Surgery verses Radiation

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New Member

Date Joined May 2011
Total Posts : 2
   Posted 5/16/2011 8:54 AM (GMT -6)   
mad  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.

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4818
   Posted 5/16/2011 9:04 AM (GMT -6)   

There is already a recent thread on the old word -> Regret.

Since after surgery - its too late to regret ones decission - most have accepted it and moved on.

You'd also have to ask the rad guys if they regret not trying surgey first to get a clearer picture.

Best thing to do is figure what will work best for YOU and go with that.


Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 5/16/2011 9:39 AM (GMT -6)   
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 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 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)

Veteran Member

Date Joined Nov 2009
Total Posts : 7187
   Posted 5/16/2011 9:47 AM (GMT -6)   
My situation sounds identical to yours. I chose surgery. It didn't work, although it probably debulked much of the cancer.
Do I regret it? No. I made the best decision I could with the information I had. I read a lot and consulted experts.
There never were any guarantees, only probabilities
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .Biopsy 11/30/09. Gleason 4+3. Age: 64. Surgery: Dr. Menon @Ford Hospital, 1/26/10. Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- yes.. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13,3/1/11--0.27. Now doing SRT

Regular Member

Date Joined Apr 2011
Total Posts : 235
   Posted 5/16/2011 10:33 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.
Age 61, psa 4.6, 30 days cipro, psa 4.3, biopsy 4/28/11, 2 of 12 cores positive, Gleason 6
Central Ky

Regular Member

Date Joined Apr 2011
Total Posts : 414
   Posted 5/16/2011 11:01 AM (GMT -6)   
I think it's important to note that every case is unique. There are just too many factors that go into choosing one method over another and whether that method is ultimately successful or not. Just because it failed on one person with similar stats does not indicate that it will fail on another.

Instead of spending too much time seeing how you stack up against someone else (although statistics can be valuable when used correctly) and playing "what if", you need to look at your own case on it's individual merits, make a decision, and go forward knowing you'll have to accept the consequences of that decision.

I do have to admit though, the decision-making process is terribly hard and I can see myself falling into the "regret" trap. It's a negative emotional response that we just can't avoid. We just have to accept things as they turn out and move on as best we can.
John (HD_Rider) - Wichita, KS
Age: 49
PSA: 3.5, 6/07
PSA: 4.5, 3/11
Biopsy, 12 cores: 04/13/11
Dx: 04/19/11
Gleason: 3 cores at 3+3=6 and one core at 3+4=7 (primarily on right side with <5% on left side)
DaVinci: scheduled for 06/09/11, hoping and praying for the best

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4818
   Posted 5/16/2011 11:08 AM (GMT -6)   
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...

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 5/16/2011 11:17 AM (GMT -6)   
Both radiation and surgery have similar results as to cancer control. Radiation has different but better risks on the side effects. The common misconception is that surgery is better because if it fails you have radiation as a back up. Savage radiation works only if the surgeon did a poor job and left some prostate tissue behind or the cancer is in the prostate bed outside the surgical margin. In either of these cases primary radiation would have worked better. There are also salvage treatments for failed radiation that are similar in effectiveness as those for failed surgery such as seeding and HDR Brachy a well as cryosurgery and salvage surgery by a specialist.
There are many good reasons to choose surgery, but having radiation as backup plan B should not be one of them. Choose the best primary treatment for the grade and location of your cancer. Good luck.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Going for brachy
Regular Member

Date Joined Apr 2011
Total Posts : 148
   Posted 5/16/2011 11:26 AM (GMT -6)   
Radiation can be as good as radical surgery.
Age 70
Resident of DE, USA
PSA 3.4 January 2011
Biopsy Feb 2011 Gleason 3 + 3 T1C 2 out of 12 one 5% other 10%
Treatment option: Brachytherapy in the next 5 or 6 weeks
Volume study 5/3/11 49 cc

Regular Member

Date Joined May 2011
Total Posts : 33
   Posted 5/16/2011 2:56 PM (GMT -6)   
My decision was to go with open surgery over radiation. The decision did not come easily though. My family GP's opinion swayed me towards surgery. He said he spoke to his radiologist daughter and she suggested there may be much scarring of the prostate leaving surgery if needed, later on very complicated and risky. If surgery did not get all of the cancer, radiation was still an option.

There are however many success stories with radiation. I think the important thing to get the most experienced Dr. you can find to do whatever procedure you choose and believe tis is the right choice for you.

I agonized over this for a long time. My decision was 100% the right one for me. I have no ed or incontinence problems one month post surgery.

I wish you well on your journey
Age: 55 Ontario, Canada
PSA: 1.2
Dec 2010: Family Dr. found lump on routine physical (not there 1 year prior)
Feb. 6 2011 biopsy: 3 of 11 cores, T2a, Gleason 6 (3,3)
Urologist recommended "watchful waiting" ...back to my family doctor he recommended surgery.
Back to Urologist asked him to refer for third opinion (he did so reluctantly)
3rd opinion: Urologist recommends surgery
April 15: open radical prostatectomy
April 27: catheter removed...absolutely no ED issues and a little incontinence.
May 6 2011: Pathology report excellent, cancer confined to prostate, Gleason score remained at 6!

Inspector 13
Regular Member

Date Joined Feb 2011
Total Posts : 181
   Posted 5/16/2011 3:13 PM (GMT -6)   
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.

Regular Member

Date Joined Mar 2011
Total Posts : 81
   Posted 5/16/2011 5:52 PM (GMT -6)   
I agree with compiler. I am a Gleason 4+5, had both RO and surgical consults. With the information at hand, I chose surgery. Good for 2 1/2 years, then needed SR this winter. I have read learned much more now, but even so, I probably would have followed the same pattern. Look, every decision carries risks and benefits. As a podiatrist, I know when I talk to a patient about foot surgery, I tell them of possible risks, alternatives, and complications, whether they are likely or not. The urologist who did surgery on me at Johns Hopkins did the same. Never regret your decision -- no gain in doing so. Best advice I can give is get your consults, read a book like Walsh's or the like, discuss it with your spouse (if married), pray, and sleep on it. That is what I did, and I remember waking up and telling my wife I decided on surgery. She said she thought that was best, too. After that, a lot of fear went away.
Good luck
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