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Surgery v RT and HT

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User
Posted 25 Jan 2026 at 17:53

Please see my bio/profile for all the details as I understand them.

The question on my mind at present is surgery v RT/HT. I saw the Urologist (surgeon) on 19/1/26 had a good conversation and at that moment in time was leaning towards surgery to the point where I signed, however we both agreed I could change my mind.

Having come away and re-reading lots of info and using the power of AI I'm now leaning towards RT/HT.

Has anyone had a similar experience? I'm thinking with success rates similar across both options, what will be my quality of life with each, thinking positively I'm thinking decades to come. RT/HT seems more predictable and less invasive, whilst being longer in treatment.

I'm also going to organise a meeting with an Oncologist to discuss in detail RT/HT. But looking to have all the facts and any experiences would be greatly appreciated.

Cheers.

  

User
Posted 26 Jan 2026 at 08:01

Kab, most of us have had to make the same decision. There is an argument that radiation treatment for someone as you runs the risk of causing further cancer in years to come but then someone quoted that  as 1 percent chance. I had surgery then needed radiotherapy three years later. Modern imaging might show spread that means radiation is a more appropriate option, but then again, there is a school of thought that removal of the mother ship is beneficial. There is the flawed argument that you can have radiotherapy after surgery but surgery after radiotherapy is more of a challenge. My salvage RT did more damage that my surgery. My surgery left me with erectile dysfunction but we had fun finding solutions to that issue. I was initially 99 percent dry 18 days after surgery. 

Thanks Chris 

 

Edited by member 26 Jan 2026 at 08:03  | Reason: Not specified

User
Posted 26 Jan 2026 at 09:40

Hello, KAB.

I'm sorry that you're now in the club that no-one wants to join, but welcome to the forum, mate. You'll get a lot of help and support here.

At 53 years, you're fairly young. I think its fair to say, for most younger men, surgery is perhaps the most favoured option.

I was finally diagnosed at 66 years old, PSA 6.6, Gleason 9 (4+5), T3a, capsular breach. I was given the option of 35 hospital visits over 7 weeks for radiotherapy/hormone therapy, or one night in hospital for robotic surgery.

Like you, I did a bit of research, and saw the the outcomes for both procedures were pretty similar.

I had a heart condition which could have made surgery a bit dodgy,. I think this is why the surgeon probably tried to push me to radiotherpy and hormone treatment. I vividly rememeber him saying, "If you were my dad, I'd be telling you to have radiotherapy and hormone treatment" I remember replying, "If you were my son, you'd know that I like to get things done asap which is why I'd prefer surgery, please."

Eventually, after various cardiology checks, I was deemed fit enough to operate on. That was three years ago. Apart from erectile dysfunction, which I'm now successfully managing, much to my wife's disappointment, with penile injections. Life's now, pretty much like it was before prostate cancer entered it.

Treatment options are a very personally thing, try to pick one that best suits your priorities.

To help you decide. I advice you watch this video.  It deals with the options open to you, and their possible side effects.

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

If you decide on surgery, please watch this video by an eminent surgeon, who tells you how important it is to use a high volume surgeon with a good track record who would probably be able to give you the Rolls Royce of  robotic surgery incuding Retzius sparing, Neuro-safe, complete urethal preservation.

https://drive.google.com/file/d/1fyYTLZpxnB9HaR7O4xQ5Ff58Pj4Cn6ZB/view?pli=1

If you like to do some research apart from this site, take a look at.

https://prostatematters.co.uk/

It is an excellent resource.

Whatever you chose, I wish you the best of luck mate, and hope that you make a speedy and full recovery.

Good luck.👍 

Edited by member 26 Jan 2026 at 10:17  | Reason: Adding lots of links.

User
Posted 26 Jan 2026 at 11:37

Hi KAB197

My diagnosis was similar to yours but I was much older than you. Because the tumour was well contained with clear margin I decided to go for surgery; that was 15 years ago and my PSA has remained at <0.003.  That is the good news. I suffer from arousal climacturia and ED (mostly because of my age).  In spite of all that we are sexually still active. 

At your age recovery from surgery (there is a lot more well experienced surgeons now) should not be a problem. It used to be the case, when I had my surgery, that for a well contained cancer with clear margin surgery was a better option because radiation options were not so well established - particularly the long term prognosis wasn't too good - but now the success rate appears to be very similar to surgery.

I find your comment  '...........and using the power of AI.....'  a little confusing. Are you thinking of changing your mind about surgery on the basis of the information gleaned from an AI platform?  

Like most other men you have a verydifficult decision to make. I don't regret mine but then hindsight is a wonderful gift!

Be confident in whatever decision you make and good luck.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 07 Feb 2026 at 15:27

That's roughly the treatment I had. Total ADT time for me was 24 months. 6 months prior to RT and 18 months post RT. EBRT was 15 fractions, so three weeks. HDR Brachy was an overnight stay in hospital.

Dave

User
Posted 10 Feb 2026 at 09:01

Hi Kab,

My treatment was pretty much exactly the same as Dave, ADT for a total of 24 months, started 6ish months prior to 3 weeks (15 sessions) of EBRT, then HDR Brachy a couple of weeks after EBRT finished. I was home on the same day, I was first in theatre :)

I think your time on ADT is based on Gleason and T staging, I would guess you would be advise similarly to us at 24months, but I'm obviously no expert

John

User
Posted 24 Feb 2026 at 10:17
Hi Kab

Maybe you have decided and had treatment already, best of luck if you have. My diagnosis was similar to yours so here are some thoughts for what it's worth. (PM if you want)

Pre your op they should be looking at your scans and able to confirm if it is contained in the prostate entirely. If it is and no chance of it spreading to surrounding tissue/ lymph nodes then the op should work well to remove the PC, assuming the scan has confirmed no secondary cancer.. Even if you have the op there's a chance you will have "clean up" RT anyway. Op runs the risk of nerve damage, but has the advantage of taking the whole damn thing out. I only had RT post op so can't comment on the efficacy of that route. It's an individual decision, I'm sure you will make the right choice for you.

All the best

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User
Posted 26 Jan 2026 at 08:01

Kab, most of us have had to make the same decision. There is an argument that radiation treatment for someone as you runs the risk of causing further cancer in years to come but then someone quoted that  as 1 percent chance. I had surgery then needed radiotherapy three years later. Modern imaging might show spread that means radiation is a more appropriate option, but then again, there is a school of thought that removal of the mother ship is beneficial. There is the flawed argument that you can have radiotherapy after surgery but surgery after radiotherapy is more of a challenge. My salvage RT did more damage that my surgery. My surgery left me with erectile dysfunction but we had fun finding solutions to that issue. I was initially 99 percent dry 18 days after surgery. 

Thanks Chris 

 

Edited by member 26 Jan 2026 at 08:03  | Reason: Not specified

User
Posted 26 Jan 2026 at 09:40

Hello, KAB.

I'm sorry that you're now in the club that no-one wants to join, but welcome to the forum, mate. You'll get a lot of help and support here.

At 53 years, you're fairly young. I think its fair to say, for most younger men, surgery is perhaps the most favoured option.

I was finally diagnosed at 66 years old, PSA 6.6, Gleason 9 (4+5), T3a, capsular breach. I was given the option of 35 hospital visits over 7 weeks for radiotherapy/hormone therapy, or one night in hospital for robotic surgery.

Like you, I did a bit of research, and saw the the outcomes for both procedures were pretty similar.

I had a heart condition which could have made surgery a bit dodgy,. I think this is why the surgeon probably tried to push me to radiotherpy and hormone treatment. I vividly rememeber him saying, "If you were my dad, I'd be telling you to have radiotherapy and hormone treatment" I remember replying, "If you were my son, you'd know that I like to get things done asap which is why I'd prefer surgery, please."

Eventually, after various cardiology checks, I was deemed fit enough to operate on. That was three years ago. Apart from erectile dysfunction, which I'm now successfully managing, much to my wife's disappointment, with penile injections. Life's now, pretty much like it was before prostate cancer entered it.

Treatment options are a very personally thing, try to pick one that best suits your priorities.

To help you decide. I advice you watch this video.  It deals with the options open to you, and their possible side effects.

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

If you decide on surgery, please watch this video by an eminent surgeon, who tells you how important it is to use a high volume surgeon with a good track record who would probably be able to give you the Rolls Royce of  robotic surgery incuding Retzius sparing, Neuro-safe, complete urethal preservation.

https://drive.google.com/file/d/1fyYTLZpxnB9HaR7O4xQ5Ff58Pj4Cn6ZB/view?pli=1

If you like to do some research apart from this site, take a look at.

https://prostatematters.co.uk/

It is an excellent resource.

Whatever you chose, I wish you the best of luck mate, and hope that you make a speedy and full recovery.

Good luck.👍 

Edited by member 26 Jan 2026 at 10:17  | Reason: Adding lots of links.

User
Posted 26 Jan 2026 at 11:37

Hi KAB197

My diagnosis was similar to yours but I was much older than you. Because the tumour was well contained with clear margin I decided to go for surgery; that was 15 years ago and my PSA has remained at <0.003.  That is the good news. I suffer from arousal climacturia and ED (mostly because of my age).  In spite of all that we are sexually still active. 

At your age recovery from surgery (there is a lot more well experienced surgeons now) should not be a problem. It used to be the case, when I had my surgery, that for a well contained cancer with clear margin surgery was a better option because radiation options were not so well established - particularly the long term prognosis wasn't too good - but now the success rate appears to be very similar to surgery.

I find your comment  '...........and using the power of AI.....'  a little confusing. Are you thinking of changing your mind about surgery on the basis of the information gleaned from an AI platform?  

Like most other men you have a verydifficult decision to make. I don't regret mine but then hindsight is a wonderful gift!

Be confident in whatever decision you make and good luck.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 02 Feb 2026 at 09:20

Hello KAB,

I was 48 at diagnosis, with T3b (early seminal involvement). I was given the option of surgery or HT/RT. In fact I recommended to take the surgery route by one surgeon, then when he was called away to a family emergency the next surgeon strongly recommended RT/HT!

It made choosing rather difficult! I ultimately went for HT/RT, and also had HDR Brachytherapy. I chose this route as I was told the surgery would be none nerve sparing and I would likely need salvage RT. It seemed I'd be getting a double wammy of side effects as a result. I also really didn't like the idea of surgery.

I've got 6 months left of HT to go, and whilst its been no walk in the park I'm happy with my choice, I remain functional and well. The radiotherapy was the easy bit, it's the HT which have caused the worst side effects, I've had all the expected ones. Hot flushes have been very mild though, I have put on a bit of weight, lost some strength, but I'm eating more healthily and have joined a cross fit group to combat this. Loss of libido and ED have been a thing too, I've been prescribed tadalafil and a pump to help avoid any atrophy and keep things healthy. I hope once off it I will return to normal.

You are relatively young and the younger guys do seem to fair better when it comes to recovery from surgery based on peoples stories I've read on here, especially as it sounds like from your bio it will be nerve sparing.

Both options are a long road and there are unknowns, everyone is different, I think if I'd have been in your situation I would probably have gone for surgery, but it's a very personal choice.

Long term survival rates are very similar so in some ways it's just down to what you like the most, or probably more accurately dislike the least from the list of side effects

All the best John

 

 

 

User
Posted 07 Feb 2026 at 09:42
Thanks for the response John1975, wow aged 48 younger than me. Saying that my father was diagnosed at 47. Whilst I did consent to surgery and it was originally booked in for the 10th Feb we’ve postponed as I have a private consultant with an oncologist on Monday. I’m doing some prep. re. questions for oncologist and think I have my ducks in a row, Chat GBT has become my best friend, I’m thinking RT boosted by brachytherapy and ADT, am I correct in thinking RT over 4-6 weeks and ADT from 6-12 months, but each treatment will be unique to the patient. Is there anything you would suggest I add to my list of questions?
User
Posted 07 Feb 2026 at 13:17

Are you thinking of HDR or LDR brachytherapy. They are quite different. ChatGPT will make assumptions about which you are having, and won't necessarily make the right assumption.

Dave

User
Posted 07 Feb 2026 at 14:10
I’ll take the guidance of the oncologist but AI suggesting “HDR brachytherapy as a BOOST. Not LDR seeds alone. Specifically:

   •   High-Dose-Rate (HDR) brachytherapy

   •   Used as a boost combined with external-beam radiotherapy (EBRT)

   •   Plus short-course ADT (typically 4–6 months)”

Not that I’m going to leave it to AI alone but keen to see how the oncologist advice will compare

User
Posted 07 Feb 2026 at 15:27

That's roughly the treatment I had. Total ADT time for me was 24 months. 6 months prior to RT and 18 months post RT. EBRT was 15 fractions, so three weeks. HDR Brachy was an overnight stay in hospital.

Dave

User
Posted 10 Feb 2026 at 09:01

Hi Kab,

My treatment was pretty much exactly the same as Dave, ADT for a total of 24 months, started 6ish months prior to 3 weeks (15 sessions) of EBRT, then HDR Brachy a couple of weeks after EBRT finished. I was home on the same day, I was first in theatre :)

I think your time on ADT is based on Gleason and T staging, I would guess you would be advise similarly to us at 24months, but I'm obviously no expert

John

User
Posted 24 Feb 2026 at 10:17
Hi Kab

Maybe you have decided and had treatment already, best of luck if you have. My diagnosis was similar to yours so here are some thoughts for what it's worth. (PM if you want)

Pre your op they should be looking at your scans and able to confirm if it is contained in the prostate entirely. If it is and no chance of it spreading to surrounding tissue/ lymph nodes then the op should work well to remove the PC, assuming the scan has confirmed no secondary cancer.. Even if you have the op there's a chance you will have "clean up" RT anyway. Op runs the risk of nerve damage, but has the advantage of taking the whole damn thing out. I only had RT post op so can't comment on the efficacy of that route. It's an individual decision, I'm sure you will make the right choice for you.

All the best

User
Posted 28 Feb 2026 at 08:22
Saw Oncologist on the 9th Feb and happy that I’d explored all my options, surgery was our choice with RT/HT a strong plan B. Surgery completed on the 24th Feb and I’m now day 4 in recovery. I’ll admit I was aware of post op challenges but I’ve rather underestimated them, my motto now, just slow and steady positive progress and with the help of my partner things are improving. Surgeon rang wife post op to say successful and nerves spared on both sides.
User
Posted 28 Feb 2026 at 16:15

Great to hear that the nerve sparing was successful.

The improvements for my OH seemed really slow at first, but they happened over time. We were traveling again 3 months later. Hang in there!

Edited by member 28 Feb 2026 at 18:47  | Reason: only part of what I meant to post was typed.

User
Posted 02 Mar 2026 at 08:04

Hi Kab,

That's great news! off to a good start with the nerve sparing and you have youth (relative) on your side.

Al the best for your recovery, you're right, take it slow and each day as it comes

John

 
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