prostatectomy vs radiation?

SBRT is brief only in the U.S., mainly (I think) because of Medicare billing rules. In Canada and elsewhere, SBRT is often fractionated into 20 sessions or more, just like other types of radiation, so that the exposure is more spread out.

As far as treatment goes, surgery and radiation have similar overall survival stats. Neither is guaranteed to get all the cancer, unfortunately (as you'll often see reported here in the forum). So talk to your oncology team about the pros and cons of each for your specific situation, and best of luck!

My brother at 76 had 4+3 Gleason, both sides of prostate , he had five doses of cyberknife radiation at UCSF. He had small cribriform. He’s doing fine and his PSA has been real low.

At 75 Surgery is sometimes discouraged, but you are in great health so you Could just pick either one.

The results are about the same matter whether you have radiation or surgery, Long-term the results are about the same.

Many people who have surgery end up having higher Gleason scores, When the whole prostate can be examined.

I faced the same choice, so looked at the side effects of both.
They both feature the delightful bladder incontinence, but radiation also offers the added bonus of bowel incontinence as well.
It was a hard no from me.

But just Google 'prostatectomy vs radiation".
You'll find lots of opinions & experiences.

If you do not have components of large cribriform and/or IDC both of treatments give about the same results. The only thing is that if you have radiation in one area, you can not repeat radiation on the same spot in case that there is recurrence of the cancer in that same spot. We decided to have RP because my husband has 4+3 unfavorable BUT he also has both cribriform and IDC and Decipher 100 : (((. Side effects can be very similar but in reverse order. For us RP gave better chance of getting rid of the cancer and gave us possibility of having radiation later if needed. My husband is 69 years old.

Wishing you the best of luck with your treatment and excellent results with whatever you decide < 3.

Yeah, I'm in a similar predicament and quandary.
I've been set up with appointments for consultation with a surgeon, as well as a radiation oncologist over the next two weeks, so I promise to report back what I uncover with that.
Similarly, the possible bowel incontinence with radiation gives me extreme pause, too, plus its added side effect of fatigue, another health issue I've been dealing with for the past year as a Long Covid phenomenon.
I'll also be getting a second opinion the first week of August from a very experienced urological oncologist, so I expect to make a decision soon thereafter.

Wishing us both good luck!

@lcbc
I see you posted intermediate risk. Did you have a Decipher test? If not would recommend doing so as more definite determination of risk level.

My original risk level was given intermediate like you. The Decipher test came back as low risk. That changed my recommendations for my treatments.

Both radiation and prostatectomy are cancer killers; both have statistically equivalent success rates (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122); it all comes down to side-effects and quality-of-life (or as that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).

Quality-of-life depends on your priorities. For me, quality-of-life and successful treatments were equal priority; with my priorities, that helped determine my choice of treatments (28 sessions of proton radiation) for my 4+3=7 at 65y/o.

> Using a rectal spacer manages the bowel incontinence and other issues with rectal tissue damage; I had no urinary incontinence.

> After having initial radiation if I ever do have a recurrence, I have many options depending on the nature of the recurrence: focal therapy (e.g., cryo), brachytherapy, SBRT, and possibly even re-radiation. Prostatectomy (salvage in this case) would again be the last choice that I would consider.

I didn’t want to risk the urinary bother that sometimes comes with higher doses of radiation (SBRT). (Dr. Rossi talked about this at the 2023 PCRI Mid-Year conference starting at 4:30:40 of his presentation: https://www.youtube.com/live/WTqPnSRYtW4?feature=share). Even though I had my treatments in April-May 2021, I had seen similar data back then.

For me being retired, the more (but shorter) radiation sessions (28) were easy to incorporate into my daily routine; that wasn’t a major consideration; the radiation center was just a 40-minute drive from home.

Good luck with your decision.

Darned Canadians, always bragging about how their country is so Great!
Bunch of showoffs...

(...I keed, I KEED!)

❝Darned Canadians, always bragging❞

Sorry. 😉