Why did you choose your treatment?

Most studies, including very well controlled ones, have shown equivalent outcomes for open vs. RALP. open has a slightly higher average blood loss and and hospital stays averaging 1/2 day longer. I have the impression that it's
easier to access and remove more lymph nodes (for high-risk patients) with an open.

A large number of procedures (>1000) is, IMO, a necessary but not sufficient condition for choosing a surgeon. You can also ask about the surgeon's percentage of positive margins (within your risk group, however), since this is one of the main parameters used to evaluate uros first learning the RP procedure. Positive margins can be unavoidable (because of PCa location) or avoidable (surgeon error). In addition, ask out stats for oncological, urinary, and potency outcomes. Not all surgeons are equal: you can stack the deck for better than average outcome chances by choosing a better than average surgeon.

Djin

ANB, if you had read the entire thread, a well known surgeon refused to do surgery on the OP because he has an uncommon heart condition that mitigates against general anesthesia.

I decided on HDR Boost, mainly because I felt the radiation treated a wider area than surgery and I had a 30% likelyhood of EPE According to the nomograms.

I had consults with 2 surgeons, my Uro who had done 250 procedures and another who had performed 300 open and 750 Robotic.

I spoke with 3 Radiation Oncologists, 1 for EBRT, 1 for SBRT and finally HDR. This guy had 30 yrs experience, done 1600 LDR and migrated to HDR with 500 procedures.

The only peer reviewed unbiased data I found was this comparing treatments and explaining the data. Note I also reviewed a lot of other data, but the link below sums things up in easy to see format.

https://www.prostatebrachytherapy.org.uk/presentations/2012_presentations/Peter_Grimm.pdf

Also after much research, I felt the HDR treatment would be the most effective and I decided I didnt want to face SRT if surgery failed since SRT is the most toxic for side effects.

So I opted HDR Boost

Per the SRT
Pay attention to what TA has to say.

From Tall Allen;
I was writing an article on new salvage radiation techniques, and I wrote a section on why salvage radiation is different from primary radiation. I thought I'd share it here (slightly edited) because this subject has come up several times on HW lately.There are several considerations that arise more in the salvage radiation therapy setting than in the primary therapy setting:

• The bladder and rectum are no longer shielded by an intact prostate, so they are potentially exposed to greater spillover radiation. The prostate bed without the prostate is highly deformable, and rectal distension can change its shape markedly within seconds during the treatment. This increases the amount of toxic radiation absorbed by healthy tissues.

• Blasting the anastomosis (the place where the urethra has been cut and re-attached, and where most recurrences occur) with unshielded, high intensity X-rays may be too much for the fragile tissue.The scar tissue of the anastomosis may become inflamed, leading to a higher risk of urinary retention, tissue destruction, or fistulas.

• The bladder neck, which may be spared during primary radiation and surgery, receives a full dose during salvage radiation therapy, increasing the probability of bladder neck contracture, urethral strictures, pain and incontinence.

• The neurovascular bundles play a large part in erectile function. The nerves are already cut or in shock from the surgery, and may take a long time, if ever, to recover. Radiation, which may cause fibrosis in blood vessels, may further impair erectile function, which is probably already impaired from the surgery. Neurovascular bundles, if spared by surgery, are far more exposed during salvage radiation. These deleterious effects are further aggravated if hormone therapy is given along with the salvage radiation because tissues (nerves, blood vessels, erectile tissues) that are not used may not recover and tend to atrophy.

Salvage treatment is bad - period. That's as true of salvage after radiation as it is of salvage after surgery. A man should never go into any treatment thinking he can just have salvage later. One should choose the treatment that has the best odds of getting it done right the first time with whatever side effects one is willing to tolerate.

- Allen

Good to see you back Gman. How's the surgical recovery going?

My decision making process was very similar to GMan’s. Now that my leakage is abating, I am reasonably pleased with my whole process.