SBRT vs. Robot-assisted radical prostatectomy

I am biased as I had an RP. I was a 4+4 and had two of them. Good margins.

Options the same as yours.

I chose RP and yes those complications are real. I chose surgery because if I had radiation and there was a reoccurrence, then surgery is off the table.

Surgery was a success, clean pathology. Incontinence is improving and ED is not. Would I make the same choice again, sadly yes. Do I miss my sex life, yes. But I am healthy and life moves on.

I wish you the best in your journey.

Hello Dave,
I am 69 years old and was diagnosed with PC in August of 2022 and had the Robotic surgery performed in October of 2022. Thankfully, 100% of the detectable cancer was removed as it was totally within my Prostate. The “nerve sparing” procedure was successful. My PSA on the day following my surgery was < 0.014 and has remained at that level through last week.

Making the decision to utilize radiation or surgery for initial treatment is ultimately a personal decision one makes after consulting with your group of physicians and specialists. Personal lifestyle circumstances along with any other comorbidity factors along with one’s own personal risk assessments come into play in the making of a patients final decision. There are other factors to be evaluated as well. Including the consideration of what can I do or what options do I have if my cancer returns.

This certainly came into play in my decision process.
The surgery first option allows you to utilize radiation treatments if needed at a later date as a result of a biochemical return of your cancer. Although the “Salvage Surgery” option can be used and is done by some patients. The vast majority of surgeons do not like to perform it for two main reasons.
Firstly, the dead tissue left after the initial radiation treatment protocol doesn’t react or heal well during and following the surgery,
Secondly, there can be and often are complications involved with the post surgical recovery process.

My personal decision for the surgery was made on a number of considerations.
1. If possible, I wanted 100% of my detectable cancer removed immediately.
2. I didn’t want to continue with the radiation process, regardless of the protocol or combination of protocols initially utilized knowing that cancer is still in my body. The uncertainty of how long it would take to remove all of the detectable cancer was a concern to me.
3. Although most patients experience episodes of Incontinence and ED immediately following surgery. Most patients recover to their pre surgical functionality within a 6, 12 or 24 month time frame. Of course, you are generally making significant improvement along the way.
4. Many patients still ultimately experience some level of Incontinence and ED along the way during their radiation treatments. It just occurs more slowly and over time versus the immediacy following the surgical option.
5. From a personal standpoint, I’ve been severely debilitated from CFS & FIBROMYALGIA for the past 30+ years. I have the comorbidity of HYPOGONADISM resulting in Low Testosterone dipping to levels of between 20-90 if I am not on my “TRT,” TESTOSTERONE REPLACEMENT THERAPY. The “TRT” has been invaluable and one of the few treatment options that significantly reduces the totally debilitating effects of my ongoing health related disabilities.
All men require an adequate amount of Testosterone in their body to help maintain overall good health and well-being. Maintain good muscle mass and bone density. Maintain a healthy libido and overall psychological wellbeing. As you can see, all of the above are very important.
6. Radiation usually involves the direct opposite employing
“ADT,” ANDROGEN DEPRIVATION THERAPY. Most men experience the loss of everything “TRT” provides me. Although not all men have HYPOGONADISM or require “TRT.”
As a result, I simply would become too physically weak in addition to suffering from all the other side effects I’ve mentioned above.
7. Due to the severity of my ongoing disabilities, it would be very difficult for me to get to the hospital consistently enough to follow whatever radiation protocol which would have been prescribed for me.
I still spend many days in bed and am home confined.
8. It’s also extremely critical to understand that ultimately, the success and eventual outcomes following your surgery almost totally and exclusively rely upon the performance by your surgeon.
In general, it’s recommended not to have any surgeon perform the “Robotic Radical Prostatectomy” on a patient unless they’ve performed at least 1,000 surgeries.
It’s also important to review what levels of success and statistical results they’ve achieved!

I’ve shared and explained all of the above to emphasize the fact that every PC Patient is usually faced with additional circumstances in their life that need to be considered while making their treatment decision.

After all of the above and more are considered. Usually the radiation or surgical option starts to emerge as the best and most appropriate choice for the patient to make.

I hope what I have shared with you will be of some benefit in your decision making process.

Best wishes and good luck with your personal journey.
GODSPEED