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

I got radiation (SBRT), fell in the unlucky small percentage with long-term side-effects, and *still* have no regrets.

Surgery wasn't an option for me regardless with a distant metastasis, but for stage-4 prostate cancer traditionally they either would give no radiation or just a low "palliative" dose to the prostate itself. I opted for a large "curative" dose of 60 gy (which was just emerging as new standard of care in 2021), nearly the maximum allowed, and while it did cause some collateral damage to my lower bladder and rectum, it may also have helped bring me many more years of life, so I can cope with a bit of mild burning and urgency (which I've learned to manage).

In fact, every time I feel the mild burning, I tell myself "That means the radiation spread beyond the prostate and took care of any local cancer there as well". If a few still-undetectable cancer cells were starting to creep into my bladder or colon, the radiation likely sterilised them.

I doubt that. I have not seen any evidence fir that and I went down the rabbit hole after my diagnosis reading every published study I could get my hands on. Not even PCRI mentions that risk in any if their videos.

I regret surgery , maybe I was naive thinking surgery would get it all, was not prepared for radiation and Lupron to follow, numerous side effects and still no sex despite using injections, good luck

There may be other factors not mentioned in this stream of responses. I consulted with a RO and was advised that the large size of my prostate and how it adjoined to my bladder made radiation therapy much less advisable. Plus my age (79) and relatively low Gleason (3+4, 3+3) < 5%, makes AS the best choice for me right now. For some reason, my PSA declined from 7.67 to 4.06 between last October and April of this year. At this time, I'm doing the periodic checking via PSA, MRI and another biopsy in early 2026. Many considerations! Good luck with your decision, but it is YOUR decision.

I mistakenly chose RALP. Nothing has worked right down there since.

For what it is worth. I'm 4+3, trying to get IRE. I fully intend to go back on TRT when I am cancer free. I found it because under TRT i was getting PSA checked quarterly. I quit TRT for now of course, and my testosterone is down to 18 from 450. Highest PSA 6.5, now that I'm at 18, PSA is .84.

The point of the article is IF and ONLY IF, you have low T, getting back to normal has no effect on cancer or recurrence. My Urologist said this, when I asked him if I could back on TRT. He said, sure, I treat patients with normal T levels all the time!

JayHall, your experience is very encouraging as I will be having my surgery August 13th. Hopefully my outcome will be something I can talk positively about.

Well

Like many things, context is relevant...

When I was diagnosed in 2014, imaging was "primitive" and choices were binary:
Surgery
Brachytherapy

Fast forward today, advances in imaging and treatment agents mean many more choices for de novo PCa.

To answer your question, I had RALP, no incontinence, I regained erectile function at around 12 months.

I am 11+ years since diagnosis, surgery, SRT, chemotherapy. ADT, WPLN radiation, SBRT...

Side effects, none.

Kevin

Yes, I had surgery and wish I had done radiation. What my urologist told me at the time was that surgery could be done sooner because we’d have to wait for the seeds. What he didn’t tell me was that he could have given me a Lupron injection to stop the growth while we waited on the seeds.

As Sinatra sang, regrets I’ve had a few… I had RALP 30 months ago. Supposedly nerve sparing but they’ve never healed and I’m impotent now. Injections work up to a point, but it’s a challenge reaching orgasm through intercourse. As for incontinence I finally conquered it with an implanted sling 6 months ago. I was 0 for 2 on the big recovery issues but I’m still glad I had the surgery. They got it early and I’m confident it’s gone.