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I’ve got conflicting treatment recommendations. What is it like after surgery vs radiation therapy? And how long do the bad side effects last?
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Report postI’ve got conflicting treatment recommendations. What is it like after surgery vs radiation therapy? And how long do the bad side effects last?
I was diagnosed with prostate cancer 30/11/25. My Gleeson score was 9 in Oct 2025. My PSA has been rising steadily by 3.0 every 6 months since March 2025. My current PSA 10.5.
My urologist scored my prostate cancer at cT3a. He referred me on to a radiation oncologist and PET scan.
The radiation oncologist revised by score to cT2c after reviewing PET scan report. He recommended starting ADT by end of the month, EBRT for 4 weeks 2-3 weeks later, with 2 years ADT afterward.
I got a second opinion last week from a Prof in Urology. He strongly recommends a radical proctectomy with 3-4 months ADT beforehand, He notes follow-up radiation therapy / ADT may be necessary if cancer has spread to lymph nodes, but said side effects are manageable. Less likely to be permanently incontinent than radiation therapy, with better chance of being cured.
I am waiting a written report from second opinion. I’ll ask the radiation oncologist to respond to the second opinion report next week.
I intend to start ADT in a fortnight. A decision will have to be made soon after that. Wish me luck.
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Comments (8)
G’day Max!
cT2c is in the intermediate risk category.
The disease/tumour is confined within the prostate. Some guidelines, D’Amico and the American Urological Association (AUA) label/stage it more high risk.
I’m assuming the Pathologist gave you the Gleason score of 9
(5+4), (4+5)? Based on your prostate biopsy result(s)?
Any other information from the biopsy? Was Intraductal carcinoma
present? Cribiform pattern present? Fat invasion? Any Lymphovascular invasion?
This Gleason score of 9 would indicate more high risk.
cT3a indicates locally advanced disease/tumour, meaning it has
spread through the prostatic capsule (extra-capsular extension) into
surrounding tissue on one or both sides. But has not invaded the
seminal vesicles and/or has not as yet advanced/metastasized.
My Gleason score was 4+3=(7) on my targeted/fusion/saturation
biopsy . It also confirmed the presence of Intraductal carcinoma and
Cribiform architecture/pattern, which are poor prognostic features.
Even though most core samples were 3+4=(7) but because of the
presence of the abovementioned I was upstaged to 4+3=(7).
I am waiting to be admitted for my Radical Prostatectomy (RP).
I concurred with my Urologist after he recommended surgery for
curative intent. Followed up with EBRT/SBRT and ADT.
I want this insidious disease out!
A couple of links below…
https://www.youtube.com/@TheProstateClinicTPC
https://www.nih.gov/news-events/nih-research-matters/comparing-side-effects-after-prostate-cancer-treatment
All The Best Mate!
Hi Peter (Max),
If you need support, please don’t hesitate to reach out to our Prostate Cancer Specialist Nurse Telephone service.
We can help provide more information about treatments and ADT as well as assisting support you with making decisions about the options presented to you by specialists.
You can reach us on 1800 22 00 99 (ask to speak to a nurse), or follow the link to request a call back https://www.prostate.org.au/nursing-support/ and we’ll get back to you. We’re here to help.
Kind regards,
PCFA’s Telenursing Team
Phone: 1800 22 00 99
e: [email protected]
prostate.org.au
I am 67
Diagnosed in October 2025
Had Psa 9.5
Biopsy showed Grade 5 lesions x 2
Prostate specific MRI showed No further spread
Declined ADT
Had a TURP December
Start Radiation 2nd March which will
include Lymph Node area
My choice not to have ADT at this stage may seem controversial but I am concerned about the side effects ( depression-low energy) and the effects that they will have on immediate family
I may have ADT at a later date but at this stage only going with radiation
Diagnosed Oct 2025, after PSA test was 45, specialist says not a real problem as PSA tests are not a true indication of cancer, had an MRI,
PSMA PET Scan and a biopsy, all confirm cancer is restricted to the prostate. Biopsy report on four lesions, 1 is benign, 1 is 3+3 and 2 are 3 +4. Max percentage of “4” is 5%. Final report is 3+4=7, but another opinion is that it should be 3+3=6 Specialist said low number
early days nothing to worry about, but three days later called and said he had a cancellation that week and wanted to take my prostate out!! Shock and horror ! This was obviously in his interests not mine. I am seeking two more specialist’ s opinions in March 2026. Thinking active surveillance is my best option at the moment. Any experiences I can draw on please?