Surgery vs radiotherapy

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Hi, my numbers are T2c NO MO. Like many others, I am currently reviewing treatment options. I've seen the oncologist and will see the surgeon in a few days. Until seeing the oncologist, I had thought that surgery was the most likely route for me, partly because I had been told (by someone whose views I respect) that my relative youth and fitness (I'm 61) would probably make this the best option for me, because radiotherapy has more side effects in the very long term. The oncologist didnt challenge the view directly, but did say that so far as external beam radiotherapy is concerned, the view that younger people may eventually experience more significant side effects is a bit outdated. Has anyone else come across this debate? Any views?

  • Hi H and welcome 

    He could well be right, the latest RT  is very good.

    20 sessions with the gold markers to aid targeting really works well.

    The bit about longer term side effects with RT I have read about but don't see so much about it with the latest RT methods.

    Anyway after reading about it I still went for the RT in 2017, no problems yet, will worry about it if and when side effects happen.

    One thing to say about surgery, some people, not all, can have ED  or/and urinary issues.

    So do take all this into account and also see what others say

    Best wishes


  • Good Evening   A warm welcome to the online Prostate Community - I am so sorry you have had to join us but we are a decent bunch.

    I have just responded to the same question on another thread and the link to this is here - my post is about the 4th post on the thread

     Pace nodes trial 

    You age makes you a good candidate for surgery but it's very much a personal choice. Have a look at my other post and please come back to me with any specific questions.

    Best wishes - Brian.

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  • I agree with your oncologist.  AW

  • Hi  .

    I see that Brian has pointed you to information on the PACE Nodes trial. This is just one of many different radiotherapy protocols which could be used so widen your research to things like Brachytherapy.  has charted his journey on the Brachytherapy boost route which is proving to be successful for many men. Standard EBRT over 20 sessions is another option with similar results.

    The thing to remember about all research is that it is reliant on retrospective results. The development of the machines, their accuracy, along with the expertise of the radiographers and radiotherapy oncologists and physicists has come on in leaps and bounds in recent years which means that side effects both short and long term have been minimised.

  • Thanks for all the comments. Unfortunately I’ve been told that brachytherapy isn’t an option for me, so the choice is between surgery and external beam radiotherapy.

  • Hi Higher1

    Have a look at Mark Scholz videos online.  He is an American oncologist and covers RT versus surgery quite well.  Most of his videos are good.  He makes the point that he has no skin in the game but definitely favours modern RT rather than surgery.

    Due to my age I could not have surgery.  However, after all my research I would still have opted for RT, even if I was eligible for surgery.

    There are shorter courses of RT now.  IIRC The Edinburgh General Hospital is currently testing 2 fractions.  The Royal Marsden has pioneered 5 fractions.  I had 7 fractions of ultrahypofractionated RT.

    I recommend a good deal of research, so that you are happy with your choice.  It took time for me to navigate the system, and in some respects it was a good thing as I was not rushed and had time to research and think about the oprions.


  • Is brachytherapy not an option medically, or because your local hospital doesn’t perform it?  I asked to be referred to a hospital that did do it. Having said that, you are only T2c, so there may be diagnostic reasons why they think it isn’t suitable as a mono therapy and it may be seen as too much if combined with external radiotherapy as brachytherapy boost.  In other words taking a sledgehammer to crack a nut.   AW

  • He was one of the doctors who influenced me when I was doing my research.   AW

  • That’s a good question, I think it was because she didn’t feel there is sufficient evidence for its efficacy in my situation. I will ask again I think.

  • That’s a good question, I think I’ll ask again.