Robotic Surgery or Radio therapy

Hi very difficult time and what a decision to make. You can download the toolkit from PCUK which will give you lots of info about all treatments.
You need to do your research from reliable sources as it is only you who can make the decision as you don’t want to look back with regret.
Click on my avatar and you will see my journey from when I was at the stage you are at and just a couple of years younge than you

Bri

Hi , click my picture and read my story. I opted for surgery at 48 but it was too late for cure. HOWEVER nearly 3 yrs on , if they’d got the cancer out , I would be in a fine place. I was continent within 3 months. I’ve had complete ED for nearly 2 yrs post op but have enjoyed sex in other ways and have tried most treatments. I’m now virtually back to normal with daily Cialis. You will lose up to 2”” off your penis length. You need to put an ALMIGHTY effort into erectile recovery and push push push for meds and treatments etc. Orgasm has never been as good as pre op and obviously zero ejaculation. But as I say life is pretty normal except I’m now incurable. I’m not familiar with long term results of RT other than itself carries long term risks and will eventually lead to ED also. I’m sorry to say there is no easy fix to prostate cancer without permanent life-changing side-effects. It has to be YOUR decision alone and you need to read the toolkit and phone the nurses for help and excellent advice. My best wishes to you and please post again as we will all help whenever

I was 46.  Opted for robotic prostatectomy.  One year later, I've been booked for salvage radiotherapy, so I have a second chance of a cure.  No incontinence but do need injections for erections. No real regrets.  Something drastic had to be done.

Ulsterman 

Hi Pete,  You're 13yrs younger than me but I never had any doubt I wanted surgery.  Getting completely rid of the main tumour seemed a good route even if it failed.  At the time I was fully on board with the idea that you can have RT after RP but once you've had a full dose of RT you don't get anymore RT, as far as I know.  I'm not sure it's quite as big an advantage as I thought because the RT is likely only to be used if it comes back locally, as you can still go for a full dose on your bladder and full cure.  I find myself now more concerned about it spreading beyond locally partly because it was near the apex edge and 4+4 although with negative margin.  It was upgraded from 4+3 to 4+4 on inspection after the op.

Also if the surgeon has offered you Robotic surgery that is what he does.  If you want a different type of surgery from what I've read you're better going to a surgeon who does more of that type of surgery.  Although I don't think many specialise in open surgery.  An experienced surgeon is something to look for.   I met one person who agreed to have a surgeon do his first operation on him and he still had bad incontinence 2 years later. That might be bad luck, he seemed philosophical about it.

On ED I was told that one nerve bundle could be saved and it would result in weaker erections.  A year later I'm just beginning to get erections a bit weakly but I've always thought, perhaps naively that it will improve and haven't used any aids.  I tried Cialis and realised it gives me aches and I'm not keen on taking pills anyway.

On incontinence I was always dry at night but leaked in the day then it got better week by week.  Now I'm dry but can be known to slightly leak if I bend down too often too far too fast. But it's no problem as I see it.

There is more in my profile which has a link to a webpage I've written as a diary on my treatment.  I've also recently written about my op in a note in General Discussions.  Every case is different, you've a lot to think about so good luck on your choice and don't let it delay anything.

Regards
Peter

I'm just a patient and the above is just my experience and opinion.

Perhaps you are not a suitable candidate for Brachytherapy, high dose or low dose seeds with or without the addition of External Beam RT as this does not appear to have been mentioned. However, for suitable patients studies show these forms of RT on average provide better long term results than External Beam only in combatting cancer. I would ask about this before making a treatment decision.

As everyone mentions here - everyone is different and its important to choose the route you are most comfortable with.

When making your choice you can go round in circles so I would advise the following ;

Whether you have surgery or radiotherapy, if your cancer is contained in the prostate your chances of complete cure are very high for both routes and to all intents and purpose both routes are equally as effective. But get it done now because once cancer has escaped from the prostate things get much more complicated.

Do not ignore the mind - some people just want to know the cancer is gone and like the idea of a surgeon "getting in there" and checking everything is removed - if this is you and you might worry if you had radiotherapy that there might be some legacy still in there after treatment then you should definitely go for surgery.

When looking at possible side effects I would suggest keeping it to the big 3 - Permanent Erectile dysfunction , lasting Bowel incontinence and lasting urinary incontinence.

The percentage chances for any particular side effect are mostly made up from figures acquired over many years an are skewed a little because until recently the number of people included in the figures were mostly older than those being treated these days. For example the chances of dying on the operating table are put at 1% - however while this might be true if you are in your 80's its not if you are fit and 60. There are no figures that tell you, for instance, if treated at age 55 for prostate cancer that the erectile dysfunction chance is 30% and at age 75 its 60% (my made up figures) - you will only be told a blanket 50% chance. It is a lottery in the end and there are no hard promises on this but if you are under 65 and fit and healthy with a good sex life prior to any treatment you are in a better place to avoid permanent side effects.

I am 60 (59 at diagnosis with no symptoms) PSA 30 Gleason 7 with 6 out of 10 positive cores and I chose to have 6 months hormone therapy followed by 20 sessions of radiotherapy. I finished all my treatment last friday and I will say so far its been a voyage of discovery. I would say that dont think for one moment that you will not notice any temporary side effects - there will be some whichever route you decide to take. I had complete loss of libido with hormone therapy - however my libido will return now that the hormone therapy has finished and even without libido I continued to be able to get erections (this takes a lot of concentration but its important to keep the mechanism exercised). I got severe cystisis with my radiotherapy but once again this should go and is already diminishing and again I have tried and can still get an erection. This could always change over the coming months I know but having finished my treatment I am confident of the final outcome and in a good place and happy with my choice.

Tony

Hi I had Robotic Surgery on the 19th September at the age of 56 and am now almost dry.
E D is coming back with the help of tablets. I don't regret it at all and feel it was the right move for me.
So far my PSA is at 0.02 go back on the 6th of Feb fingers crossed.
Andy