Why would my doctors recommend surgery over radiation?

Radiation treatment first removes the use of a later surgery treatment but surgery treatment first preserves the use of radiation at a later time. Hence, more heavy duty treatments are available with surgery. Also, removal of the prostate permits the better examination of it to better determine the state of the cancer and better address the cancer treatment. Robo surgery requires one night in the hospital while radiation requires many trips for treatment ( this is relevant for men like me who live far from the treatment center). There are other difference between surgery and radiation but the above are the differences that persuaded me to have robo surgery and I am still pleased with this decision. The surgery and recovery were painless and fast.

Thanks. I m scheduled for surgery but I am a little scared.

You will be ok. 1000s of men have had this surgery and recovered just fine. It isn't a horror story as some try to make it sound. Form an opinion that is positive about the whole process and go with the flow. You will probably have ED, most of us do. You may have some incontinence or a little leakage. Most of us don't. There are ways to deal with ED. That seems to be a huge concern for most men that have still been active with a partner. It takes time to heal but you will get through it. Just use your resources and do research on line. Education in this field is a great tool. Good luck.

Thank you

Hi, your question seems simple, but the answer is complicated.

First it’s easy to react to a cancer diagnosis by saying “Cut that sh_t out of me” We have probably all heard of people who had some kind of cancer discovered and had a fully encapsulated tumor removed without a need for further treatment. The prostate and Pca (prostate cancer) is different (among the many ways because the urethra goes thru’ the middle. Also Prostate cancer does not (to my knowledge) occur encapsulated. I’ll suggest lots of research.

With a Gleason 3+3 you are probably a good candidate for Active Surveillance.

Most urologists are urological surgeons. When not on salary at a major medical center they make the bulk of their income from procedures and surgeries. They suggest prostatectomy because thats what they know best. Referrals to other specialties (i.e. a radiation oncologist) don’t generate any income. If post prostatectomy PCa shows up they aren’t hands on in the treatment.

Each type of treatment for Pca has side effects and risks.

I’ll suggest a resource: the Prostate Cancer Institute pcri.org has lots of videos about prostate cancer - treatment and side effects. Dr Mark Scholz suggests that most men who have a prostatectomy have permanent problems with erectile dysfunction.

At age 65 I might guess that you have some ED, which may be mitigated by Cialis or other meds. But if you still have an active sex life with a partner (or solo) you may want to look closely at Pca treatments that may make your ED permanent and irreversible.

A single example: A good friend chose a prostatectomy. He chose the best urology surgeon in Detroit. (He was in a position to find the best). Somehow he had a blood vessel nicked and had a giant hemotoma; he lost a lot of blood. Three years later he has not been able to recovery the ability to have an erection by any means and still has occasional urinary urgency (must avoid certain things (beer, maybe caffeine.

A second example. A family member who chose RALP. With micro sensitive PSA it because apparent that his numbers were going up. He has had salvage radiation. And is on a long course of ADT (not fun for him).

I’ve written about my experience elsewhere in Mayo Connect in detail.. Briefly diagnosis 11/19, 5 Proton Beam treatments in early 2020 at Mayo Rochester, 4 month treatment of ADT (Androgen Deprivation Treatment aka chemical castration). My PSA are staying below the detectable range. I say that I am in remission and that I hope I stay there for the rest of my life. My ED is about he same. I take flowmax to improve my urine flow and complete emptying of my bladder (issues that predate Pca treatment.

I also want to call out the statement that if you have radiation rather than prostatectomy that it makes prostate removal in the future much more difficult. Sounds pretty logical. I’ve done some casual looking and not been able to find any research about this - mostly hits where urology surgeons have said this to patients.. Perhaps it is appropriate to ask the urology surgeons who makes this statement about how many patients post radiation have they every done a prostatectomy on.

This is an interesting interview with a Mayo urologist about post Pca treatment ED etc. a lot to take in:
https://youtu.be/CaPwnxlpp6w?si=jnjqyvp0TbCUAwTL

Finally if it would be helpful to talk on the phone I’d be game. Please private message me to connect.

Best wishes: Remember educate yourself, be an informed consumer, and have an advocate/partner who can help you figure all this out.

I was on AS 2.75 years, till biopsy said it was time to treat. I opted for Tulsa Pro, keep in mind the old way of thinking was surgery or radiation and just those two options. There are other options now.

I know. But my doctors said that was experimental and doctors who did that wanted cash up front and me to bill insurance

When I was diagnosed with Gleason 8, my urologist (also a surgeon) asked if I'd like to be referred to a radiation oncologist for another opinion. The engineer in me (of course) said YES!.

After meeting with the oncologist and having already had a details consult with my urologist and as I had a PSME scan done, which showed 100% containing within the prostate, I opted for robot assisted RP because of the "1 time" procedure versus weeks and weeks of daily radiation and yes, "Get the damn thing outa me!". As I've been healthy my entire life and have never faced any serious medical procedure before (except possible my vasectomy done in my 30's after I was married), I spent weeks watching various videos on YouTube, many of which were 1st hand experiences. The day of my surgery, I was calm and only slightly anxious, which they say is a major aid in a smooth recovery.

Into the OR at 8 am, out just after noon and I was home the next day. I never needed anything stronger than Tylenol and the catheter really was more of an annoyance than anything else. 1 week later, it was removed.

Next week on the 31st, is my 1 year anniversary. I'm doing fine!

Well I worked in medical research and no things like Tulsa Pro are not "experimental". It even has a medicare code, if that is what you mean, though the medicare code won't go into effect till next January. Some insurance is covering it already, but I think not many. If you mean it isn't being done at average medical centers, well it is being done at Mayo now though Mayo doesn't put much into it just yet as they are letting others take the lead. Mayo and places like that try to lead in advanced cancer that have spread or metastasized, and that is very valuable to the world. Tulsa Pro is not for that. So I don't know what you mean by "experimental" as that word can have differing meanings. Tulsa will become widely available next year when anyone can buy the machine and bill insurance though it may start at medical centers that get it going, but that is not a very good criteria for meaning "experimental". Tulsa Pro is for localized PCa, so MRI and PSMA clears you that it hasn't spread. I have seen experimental diagnostic equipment and purely research based studies in my work, and it is well beyond that. It is coming out of an earlier stage, soon into the forefront in coming years as machines are bought, so not widespread till later, but it isn't experimental at this point.

Tulsa overview article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231661/

At the age of 72 and a half, I was diagnosed with Gleason 8 in August 2022, accompanied by metastasis to lymph nodes and seminal vesicles. Despite the initial confidence of the Onco Uro regarding the feasibility of a Radical Prostatectomy (RP), the discovery of metastasis prompted a referral for radiation. I completed 20 sessions of Tomotherapy in February last year.
During the initial sessions, the Radiation Oncologist informed me about the probability for long-term side effects in a small percentage of patients undergoing radiation. After more than 10 months post-treatment, I found myself among the minority experiencing side effects. Two weeks ago, I began passing blood and mucous through my rectum. Consulting my Medical Oncologist, he diagnosed it as Radiation-induced Proctitis. Reassuringly, he mentioned that it would heal soon, prescribing medications to alleviate the condition.

So, in cases where Radical Prostatectomy is not an option, radiation therapy becomes the alternative, accompanied by the inherent risk of long-term side effects in a small percentage of patients. Fortunately, these side effects, such as Radiation-induced Proctitis, are manageable inconveniences that may persist for a short duration. Overall, I've experienced improvement and am much better now.