What if radiotherapy fails

I was diagnosed 2 months ago. I am in a similar position. I have one advantage I live near houston and was able to go to the medical center. I had two very good oncologists (one a MD Anderson and the other at Houston Methodist). One said very clearly she recommends radiation. I have since talked to the radiation oncologist. The other oncologist recommended laparoscopic surgery. I have decided go with surgery. It does not appear to be a right or wrong way, there are risks and side effects for both. I wish you the best of luck with however you decide to go.

My radiation failed. I did have have about a year after I started radiation where I could have sex. After that, pretty much an old man ****. I was 60 when I started radiation. 10 years later my PSA started rising and I ended up having a salvage prostatectomy and am still recovering from that. I found out that surgeons don't like to do these because of the difficulty and they don't want to listen to guys **** afterwards. I have had one doctor visit since surgery and try to tell myself that the alternative to this is dying from prostate cancer. Anyway would I trade that year of sex for my current incontinance? That year was pretty good. Now I'm an intact eunuch. I have 6 grandkids ranging from 6 months to 16 years that I would like to live long enough to see all of them starting their adult lives. My Woman is awesome and my kids are also awesome so that is what keeps me going. We will see how it turns out.

swl1956,

I wanted to go into detail regarding my surgery. We all hear about having nerve sparing surgery but their are now even more advancements in the surgery. I know you are trying to make your decision and are concerned about side effects as I was. My surgery was one month before I turned 71. My first PSA after 9 weeks was non detectable.

After surgery, I was dry with no leaking immediately after the catheter was removed 11 days later. The latest DaVinci Robotic technique is a single port entry. Only one very small vertical incision above your belly button not your typical three or four incisions. In a certain technique which not all Surgeon’s are trained in, the Surgeon is able to spare what’s called the puboprostatic ligament during robotic prostatectomy. In essence my Surgeon said this technique keeps the continence mechanism intact and it also helps maintain urethral length. A longer urethra allows for more control in the release of urine reducing the likelihood of incontinence and also the Puboprostatic ligament provides support to the urethra in keeping it in its position. He further does Retzius sparing of the tissue between the bladder and the prostate which further helps with continence. Another benefit of sparing the Puboprostatic ligament is the less likelihood the patient will see any reduction in their penile size that many patients report by either perception of it or a slight amount as its drawn in. He stated that this keeps the bladder anatomy more intact and in it’s natural place.

He explained that during Surgery I am certainly not upside down but he will operate through the Davinci robotic system as if I were upside down during the surgery, working on me looking down towards my feet. He said many surgeons are not familiar in the use of this approach and this is how he is able to spare the ligament. He said it was developed by a European Surgeon.

He also while I was under anesthesia sent my initial tissues immediately to Pathology to get an immediate staining for positive or negative margins. He was not expecting anything as the PET scan had indicated everything was in the capsule and from his experience did not see anything suspicious in the outlying tissue, however although the lymph nodes came back negative, there was positive margin, having just left the capsule. He then had to go back in and spent additional two hours trying to cut what he could to eliminate the positive margin. At that point I needed then to wait two weeks until I saw him and he said the final pathology report showed negative margins.

I know when people are considering Surgery, and questioning surgeons in consultation in addition to inquiring about nerve sparing, ask about single port, Puboprostatic ligament sparing and Retzius sparing .

On the ED side, it is coming back after 90 days. I also still have Radiation as a backup.

ADT should not be avoided at all cost but I agree that its use should be carefully considered. Whereas most men do recover with time, it's well established that the length of ADT and the age of the patient play important roles.

Here is a link to a referenced paper:

Testosterone Recovery for Relugolix Versus Leuprolide in Men with Advanced Prostate Cancer: Results from the Phase 3 HERO Study - European Urology Oncology