Consultation

Julius,

I was very close to your age when I was diagnosed, 10 year ago. I chose surgery, and have had a full recovery.

That being said, some percentage of men who opt for surgery end up with lifetime ED and/or incontinence. What that percentage IS, is really hard to tease out of the available data. The self-reported data on this forum is higher, I expect, than the overall global number.

Also, if you have to have ADT (hormone shots to shut down your testosterone), then you will also have ED from that, for as long as you're on the hormones, and up to double that time. So, 1 year of ADT can mean 2 years of ED until your testosterone levels come back.

Some men who have RT also report varying levels of ED during the treatment cycle, but it's not as immediate, and it generally resolves fairly quickly.

Some additional thoughts:

Have you had any additional scans such as an MRI or PSMA scan to look for metastasis?
Where are you located, and where are you planning on getting treatment?

I would suggest that your primary goal should be cancer control-yes, with minimal side effects, but cancer control is the priority. Some studies suggest that up to 25-30% of men have an actual Gleason score higher than what the biopsy shows. Gleason 3+4 is considered "low intermediate" risk--which means it gets treated as moderate cancer. It may well be that the RO you talk to will recommend something more than straight radiation therapy.

I'll also note this: when I was treated, 10 years ago, one of the more common (today) RT protocols called SBRT was just coming along. It's a treatment where they insert gold markers inside your prostate, and then aim the beam at those markers. It's all over in 5 treatments over 2 weeks. If it had been established where I was treated at the time, I might well have gone that route.

Good luck to you! Stay in touch

Julius…Mumbo and Halbert have provided some excellent advice. I’m a low risk guy who chose SBRT for treatment. Although all the treatments offered very high cure rates for my situation this form of radiation treatment had very low risks for unwanted urinary or sexual side effects. With only five treatments it was very convenient as well. I had little impact to my life and was encouraged to stay both physically and sexually active. I’ve read and heard that radiation side effects can come later. I’ve been blessed with no issues since treatment and only very minor urinary burning issues for a couple of weeks during treatment. Seven years since treatment and sexual and urinary function remains pretty much like it was twenty five years ago. I’m only a data point of one; however, I believe I’m more the norm than an exception for radiation guys. Best wishes and feel free to ask any questions…Terry

Julius, welcome to the forum.

I would strongly suggest that you educate yourself using google, AI engines, or whatever you find most useful about the success and side effects of surgery and the various forms of radiation available, and then make your own decision
While you've gotten good responses above, and while its always good to talk to people who have already traveled this road, everybody is different, and what will be the best route for one, may not be the best for another with the same pathology.

I would also consider getting a second opinion on the pathology, by sending slides to a highly reputable pathology lab, such as Johns Hopkins, or one of the major cancer centers around the country. It's an easy process and not too expensive (generally not covered by insurance). Reading PCa slides is somewhat subjective and if you found that an expert changed your pathology to a G6 or G8 it might change your idea (and ours) of what the best approach might be

Best of luck

It goes almost without saying that prostatectomy results in loss of ejaculatory function. However, loss of ejaculation is not the same as ED or loss of ability to get and sustain an erection, nor is it loss of sexual function.

Orgasms and ejaculation are separate functions. Loss of one does not indicate loss of the other.

The surgical risk is that the nerves will be damaged in the surgery, which almost guarantees loss of erectile function (and sometimes also loss of continence).