agree with all from bens1.

Will add that your comment about being told you "should have" a prostatectomy seems different from many of us who were offered multiple treatment options for Gleason 7 (3+4 or 4+3). Familiarize yourself with the NCCN guidelines from Ben's post so you can ask, for instance, why radiation wouldn't be under consideration. There may be a good reason, such as severe irritable bowel disease. Each doctor should be able to explain what's behind their recommendation for you and your particular cancer: accepted guidelines, current state of scientific literature, individual experience, personal preference, etc.

I had 2 positives on my biopsy and was classified as a Gleason 7. I went for hi dose brachitherapy, hormone therapy and 15 rounds of radiation.
There is no sure bet way to go with this. Cancer could come back in either. My thinking was there seemed to be less life changing things that happen without the surgery than with it so
I opted away from it.

Two years ago I was diagnosed with PC Gleason 9. I was advised by my UCLA doctors that my cancer was aggressive, CR, but did not spread beyond the seminal vehicles. They advised me that Radiation and RP were about the same effectiveness, but if I had radiation, a later surgery would probably have little benefit. I chose RP. It was not a bad surgery and after surgery was not bad ( but the ADT ended libido etc). I thought then and now that the RP kept important additional options for me, especially due to the aggressive, castration resistant cancer that I have. I believe that my thinking was rational and I would make the same decision again. Good luck to us all.

I was 72 when diagnosed (3/2022). PSA of 19.8, Gleasons up to 3+4’s and 4+3’s. PSMA showed cancer confined to prostate. Eventually I opted for RALP in late 8/2022, after having a month of Pelvic Floor PT, resuming PT after catheter removal. Post-RALP pathology report showed a cancer that would have survived radiation. Zero incontinence. PSA now at 0.008. Best of luck which ever choice you make and good health to all of us.

Take your time and calm down as normally prostate cancer is very slow growing, and you have time to make a decision. There are many threads on this site and comments from many of us with experience with many different types of treatment. Read all you can because from what I have read and seen is many of the doctors are not up on the latest innovations in treatments or their hospitals cannot provide them, and you may have to go elsewhere to get the best treatment for you. Best of luck.

First, get the book I have pictured here. My Gleason was 8, 4+4, 25% involved. Bone scan and CT Scan showed no metastasis. 62 years old.

Doc advised surgery because of aggressive cancer. So I did my reading and it backed up my doctor.

This is a proven work of information. Statistics bear out the options so you are a little more objective with your decision.

There is the shock factor, but once you get past the initial wave, I pray for you to have peace with your decision.

Recommend Dr Walsh's book 100%.
Pls note 2018 Ed and some protocols have evolved.

Try a pump for your libido. Works.