Deciding: Surgery vs. Radiotherapy 64yr old Gleason 3+4

@jeffmarc
I often hear on this board patients discussing how they have no ED after radiation. I wonder if their Doctors sold their radiation option that way over surgery without the caveat, but yes in two to three years you will definitely have ED because we fried your nerve bundles. Their is no coming back from that after radiation. I personally feel Surgery gets a very bad rap about ED, because with many with localized cancer, nerve bundles spared and the Retzius sparing surgery, their ED goes away fairly quickly with use of like viagra, and for many they have resumed normal relations by 18 months post surgery even without drugs. Incontinence is even way down with the newer surgeries. I think many are living in the past when they think of prostate surgery. Will everyone have the same results, likely not, but way more today fare way better than in the past. Results between radiation and surgery for localized cancer may be the same when they measure the cancer itself being gone, but the side effect difference can be huge. So many radiation side effects including rectal and urinary issues can come two+ years later . Your ED will definitely come . I really don’t think patients realize that.

I was presented with the similar treatments for my PCa - originally scored as 3+5, intermediate unfavorable. I had the options of surgery (standard RALP, because I wasn’t a good candidate for RS-RALP), or hormone-and-radiation therapy. 59 when I was diagnosed and had surgery, 60 now.

I chose surgery (partial nerve-sparing) based on what I saw as far fewer major side effects and the length of treatment - surgery, they pluck it out and then I was on my way to recovery, but the other treatment plan was 3-1/2 years, and then the ongoing recovery from that. As the outcomes were statistically the same, I went with the surgery, and had that done in January.

Do I like the side effects (incontinence and ED)? No, but I sure do like that the treatment is over, and now all I focus on is recovery, which at this point consists of pelvic floor exercises twice a day and avoiding all bladder irritants (caffeine, alcohol, spicy foods), and penile rehab (daily low-dose Viagra, daily vacuum erection device session, and a weekly full-dose Viagra and attempt to achieve an erection, just to gauge progress).

My incontinence is much improved (I’m on track to have an entire week of daily leaks of <100ml, that’ll be a first), and I’m occasionally feeling little indications of signs of life with my erections, but nothing even close for penetration. That can take years, though, to recover (if it does recover).

BTW, after surgery, pathology downgraded my cancer to a 3+4, intermediate favorable, though they did find cribiform glands, and technically, the cancer had begun to escape the cap, but it doesn’t appear to have spread so far. All the tissue and bits and pieces they took out of me came back negative, and I’ve had two clean PSA checks since then.

Good luck with your decision.