RALP vs Radiation

When I was at the Urologists office and was first told I have Prostate Cancer, he said your choices are Surgery or Radiation. It was a very sobering discussion. My doctor understood the gravity of the conversation. For someone who never seemed to stop when I came to his office earlier for kidney stones, he was patient and empathetic as I sat there staring at him in disbelief. We concluded the conversation after my wife’s questions. I was too dumbfounded to say anything. He then gave me referrals for those consultations. He said there are other options but these are the two most prevalent ways to address your situation and please avoid the internet. My Urologist has a framed xeroxed picture of a tombstone on his desk with the epitaph “I did my own research.” I always got a kick out of it. I was about to go down the “statistical mortality” rabbit hole by doing my own research .

My initial discussion with the Urologist was late August a couple of weeks prior to my 54th birthday in mid September. In that time I started to feel the gravity of my situation and how it would impact the rest of my life. I’m not a talker or forthcoming, but I told everyone and anyone that would listen. I was having a hard time coping with my situation.

My brother-in-law and his wife came over one night as I was working through my realization. I was stuck on the fact my life could end sooner than I thought. I think it’s the first time I’ve hugged him and I told him my fears. Honestly they themselves didn’t know how to even deal with my situation but it was comforting to have them there to discuss.

For my birthday we had a small group of family over and I saw my brother-in-law and his wife again. They gave me a present I wasn’t expecting, a book. It is titled “Guide To Surviving Prostate Cancer.” In the introduction the author references their father-in-law who passes away from prostate cancer at the age of 53. This line from that ordeal haunts me. “He died in a nursing home, castrated, hooked up to a catheter, in agonizing pain, pitifully thin, his bones so riddled with cancer that his arm shattered when a nurse tried to move him.” To think he was the same age as I am today. I believe to the dismay of my father-in-law, on my birthday I sat and started reading more of what this book had to say.

I have the fourth edition of this book published over four years ago and one of the chapters in this book is “What are my Options?” Here I found my most confirming determinant of surgery over radiation. I won’t get into the details here but it breaks down my options based on different factors such as the cancer grade, my age, the Gleason Score, PSA levels, etc.

When we consulted the Radiologist as a possible solution the experience was probably the first clear indication of the cancer’s impact on my mortality. So my Gleason score from the biopsy is an 8 (4+4). Reading any statistics or literature on the internet you’ll find that this means my cancer is “High Risk” and essentially will reoccur. Meaning I will likely succumb to the disease within my life time. My cancer was localized in the prostate. So naturally, no contamination, just remove it and the cancer is gone. But the Radiologist, in our discussion, painted a pretty good picture of the reality of the situation. So with any cells from your body; if you brush your finger over your other finger, that act in itself sends thousands of your cells into the air. In regards to inside your body this too is true. Cancer cells, though they may show as being contained in your prostate, they are not entirely contained. Once the cancer is in your body it is there. It then becomes a matter of when it will spread. He then mentioned how statistically radiation overall has better results for longevity in overall mortality.

So what does radiation do? They radiate your whole pelvic area from one side to the other, killing everything within that region including cancer cells. Of course as the treatment continues over weeks the symptoms worsen and then when the treatment is over eventually your body’s normal cells are regenerated. On top of that he suggested hormone therapy over several years. This is known as either male menopause or chemical castration. You could imagine the side effects from that. No metabolism (weight gain), hot flashes, cold sweats, etc.

So now where am I? Well I had the surgery. Why? For several key reasons. It being localized means something. Being localized means that the amount of “cancer contamination” may not be too great. Meaning that yeah the cancer exists in my system but small enough that my body’s immune system can fight it off for a period of time. Whether that is the case or not is based on if my PSA ever starts to rise again. I’m 54 years old. Radiation therapy you have to go every day over the course of several weeks, 6 or more. Surgery is one day and done and recovery is two to three weeks. Is radiation off the table? Yes and No. For now Yes but in the future No. When and if my PSA does start to rise then yes radiation and hormone therapy may likely be the next course of action. Of course the drawbacks of doing surgery and then radiation is I have to deal with any side effects from surgery as well as radiation when or if that point comes. My wife and I are hoping that never comes.