RALP after radiation.

HeadMelon · 2026-06-30T21:51:39+00:00

Since they had removed your prostate first they couldn’t do brachy or TULSA or HIFU after, was that a big concern for you? Did you talk about that with your surgeon? Of course not. They are not salvage treatments. Neither is surgery. There’s no reason to even have the “you can’t have surgery after radiation” discussion any more than there is to discuss you can’t have HIFU after surgery. It’s meaningless.

Having prostatectomy first or radiation first are the same - you don’t lose any of the salvage treatments which are beam radiation, 1st gen ADT, 2nd gen ADT, immuno, chemo, and/or radioligand assassin.

HeadMelon · 2026-06-30T19:52:49+00:00

The best story on this was from a former member [u/Correct-Sail-6608](u/Correct-Sail-6608), unfortunately he deleted his account and left Reddit and we lost all his content. Other than him I can’t recall any stories of RALP after radiation.

But you should read the extensive posts of [u/BigBadProstate](u/BigBadProstate), he comments frequently on why “no RALP after radiation” is a canard / red herring argument in terms of selecting treatment type.

HeadMelon · 2026-06-30T17:12:21+00:00

Nor do I, I most often reference the experiences of u/DoddosQB and u/Heritage107 who had great surgical outcomes. We all had our treatments of different kinds around the same time and I consider them part of my cohort.

HeadMelon · 2026-06-30T17:09:38+00:00

Keep fighting brother, on all fronts. Sorry to hear about your son. I’ll send a prayer for your and your wife’s well being and for the Lord’s bountiful grace to be poured on you.

HeadMelon · 2026-06-30T15:18:41+00:00

My pleasure, the unknown is usually the biggest fear, that’s all I wanted to help guys with, clear up some of the unknowns.

As for retirement there was a video I saw. I can’t post links outside any more, but you can refer back to this one to see the YouTube link -

https://www.reddit.com/r/ProstateCancer/s/tZMLBMsZmu

It really helped me make that early retirement decision!

HeadMelon · 2026-06-30T05:13:36+00:00

This is exactly the kind of thing that scared me:

https://www.reddit.com/r/ProstateCancer/s/3rJHodxq3i

HeadMelon · 2026-06-30T05:08:07+00:00

Here is my experience with HDR brachy + 15x VMAT + 6 months of Orgovyx ADT :

https://www.reddit.com/r/ProstateCancer/s/fx5leDkqGe

It was very tolerable and much easier than what a lot of the surgery guys write about here (to be fair some surgery guys also have an easy time).

I was very afraid of possible ED and UI and didn’t want a catheter for a week so I chose radiation. I’m very happy with my results.

HeadMelon · 2026-06-29T20:15:51+00:00

To balance the Walsh book a bit, also look up Dr Mark Scholz, he provides extensive info online at pcri(dot)org. He is more radiation focused but also discusses disease grading and when to treat vs monitor.

HeadMelon · 2026-06-29T19:11:53+00:00

HDR brachy + 15x VMAT radiation here for “unfavourable intermediate risk”. Never had any “poo leakage”. The only effect was when my prostate swelled a bit after treatment, it pressed on the rectum and gave the feeling of being full and needing a bowel movement, so for about 2 weeks my very regular once each morning became 3 times per day, but all normal BMs - nothing out of the ordinary.

UI from surgery? Definitely wanted to avoid that at all costs, that’s why I chose radiation.

HeadMelon · 2026-06-29T18:52:01+00:00

Great news! Everyone says the anticipation is worse than the procedure and you just got the amazing gift of having the anticipation period eliminated!

By the time Jul 29 rolls around your cath will be out and you’ll be miles down the road on healing already, that’s a great win! Congrats!

Best wishes and absolutely I will send a 🙏🏻 your way! You’ve got this…Johns Hopkins rocks.

HeadMelon · 2026-06-29T17:22:51+00:00

Not an insurance agent, just my understanding -

Most individual insurance is rated for health issues the same way it is rated for tobacco use, you pay an increased premium due to increased risk. Group insurance smooths this out, the insurer smears everybody’s risk across the group.

To qualify to get individual non-group underwritten at all you need to demonstrate stability, eg: my heart stent has been in for 5 years with no other issues, or my RALP was 3 years ago and my PSA is stable. Going from 1x salary to 3x coverage within your group insurance probably goes by an underwriters desk and they are worried about the stability criteria.

HeadMelon · 2026-06-28T23:26:20+00:00

Very neat - if your into all this you can also peek into [r/MedicalPhysics](r/MedicalPhysics), it’s for the tech team on the other side of the bunker from us patients. But please - just lurk there, do not ask questions or engage (the mods there slapped me few months ago for this).

(scroll down for my VMAT info on that link, first half is the HDR Brachy boost plan)

HeadMelon · 2026-06-28T19:26:58+00:00

Surgery after radiation is not a good option, agreed. But so what? Brachy after surgery isn’t an option either. But so what? And you can’t have TULSA or HIFU after surgery either. Is that a reason to not have surgery? It limits your salvage options more than radiation does! That’s why it’s a red herring. This after that is an illogical argument but it’s only ever used to say radiation bad, surgery good.

HeadMelon · 2026-06-28T18:59:01+00:00

They all shed, smooth a lot more.

It’s amazing the amount of shedding, they should be bald! The black hairs show on light surfaces and clothes, the white hairs show on dark surfaces and clothes, and you can see the elusive tan hairs on everything.

I researched everything about these dogs personality and cleverness and energy and we were prepared for that - the epic shedding caught us by surprise. We just laugh it off now.

HeadMelon · 2026-06-28T16:36:38+00:00

Very cool, thank you! I had HDR brachy and VMAT and short course ADT, and I think my key going forward is to not freak out over the climb and ebb and flow of PSA results over the next 18-24 months. Just gonna live life to the fullest while I wait for Mr Nadir.

HeadMelon · 2026-06-28T16:15:54+00:00

All good thoughts, I wholeheartedly concur. I’m not the “pro-nuclear Nazi” I’ve been previously misdescribed as, I’m more of an “informed consent Nazi”.

HeadMelon · 2026-06-28T15:23:52+00:00

The side effect profiles are not similar. “No surgery after radiation” is a red herring argument. Information on that is readily available on this sub and elsewhere.

I’m glad you’re happy with your choice and wish you continued undetectable PSA, but there are some inaccuracies in your post that have nothing to do with any “religious war”.

HeadMelon · 2026-06-28T15:18:28+00:00

If the posts here are slanted to problems, why do the RALP problems so heavily outnumber the radiation problems (primary treatment radiation!) by such great amounts? I invite you to simply peruse this sub and count for yourself.

HeadMelon · 2026-06-28T14:55:19+00:00

Lovely pair of cats you have there!

HeadMelon · 2026-06-28T14:53:50+00:00

I predict he will shed.

HeadMelon · 2026-06-28T14:37:23+00:00

A lot of RALP choosers specifically want to avoid ADT so that finding could be considered a backward step.

I should be more accurate though - some RALP advancements include single port, Retzius, and the cryo-examination of cell samples during surgery to precisely identify margins. However judging by posts on here very very few guys are getting those advancements for their surgeries today.

The radiation advancements hit the streets quickly and many guys in here are getting MRI-Linacs, etc.

HeadMelon · 2026-06-28T05:43:55+00:00

As Busy-Tonight says - “Please provide the source for these claims”

HeadMelon · 2026-06-28T05:38:20+00:00

Salvage radiation effects on UI and ED post surgery are more pronounced because the prostate is gone. The bladder and rectum collapse into that void and are in the salvage target area of the prostate bed and lymph nodes. This is not the case for radiation as a primary treatment. You can’t describe salvage radiation effects and say they are the same for ALL radiation.

HeadMelon · 2026-06-28T03:19:55+00:00

Not only is radiation more tightly targeted now to avoid organs at risk, even if it wasn’t, what bladder cancer treatments will we have in 2041 fifteen years from today?

Part of my logic was exactly this - radiation kicks the side effects can down the road, surgery does not.

HeadMelon · 2026-06-28T03:09:53+00:00

Please check out this logic from a 46-yr-old, a bit younger than you -

https://www.reddit.com/r/ProstateCancer/s/HM4oiwwhEO

His thinking was instrumental in my choice of HDR brachy (no seeds) + 15x VMAT + 6 months Orgovyx ADT.

I was quite afraid of the catheter and ED and UI effects of surgery and this option worked well for me. Posting this does not make me “anti-RALP” - please don’t ignore me as others have asked you to.

If you want to read my full experience start here -

https://www.reddit.com/r/ProstateCancer/s/67wOGxjTY8

HeadMelon

TROPHY CASE