Surgery vs. Radiation and other ?'s....

1.  Why is surgery more recommended for younger guys (< 55)?

I know there's more time for recovery, but is that it?  Why would a 48 yr. year old consider it more appropriate over a 62 yr. old, for example?

2.  What are the advantages of surgery over brachy, cyberknife, etc.?

Are there other advantages besides knowing pretty soon whether the cancer is spreading, and it's 'out' once the surgery is over?  (and I know that's a big advantage).

3.  I just can't think of a reason for not trying for a radiation treatment over a surgery.

I want to be cured, first and foremost, like others I'm sure; but how often is the only side effect the inability to ejaculate?  That's the only SE I think I can stand...  Is there a % on that number?  Or am I being unrealistic?  Seems something like the pellets would give the best probability for those goals.

Thanks.  This site has really helped me so far the past week.

Post Edited (Dewayne) : 10/21/2014 3:46:15 PM (GMT-6)

Answer to your questions.
1. In the past surgery was always recommend for younger men since young men typically have a longer lifetime and radiation does pose an additional risk of secondary cancers.

2. The huge advantage of surgery is the post surgery pathology report of the prostate. This pathology is the gold standard on staging your prostate cancer. And it can be an accurate tool for predicting potential re-occurrence of cancer using gleason score, and if any invasion outside of the prostate such as positive surgical margins, seminal vesicles and lymph glands.

3. With all that said, radiation is very effective in treating prostate cancer. The only negative of radiation is if it fails. If surgery fails you next step is radiation and if that fails then hormone therapy. If radiation fail, salvage surgery is very difficult requiring a very highly skilled surgeon due to unclear margins and scaring, additionally salvage surgery and can have devastating effect on quality of life. So in most cases the next step to failed radiation is hormone therapy.

All treatment plans have negatives and positives.

If there was one real good plan, we would all choose it!

I myself was more scared of radiation than the cancer. I also wanted to get the %$#*&@$% cancer out!

With surgery you get a final pathology report giving you all the information that a biopsy couldn't regarding the cancer.

There are guys here that have done very well with different radiation treatments.

So you can see, it is still as clear as mud. Investigate them all and choose what you feel most comfortable with and don't look back.

Bill from Florida

The tale of the three brothers:
I've got two brothers who also have PC. One did surgery, one did brachy and I did IMRT (beam). It's about four years since the first of us was DXed. To date, we all have very low PSA (surgery dude is undetectable) and all about the same amount of side effects.

The thought of surgery scared me and I have heart/lung issues that put the risk of surgery high so I went with beam radiation. The biggest side effect is a slight worsening of my hemorrhoid problem and a slight case of ED - 80-90% of pretreatment. And there is a bit of urgency - I now have a mental map of all the men's rooms within 5 miles of my home. But this is no different than my brother who did surgery (we often trade notes on the location and status of restrooms in our city).

You'll be fine with whatever treatment plan you choose - the trick is to get the best medical team you can. I always say to go with the treatment plan you feel the best about. Trying to find strong, objective evidence for one method over another is difficult for us low/intermediate risk types. They all put you in the 'cure' zone with a slight trade off in risk vs. side effects.

Andrew

Dewayne,
All I can tell you is that at first I was going the radiation route and my Uro pretty much talked me out of it. He explained if surgery failed, then radiation would be an option. If radiation failed then surgery pretty much is off the table. So I like the idea of more options if needed. Also in my mind I had something in my body trying to kill me and I just wanted to be rid of it. And as it turns out, I think surgery was my best choice because it turns out the cancer was more advanced than the biopsy showed. On the downside, apparently some cancer tissue was left behind following surgery and I had to have radiation, but on the positive side, at least I had that option. Still too early to tell if radiation has been successful but first PSA reading has offered hope. As others have suggested, you really need to do a lot of research but in the end you need to do what is best for you. I feel comfortable with the choice I made and even with all the side effects of surgery and radiation, I would not change a thing about my treatment choices.
Jim

Hello Dewayne,
I am 64 and had the robotic prostatectomy in March 2014. One other thing to consider is the side effect of
incontinence. I am 7 months post surgery and still incontinent (sitting and lieing down I am okay but going on
my usual walk or playing golf I have no control). Incontinence IS a pain in the butt and I am wondering if
I should have chosen radiation. I have hemorrhoids and irritable bowel syndrome and a mother who died of
colon cancer and just didn't want the radiation.
My 3rd PSA is this week. So far so good on that.
Good luck with your decision. Take in all the info and trust yourself.
Jess

While others feel differently I went to arguably the best hospitals in the US due to my location in the US. The layout of side effects surgery v radiation etc are factors of three things.

location and Means (where you are or can get and afford for treatment)
Staging (what level advanced you are)
Age/Condition (physical age and real world age based on any other medical problems)
Side Effect Comfort Level for each solution

Often times this combo leads you to your answer.

My decision was based on my age and health and available drs. I only stretched the choice on my staging which was worse than optimal for surgery.

If your staging is a 4+3 or higher you may not even be advised to do surgery.
If your age exceeds 60 you may not even be advised to do surgery

There is another option which is to do nothing but watch also known as "AS".

This is a great option if you are a 6 and are older than 60. If you have a 6 and are 48 like I am then that becomes a fence rail decision. Could go either way. But at 6 and 48 there is a pretty good chance it is not going away and older you get lowers your chances of best results on either method

I also am a believer based on some research I did that the near-term surgery results among the best drs have a massive advantage v other methods. The long-term studies available include the dark ages of surgery which frankly is only a few years ago when it was crude at best. Even the early days of Davinci 7 were primitive explorations. And most doctors out there today are simply not skilled enough in surgery or radiation to improve your chances of no side effects in either direction.

Sorry you had to join this forum with us. I will tell you a little about my storey in the hopes that it may help you in some small way make the decision that is right for you.

I myself am a recent participant as I was diagnosed in August 2014 with PCa. Our stats are very similar. As you are, I struggled determining which treatment would be best for me, as I think we all do that are in this situation. There is no magic bullet or one right answer for all of us unfortunately. I went to 5 different doctors. 4 of the 5 either leaned towards or recommended surgery although they all said that any treatment option I chose should have about the same curative outcome.

For me, the big determining factor was not only what treatment could "cure" me of the cancer but what are the SE's. Being only 52, I was having a very difficult time coming to grips with the possibility of incontinence and/or impotence for the rest of my life in one form or another. I wanted this thing cured and be back to my normal self with no side effects. Unrealistic, yes, but that was my goal. In my mind, right or wrong, the "cure" was almost worse than doing nothing.

In the end, I chose to do Brachytherapy. So far, I couldn't be happier with my choice. For all practical purposes 2 days after the procedure I was back at 100%. If it wasn't for the slightly more difficult time I have in urinating I wouldn't even be able to tell that I had done anything. That said, I know I am on the early side of this treatment and won't really know if it worked for anywhere from 2 to 4 years. I also know that SE's with brachytherapy are more likely to happen years down the road rather than right after treatment. That was a risk the I was willing to take and can only hope that if anything does happen later that medical science will stay out in front of me and have better treatments and procedures that I can take advantage of then. My goal was to do as little damage to my body as possible but still have a very good chance of curing the PCa. I'm a patient guy and didn't need the instant feedback that I would have gotten from RP surgery.

As I am sure you have found out there is no study that compares head to head or a blind study (not sure of the technical term the doctors use) the different treatment methods which allow you to compare outcomes. The best resource I found for this was at the following link:

http://www.prostatecancertreatmentcenter.com/prostate-cancer/study-group/

They took different research reports and data from all over and used that to try and graph the results of the different procedures and their outcomes. I found this very helpful in making my decision.

I hope this helps some and good luck in your journey. If I can help in any way, please don't hesitate to contact me.

Damon