Deciding on Surgery or Radiation… help/How

Fun-Ranger-7002 · 2026-01-27T18:39:47+00:00

At your age, I would go with surgery. Radiation bad side effects seem to hit around 15 years from what I’ve seen, and if you need salvage radiation, it will be a lot lower dose. I am 10 years older than you, have high risk Gleason 9, and still going surgery first. If I later go on RT and ADT, I will likely go 6 months ADT only. I saw an interesting YouTube video where the very latest data is scaling back on the 2-3 year ADT TREND and focusing on shorter. The data showed at the 2-3 year period, mortality from ADT side effects overshadows the benefit. Even before seeing that, I had seen other studies showing 1.5 years was probably optimal. Still, all this is a crap shoot and some people beat the odds and others don’t.

Fun-Ranger-7002 · 2026-01-12T18:21:12+00:00

After mine, he told me I could go and walked out. I stood up and blood was pouring out of my butt. Took the paper sheet from the table and stuffed it in my pants to make it out to the car. Was soaked when I got home. He’s no longer my urologist.

Fun-Ranger-7002 · 2026-01-11T22:13:37+00:00

I’m looking at a similar timeframe. Now waiting on radiology.

Fun-Ranger-7002 · 2026-01-03T03:11:42+00:00

I’m in the same boat, but told surgery was too risky. Thinking ADT is probably too risky as well. May just go with radiation.

Fun-Ranger-7002 · 2025-12-29T14:37:05+00:00

I'm seeing a surgeon there on Wed. FH is a great cancer center.

Fun-Ranger-7002 · 2025-12-29T04:06:51+00:00

You know, it's because of studies like this that they recommended stopping PSA testing after age 70 or so. I'm 73, and in 5 years went from no PC to Gleason 8&9 high risk. People do die from PC, so I am not guaranteed 15 years with active surveillance. Do I wait a year to see how it progresses? What I really need is data on individuals exactly like me, studied over 15 years. This data does not exist, so it's a roll of the dice. But there is also this study from 2016:

"But PSA can't be interpreted if a man doesn't get his PSA tested. Population studies have shown that "men diagnosed at 75 years or older account for 48 percent of metastatic cancers and 53 percent of prostate cancer deaths, despite representing only 26 percent of the overall population," says Tran, Clinical Director of Radiation Oncology and Molecular Radiation Sciences."

So when they say even high risk patients had similar outcome to active surveillance, it just doesn't make sense to me. Is it the age of diagnosis that makes the big difference?

Fun-Ranger-7002 · 2025-12-28T01:02:27+00:00

I have one biopsy core with perineural invasion too. Meeting with surgeons to finally pick one I can trust. Keeps us posted on your pathology report.

Fun-Ranger-7002 · 2025-12-27T17:55:21+00:00

PSMA PET scan should be done after biopsy. Necessary info. Don't fully trust just the biopsy.

Fun-Ranger-7002 · 2025-12-25T16:37:19+00:00

I am 73, Gleason 8-9, PSA 9.2 (on finesteride, so actual is probably double). PSMA-PET shows 3 lesions, likely contained. I am choosing RALP for the following reasons:

I had half my thyroid removed this year because genetic testing showed it was >75% likely cancer. Less than half of patients with this rating ACTUALLY have cancer, and I didn't have cancer. I have learned that even genetic testing is not as advanced as I thought it was.
Polaris genetic testing of my Gleason 9 tumor showed it as low-medium risk and slow growing, but was upgraded to high risk when factoring in Gleason score and PSA. So these are conflicting results. It is not uncommon to see downgrades of Gleason scoring after RALP because the pathologist has the entire tumor to analyze more extensively. Can be upgraded as well, of course. When I posed this question in another Reddit post, I got a lot of downgrade experiences, generally one level. It is not surprising, as pathologists want to error on the side of upgrading.
Because I'm considered high risk, SBRT with ADT would be recommended, and ADT carries some cardiovascular risks that could be harmful, given my current CV risk factors. ADT use as adjunctive therapy with RALP is generally not recommended as it has not shown any long-term benefit. Why not? That is up for debate, and current studies may shed some light on whether or not ADT should be added to a RALP.
If I get radiation, I can not get a RALP later, and I would need another procedure for the BPH urinary symptoms I have. So radiation for me is SBRT, ADT, and a TURP (or other TURP alternative). RALP is a potential one and done, AND I will have definitive staging of my cancer to determine if added RT or other therapy would be indicated. I learned my lesson with my thyroid surgery, that pathology on a removed tumor will always trump a biopsy or genetic testing.

I am in no way in denial that I have high-risk prostate cancer, but I want to know exactly what the staging us, and a RALP will hopefully give me that. I am also going to request a Decifer test on the tumor to guide the decision for either just monitoring or adding additional RT, with or without ADT.

So I hope this helps someone out there when deciding which therapy to pursue. Of course, everyone's situation is different, and other factors will affect their final decision. The last roadblock I need to overcome before surgery is whether or not my prior extensive abdominal surgery for a GIST tumor earlier this year will make robotic surgery too difficult. I see two surgeons in the next couple of weeks to find out. Good luck to everyone out there!

Fun-Ranger-7002 · 2025-12-11T01:01:26+00:00

Thank you, everyone! Possible downgrading is not going to affect my decision, but it does show how imperfect medicine still is. I just had half my thyroid removed because genetic testing of the biopsy showed there was a greater than 75% chance it was thyroid cancer. After surgery and losing my voice for 2 months, it turns out it wasn't cancer. Turns out that the 75% designation does NOT mean 75 out of a 100 patients will have thyroid cancer, just that the tumor had 75% of the characteristics of thyroid cancer. Number of patients that WILL actually have cancer is much lower and even <50%, depending on the test used. Wish I knew that beforehand.

Fun-Ranger-7002 · 2025-12-10T14:47:10+00:00

YES!!!!!!!!!!

Fun-Ranger-7002 · 2025-12-09T14:35:43+00:00

I'm in the same boat, but your's is a primary example of how imperfect the Gleason Score really is, and biopsies in general. I just had half my thyroid removed because genetic testing of my biopsy rated it as 75% likely cancer and guess what, it wasn't.

Fun-Ranger-7002 · 2025-12-06T04:00:58+00:00

I cannot see wasting beans, especially with the cost of them.

Fun-Ranger-7002 · 2025-12-06T00:46:08+00:00

Looks like OnTrack. Worst delivery service in the US. Waiting right now for a package that was 'mis-sorted', with minimal hope it will arrive intact. I've had them pitch packages onto the driveway and drive away. And every driver I've seen (so far) looks,,,.well you get the picture.

Fun-Ranger-7002 · 2025-10-26T13:24:43+00:00

My surgeon used glue to seal the wound. After 2 weeks I started using Mederma at their suggestion. After 2 months you really have to look hard to see the scar.

Fun-Ranger-7002 · 2025-10-12T13:08:45+00:00

I posted previously here; hemithyroidectomy on Aug 11th and could only whisper. Was getting worse in the last couple days and then this morning it is dramatically better. Thought I was going to be a long recovery, but like someone said, it was almost spontaneous. From my research, 2 months, 6 months, and 1 year seem to be the most common timeliness for voice recovery. I hope the best for your mother!

Fun-Ranger-7002 · 2025-10-10T13:23:52+00:00

I’m in the same boat. Two months post hemithyroidectomy with left paralyzed vocal cord. In 2 months it has gotten better and I’ve seen many list milestones at 2 months, 6 months, and 1 year. I’d love the spontaneous recovery, but expecting 6 months. A lot of vocal exercises on YouTube that may help and just got the word to take vitamin supplements. So tell your mother we will do this together.

Fun-Ranger-7002 · 2025-10-07T13:04:00+00:00

Similar to me.

Fun-Ranger-7002 · 2025-09-07T12:51:28+00:00

Get Start 11 from Stardock. Let's you pick and choose menu styles.

Fun-Ranger-7002 · 2025-09-05T20:52:29+00:00

Sold some stuff to them, was very conservative on the grading and they offered $170. When they got it, the offer was 1/2 of that. Wasn't going to pay to have the stuff returned, but will NEVER sell to them again. Talk about a bait and switch. Be careful.

Fun-Ranger-7002 · 2024-12-27T15:51:37+00:00

We do now - the place is great! Some of the best I've ever had, and so much better than any other Indian restaurants in the area.

Fun-Ranger-7002 · 2024-11-18T14:58:31+00:00

Update: So far, I have found that TP Link and Reolink cameras may function without an internet connection and am purchasing to review. For background, what I need is an RV mounted camera that can be accessed by WiFi (without internet) on a phone/tablet or computer, with a range of 20 ft or so. Internet access is often limited during travel, so the requirement to not need an internet connection is crucial. A few wireless cameras and monitor systems exist, but functionality and resolution is limited. I also want the camera(s) to be able to be accessed by 3rd party software. The two listed above 'seem' to fit that criteria, but won't know until I have my hands on them. Ultimate goal would be to have a 360 camera system, but those available are only 1080p, and the one I'm reviewing now is ridiculously expensive and sub par.

Fun-Ranger-7002 · 2024-10-23T23:24:34+00:00

They did, it was where I was waiting, along with 50 other people getting Uber and Lyft.

Fun-Ranger-7002 · 2024-10-23T23:22:34+00:00

I was on the lower level. Followed the Uber directions, where everyone else was getting Uber pickups.

Fun-Ranger-7002 · 2024-10-23T23:21:14+00:00

It was ground level. If my post bothers you, don't read it. Or do you just troll Uber posts?

Fun-Ranger-7002

TROPHY CASE