Robotic prostectomy Vs Radiation

isamaeya

Hi,

My husband is 50 years old and is diagnosed with prostate cancer with gleason score of 6. The biopsy report also shows perineural invasion shows cancer spread in 15 out of 17 cores. 

The urologist initially recommended monitoring but when we questioned regarding perineural invasion and risk of spreading the cancer outside he advised surgery.

We have also met a radiologist who advised surgery. We are in Canada and talked to another radiologist in USA. Who highly recommends radiation and assures us that there are no side affects associated with it as compared to surgery and the chance of recurrence is far less as compared to robotic prostectomy. And if it does recur a surgery can be performed at later stage.

We are so confused. Please guide. Any information regarding this will be much appreciated. 

Clevelandguy

Hi,

I have been on this info board for 10 yrs. and have heard from hundreds of both surgery and radiation patients. I would say probably +90% of either surgery or radiation folks have had side effects of some kind. ED and urine leakage are the two biggest side effects. With both methods of treatment, side effects will vary from almost nothing to pretty severe. With surgery side effects are normally immediate and with radiation they tend to be months later. When you do radiation the areas around the cancer are killed but you will still have Prostate tissue left in your body which will produce some PSA. Also since he has perinueral invasion which means the cancer is starting to grow around the nerve bundles, I would think radiation would damage the nerves to some extent as the area is radiated to kill the cancer and also a small margin around the nerves. From what I have heard on this board the Prostate is harder to remove after radiation because of tissue changes caused by radiation. Learning from this board, the success rate of surgery vs radiation are about the same. Find a good doctor group and the best facilities which should give the best results. I had perinueral invasion and chose surgery because of my perinueral situation. The nerve bundles kinda grasp the Prostate like you holding a grapefruit in your hands and the nerve bundles are you fingers, if you get my somewhat poor analogy. I would act sooner than later because you don’t want to let the cancer escape the gland. I would also suggest a PMSA PET scan to see if the cancer has escaped the gland. I have included a link to give you some info on the various treatment types.

https://www.cancer.org/cancer/types/prostate-cancer/treating.html

Dave 3+4

Rob.Ski

I'd question the advice of the second radiologist. I've always heard radiation & surgery have similar outcomes as far as success & failure. There can be side effects associated with radiology, usually show up later where side effects of surgery are typically immediate. Surgery side effects aren't guaranteed. I had RP about 2 years ago. I am 100% continent and have mild ED addressed with viagra. The other side effect can be shortening of the penis which, I don't really notice. There are people who experience all side effects so, if surgery is chosen, it's best to find the most experienced and successful surgeon you can. Surgery after radiation is much more difficult due to scar tissue. Radiation after surgery is typical for recurrence. I was adviced by surgeons & radiologist to do surgery based on my age (50 at the time) and assumed PCa contained. I was told options are better if recurrence occurs. Just my two cents. Keep researching to get as much information as you can before treatment.

Clevelandguy

Hi,

Wow, Rob.ski &I both responded at the same time and basically said the same thing. Very interesting 🤔

Dave 3+4

isamaeya

Thank you for detailed information. It does make sense.

Old Salt

Surgery after radiation is hard; not many surgeons/urologists will have experience. However, if there is a recurrence after radiation, there are several other ways of attacking the issue.

I am not recommending radiation over surgery, just adding some info. You (and your husband) do have some time to make a decision.

More in general, I am sorry to hear that your husband has prostate cancer at such a (relatively) young age.

Steve1961

hello what is his psa score ..was a psma scan done ..was an mri done ..was the biopsy slides sent for genomic trsting .. all these things should be done before any decision is made. This will tell you the aggressiveness of the cancer and the scans and MRI will tell you if it has spread. Please get these things done first and then maybe come back on here again, or if they were done send the information.

Steve1961

I want to throw this out there genomics scoring is very important.. tells you ore details than the diopsy report anout aggressiveness when studying the biopsy report, I’ve noticed it how they say no perennial invasion involved no so-and-so involvement now they’re saying cribform not seen or present.. unfortunately, I had radiation treatment and radiation treatment failed because we are now learning that Cribi form is radiation resistant. I have cribiform cancer Unfortunately I feel like a guinea pig I should’ve known better but the board is right. I am seeking out salvage surgery fortunately they do the surgery in UCLA and I found a surgeon who’s done around 20 of them and he’s done over 3000 regular ones and I have a son that only lives about 25 minutes from there but the side effects are greater and I’m about to make a decision within the next few days between that and cryro .. find out as much information as possible before you go forward you don’t want to make a mistake in choosing treatment

centralPA

Does he have any other issues? BPH? Urinary problems? What is the size of the prostate? MRI done? Where were the lesions located? They can all factor into the choice.

cazie99

My husband 54 has Gleason score of 7 and Perinureal Invasion. He decided to go for surgery and is booked in for Monday 5th Feb.