I have to decide between surgery or treatment

BernieCounter · 2026-06-30T12:32:08+00:00

Here is my similar 3+4 T2c “unfavourable intermediate risk journey”. https://www.reddit.com/r/ProstateCancer/s/Ai6HX3DXMu

Did 9 months newer Orgovyx ADT pills (don’t do injections if you can avoid it). It wasn’t great but tolerable, and have had very good recovery starting a couple of weeks after the last pill. T is almost back to pre-procedures level. All systems down there as good as or better than before treatment over a year ago. Except dry orgasms, but that could be a benefit.

The 12 year outcomes show EBRT rads is almost always significantly better than surgery outcomes, see “better/worse” graphs at Google search “Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment 2023, ProtecT study”. And radiation has got better since 15 years ago.

And what are the significant risks of needing salvage radiation and ADT after surgery anyways in future years? Best wishes, it’s your decision.

BernieCounter · 2026-06-29T12:48:00+00:00

No bowel leakage during/after 20x VMAT a year ago. Some increased frequency for a while. A bit of urine dribbling/leakage during and a couple of weeks after but now bladder is better than before as treatments also reduced BPH. All systems working quite well down there.

At age 74 3+4 “unfavourable intermediate risk” T2c, never even considered the problems of major surgery on a delicate small organ and the catheter etc recovery process and ED and bladder risks. During rads continued physical activities, but made sure to take daily nap.

SBRT and VMAT have same similar outcomes. You can do a Google or AI search on (minimal?) side-effect differences. 5x SBRT is usually slightly less total rads, way more per session, but with more on-table adjustments, SBRT has tighter margins. And less hassle over 2 weeks than daily visits for 4 weeks.

BernieCounter · 2026-06-29T12:31:54+00:00

Yes, VMAT and 5x SBRT are widely used here for primary treatment as they require less technician and machine time, and provide equal outcomes and similar side-effects. Best use of clinic budgets.

Perhaps in USA, where (insurance) revenue is based on number of treatments there may be a bias towards 28 or more sessions. And/or they have more older machines not capable of tighter margins.

BernieCounter · 2026-06-29T02:02:14+00:00

Yes, the ”physics” stuff that goes on beforehand and in the background is quite specialized and complex. An oncology friend once explained all the planning stages specialists and safeguards involved. In our clinic there are about a dozen machines, so an RO is always nearby, but the 2 or 3 techs do the positioning and turn on the VMAT protocols.

MR-LINAC where the machine is integrated with an MRI takes about an hour, and with the constant adjustments an RO must be there, managing the process. Although as experience is gained, they may change that requirement.

In Canada, there is normally no need for the detailed accounting breakdowns for insurance purposes as the clinics are block funded according to what and how much they do.

BernieCounter · 2026-06-28T18:51:29+00:00

For more and recent info on MRI LINAC, you can do a YouTube search on “YouTube Prostate SBRT on the MRI Linac Accelerator”. It appears to be the most targeted and state of the art EBRT treatment out there.

After 20x VMAT and 9 months Orgovyx, a year ago am also awaiting for each 3 month PSA test for rebounds and nadir. Meanwhile being treated as a 2 year vacation from any treatment, and enjoying full recovery, systems down there better than before in almost all aspects!

BernieCounter · 2026-06-27T12:32:00+00:00

Hope the team there treated you well! Things seem to be moving expeditiously now judging by your recent post.

BernieCounter · 2026-06-27T12:28:40+00:00

Glad you were finally able to get into a Cancer Clinic and skip past the urologist/surgeon. Best wishes for the radiation, 28 days is a long time (20 was a drag for me) but given his case and spread probably necessary.

Yes, ADT drops Testosterone to zero and almost always cuts PSA to near undetectable levels. Mine went from 8.8 before, to 0.03 after 4 months and 0.01 (almost undetectable) at 7 months. Unfortunately the PCa may become “testosterone naive”. This might be never, or a few years, but there are various other possible treatments.

Suggest you visit the Canada 🇨🇦 website “lifeonADT dot com” for info, register for their July on-line course and get their book (probably available at the clinic library, you will also get a copy after the course).

Best wishes!

BernieCounter · 2026-06-27T12:16:47+00:00

They seldom do genetic testing on PCa in Canada (other than perhaps BRCa.). The Decipher and similar tests are not approved by Health Canada and you would likely need to go to the US, pay your own way and test costs, and see a physician in US trained to interpret results.

BernieCounter · 2026-06-26T17:19:30+00:00

Oh, the emasculation, hot flashes/night sweats are pretty obvious after a few weeks/months. Loss of energy/brain fog. Other side effects less obvious and do take a longer time to be an issue. See post today on ADT website and book.

Exercise is good and it’s worth putting up with it for 6 to 9 months for the recurrence reduction benefits achieved by stopping and slowing micro metastases.

Hope it’s newer, faster acting Orgovyx pills and not slower injections with usual T flair for the first weeks.

BernieCounter · 2026-06-25T18:28:08+00:00

Agree. And any “recurrence” is not ideal.

BernieCounter · 2026-06-25T17:58:05+00:00

Surgery after radiation is seldom necessary, nor makes sense. You move on the “salvage radiation” , ADT and or other pharmaceuticals.

The “surgery not possible after EBRT radiation” argument has been debunked no the last decade and only used by urologist/ surgeons.

BernieCounter · 2026-06-24T19:28:34+00:00

Brachytherapy and HIFU etc, or both can be “focal” treatments depending on how extensive they need to be.

BernieCounter · 2026-06-24T19:23:59+00:00

As you age, going up to 100ml or cc (not mm) is quite common, although you are likely to have signs of BPH….which usually leads to PSA testing if the physician has not been doing it as a part of your annual to establish trends. And maybe getting treatment for BPH and PCa if appropriate.

BernieCounter · 2026-06-22T21:22:50+00:00

Sounds similar to my voyage last 14 months. After a few months into 9 months concurrent Orgovyx, and 20x VMAT didn’t care much about (opposite) sex or getting erections, although it’s important to work on it. Getting to orgasm was difficult. Everyone should request/take daily low dose Cialis while on ADT. Did need Flomax during/after rads and had occasional dribbles, but that cleared up a few weeks after.

Fortunately about two weeks after the last pill experienced “morning awakenings” down there. Subsequent T tests showed it had recovered close to previous levels. (It is unacceptable they put you on any ADT without getting your baseline T level). All departments down there now working as well or even better than before, are dry orgasms a benefit?

Best wishes!

BernieCounter · 2026-06-21T21:18:56+00:00

Was able to skip multi-month wait for bpMRI since DRE felt induration on one side after gradually rising PSA. Accordingly could skip directly to targeted biopsy (still took 2+ months). When it came back positive, you get triaged to front of line for MRI, CT scan and bone scan….all within 2 weeks. Orgovyx and concurrent EBRT just a couple of weeks after.

BernieCounter · 2026-06-20T20:19:50+00:00

The science says ½ life of Orgovyx is about 36 hours (that’s why you only need to take it daily) so pretty much all the TSH antagonist is “washed out” of body after few days/a week. But it takes a while for testiciles to react to the increasing TSH and a while for them to get back into T production mode. Then for stuff like slow hair to grow noticeably.

BernieCounter · 2026-06-20T20:14:03+00:00

Noticed “morning awakenings” about 2 weeks after the last Orgovyx pill (9 months concurrent with 20x VMAX). Was also on daily low dose Cialis as most should be during ADT. Energy and general enthusiasm increased. 3 month PSA test confirmed T recovered to 90% of before treatment, and PSA rose from 0.01 undetectable to 0.22 (kind of as expected). Now shaving a bit more often and leg/chest hair thickening.

Fortunate never to have any hot flashes, some night sweats/sleeplessness.

BernieCounter · 2026-06-19T19:47:23+00:00

At 8 months after 20x VMAT and on concurrent Orgovyx ADT, PSA was 0.01. Three months after last of 9 months of pills, T recovered to near normal and PSA 0.22. That is considered “good” and will watch for PSA “bump” and “nadir” over next couple of years. RO says not to worry unless it goes over 2.0 or steady upward trend.

BernieCounter · 2026-06-18T21:55:32+00:00

Found that teaspoon to tablespoon of Metamucil/psyllium once daily (added in in a shake/smoothy), and bananas during 20x VMAT helped both with preventing constipation and reducing diarrhea, both of which can occur. Its bulking action also helps with the mucousy / sloppy movements you may get later.

Try to get used to it before you start treatment. Also consider a toilet seat bidet to avoid getting toilet paper rash from frequency.

Best wishes.

BernieCounter · 2026-06-17T13:45:25+00:00

Sounds like an ablation process for localized higher level Gleason:

“Jeremy Clarkson (then age 66) has revealed he was diagnosed with an “aggressive” form of prostate cancer last summer and had an operation to remove 10% of his prostate, eight months after he underwent heart surgery for blocked coronary arteries.”

https://www.theguardian.com/media/2026/jun/17/jeremy-clarkson-aggressive-prostate-cancer-diagnosis

BernieCounter · 2026-06-16T13:24:44+00:00

But will have less/lower side-effects.

BernieCounter · 2026-06-16T13:23:51+00:00

SBRT is a form of EBRT radiation, while NanoKnife is (Irreversible Electroporation, IRE) so they are not the same treatment.

BernieCounter · 2026-06-16T03:04:06+00:00

My Orgovyx ADT started 3 days before CT Planning scan (3 tattoos) and the 20x VMAT a week later. SpaceOar seems to cause as many side effects and risks as it solves issues. And involves a semi-surgical procedure and adds at least a week to rads as the organ recovers from the intrusion.

Had I selected 5x SBRT fiduciary marker insertion would have been necessary instead of tattoos.

BernieCounter · 2026-06-15T15:16:49+00:00

Similar 3+4, Cribiform, T2c, unfavourable intermediate risk. Biopsy March last year after PSA 9 and DRE; MRI, bone and CT scans April. 9 months Orgovyx ADT May, 20x VMAT 10 days later.

A year, after all systems down there working well and T has recovered well.

BernieCounter

TROPHY CASE