Outcomes and impacts from SBRT and/or Robotics Radical Prostatectomy

My brother had small cribriform And was treated with five sessions of SBRT radiation at UCSF with Dr. Roach. He had that three years ago and he’s now 80 and doing fine. I know other people that have been treated by him, One guy with a Gleason eight treated 15 years ago had ADT for a short time and has never had a reoccurrence.

I had an RP And I’m still around 16 years later, even though I have a Genetic problem that makes it more aggressive. 3 1/2 years after my RP I had to have salvage radiation. I’ve been on ADT for nine years and at 78 It’s not really a big deal Since I have no fatigue.

There’s a new surgery technique that makes incontinence a very short term thing and the same with erectile dysfunction as long as you can have the nerves spared. Here’s a couple of links discussing it.
https://connect.mayoclinic.org/comment/1548188/
https://www.mdanderson.org/cancerwise/how-retzius-sparing-prostatectomy-helped-a-prostate-cancer-patient.h00-159538167.html

@jeffmarc Thanks for your response Jeff. I appreciate you in depth experience on these matters! I will review your link and circle back. Can't believe how tough the decision is. My two brothers had radiation two years ago and are happy with results. I just don't know which way to go yet...

My 2 cents....

I was doing the radiation vs surgery thing, too.
Reading about them, I found that surgery often results in incontinence & ED pretty much immediately (although they do resolve later).

Radiation (which I didn't choose) can result in bladder incontinence AND bowel incontinence.
ED doesn't immediately appear as a problem, but can show up later.
Bowel incontinence was a hard no, for me.

But if continence & erectile function are important to you, surgery is not your friend.
https://www.differencebetween.net/science/difference-between-surgery-and-radiation-for-prostate-cancer/
Other opinions incoming.....

In brief, diagnosed Gleason 4+3 at 59 in Dec 2025. Retzius, single incision RALP Jan 2026. I chose the surgery for a few reasons. I am working and radiation would be most disruptive for work and I would need ADT with my risk being higher at 4+3. Wanted to avoid ADT. Otherwise, I would likely have had radiation. Surgery was very successful. Currently undetectable. No real lack of continence, except a bit of stress incontinence which resolved in less than two weeks after catheter. Natural return of erectile function progressing 7 mos post surgery. Utilize Trimix for sexual intercourse. I have zero regrets and am very grateful!

@johnnyz
I believe you asked to provide our direct experience.

I had 30 rounds of proton radiation with no hormone treatments. This treatment plan was specifically designed for me based on my individual cancer, diagnosis, prognosis and my full mental and physical health history.

I had little or no side affects from the radiation. Proton radiation stops a a calculated spot and does not continue out the body like photon does. With proton you can possibly reduced radiation damage to surrounding organs and tissues.

At my second C.O.E. I saw so many children there. I was told because children are so young the secondary damage from radiation proton treatment can add an additional benefit.

I also saw patients from all over the world there to get proton radiation for eye and brain cancers because of the ability to control the radiation beam and will (research still being done per my R/Os) lesson the side affects of radiation as much as is possible.

The bladder does get secondary radiation damage explained to me. The technique to reduce bladder secondary radiation damage is drinking water prior to treatments. Per my R/Os it helps move the bladder away from prostate.

My R/O also used the Space/Oar to help move the colon/rectum away from prostate to lesson the radiation damage there as well.

My R/O radiates the entire prostate and margins. Why? A biopsy only shows if cancer is present in that one sample. A MRI looks for suspicious spots but does not see all as can be microscopic.

My R/O explained to me why he does all the prostate and margins. He did not want to miss a part of the prostate with cancer that was not seen or identified by MRI and the biopsies done (I had 16 MRI/Fusion).

I want to make sure that I stress this information comes from my R/Os fromt two different C.O.Es, R/Os, urologists, and my PCP. Not describing what another did as your cancer is specific to you. My R/Os said they have been doing radiation treatments for 20 years and thousands of patients.

My side affects which is my personal experience, not what others had, or a research somewhere, were very minor. Had nothing during radiation other than some minor fatigue which I fought and kept exercising.

Some time after it ended I noticed frequent urination and some dripping. My R/Os stated again my prostate just went through WWIII and is going to be very irritated for many months to come.

My side affects I would rate as minor and easy to deal with. I am not experiencing any side affects 3.5 years later other than dry organisms and was told common as seminal vessels are damage by radiation. I am 79 now and nothing works like it did in my 20/30s.

I think it is important to recognize this is your body, your cancer. Only you, and your medical doctors have your full medical and mental health history and what is best for you.

There are many site (Mayo, Cleveland Clinic, John Hopkins) you can got to for research to also help you understand more but remember those statistics are not you and your specific journey with prostate cancer.

I got a second opinion even though I was original diagnosed at a C.O.E. The second opinion also came from a C.O.E. institutions. There was no disagreements on my diagnosis and treatment recommendations.

And what is my prognosis 3.5 years after my treatments ended. My PSA was undetectable 3 months ago.

@peterj116 Thank Peter, much appreciated. the link is also helpful

@tattodice Thanks for your story, much appreciated. Good to hear of your progress!

@jc76 Hello JC and thank you for responding. Your detailed story sounds like all was just right for your cancer situation. I am thankful that my numbers are not too high as I am graded as T1 Intermediate barely favourable, on the cusp between favourable or unfavourable. So , Will work to become as informed as possible in making a treatment decision. Again, thanks

@peterj116
There’s a new type of surgery Retzius Sparing that greatly reduces the chance of incontinence and ED. You should consider a surgeon that has done many.

While you have heard of many side effects of radiation, 5 sessions of SBRT seldom results in long term issues. You could pick proton radiation, though some people still have side effects from it.

Keep in mind around 40% of of men who have prostate removed end up needing RT anyway. I personally like you radiation oncologist's plan.