Diagnosed T3a - Worried it may have spread

Might be better to find out whether you have a centre of excellence near you - don't assume that going to London will get you the best treatment. Also, there is no research to say that robotic is better than laparoscopic or open RP; in some cases (depending on where the cancer is locally advanced to) open is the best option for T3. In other cases, surgery isn't even offered to T3 patients if it is suspected that the cancer can't all be removed successfully.

My husband had open RP because a) he had a suspect lymph node that could not be removed by keyhole b) the surgeon felt that in this case 'getting his hands in' would give the best chance of recovering erections afterwards and c) he had his appendix removed years ago and the scar tissue was in the way.

Open and LRP/da Vinci all have the same success rates in terms of positive margins, recurrence at 5 years, remission at 10 years. Permanent incontinence and serious ED are slightly less likely with open. The advantage of LRP / da Vinci is shorter inpatient stay and less time off work.

I had my open rp in Reading (private) a year ago (couldn't have robotic due to previous stomach surgeries) after being diagnosed with Gleason 7 T3a PSA 49. I'm doing fine now and have 4 consecutive 0.01PSA behind me. No regrets about any of the decisions I made. All the best.

Cheers AL

Hello,

I was diagnosed with Gleason 9 (4+5) last December T3b m0n0. My urologist talked me out of surgery because they couldn't guarantee continence or erectile function. I was immediately put on hormone therapy and after 3 months a 20 day course of radio therapy which I am now under going. Even after 3 months of hormone therapy (no testosterone now) I still have full erectile facility and my urinary problems have vanished but achieving climax seems now impossible but I'm glad that I went down this path not the surgical one.

23/04/17

Further to my comments, I'm just about to finish the radio therapy 2 to go. Minor side effects: Sore anus and some difficulty urinating again but coping o/k with steroid suppositories and an increase in Tamsulosin dose. I still have erectile function, the rads do not seem to have effected this so far, but climaxing still a big problem which is beginning to drive me nuts.

Edited by member 23 Apr 2017 at 13:29  | Reason: Not specified

HI, my husband was diagnosed with T2B Gleason 3+4 2 years ago this month. He had very rapid robotic prostatectomy. Pathology report showed one tiny area without 'negative margin' i.e. small area of spread just on edge of that area, so recategorised as T3a. He therefore qualified for a clinical trial (RADICALS) which is running here and so had radiotherapy a few months later - which made us feel a bit safer to be honest.

SO important questions are, I agree - where is nearest centre of excellence if you are considering daVinci robotic prostatectomy - ask how many the surgeon has done - see numbers above to give you an idea of what to listen for - hundreds is what you want to hear. I agree London not necessarily a guarantee of better care/outcomes.Being a research-active teaching hospital is a good sign though - but ask more questions about the specific uro-ooncology service!

And ask what clinical research is going on that you might be eligible for - patients who take part in clinical trials ( in general terms not just prostate) have overlal better outcomes than patients who don't - and even being treated in somewhere which is 'research active' is a plus - tend to attract docs etc who are in touch with the latest evidence, more forward thinking, if in a trial you tend to be more closely monitored and have access (like my husband) to treatement that may be non-standard. By the way it is a ( not very well known) right under the NHS Constitution to be offered the chance to take part in clinicall research relevant to you...

Ask if they have any kind of pre-op patient and partner education session and if it has patient involvement - if not - then they should have and it makes a big difference to how prepared you both are for what lies ahead. It seems to me 2 years down the road that it is very hard to predict the 'other' aspects - incontinence, ED, other side effects -I don't know there is any hard and fast pattern on this on the various treatment options. There are 'generalities' or 'probabilities' but no guarantees. So what lies ahead will be a bit unknown and i would say put getting the best possible chance of getting rid of the cancer now and for the foreseeable future and let that be your guiding principle. Best wishes.