Why did you choose surgery instead of radiation or vise versa?

I have heard same comments from friends who had surgery back in early 2000s. Proton radiation was very limited. Then more hospitals and facilities started building them like UFPTI and Mayo.

The early days of having photon radiation did create a lot of side affects. However today's photon radiation has been fine tuned to keep radiation damage and side affects down from original treatments.

I chose proton as the biggest difference was photo will pass through body where proton stops as prostrate as it can be control where is releases it radiation. Proton and Photon have same cure rates it is just the fine tuning and radiation not passing through body is the biggest difference.

For myself, watching cancer grow within my body would be a difficult choice. I am currently 15 years younger, but pray that at 72 I will still be active and living life to its fullest. If you address Gleason 6 (3/3) cancer, BCR percentages are quite low, giving you a great chance of a prostate cancer free life.

Good luck with your Mayo appointment!

Jim

Rice: Although doctors dedicate their lives to helping people, they are not infallible. They suggest, many times, what their success has been which is not necessarily the best choice for you. When I was making a choice for myself (I had 3+4 and 10.2 psa), with 5 RO opinions including one that said hormone therapy, I decided no to hormone therapy because of side effects and went for targeted narrow margin radiation to protect healthy tissue. I got the decipher test using the biopsy material which is good for a year, to get an idea of aggressiveness and doctors DO use the test to evaluate your treatment. I did not want my prostate removed because of potential side effects and 20-30% chance of biological re-occurrence. Do your research on radiation machines, margins and side effects. Your getting another opinion with Mayo so that's good.

Hello Rice,
Yeah, confusing but probably not unusual to many of us.
I was/am lucky to have a great oncologist and my decision was easy.
FWIW, maybe have a second look at the biopsy. On my second biopsy my PC was a small growth and only showed 2 cores (7 score) but on the far right side.
Had RALP but bad margin and the PC had escaped.
So a close re-look at your biopsy MIGHT help focus your decision.
Good luck and Godspeed.
bob

I am in same situation.
AndO agree - every MD has a different opinion

Ken

As for me, Diagnosed at 72 on March 28, 2022. I did tons of research, compiling a 2" binder filled with articles from various reliable sources, like Mayo Clinic, Johns Hopkins, Cleveland Clinic. I read Dr Walsh's book on surviving Prostate Cancer. From all of this I learned that Radiation after Prostate Surgery was viable, but Surgery AFTER Radiation was very specialized.

A PCMA (?) test showed the cancer to be confined to the prostate gland. I was up to 3+4's and 4+3's. I had the last appointment of the day with my Urologist - he and I were the last to leave his office. I told him I was choosing the RALP, having reviewed many of the articles with him. He said that he would have made the same choice with the same numbers.

Surgery was 8/23 of same year. My pathology report was that there was a previously-undetected cancer in the prostate gland that would have survived radiation. That made me feel REALLY great.

BTW, I did about 4 weeks of Pelvic Floor PT prior to the surgery and 4-6 weeks more after the surgery.

I had ZERO incontinence issues, NONE, ZIP, NADA, NICHTS! Note one leak, dribble or spotting

I with you the best of luck in your journey and in your choice.

There are many ways of identifying the extent and progression of prostate cancer. Cancer in general is listed as stages 1-4, and this can also be applied to prostate cancer, but it is often not what people are referencing. Here is one link that provides some further information (and correlation) without getting too far into the details. https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/staging.html
1. At that link you will find that "Grade group IIB" correlates with a "gleason score of 3+4."
2. Gleason scores refer to cell analysis under a microscope of removed samples, either biopsies or slices of a prostate. In general, they are talking about the most abnormal (cancerous) sample when only one is given. 1 and 2 are considered in the normal range, 3-5 indicate increasingly abnormal cells.
3. The first number is the most common in the sample, the second is the second most common. So 3+4 is better than 4+3, even though in a different scheme they might both be referred to as 7.
4. Since biopsies get graded as 3+3 up to 5+5, one scheme is to renumber these as 1 through 5, where 1 is 3+3...and 5 is 5+5. If this were the scheme, over 1 is beyond 3+3, and 3 is 4+4.

But wait, there's more! Another way of looking at prostate cancer (pc or sometimes in the literature PCa) is low risk, intermediate risk, and high risk based on the aggressiveness of the cancer. In the staging table above, intermediate are the II's (a, b, and c). However, there's a big difference among intermediate risk cancers, so they can be split into intermediate favorable (lower risk) and intermediate unfavorable (higher risk). While there are other criteria, initial diagnosis based on biopsy would split between intermediate favorable (3+4=7) and intermediate unfavorable (4+3=7). As you might guess, when more abnormal (cancerous) cells predominate in a sample, there is more likelihood of spread beyond the prostate.

Lastly, here is a link basically describing the 4 (5) stages of cancer. https://www.webmd.com/cancer/cancer-stages
There are five if you include the zero stage. Once it is detected, it is always at the stage detected. If you want to correlate, generally stage 2 is intermediate unfavorable, stage 3 is spread to nearby lymph nodes or other tissue at the margins of the prostate, and stage 4 is elsewhere, typically many other places in the body--prostate cancer eventually spreads to the bones. The label sticks with where the cancer cells initially came from, because it indicates the type of abnormal cells spreading, so cancer in the bones that started in the prostate is metastatic pc, which is another name for stage IV prostate cancer.

I was diagnosed just over a year ago at 70. Initial biopsy showed Gleason 4+3, consultation with 2 urologists and a radiation oncologist let me to the decision to have RALP this past January. MRI indicated cancer was contained. Post-surgery findings lowered Gleason to 3+3 and 4 lymph nodes were clear.

My major reason for choosing surgery was that future radiation treatment would be available in the event of recurrence.

PSA post-op has been non-detectable (< .01) and incontinence is almost a non-issue now. Next step is physical therapy to help restore erectile function. I’ve kept up with pelvic floor and Kegel exercises as well as overall fitness.

In retrospect, I’m happy with with the treatment I chose. The past 16 months since initial diagnosis has been a roller coaster of emotions and has given me a somewhat different perspective on life - all in all a good experience.

Good luck with whatever treatment you choose.
Jim

I'm 59, and just had Radical Prostatectomy surgery 4 months ago. The cancer was removed and everything is clean after my 3 month check up as well. I too had 3+4=7 on 1 core out of 14. Wishing you the best! I'm sure you've been told this, but be prepared to wear pads for sometime afterwards. I am down to 1 daily now. But glad that I had the surgery.

Glad to hear you’re doing well. I’m prepared to wear pads. And also the catheter for a week.My doctor puts a lot of emphasis on Kegel exercises. I do them religiously throughout the day, everyday. Hoping it makes a difference. Thanks for the response!