Do you regret having had a prostatectomy vs. radiation, or vice-versa?

They wouldn't have offered me a prostatectomy with advanced prostate cancer anyway (local spread is highly likely in addition to the distant metastasis, and radiation handles that better).

But regardless, I'm glad I didn't have to have any more surgery. I was in bad shape for many weeks after my spinal surgery with a cascade of serious post-op issues (including losing 40 lb in a few weeks), so no one's cutting into my body again unless there's no reasonable alternative.

Radiation and prostatectomy are both reasonable choices — I'm not trying to change anyone else's mind — but from my personal PoV, radiation is less invasive and equally effective, so no regrets. 🤷

This is a very tricky question and I do not think that you will get a correct statistic here since most people that are here have some lingering problems.
Vast majority of patients that didn't have any problems with either RP or RT will tell you that they are very satisfied with their choice - but they are not here to tell you that, or are here in very small number.
"Better" is what is more acceptable for you - dealing with side effects immediately or later IF there are any side effects. Some people have RP and no recurrence and no side effects and they will tell you (if they were here) that they are very happy with their choice and it would also apply for RT patients.
Both methods can have possible (and almost the same) side effects. Some people got incontinence after RT but rarely, but they will mostly deal with possible urethral blockage in couple of years down the road or chronic cystitis, or chronic proctitis, or secondary cancers etc., some have serious side effects from using ADT , like osteoporosis, heart issues, low testosterone levels that might not ever return to normal amount thus having ED and low libido, etc, etc.
At the same time RP can cause permanent incontinence in about 5% ( but percent can be much higher with inexperienced surgeon) and also ED.
Both have pros and cons and unfortunately nobody can try the both ways and see what worked better for THEM. So - it is all about "picking your poison". What looks more "manageable" for you ? It also depends of you age, health status and life expectancy.
Regarding success rate, the only time where RP has little bit more advantage than RT is in the case where pathology shows presence of cribriform or ID formations.
My husband will have RP and he will never regret it, no matter what will side effects be. One can not regret a choice well made, one that you make with certainty and well informed - one that gives you the best chance for survival. Also, he sees surgery as "no big deal", and to him it looks like "one stop service" - chop it out and "finito", (hopefully, knock the wood). For example, to him ADT looks like a torture, especially since it effects cognitive capacity and his whole work is based on creative and inventive processes. He works full time one job and has 2 additional startups on the side. Downtime due to tiredness or "brain fog" is just out of question for him.
Second important factor is that his pathology showed both cribriform and possible IDC , and RP can offer a better result in those cases. He is fully aware that down the road he may need additional treatments if RP does not prove to be curative for him, but again, than he will have no choice. Given a choice (as he has it now), surgery is more appealing to him and will give him possibly a better chance for survivorship.

My personal belief is that invasive surgery will most likely result in the spread of cancer and there are so many surgeons that are eager to perform surgery- after all that is how they make their money!!

We must face the fact that cancer is such a sneaky bastard that when is put in remission at location it will show back up in another location so we are charged with battling one at a time, but I believe that each episode must be battled with a furiosity that lets the bastard know that you refuse to back down!

If I had to do I again in 2025, I would choose radiation. I had my prostate removed in 2006 and have had all kinds of side effects. Radiation back then wasn’t as perfected as it is today. So I think I would choose radiation.

I think the main thing to avoid is the misconception that surgery can "get it all" while radiation can't.

If the cancer is still fully confined to the prostate, perhaps surgery has a very slightly better chance of "getting it all"; if some undetected cancer cells have already crept just outside the prostate, then radiation has a slightly better chance of "getting it all".

But since there's no way to detect tiny local spread, neither option is automatically the safer choice, as the overall survival stats show. If it were an easy, obvious choice, this question wouldn't keep coming up every couple of weeks.

Like many of us, I had the choice of radiation or removal. My goal was side effects and quality of life and of course, getting rid of the cancer. I did not want to take the chance of the side effects with removal. I narrowed my choice down to Proton or a radiation machine that had a built-in MRI versus fused images. I felt my chances for side effects were minimized because the margins with that type of machine were smaller so there was less healthy tissue exposed.
I had slight urination issues after the third treatment which Flomax took care of overnight. That was in February 2023 and since then, I have had no issues. I did have spaceor put in. I had no ADT, a PSA that started at 11.2 and my prostate cancer was contained within the prostate. I understood that once I had radiation I could not re-radiate the same spot if I had a biological reoccurrence. So far so good.

I would have still done radiation but would have skipped ADT and taken my chances. I was only on it for six months but now it's a full year later and I'm still having problems and side effects from my testosterone not returning. That's the single thing that makes me angry about the whole experience--I was given minimal information about ADT (you'll have tiredness and hot flashes is all I was told). I suppose part of it is my own fault for trusting my doctor without doing additional research on my own. I was a G7 4+3. In terms of PSA, radiation has knocked it down to .04 which I'm told is good.

@sandguy
This is always such a subjective question as it deals with personal choice. I agree with poster who say what is important is quality of live, side affects, degree of the type treatment will have on your life, etc.

The thing that is important to me was what is the best treatment for me based on mental health, physical health, and the prognosis of successful treatment. With that I got 3 different opinions learning much by doing that. Then did research and saw what a lot see a urologist will most like say surgery, a R/O radiation. Not hard to understand that because that is the area of their expertise.

I would not change the method of my treatment. I had 30 rounds of proton radiation with no hormone treatments. But I had additional test after my biopsies (Decipher, PSMA, bone scan) all those confirmed to me my choice of treatments.

I then met with my PCP and we went over all consultations and tests and he said I agree with your choice as being best for you. The only think I have a question about was would I change to the high dose 5 treatments versus the low dose 30 treatments.

However both my Mayo PCP and R/O at UFHPTI was saying information and feedback coming back on the 5 high dose (which is fairly new) was showing more degreee of side affects. But then I thought that would make sense and the high dose was damaging the prostate cells and other areas at a much high dose. So what was my deliema now. I think mental health when you have prostate cancer is just as important as physical health.

With that I think getting the treatments over faster would have reduced the stress and axniety. But I would weight that with the probablility, and will say that again, probablility, that could cause quicker and increase in side affects. Both the long term low dose and short term high dose have shown (per my PCP and R/O the same success rates. So really comes down to getting it over quicker and back to normal lifestyle or long dose and the possibility of lessor side (degree) affects.

So you can see by my post really comes down to you the individual and what you chose after a lot of research, 1st and 2nd opinions and that is important to you as an individual not what is what important to others as it is your life.

My Post op PSA blood work is coming up soon and I will know more after I get those results. Do I regret having a RARP. My current answer is No I do not. I have little to no incontinence and I'm slowing regaining my ability to get an Erection. My PT for my Pelvic floor was a success and I no longer dribble, etc. My life is returning to normal and overall I am feeling better.