Surgery or Radiation for Intermediate Prostate Cancer?

First, I had two cancerous cores, one 3+4, as the result of my biopsy. I made a decision to have surgery. Prior to surgery, I religiously did my Kegel exercises. Post surgery, no nerve sparing damage and I had zero incontinence issues. Second, , my pathology results showed the Gleason score was actually 4+5; so the biopsy was not accurate. I also have a high Decifer score.
Since that time I have had 3 PSA tests all showing < 0.01. Hoping and praying for more of the same in the future.
My best advice would be to make sure your Gleason scores are accurate and get the best surgeon possible if you choose surgery. BTW, most doctors say surgery is not practical if you choose radiation first and it isn’t successful. Hope this helps. Best wishes👍🙏

Hi, I am answering as a wife. My husband was diagnosed in 2020 with intermediate PC. As will everyone, we did mountains of research and spoke to numerous support groups and got 4 opinions from top notch MDs in Nor Cal.
Long story short; my husband went with the surgery. Best decision ever made. It had spread into Seminal Vesicles (which we never would known if Radiation had been chosen). I am a worrier by nature. We now know several men who chose Radiation and they see their PSA fluctuate on a regular basis which keeps them on pins and needles. We are blessed to have a clean PSA (i.e. < ,01) currently 4 years post surgery. I would not have been able to handle the fluctuation of seeing ANY PSA over time. If, God forbid, it ever returns, we know it has come back. With Radiation you never know and your option for surgery post Radiation is much more difficult.
Recovery time was minimal and husband is strong and healthy. Just a personal opinion; we thank God every day we did not go with Radiation. Best wishes as you process this decision. Dee

I am thankful I had a Prostatectomy first. 8 years later, a recurrence, then radiation. No problems, PSA undetectable for the last year. Have it taken every 6 months. Good Luck!

That is awesome! Enjoy life and NEVER GIVE UP!

- Bob

I just viewed a UCLA Video on SBRT - 5 sessons . Mon - Wed- Fri. then Mon Wed the following week .
They also use it as a Monotherapy treatment . No ADT S ---T.
It's worth investigating this or Monotherapy HDR Brachytherapy .
Discuss with your Radiation Oncollogist .

Where you advised about a temporary PSA bounce ?

Hi. Just checking in to see how you’re doing. If you haven’t already seen the surgeon, you may want to add this question to your list

“What is Plan B if plan a fails and cancer returns?”

The only non-medical advice that I’ll share is if you decide to go the surgery route and perhaps even the radiation route I would learn how to do and start doing Keagles before whatever procedure you go through. That advice was given to me by someone on this forum. I did Keagles for three weeks before my surgery. I was mostly continant a week after the catheter was removed. I continue to do keagkes each day and seldom am in a panic to find a bathroom.

Good luck on your journey. We’re here for you!

There is no right answer. There's a list of potential side-effects for both radiation and prostatectomy, and you won't know until afterwards which ones actually occur, how severe they are, or whether the procedure did the job. You'll *never* know whether the other choice would have been better.

Maybe talk with your care team about different outcome scenarios for both in your very-specific case, which isn't exactly like anyone else's— what do mild side-effects usually look like? what do (rare) severe side-effects look like? what happens next if your PSA keeps rising? — and then choose the ones you're most willing to (maybe) face.

Good luck!

We were aware of 'PSA Bounce" is relation to Radiation. As far as surgery; we were made aware after 12 weeks it should be < .01 and remain that way going forward. Thankfully, that has been the case. With Radiation it can fluctuate all over the place. We know a few that have had the experience which is why we opted for surgery.

is there a specialist at Mayo In Phoenix doing Brachythetapy either high dose or low dose? what is the name? does this specialist do brachytherapy for intermediate cancer that is present on both sides of prostate? really could use the info.