Surgery verses Radiation

 Two weeks ago I found out I have this disease. I was 5 out of 12 at a 7 Gleason (4+3). I am 62 and have met with the Urologist and still have the Rad/Onc to go later this month. At this point I am about 85% certain that I am going to have the robotic surgery, and even have it already scheduled for later this summer. The doctor that will do it is a world class expert in this procedure with at least 1,000 operations under his belt. I want to get this stuff out of me, even given the bad side effects of E/D and temporary (I hope) incontinence and I believe that surgery has the highest chance of doing that with the least chance of a recurance. If it does come back, which I understand happens 15 to 20% of the time, having had surgery on the front end seems to leave me with the best options for follow up treatment. The loss of an active sex life is really on my mind but it seems that my only choice there to avoid the E/D problems is to keep the cancer, which is no choice at all of course. So I am stuck with that grim reality. My wife and I are in full agreement on this decision.

My question is, has anyone that elected to have surgery instead of exposed beam radiation regreted the decision for surgery instead of EBR and why do you regret the decision? Also, has anyone that had the surgery and is over it now, more convinced that it was the right decision. As you all know, there are no good choices with this crap. I am just looking at taking what I think is the best bad choice.

Thanks for your advice.

There is no simplistic answers in PCa, just somewhat simplistic choices. You have some high risk PCa within that pathology shown. Was it even done by a reknown expert like Bostwick, Oppenheimer, Epstein, Grignon etc.? Still could be reviewed and further tested for AR (androgen receptor expression-Chromagrainin testing), further tests optionals like various PCa variant types(24+), ploidy analysis (3), and gene expressions i.e. BCL2, P53, HER1 and such things...only a few experts can test this...it will become common place in the nearer future). Some of those have prognosis value and some oncologists use that information, the uro-docs don't look outside their own domain to much, they want to get busy.

So much is unknown and non-definitive enough on all us patients, that it boils down to a gamble, nobody knows if PCa has escaped the capsule, even with clean post surgery and all clear verbage(we got it all)....we have some PCa patients here in whom found BCR/failure. They cannot see or predict micro mets with any perfection...you get a best guess analysis and some people don't even get that much. Did you check out nomograms and partin tables to see how averages like your stats, have stacked up...still no guarantees. You may end up with salvage radiation as next protocol (SRT) and so you might have to think do I need surgery on top of radiations(having a risker original scenario)? I could bypass surgery and the radiations could get beyond the gland anyway (pelvic radiations) or brachy seeds and IMRT combined is a very good shot at this(and other choices)...I had worse stats like in my case..was not all curative in my protocols..then you go to HT drug therapies. So you really need to think it out, like a chess game if possible?

I was denied surgery by Dr. Menon and glad he told me the truth flat out. Another surgeon I saw a couple days before (more of a rookie in comparison) was guaranting me a cure and 1% of incontinence....I smelled the b.s. sales job and fired him immediately, also fired one onco-doc in the beginning(inept) and one radiologists (she actually lied about the equipment available in our area and if they even owned IMRT machines at their hospital, they had them but not using them on PCa in 2002). Wonderful world out there.
Tough decisions in every move and no rewind in this, best to you in whatever you decide. In this game either you choose the moves or let someone else choose or be the referee and play nicely together.  Hope whatever choice(s) you decide have your own input and decisions, only you walk the walk and live with whatever side effects from anything.

Best to you.

Post Edited (zufus) : 5/16/2011 9:44:50 AM (GMT-6)

I am also newly diagnosed, and also trying to figure out what treatment I want to undergo. I am strongly leaning toward radiation over surgery, and especially proton beam therapy if my insurance will allow (now pending). I have a very good friend who was diagnosed and had surgery in 2006 at Johns Hopkins. The surgery was a failure. He then underwent proton beam therapy at IU in Bloomington. He now regrets his surgery decision very much, and wishes he had undergone proton beam therapy from the get-go. His biggest grip is that no one in 2006 even discussed the radiation option with him, much less proton beam therapy.

At least you are aware of these potential treatments as you make your own decision. There are trade-offs and potential side-effects to whichever way you go. You have to do what you think is best for you, and don't regret your decision if bad things happen. Nothing is guaranteed.

One of the top five reasons why I chose surgery was the 40+ trips across town for radiation didn't sit well for me. I hate repetitive tasks of almost any kind...

Radiation can be as good as radical surgery.

There just don't seem to be any clear answers for anything about prostate cancer. My situation was that I had early stage Gleason 6 and substantial enlargement (nearly 200 grams) and was given the options of surgery, radiation, or Active Surveillance by two different doctors. I chose surgery because it seemed like the best way to stop the cancer and prevent any future problems from the enlargement at the same time. Was it the right choice? Things have worked out well for me but I will never know if a different path would have been better. All I can do is believe I made the right choice at the time I decided surgery was the way for me to go.