Would you recommend proton therapy vs surgical removal of prostate?

@seekingclarity
You are getting medical information from two different urologists. Ask your questions to them. They are the only ones who have your medical history and have examined you.

Medical professionals are your first line of getting guidance and if you still have questions asked them. Many of us will get second opinions from medical professionals to help you decide on what is best for you. Many of us feel our mental health is important and that helps guides us on decision like active surveillance, RP, or radiation therapies. You have two different urologists who I would flood them with your questions first.

Was the Decipher test mentioned to you? It is a genetic test to more accurately determine the risk level of your PC. My Decipher was same as yours 3+4=7 and given to me as intermediate risk. I had the Decipher and lowered to low risk.

Based on my Decipher both Mayo Jacksonville and UFHPTI (my second opinion) recommended radiation but no ADT.

You have been diagnosed with cancer. Active surveillance is something to consider but that should be your decision working with your medical doctors, and second opinions, and other test available to help guide you. Your medical doctors (present and if you do more opinions) have you complete medical history and have examined you.

There are some urologist that will do surgery on a patient that has gone through radiation prior. My urologist said most will not try as is real difficult for surgeon because of the condition the radiation leaves the prostate. I don't know anyone on MC Connect that posted doing this. However my Mayo urologist confirmed there are some urologist that have experience and expertise to do RP after radiation but are rare.

Proton radiation is what I had. I can give you my personal experience with it. May I suggest you contacting UFHPTI and request a information handout. It is free and no pressure to go to them. The package will include research on all PC treatment plans, two books on prostate cancer (one is Walsh book) and a complete packet of the program at UFHPTI. It contains a ton of research on PC, diagnosis and treatment options that you can read at leisure.

The cyperknife I do not have personal experience so will no try to comment on something I do not have personal experience with. I did have proton radiation as both my PCP and I liked the added benefit of the beam dose level being controlled going in, releasing is full dose at specific spot and does not continue through body like photon.

You need to get as much information from your medical doctors with all the questions you can think of. Then do your own research and consider additional diagnostic test, and second opinions. Passing on to you what I did, why, and my personal experience with PC as I did just what I posted to you.

I opted for surgery. Urologist indicated that the prostate turns to a raisin with radiation and while removal is possible it involves just cutting everything out. No opportunity to spare any nerves. Thats probably a pretty simplistic answer. Ended up with ED and incontinence.

@jc76 I went to the UFHPTI website. I looked all over (Pca link, site map) and could not find a place to request the packet. Do you mind sharing the link?

I was diagnosed with PC in Sept of 22. I was a 4+3/7 Gleason, stage 1 intermediate. My surgeon, after testing a core for how aggressive it was, told me that surgery would not be a viable option and sent me to an oncologist, who wanted to do brachytherapy but my pubic bone was blocking access to some of it. After that he suggested radiation. I decided, after a lot of thought and research, elected for Proton therapy with 5 blasts over two weeks. I also got ADT, 3 shots total. Everything went well and at my last consult with the surgeon, he congratulated me for having the lowest PSA of all the patients in the practice and ever. The only issue I had with the radiation was having to learn to go to the bathroom. For about a week, if I needed to piss I had to sit because I could go #2 as well. The ADT was another thing. After the first two shots, within 24 hours I felt like total shit, it took out my testosterone almost completely. I made thru the treatments but now I’m fighting the side effects of being chemically castrated. And I’m one of the lucky ones, whose testosterone level hasn’t returned to normal, among other issues, like bone loss and a smaller penis size, low libido and dry orgasims. All I can say is, do your research and welcome to the club Brother.

I have not read all responses so I may duplicate comments.
1) I would ask for a decipher test to see how aggressive cancer is, maybe treatment is not required now.
2) I had Proton at 69, honestly I don’t think I would do it again. I believe I am cured and that’s number one but it is CT guided. It’s like using a highly accurate gun with a not so accurate scope. Some speculate that since you are positioned via fiducial. Then you have to wait until accelerator is ready giving time for additional movement.
3) After completion the doc tells me rectal bleeding happens in about 30% of cases.
4) I have a study regarding proton and how important spacers are, there appears less margin for error.
5) Talk to California Proton about bleeding.
6) Finally I think MRI guided SBRT is superior so why not go with it.

All my opinions