Radiotherapy vs Radical Radical Prostatectomy

As Adrian says, a biopsy is only a sample and the difference a year later means the difference is more likely in the sampling than in cancer progression. And if you choose to have surgery, pathology will be done on the whole prostate which may change the grading again.

On paper both approaches have roughly similar success rates, and both have side effects. Although if you receive radiotherapy on the latest machines the risk to nearby organs should be less than it used to be. The decision is personal.

As you recognise age matters, which is why surgery tends to be favoured among younger patients and radio among older. The younger you are the better you recover from what is pretty serious surgery, and you are more likely to live long enough to experience a secondary cancer (though as said above, those risks should be reducing). And following surgery you have radio still available should cancer return while the reverse is rarely the case. On the other hand the worst side effects of surgery, incontinence and erectile dysfunction - which not everyone gets to a debilitating extent - are going to be worse with a lot of your life before you.

It is tough for all of us making the decision. There are men here who have chosen both with good success, and others who are suffering from ongoing side effects or recurrence whichever they chose (to be fair, successes are under-represented, those happy folk stop following the forum and posting).

Hi there. I thought I'd post an update following my RALP surgery that might help men just about to go through this journey. As a reminder, I am 52, had a 4+3 Gleason with a 1cm tumor on one side of the prostate and PSA of 5. My surgery was just over three weeks ago now. Nerves were removed on one side but spared on the other.

The robotic surgery went fine (fantastic job by Ed Rowe and the team at Southmead Bristol).

On waking up after 4 hours of surgery there are those mixed emotions of being ecstatic the surgery is over and hopefully, the tumor that I have been living with for what seems like an eternity has finally left the building, while at the same time seeing a catheter and lots of wounds and realizing the recovery is only just beginning.

I spent one night in the hospital and home the next day. Because you are operated on for 4 hours laying 45 degrees downwards,  my shoulders ached badly for about 4 days afterward but fine after that.

I quickly got used to living with a Catheter and found using a coat hanger sandwiched between the mattress and bed frame with the lower velcro strap attached worked a treat to hold it while sleeping. I was up on my feet for small stints during the day, and made a little walk to park after just a week. Only forget to close the catheter tap once typically on the last day after emptying it!

The catheter came out after 2 weeks and was nothing to worry about, a 2-second weird discomfort then all over. I had heard some horror stories on this site about men needing 20 pads a day initially so bought loads of pads and nappies but I am pleased to report I just used one pad on the 1-hour car journey home. No leaks while sitting or sleeping from day 1 of removal. 

Just under 3 weeks after surgery I made my daughter's graduation, a 1 hour drive, on my feet for a lot of the day but just needed one pad. I assume my leaks are caused by pulls on the wound between the urethra and bladder which is still healing as they come occasionally while walking, coughing, or bending and are a little bloody. 

No sexual sensations down below yet, on drugs to stimulate the nerves but the consultant says it can take up to 2 years and may never come back so just need to be patient on that one. 

The biopsy of tumor came back as 4+3 i.e. same as before and although it had broken out on one side because nerves were also removed the consultant thinks  it has safe margin and lymph node was clear. So now just need to wait on PSA results in 3 weeks time.

So there we are, I know the journey for each of us is different but hopefully this is a positive story that we all need when going through this.

Hi Skeir,

Thanks for sharing your journey - I have just read the whole thread as I have got a similar decision to make, and reading your posts was very helpful.

I have just returned from the surgeon, who was checking my MRI results. I am 42, so a bit younger than you, and diagnosed with a Gleason score of 3+3. My PSA level was actually low/normal, and they only discovered the tumour while dealing with something minor and unrelated. I believe there was only one core that came back positive in the biopsy.

Anyway, now the surgeon has told me I must make that decision between radiotherapy and surgery with a robot (he believes surgery is best, but admits that is because he's a surgeon). I will speak to a radiologist, but I'm leaning towards surgery because of the fear of the cancer returning. I'm very scared of the operation and the side effects, but somehow having a choice between two treatments has given me a better feeling of control over the situation, if that makes sense.

All the best for you and I hope the recovery continues to be positive.

C

I asked CC Brun the same question, a couple of months ago, on his conversation https://community.prostatecanceruk.org/default.aspx?g=posts&m=297211#post297211

I'm mystified why he has been advised that he is too young for active surveillance.

Edited by member 22 Jul 2024 at 23:58  | Reason: Link

hi CC

My initial diagnosis was 3+3 but as it fairly common place the biopsy/scans don’t always tell the full story. Very much the case with mine as had I waited any longer it would have gone T3 and breached the prostatic capsule plus higher chance of mets etc. AS is all very well and something I was offered. Pleased I decided to opt for surgery ASAP… fundamentally the longer the cancer is in there (even type 3 cells) the higher chance of spread plus be mindful that in ~44% cases the cancer staging is upgraded with post op histology.