prostatectomy vs radiation?

I am 64, and was diagnosed in late March 2025 with Gleason 4+3, Cribriform pattern and unfavourable intermediate risk. A PSMA MRI Scan in January detected a 1.1 cm lesion with a gross extraprostatic extension on the left side of my prostate that could not be detected by a DRE or ultrasound. The biopsy found cancer in all four cores from the lesion, but not in the other 12 cores. A PSMA PET Scan found no evidence of metastasis. I am also fit, overwise healthy and am an avid mountain biker and cross country skier. I used to play squash competitively, and some of my old squash buddies are now pickleball players, but I haven't tried it yet.

Armed with all this information, I started my research. I read everything I could find from reputable sources. As part of my research, I also travelled down to the Mayo Clinic in Jacksonville Florida (from Alberta Canada) to have consults with a Urologist (surgeon) and a Radiation Oncologist. Each consult included a resident in addition to the specialist that I booked with. I also spoke to two different urologists here in Alberta. In total, I spoke with four urologists and two radiation oncologists. For my situation, all six doctors agreed that radiation and a RARP were good options that would have a good prognosis. All six doctors also told me that in my specific situation, they would opt for the RARP. The urologists were concerned that radiation would preclude the option of surgery later on. The one surgeon said that if cancer re-occurs after a prostatectomy that it is often localized and follow-up surgery can be an option in this circumstance. The radiation oncologists said they would opt for surgery because of the negative side effects of hormone therapy that would be required after radiation.

One of the urologists I spoke to was the son of a family friend who specializes in helping patients who have complications post treatment for a broad range of prostate issues including cancer survivors who have undergone prostatectomies and radiation treatments. He told me with surgery you get the bad stuff over with up front, but with radiation the side effects tend to show up ten years plus or minus down the road. He told me that if his dad was my age and in good health, he would advise him to have surgery. If his dad was 80 then he would advise to have radiation. The primary determinants were health (able to handle the rigours of surgery, age (likelihood of living long enough to experience the delayed effects of radiation) and no evidence of metastasis.

Your situation and mine have some similarities (health and fitness) and differences (age). I am glad that you are also speaking to a radiation oncologist. Ask a lot of questions about side effects of hormone therapy that I was told can linger for months or years after therapy is finished, as well as the potential for longer term side effects.

I wish you well with your journey and in making the right decision for you. FYI, I had my surgery (RARP) on Monday, July 14th, and I am writing this comment on day three of my recovery with my foley catheter bag at my side.

I am 64, and was diagnosed in late March 2025 with Gleason 4+3, Cribriform pattern and unfavourable intermediate risk. A PSMA MRI Scan in January detected a 1.1 cm lesion with a gross extraprostatic extension on the left side of my prostate that could not be detected by a DRE or ultrasound. The biopsy found cancer in all four cores from the lesion, but not in the other 12 cores. A PSMA PET Scan found no evidence of metastasis. I am also fit, overwise healthy and am an avid mountain biker and cross country skier. I used to play squash competitively, and some of my old squash buddies are now pickleball players, but I haven't tried it yet.

Armed with all this information, I started my research. I read everything I could find from reputable sources. As part of my research, I also travelled down to the Mayo Clinic in Jacksonville Florida (from Alberta Canada) to have consults with a Urologist (surgeon) and a Radiation Oncologist. Each consult included a resident in addition to the specialist that I booked with. I also spoke to two different urologists here in Alberta. In total, I spoke with four urologists and two radiation oncologists. For my situation, all six doctors agreed that radiation and a RARP were good options that would have a good prognosis. All six doctors also told me that in my specific situation, they would opt for the RARP. The urologists were concerned that radiation would preclude the option of surgery later on. The one surgeon said that if cancer re-occurs after a prostatectomy that it is often localized and follow-up surgery can be an option in this circumstance. The radiation oncologists said they would opt for surgery because of the negative side effects of hormone therapy that would be required after radiation.

One of the urologists I spoke to was the son of a family friend who specializes in helping patients who have complications post treatment for a broad range of prostate issues including cancer survivors who have undergone prostatectomies and radiation treatments. He told me with surgery you get the bad stuff over with up front, but with radiation the side effects tend to show up ten years plus or minus down the road. He told me that if his dad was my age and in good health, he would advise him to have surgery. If his dad was 80 then he would advise to have radiation. The primary determinants were health (able to handle the rigours of surgery, age (likelihood of living long enough to experience the delayed effects of radiation) and no evidence of metastasis.

Your situation and mine have some similarities (health and fitness) and differences (age). I am glad that you are also speaking to a radiation oncologist. Ask a lot of questions about side effects of hormone therapy that I was told can linger for months or years after therapy is finished, as well as the potential for longer term side effects.

I wish you well with your journey and in making the right decision for you. FYI, I had my surgery (RARP) on Monday, July 14th, and I am writing this comment on day three of my recovery with my foley catheter bag at my side.