Why did you choose surgery instead of radiation or vise versa?

Posted by ozelli @ozelli, Oct 13, 2023

I think this may be a topic that the newly diagnosed may find useful.

The differences are often subtle which makes the decision even more difficult but better to be information-overloaded rather than information-deprived.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

I was told by my urologist that the younger men they look at as better Candidates for surgery and old rr men, 65 and up for radiation. I was 70 healthy and in very good shape. I asked my urologist which one he would chose for himself, he said he couldn’t tell me which way to go but he would take the surgery. I had to convince a very good Mayo doctor I could handle the surgery. I had the R.P. In May 2022, best decision I ever made. I am now cancer free, cancer was all contained to the prostate. I just had the penile implant, another great decision. Good luck


Biggest reason for me was to have a "back up"
I was told that if you have the radiation, and then need the surgery later, it's a very specialized surgery with less chance for good outcomes (cancer aside). Meaning more permanent damage to the body from surgery on already somewhat damaged tissues.

If you have the surgery, you can have salvage radiation / ADT later if the PSA starts to rise again. Generally with little new side effects. My only annoying lingering new side effect is the hot flashes from the ADT.


I was 75 when I had my RARP. My oncologist/urologist said he as 50/50 on surgery vs radiation.
I chose surgery for the above reason that rescue radiation would still be an option plus surgery could be a 'one and done' if PC was contained.
It wasn't contained and I had a small spot of PC on a rib. But the ADT (Lupron) has done its job providing negligible PSA readings and I look forward to completing the 24-month series of shots next March. And the end of hot flashes and muscle loss.
For the Hot Flashes part, may I suggest you look at the post by "bnice268" about "Any tips on Reducing Number of Hot Flashes after ADT". Some good comments there may help you form a well considered decision.
Best of luck for you; we all need it. Just get that PC demon under control soon.
Good luck and hang in there


Similar to the above, I was 41 when I had to deal with the first round of PCA and the best long-term strategy was to remove the prostate and then keep all the other options available.


Mayo Clinic Jacksonville would not recommend surgery if you have any serious cardiac problems along with and if you are at an advanced age. I have heard same information and from radiologist/oncologist that if you have radiation having surgery after is very difficult and most surgeon will not do it. If you have your prostrate removed and need radiation means that the cancer was not limited to being inside prostrate.

I agree with most post elsewhere on MCC that surgery when younger is probably more of a decision maker than at advanced ages. Radiation treatments when prostrate cancer is limited to prostrate if very affective in cure rates. When you have prostrate removed you should PSA levels as undetectable. When you have radiation you will always have PSA. If you have PSA rising with no prostrate means prostrate cancer is elsewhere where rising PSA still having your prostrate may not be cancer.

Probably all us old timers (I am 76) have heard the same thing, "probably you will not die of prostrate cancer but something else." I challenge that because they expect your life expectancy to be lower than what I expect. I think that is a positive outlook and chose to get rid of it with radiation and not wait for it to spread.

Catching it early is the best treatment and why monitoring PSA rising (not just normal or abnormal) is such a determining factor in getting further diagnosis. I had normal PSA 3.75. But was rising over the years and primary care doctor did not like that and referred to urologist.


The answer will vary a lot with individual PCs, its location (MRI/Biopsy), aggressiveness (Decipher Grid), risk factors (Cribriform pattern 4, Intraductal carcinoma of prostate (IDC-P), Perineural invasion, and Extraprostatic extension), PET Scan and Gleason Score.

My initial urologist said that he'd take radiation, likely due to the anterior position of positive cores, as the recurrence rate would be lower than surgery and the RO agreed. A well renowned urologist (second) suggested surgery but, after talking with my RO, said his recommendation was neutral. I got a second RO opinion and changed my boost radiation from HDR to Cyberknife, then 23x EBRT and ADT (Relugolix). Clearly, radiation is less invasive and does not require a catheter.

All the PCs are different and having multiple seconds was helpful for me. In addition to the formal opinions, I got an informal opinion from a retired urologist friend. A trusted friend will reveal many details that other Drs. can't or won't.


I did not want to have my prostate removed as I did not want the potential side effects and the stats said there was a 20-30% chance of biological re-occurrence. I understood the additional complication if I chose removal later on.
It was either Proton or the mridian machine. I chose the mridian which may not be available any more. In any case, protecting the healthy tissue was of huge importance to me as that impacts side effects. The area around the prostate that gets exposed is different from one machine to the other. The claim is all have the same result but the truth is side effects are different from one person to another so again, ask about margins and the amount of healthy tissue impacted.

Had my treatment in February. All good. PSA down on every blood test.


I’m 71 and in excellent health(knock on wood). I was diagnosed with 3+4=7 on one core out of 14 taken. I saw two very reputable urologists to discuss my options. Both of them agreed that removal was my best option. The doctor that will perform the surgery told me that anything over 1(10%) he believes surgery is the best option. He has done over 1,000 surgeries. My regular urologist told me when selecting a surgeon to have a real comfort level with my choice. I’m comfortable with my decision. Surgery is in 3 weeks🙏🤞


I don't understand your reference "anything over 1(10%)


I don't understand your reference "anything over 1(10%)

Jump to this post

I’m 3+4. My doctor feels anything over 1(I’m 3) should be surgery.

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