Surgery or Radiotherapy ?


I have been recently diagnosed with Gleeson of 3 + 4 and a cancer that has not spread beyond the prostate. I will soon have to choose between hormoen/radiotherapy and surgery. Any thoughts welcome.

  • Hi

    Although I’ve not had that choice, ( incurable ) most on here went for surgery and I’m sure that others will jump in and let you know.

    Stay safe


  • Hi RB 

    Difficult one really, with your situation u could easily go for either.

    Take a good look at side effects , potentially surgery can have more but not always.

    ED can be an issue with either treatment but arguably more so with surgery.

    One plus side to surgery is that u can still have Radiotherapy if the cancer returns but very tricky the other way round.

    So do some research and see what others say.

    Good luck 


  • Great question, think I'm going to have the same decision soon.

    Which radiotherapy have you been looking at?

    Outcomes seem similar to for ldr brachytherapy and surgery, seems impossible to make a decision with data/results.

    Looks like it comes down to personal preference.

    It's a nice choice to have when you read the other stories on here.

    If I was pushed to choose surgery or brachytherapy now, it would probably be surgery. I'm not filled with joy at the thought of putting radioactive stuff in my body but I'm happy to take a risk of surgery when others will be the opposite. I'm 51 so I like to think I have a few years left yet so worry there might be longer term impact from the radiation but I've not yet spoken to the brachytherapy consultant. The surgeon seemed confident with nerve saving removal of prostate but it seems to be a lot of luck required. Every consultant I speak to is upbeat and positive which is great but makes it hard to decide.

    I've also read that it can be harder for surgery after radiation treatment.

    I also don't want it to come back or spread and I think surgery might be better for that. My dad had an open surgery prostatectomy at 60 and has done ok although the cancer had spread, this is probably also influencing my decision.

    I'm also researching focal therapies and have an appointment this week.

    Either way, start those daily pelvic floor exercises now, I use the nhs sueezy app :)

  • I had the da Vinci a few years ago. Just wanted the damn thing out. Never really regretted it. Sex life suffers a bit so there's that to think about. I'm getting on and I have a very understanding partner. So it hasn't been a problem. Neither has incontinence.

  • 123,

    I had 20 sessions of IMAT Radiation treatment last October.  Wasn't suitable for surgery, my choices were Hormone and Radiation Treatment or do nothing.  Not much of a choice really.

    My Gleason score was 3+4 (localised to the Prostate, hadn't spread).

    I thought the VMAT Radiation sessions were good, by the 3rd week I was absolutely knackered.  The Fatigue was overwhelming.

    Not once did I regret taking that choice.  The Hormones shrunk everything, and I mean everything.

    It took about 3 months before I could stand up for a Pee.  Still can't if anyone else is around.

    In February my Oncologist told me that I was in Biochemical Remission, and I wouldn't require anymore treatment as long as my PSA levels could stay between 0 and 2 (0.09 last one in February).

    I don't know if I would have been brave enough to get the surgery done.

    Hope your choice is a good one.

    Plenty of good first hand advice in this forum.



    "In Biochemical Remission, hope it lasts ".

  • Thanks Steve=very helpful

  • I too am in exactly the same situation. I am finding it extremely difficult to make a decision. For me it comes down to the extent and longevity of side effects of each. Unfortunately I am unable to find any meaningful statistics comparing the likely hood of the different side effects with the different treatment options. e.g. It would be helpful to know if  the likely hood of long term severe incontinence associated with each treatment is 10% 50% or 90%.

    Have you managed to source any information?

  • Hi

    i was veering towards hormone/radio therapy but had a very encouraging discussion with the surgeon and today a long call with a friend who has recently had the surgery. 3 months on, he has more or less fully recovered with no lasting side effects. I am going to have a consultation with my GP and, subject to his views, I think I ‘ll go with surgery.

    best wishes


  • Thanks Roger. I have lost count of the number of times I have changed my mind on which way to go. I have a telephone appointment with the urologist next week (I had the initial face to face meeting a few weeks ago). I will make a final decision following next week's meeting.

    Best of luck, whatever your decision.

  • I'm in the same position and keep changing my mind between surgery and ldr brachytherapy.

    I'm also talking to a consultant on focal therapies this week, express article yesterday  but not sure I'll be suitable as 12/18 cores had cancer in the biopsy 

    Not sure how useful it is but there is this website that uses data I think the predictions for me between the two options are very similar