Robotic prostatectomy or Radiation Trearment?

I went for a RP simply because it was the quickest way of getting rid of the cancer. 6 months on PSA is still <0.01, continence has significantly improved. Still no movement downstairs - that could take 2 years - but even if nothing happens naturally, I can live with that. Better to be alive!

No regrets, but in the end, you haveto make the decision yourself.

If your inclination is for surgery, the most important aspect of this is for your surgeon to be well experienced and have good results whatever the method of surgical removal is used. Some surgeons prefer one method to another and could be influenced by the anatomy of the patient and whether nodes have to be removed for example and not all hospitals have the robot. To be a good surgeon using robot he/she has to become proficient using conventional surgery and the gain further skills using the robot. Healing time and blood loss is generally reduced with the robot. If the cancer has been found to have escaped the prostate and this is sometimes found to be the case, subsequent RT may be given. A few surgeons are prepared to surgically remove the Prostate after RT but this makes a delicate and intricate operation even more difficult. There is a greater risk of urinary incontinence with surgery.

If you wish to consider one of the several types of RT, I would discuss this with an oncologist to see which type is thought would be better in your case.

Edited by member 11 Nov 2014 at 11:29  | Reason: Not specified

What a great site, thank you. I have asked to see my consultant again and have an appointment on Tuesday this week ..... when he told me I had localised prostate cancer about 8 weeks ago, although relived that the any cancer hadn't spread, I didn't really take in anything else he said afterwards.

I am approaching 59, but apparently because my Gleason is 3+4 and my PSA at the time was 13.8 (recent check shows 11.8) and despite being told the cancer was detected by biopsy (nothing felt re. DRE) in 20% of samples on one side only of my prostate I have been strongly 'encouraged' by my consultant to have robotic prostatectomy rather than radiation treatment. The hospital concerned specialises in robotic prostatectomy so, perhaps, the recommendation is not surprising! Being the inquisitive type I have searched the internet for some sort of recent comparison between robotic prostatectomy and radiation treatment and am really struggling to find anything that makes me feel one is better than the other. It seems to me that most guidance is out of date before it is written!

Can anyone please point me to a decent recent comparison ......... re. short and long term side affects of both techniques after treatment? ATM I feel fine, 'healthy' and in good spirits ..... but I know that after I have any treatment I will not feel so good and will experience some pretty nasty challenges for a period of time, the length of nobody seems to be able to forecast. That's the worst thing in my mind about being diagnosed with cancer, you can feel good and healthy before you are told ..... and then you become aware that treatment is going to make you feel pretty rough!

Any help please re. the best way forward would be so much appreciated.

devon lad

Had brackatherapy treatment in march this year ..My brother had his removed and lost quite a lot of weight .I lost none .. he goes once a month for check ups since last years . Apart from head wobbles now and then feel ok .Had all the symptons they said i would have .And slowly improving day by day no app until dec .Goodluck .he had a cathater for about 2 months or so.I had mine removed before i woke up.In at 9 am .out by 1pm ...

He is 90% there .All his weight back on , he also lives in america .We both have sons who can possibly get it later in life .My father had it in his nearl 50s .had it removed Still going strong at 77 ....So would say from my point of view  and my brothers point of view we both chose our best options .Hey if i get to almost my fathers age would take that now .I could not have it removed to there being a scar when i had my appendix out.  So was 30 days going everyday or , have it done all in one .Think i lost about 2lb in weight .And took up running .My brother was always so fit ....And still can do his boxing training .  he is 56 i am 55.......They reckon by the size of his tumour he had it a few years growing ..So my oldest brother is clear as a whistle ..Something us two are pleased about ..pretty  hereditary  in our family 

Goodluck ;-) 

Hi Devon Lad

Yes, I had the robotic (Da Vinci) prostatectomy.  The surgeon was very experienced - he had done 800 or so of these ops - so I believe that asking what the surgeon's experience is would be a good pointer.  He was able to give me the statistics for all the men he had operated on.

Nerve sparing was a crucial question.  He and I agreed before the op that he would spare nerves if at all possible and he thought this would be the likely outcome.  However, the agreement was that nerve sparing was secondary to removal.  In the event he spared the nerves totally on one side and partially in the other.  He told me that he would be dealing not in millimetres but cells as the margin for error.

 I hope that helps but please don't hesitate to ask any further questions.

I must add another reason I chose RP was that 2 other members of my golf club had the procedure. All 3 of us are doing well, although one who had his op 3 years ago has to have the injections as he is unable to have an erection without. Whether the 2 others of us will need these remains to be seen. Furthermore, another sadly died a few years ago after having gone down the RT route, his cancer returned, and he died wishing he had had his prostate removed.

These are the experiences of a few of us, so there is some bias due to the experiences of others. You may hear of different outcomes - in the end it is your choice.

Hi Devon Lad are you from Devon as the tag suggest if so are being offered RALP at the royal and devon in Exeter,if so this is where I had mine some 16 months ago,maybe I can give you my experience of the op.

When I had my biopsy, I was told my scan looked fine. if only.....

I had two template biops following two MRI scans neither scan showed any cancer,so for some a biop is the only detection.

My consultant, a surgeon, recommended surgery. He also recommended that I see an Oncologist before making up my mind. I saw the Oncologist who suggested I have surgery and quickly.....my decision was an easy one to make thank goodness.

I'm sure you won't regret it. Have a great Christmas and New Year in the meantime..

Good luck Devon Lad.  I'm sure you will have many questions on the op itself, before and after the event.  I and many others who have been down this route will be able to answer those questions.

There are two kinds of Brachytherapy, high dose where highly radioactive probes are inserted for a relatively brief period during an operation and low dose where radioactive seeds are placed in preselected parts of the Prostate. Either method can if considered appropriate be augmented by External Beam radiation as part of the therapy. My question would be that because either treatment is designed to kill existing tumours, what are the chances of new tumours growing elsewhere in the Prostate in due course? Although it wasn't Brachytherapy, (which is just a different form of radiation), the combined External Beam plus Particle therapy I had eradicated the tumours found on diagnosis but a new tumour has since grown in another part of my Prostate. This can't be treated with more radiation because I have had as much of it as is deemed reasonably safe. Surgery, if I found a surgeon who was prepared to do it, would now be more difficult with increased risk of side effects. So I am hoping that I will be considered a suitable candidate for salvage HIFU. However, had I opted for surgery in the first place, backed up by radiation to cover beyond where the knife could cut, now I wouldn't have a prostate where a new tumour is growing. So as well as there being the possibility of radiation initiating cancer in the long term it may not prevent new tumours growing within the Prostate in the short to medium term as in my case.   Something to take into account.

Edited by member 12 Dec 2014 at 18:18  | Reason: Not specified

Hi DL,

You ask " It is LD Brachytherapy that I have been 'battling' to explore. Not sure anyone knows the % chances of any particular individual having a recurrence of the cancer but whether you have radiation treatment (inc. Brachytherapy) or a radical prostatectomy there is a risk that the cancer can return, usually I told this is 10 - 15 years after treatment."

My understanding from reading is ;

The chances of needing further treatment after surgery are around 30%.

After R/T around 40%

Surgery recurrence is usually seen quite quickly after as the psa is an excellent marker in that if it goes above about 0.1 and continues to rise, then further treatment is required. Usually R/T if thought local.

With R/T recurrence it is usually around a three to eight year period with psa again being the marker. Local salvage treatment may be offered but more often it is just HT. If you get to ten to fifteen years out then the chances of recurrence would be much smaller by then. Same with surgery.

With Brachy, there are a couple of weak points & maybe why some consultants have strict cut-off for suitability.

One is the aggressiveness of the tumour. ( Gleason & psa figures ) in that each seed is strong enough ( enough radioactivity ) to actually destroy every bad cell.

Another is volume ( size ) of the prostate. The danger is that a gap occurs between the seeds allowing cells to escape. Sometimes more seeds are used but it is a risk. Each seed only covers a certain area or distance.

Obviously, if  on the margin then again the seeds may miss cells.

This is not to put you off your chosen treatment by any means  but just to make you aware of some points.

Devon lad my husband and as well as member Kennt and others have had low dose seed Brachytherapy.

Kennt's and our profiles are pretty up to date.

For information only of course since the decision is entirely yours.

Of course there is the possibility of recurrence, the same as with any of the treatments, as well as the possibility of bowel cancer further down the line.

It seemed to us that there were not real guarantees with any of them and the possible side effects from some of the others cancelled them out as treatment as far as my husband was concerned.

We were assured before we went ahead that survival rates for Brachytherapy equalled that of surgery.

It's horses for courses and what suits your particular form of the cancer, your lifestyle and your mental ability to cope with having the prostate still inside you.

John's prostate was small apparently and only required 58 seeds (which I must admit I personally find a little disconcerting as I expected them to zap it with a lot more)

Mine isn't a "young man" being 74 (although for some reason he's taken to doing squat thrusts as exercise - I think he's trying to kill himself some other way!!). He's (we) are still hoping for a long and relatively healthy rest of our old age.

Sandra

Opting for the best treatment according to the known biology at diagnosis ( no-one can do more ).Providing the diagnosis is thorough enough.

Accepting the decision made was right at the time. For you.

Having consultants who are well-skilled in administering the treatment.

Not being swayed into picking the treatment just for the least likely side effects; trying to negotiate with cancer may not be wise.

Accepting that one or two stray bad cells can cause problems later on & always being watchful ( thank you psa testing ).

Always being realistic.

And luck. Definitely luck. Perhaps most of all.

Hi Rob

I am lucky that because my cancer is localised and only Gleason 3+4 (and yes I do know that it could be worse as a biopsy is only a sample) that I have had a little time to consider my options and overcome my initial fear. Think I have said before but will mention again that having cancer seems to me to be a little like the autistic scale ……. you could have cancer but be anywhere on that scale and your individual prognosis is almost unique to you.

Gleason, PSA, Staging etc are all attempts (and good attempts at that ……. thank God for them) at defining your cancer and the risks associated with it – but at the end of the day like most things in life it, and you (meaning ‘one’) is unique. Luck, well having cancer is not lucky but I agree that the advice you are given and the choices you make re. treatment have an element of ‘luck’ to them as no-one knows exactly how the cancer is going behave in the short term and after treatment.

I have studied the options inside out, and spoken to many folk and several consultants and I am convinced this is the treatment I want, if I prove to be suitable and ATM I have not been told that I am not suitable …. only that it is a viable option that in most cases would be as successful as radical prostatectomy.

Finally let’s remember that most men with prostate cancer die with it rather than of it.

Thanks for your comments, really appreciate and the help that I have had from this site.

dl

Yay, just what you wanted. What a Christmas present.

We are on our L.D. Brachy journey already. Hope all goes well for you.

Were you given a date yet or do you have to wait until after Christmas to find out?

Enjoy Christmas.

Best wishes
Sandra

Excellent - you can enjoy your Christmas more relaxed now, and many more, I'm sure!!

I was startled at the number of men I talked to, in the Hospital, waiting for their RT treatment who were there because the surgery hadn't got it all.

RT is no fun for 7 weeks of treatment. They don't tell you of the torture 4 beakers of water you need to drink, in 10 minutes,  then the 40 minute wait before treatment.

I found the whole business hugely stressful and so did all the others I spoke to.

It's all over now but a week or so down the line I still need to pee 8 times a night, bowels are in a right state and the "tiredness" anticipated is more like the paralysis of exhaustion.

There were 3 months of hormone therapy before all the above, which wasn't so great.

They are not joking when they warn of breast development and weight gain around your middle. Fortunately the former can, I was told, be corrected by surgery, the later would disappear in time . 

I really regretted having taken this route until I met all those guys who had had surgery and were now hit with a double whammy, so to speak.

I cannot praise the Hospital Staff enough for their caring good humour and concern for me and my difficulties, so it's not all grief lads!

Got to agree with Lyn, I also had RT (37 fractions) and absolutely sailed through it with no side effects at all. I am 100% happy that I went down this route, my first post RT PSA test was <0.2 which my Oncologist says is virtually undetectable although he still expects it to fall further.

I attended the Beatson Cancer Center where I was given three cups of water to drink, I then waited 30 mins for treatment which only lasted approximately 3 minutes. No enemas were given.

I have also been on HT since Feb 2014, and for the first six months was getting very manageable hot flushes but since then they have subsided. I currently have no side effects from HT (Zoladex LA), I have not put on weight, I have not felt emotional or weepy, I have no problems with breasts, depression or anything, up to now I have been very fortunate when I read how some other people have been affected.

I was put off RP which is a major operation due to all the many immediate side effects and no guarantees, and felt very positive about the RT route. What also made my mind up was the fact my PSA was 59, I had been told that many surgeons will not operate if the PSA is over 20 as the success rates were not as good. Also due to my PSA level they were going to give me Adjuvent RT even if I got the operation, so I thought to myself I need RT anyway, so there is absolutely no point in going through a major operation if I had as good a chance at cure with RT/HT and my Oncologist totally agreed with my reasoning.

But as has been said everyone is different, their bodies and even their minds react differently to cancer and its treatments, remember your cancer grows from your own cells and everyone has a unique DNA therefore everyone's cancer is also unique that is why it is so hard to find a one size fits all treatment. But we all live in hope.

Best wishes to ALL who are fighting or affected by cancer.

Regards,

Gerry

Edited by member 07 Jan 2015 at 21:10  | Reason: Not specified