Prostatectomy vs Radiation for prostate cancer

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Hey everyone! I was just diagnosed with prostate cancer today, I'm 56 y/o. Was wondering if anyone could weigh in on whether to go straight for the prostatectomy or do the 8 weeks of radiation. Which is better in terms of incontinence side effect? Located in Boston with a good urologist. Any advice would be appreciated. Thanks.

 

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Hey MOD, ONE THING MY UROLOGIST TOLD ME WAS ONCE YOU HAVE RADIATION, AND IT DOESNT WORK, YOU CANT HAVE SURGERY, MY CANCER WAS STILL WITHIN THE PROSTATE, SO I CHOSE SURGERY. I WISH YOU THE BEST WITH YOUR DECISION.

 

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It would be best to get your doctors suggestions. He probably would have the best options. Good luck.

 

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Check out high intensity ultra sound treatment. My friend got his prostate cancer cured in Bangkok two years ago - after two weeks, no side effects. He paid $18,000 and his US insurance company paid the bill. I found out too late to try this procedure and did the surgery. Worth doing some research. I understand there are clinical trials in the U.S.

 

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I was 56 when diagnosed as well, most likely contained in the prostate. I checked into both and each treatment path claimed to be equally suited to yield success. After a lot of reading and discussion with physicians, I chose surgery for 2 reasons: 1) at my age the long term effects of radiation could be problematic later and 2) as noted previously here, surgery is very difficult and less successful post radiation. Whereas if you have surgery and pathology shows it isn't contained to prostate, radiation is still an option. There isn't a single right answer for everyone so ask a lot of questions and do your homework to make the best choice for you.

I just passed 9 month post surgery and I am comfortable I made the right decision for me. I use a pad for security but other that physical stress, excessive volume of fluids, and alcohol (LOL), I am usually pretty well controlled. Continence recovery has been a process for sure, and continues to be something I work at every day. I'm impatient but doing well and still improving despite rumors that the 1st 6 months is where it ends. Some people do great at 3-4 months and others need more time, there are many factors that affect every recovery, but I have found personally and in speaking to others, that the best results come from persistence

Good luck with your ultimate decision and your own journey!

 

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That’s excellent input MLrichard. I think a lot of us that chose removal was to get the cancer out of your body, and have options if it returns. The chance of side effects with radiation is a factor too. I think if I was 70 instead of 53 I would have chosen radiation.

 

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Agreed. I probably would have made a different choice as well if I were 70.

 

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Hey everyone! I was just diagnosed with prostate cancer today, I'm 56 y/o. Was wondering if anyone could weigh in on whether to go straight for the prostatectomy or do the 8 weeks of radiation. Which is better in terms of incontinence side effect? Located in Boston with a good urologist. Any advice would be appreciated. Thanks.

I'm 57 years old, about 3 and a half weeks post prostatectomy. Radiation vs. surgery also depends on the size and Gleason score of your cancer. Mine was a Gleason 9 tumor that was 3.8cm tall. The MRI showed potential seminal vesicle involvement, but not lymph node intrusion. When I had my surgery, there was spread to the seminal vesicles which is pretty common and which are removed as part of the surgery. But there was also a small number of cancer cells in 1 lymph node out of 4 removed. But all margins were clean. I think a real benefit of surgery is that pathology and proper classification can be done on the removed prostate. Mine was classified as stage IIIB. I wish you well and good luck!

 

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In my opinion, the possibility of becoming incontinent is secondary to what treatment is most likely to get rid of the cancer. Getting rid of the cancer is the important thing. Incontinence can be lived with if necessary and is often treatable.

 

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This may be of some help

Selecting Treatment for High-Risk, Localized Prostate Cancer: The Case for Radical Prostatectomy

The most common treatment options for men with clinically localized prostate cancer include radical prostatectomy and radiation therapy. The choice between these options is often controversial, and selecting the optimal treatment poses a great challenge ...

www.ncbi.nlm.nih.gov

 

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As has already been stated, there are many variables to consider in making a final choice. I was 61 years old when diagnosed, with Gleason 6 and PSA 4.5. Since I had had a TURP @ age 50, my urologist said I would almost assuredly have incontinence if I went the prostatectomy route, since the TURP had already removed some of my working parts related to continence.

I ended up doing high dose rate (HDR) brachytherapy @ UCLA. I had absolutely no incontinence and only very mild ED afterwards. However, in 2017 I started to experience persistent bleeding during urination, and it was discovered I had developed calcium stones in my prostate. I had a second TURP to remove the stones, and now have a very mild case of incontinence, as my urologist said that radiated tissue that is subsequently operated upon never quite heals properly, due to the fundamental damage radiation does over time.

I am still happy with my choice, and my PSA continues to be negligible.

One thing I have experienced that may be related to the radiation treatment is penile shrinkage. I would say I am about half of what I used to be. But I've never really discussed this with my urologist, so I'm not sure what the cause is.

Good luck with your decision!

 

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Thank you everyone for such considerate responses! I will keep you posted with my decision.

 

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Diagnosed at age 60, I went straight to surgery. What influenced that decision: 1) desire to know my actual cancer pathology and that comes only with surgery, 2) I had been dealing with bladder issues for several years supposedly due to BPH, but more likely the cancer, and I wanted to avoid living with urinary retention, 3) took my chances that being relatively young I could recover from the side effects of surgery but radiation would be cumulative and can have effects on one's bowels, and 4) radiation is really good for cancer that has actually spread or if you have other health issues and so on with surgery not a realistic option after radiation.

It mostly worked at well for me except for #3,I had both side effects and they are permanent. However, I've adapted and accepted it and I still would rather have gone through what I've had than chance long term urinary retention or bowel problems. Nonetheless, if my cancer ever comes back I will go ahead with 'salvage radiation'--just keep in mind that is more radiation affecting more tissue than the primary treatment.

Having said all that, you should weigh your options carefully and consider multiple opinions from doctors. Radiation might be best under some circumstances. And with surgery you will face some permanent side effects including impaired erections and continence. Very few totally recover all former function.