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

Pardon my potential ignorance here, but what is the cause of your tinnitus? Might that be a Lupron side-effect, or are you secretly a Heavy Metal enthusiast?

Well, it may have had a little something to do with the Ozzy Concert at Treasure Island. 🙂
They put me on Venlafaxine to help with the unbearable hot flashes and stomach pain from Lupron (I get it Ladies), and it has given me incurable tinnitus (google it), the VA gave me hearing aids that help but 24 X 365 loud high pitch in my head.

I get it, this was 2016 so may not be a common treatment anymore.

It's in my bones - goodbye cruel world

When my urologist diagnosed my prostate cancer (see my profile for the history) in 2020, he did a very smart thing: He gave me Dr. Patrick Walsh's book "Guide to Surviving Prostate Cancer" & told me to read it. Dr. Walsh of John Hopkins is considered the world's expert on prostate cancer treatment, & he presented both options equally. I read the book, & it seemed to me that surgery was the best option. I weighed the issue of nerve-sparing surgery, & considered that the risk (the cancer had reached the surface of the prostate gland) outweighed the benefits at my age.

That book said, if you are going to have surgery, get the most experienced surgeon you can find. My urologist was doing 35 a year, but at the U. Wash. Medical Center, Dr. William Ellis (now retired) was doing 115 a year, so I selected Dr. Ellis. He told me that he was willing to do the surgery, but he didn't recommend it for men over 75. He recommended radiation, & sent me to a specialist for that.

Well, I wasn't having any of that age stuff (both of my parents lived to be over 100), so I selected surgery. Well, I wake up after surgery, & there are five tiny bandages, each the size of a dime across my abdomen, & no pain. I walked that night in the hospital, & the next morning was told in my room that I could get dressed & leave (with a drain & urethra catheter). No wheelchair or escort.

I resumed normal activities immediately. Ten days later in a follow-up meeting, the drain & catheter (which were a minor annoyance) were removed.

There is no question that I would heartedly recommend surgery. I had one friend who had the non-robotic surgery & has been cancer-free for 15 years. I also had two friends that chose radiation for their prostate treatment, & both have ongoing urinary issues which restrict their mobility.

My PSA started to rise rapidly six months after surgery. My new oncologist did a PET scan & found a target in a periaortic lymph gland, about 8cm from the prostate site & 1cm from my lower aorta. That was a bit too close to the aorta for radiation, so he began ADT.

From reading here, I guess I have been fortunate. The only side effects of the ADT have been occasional mild hot flashes about once a month (which I consider amusing), & not having to shave every day. I moved the contents of my house from one state to another, with help only for the heavy stuff, so I didn't perceive any noticeable loss of strength. The Abiraterone did cause a rise in blood pressure, which was successfully treated with Losartan.

Last year, my new oncologist asked if I would like to try going off ADT . I initially declined, as I had been comfortable with an undetectable PSA for 2.5 years. However, I was curious if the cancer was gone, so 15 months ago, I stopped ADT . My BP returned to the 123/78 that it had been for over 60 years, but now I have to shave every day! As you can see from my profile, my PSA started to gradually rise after a year of no ADT . My oncologist says I can go back on ADT any time I want, but he'd like to wait until my PSA gets to 0.20, at which point another PET scan would be useful. The fact that my PSA appears to have flat-lined is curious.

Questions welcome!

I had an RP and would have gone with Proton radiation with hindsight. So many of us RP guys end up with salvage radiation anyway. A friend of mine will be starting 45 sessions of proton in a few weeks and after talking about the process I wish I had gone that way. Apparently they start with the margins and lymph nodes first and work inwards toward the prostate later in the process. I found EBRT horrible due to the side effects and the wide area it hit. Still having some side effects 4 months later.

I had RARP and almost two years ago. My life has been back to normal for more than a year. I cannot imagine wanting death over the inconveniences following RARP.

I had RARP 22 months ago. I have no regrets. There was little pain. The catheter was an inconvenience for 10 days, but nothing more. Incontinence was an issue. Slow progress for almost three months and that became discouraging. I then started using a rowing machine at someone's suggestion and that proved very effective. By five months I was using one Depends and by six months had no issues. My PSA was quite high, but is now undetected. I feel that I have more treatment options, including radiation, if I have a recurrence.

I had a radical prostatectomy in early 2011, so everything I was told or offered back then would appear to be outdated today. But, for what it’s worth, I had a PSA score that was still within “acceptable” levels, but suddenly and quickly rising at age 59. A biopsy confirmed cancer, and as the PSA continued to escalate, it appeared to be fairly aggressive. I had a consult with three different specialists - urologic oncology, radiology, and surgery - at the same time in the same room, explaining what my options were and fully expecting each to recommend a different approach. I was then quite surprised when all three recommended surgery, and the sooner, the better. Despite the associated risks, side effects, and obvious lack of guarantees, their unanimous recommendation made my decision fairly easy. The next available date wasn’t for several months, but I jumped to the top of their waiting list when there was a cancellation several weeks later. That, too, reinforced how quickly they wanted to stop the fast moving cancer from continuing to grow. I am thrilled to say that the surgery was quite successful with never a sign of any cancer some 14+ years later. During the consultation, it was explained to me that if the surgery did not get everything, I could then go the seed or radiation route. Surgery, first, still kept other options open if needed. But, if I opted for radiation first, that would rule out a prostatectomy forevermore, even if the radiation didn’t do the job. I don’t know if that would still hold true today. And, as my surgeon said after it was confirmed that there was no trace of any post-surgery cancer, I would never have to worry about a recurrence of prostate cancer ever again because I had no prostate! Was my recovery trouble-free? Heck, no! But, it was manageable, and I have been able to thrive, not just stay alive. Is my experience somewhat typical and to be expected? I can’t say since everyone is different, and I know there are a lot of men who haven’t been anywhere near as fortunate. But, I am at least one good example that surgery can yield some great outcomes, the side effects be damned.

I finished 28 sessions (250 C gy per for a total of 7000 C gy) of EBRT May of this year. I find it interesting that I mainly see Proton radiation in these discussions rather than Photon. I am two months past my last radiation session and am curious about the unknown for side effects in months to come. The local cancer clinic only provided Photon. The radiologist told me there was much more experience with photon than proton. And they used a Truebeam which targets the prostate more accurately. Curious if side effects down the road are better or worse with photon vs proton.

Everything depends upon your age and health at the time of discovery, family history of other medical issues etc. If you are 60 when diagnosed and most men in your family history live past 80, doing nothing would not be a good choice. If you are 67 and your father and his father died at 72 of a stroke, the decision is altogether different. In spite of all the hype about how aggressive prostate cancer is, my most recent urologist at a world renowned cancer center said it like this. You don't have aggressive cancer, you have active cancer. "On a scale of 0-100 with 100 being the most aggressive form of cancer, you are a 2!" He is fully aware of 2 MRI's, a biopsy 4+3 gleason, Decipher Score or .84. "Whatever treatment plan we come up with, we are treating what is going to happen 10 years from now!" I wish the 3 other urologists and the oncologist I saw before him had explained it that way.