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.

Still makes no sense but I wish you well with your surgery. The important thing is that you are comfortable with the decision that you have made.

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At 68 YO, I was diagnosed at 4 + 4 with a PSA 6.4. Biopsy showed 6 out of 12, all on the right side. PSMA showed nothing outside of the prostate. This was August of last year. I chose RARP for the reasons others have pointed out - radiation etc, are possible if needed down the road. I was scheduled for surgery at the end of November but came down with the flu 2 days before so was rescheduled for the end of January. So on 1/31/23, I had it done. Pathology showed clear margins and clear lymph nodes
Gleason was finalized at 7. PSA has been undetected since.

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When I was diagnosed in 2006 . Removal was the best option, as radiation wasn’t perfected as it is today. I had a friend who had radiation back in 2004 and he had very serious urinary and bowel issues. If I was in the same situation in 2023 I think , now, I would choose radiation, because it has been perfected so much.

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@kjacko

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

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I am confused like GKM. What is anything over 1? A 3+4 would be 7. That is the Gleason Score.

Did you have a Decipher test done? It shows the risk of metassinging.

There is another score of 1, 2, 3, 4. I was originally a 2. But my Decipher came back low risk.

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Similar story with me. Last November I was 69 and had one (of 14) biopsy core diagnosed with 4+3 =7 and all imaging made it seem completely contained within the prostate. I got three unanimous opinions and the one that convinced me was the radiation specialist. She said if her husband had my results, she would tell him to have his prostate removed. My situation allowed for great confidence in removing all the cancer once and for all. Yes, there would be side effects, but those could be dealt with. So, three months later (on my 70th birthday) I underwent RALP and my PSA's have been negligible and steady ever since. For that I am happy with my choice. However, I was deluded by all the YouTube videos by men who went through this. They had me convinced that in just a few weeks all the side effects would be gone. They were wrong. It has been 8 months and the incontinence has reduced a lot, but it is by no means gone. I am undergoing Pelvic Floor PT now, and getting many exercises that should help me get drier. If you choose surgery, pay great attention to getting your Pelvic Floor in the best shape possible.

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Great comments above. I am a big advocate for removing the prostate when cancer is detected. There are obvious exceptions --> Those with other serious health conditions, advanced age, metastasized PC, etc... After my research, I went with a radical prostatectomy at Mayo-Rochester last year and I am very happy with my decision (most men will say this with whatever treatment they chose 🙂 ). I looked at other treatments, but could not justify the potential of leaving unknown cancer cells in my body - With my robotic RP, the prostate and seminal vesicles were removed (plus 9 lymph nodes for me) and a full pathology was performed to determine margins. With alternate treatments, they believe the cancer has been treated, but there is no physical evidence. For me, this was very important, I wanted to know if the cancer had been addressed to the best of my ability - Fortunately, pathology showed the cancer was contained to my prostate and outlook is good. Unfortunately, cancer is cancer, and reoccurrence can always occur.

Personally, I struggle with the statement "don't worry, prostate cancer is slow growing, you will probably die from something else". Obviously, there are exceptions when you have other serious medical conditions and you know your lifespan is limited. However, if you are in your 70's and the doctor tells you something else will kill you, he is probably basing this on the average life expectancy (77 for us in USA). This age includes all of those that have abused their bodies with drugs, heavy alcohol use, no exercise, over-eating, getting your food from the center of the grocery store (processed food), difficult jobs, etc... For myself, I work to stay in shape and I pray for a much longer life (it is my hope, only God knows) - To not do everything possible to fight the cancer is like giving up.

My opinions are simply opinions. Everyone has to do their own research and base their decision on their individual circumstances. If someone (doctors included) tells you that there is only one treatment possible for your situation, you should probably get a 2nd/3rd opinion. The only rule set in stone, you MUST utilize a center of excellence (like Mayo-Rochester) to address your prostate cancer. To utilize a local doctor because of a relationships or travel inconvenience is not a wise move.

Good luck to everyone in making your decision and ultimate treatment!!

Jim

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I did both. Cancer free for 5 years.

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At the time I was diagnosed as having prostate cancer our child faced extreme surgery for metastasized testicular cancer. I delayed my treatment and chose Cyberknife because it demanded the least disruption, particularly in recovery from surgery to an already chaotic family situation. As the sole driver in the family this was of importance. My reasoning intentionally excluded consideration of the efficacy of the alternatives, but we are both gratefully alive after more than five years. Our child suffers serious but expected lifetime after-effects from surgery and chemotherapy, and I would strongly suggest serious investigation and comparison of possible after-effects of all treatments including radiations before acting as I purposefully did not.

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I have 3+4 6 less in 5 % in one core my urologist wants to operate my radiologist said I could watch it or he could do 5 radiation treatments I went to a 3rd doc he wanted to put me on casodex. I am 72 I’ve been watching it for a year I got a appointment at Mayo from a srcond opinion it makes it hard to decide what to do when every doc you see tells you something different

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@rice

I have 3+4 6 less in 5 % in one core my urologist wants to operate my radiologist said I could watch it or he could do 5 radiation treatments I went to a 3rd doc he wanted to put me on casodex. I am 72 I’ve been watching it for a year I got a appointment at Mayo from a srcond opinion it makes it hard to decide what to do when every doc you see tells you something different

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My mistake 3+3 =6

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