Radiation vs. Surgery

RM, this is the age old debate on our site with energetic answers on both sides of the equation. Before I answer your question from my perspective I will suggest that your education begin by reading the sticky thread at the top of our forum as well as three books: "Guide to Surviving Prostate Cancer" by Dr. Walsh and two books by Dr. Scholz, "Invasion of the Prostate Snatchers" and "Key to Prostate Cancer". Dr. Scholz also has produced a number of excellent videos that you can search for on YouTube. Many of them are specific to a diagnosis so you might want to wait until after your biopsy so you can target your research.

For me, in hindsight, the decision seems clear cut. I'm 76 years old and going on 15 years post-treatment with no lasting side effects except reduced ejaculate. Urinary and sexual functions have continued to be just fine since the treatment and, most importantly, I consider myself cured. But at the time I must admit I wrestled with the decision. I had low intermediate cancer, no pre-existing ED or urinary issues, a normal sized prostate and it was clear that any of the mainstream treatments was likely to cure me. So I carefully evaluated both open and robotic surgery with several urologists and spoke with radiation oncologists about EBRT and LDR Brachytherapy. SBRT was just emerging at the time of my diagnosis so I was hesitant to try something new and HDR Brachy just didn't make it onto my radar. Today I would strongly consider both HDR Brachy and SBRT given my particular case. My decision might not have changed but that would have expanded my education.

Almost all of us desire triple success in our outcomes -- cure, continued continence and continued sexual activity. Given that both surgery and radiation were likely to cure me I then focused on the side effect profiles and found multiple studies that showed fewer onerous urinary and sexual side effects with radiation. I also learned of less frequent side effects of both treatments, e.g. secondary cancers from radiation (very low probability) and shortened penis and ejaculation of urine from surgery. I considered what might happen if the original treatment failed and determined that there were equally effective options for both failed surgery and failed radiation. Finally I considered the annoyance factor associated with the treatments. Surgery was a big deal with an extended recovery period while LDR Brachy was a day procedure and I was back to normal almost immediately. So at the end of the day, with cure being fairly certain with both surgery and radiation, I let the side effects be the determining factor so LDR brachytherapy won the day.

Hope this is helpful. More importantly, I sincerely hope you just have an infection that has caused your high PSA and you don't have cancer at all!

Jim

P.S. You can read my long winded story in my signature if you wish.

It is a very individual decision as there is a bad story and a good story for every treatment method. Just be "fair and balanced" in your research of all treatment schemes and ask the doctors (GP, urologist and radiation oncologists) all the questions important to you before making any decision. There is always time to do this with prostate cancer and you do not need to be rushed to pick a treatment which is the natural inclination with any cancer diagnosis.

You do not have to go down the current HW posting too far to find men looking at artificial urinary sphincter implantation and some peeing blood & clots as a result of treatment choices, stuff happens. You can also find lots of men that did fine with whatever method they chose. There is no treatment without risk. Best is whatever you determine that to be after the appropriate research. Regrets are for those who did not do the research and were surprised at the results.

When you get a specific diagnosis, you can then ask the specific questions you need help with. Starting the endless discussion about the preferred treatment scheme will get you no closer to an answer for your specific situation, whatever that may be.

read the forum paying attention to permanent side effects and come to your own conclusion which is best for you

I am on other, non-health related forums and your question reminds me of some I see on those such as “what’s the best oil to use” or “what’s the best film to use” etc. What I have learned via social media is that the recommendations you will receive are based on what the poster did and therefore believes to be the best because that is what they did. What you end up with is a list of possibilities that you have to weight for on your own. Caveat emptor.

When I see a reference to “prostate snatchers” I run the other way. Fear is a primary tool in marketing and one needs to be aware of that.

Vince, I never asked what was the best as I understand the folly in a generalized query like that, only what criterion individual patients used to make their specific choice.

It really seems to be a decision between:

• Surgery

And

• Internal (HDR brachytherapy, LDR brachytherapy)
  
• Photons (IMRT, SBRT, MRI-guided RT)
  
• Protons (various dosing schedules)
  
• Pluvicta (internal into bloodstream, I bet some day it will be a frontline therapy)
  

So pretty big spread in radiation therapies. The big common thing is you don’t get to examine the prostate. It’s true condition remains an informed guess.

Also, I doubt any one radiologist is a true expert in all of the radiotherapies, so more doctors to consult with.