Salvage surgery or HT

User

Posted 01 May 2017 at 12:31

I was diagnosed with prostate cancer in 2009 and chose to be treated with radiotherapy. In 2013 the cancer came back and I had more radiotherapy. Now after several tests and a biopsy the Marsden have cnofirmed that the cancer has come back for a third time though PSA is still only 6.6. Tomorrow I find out if the cancer has spread and discuss what to do. Assuming it is still localised the choice seems to be salvage surgery or HT.

I've heard salvage surgery is only 30% chance of success but will definitely mean no more erections with a high likelihood of incontinence. Im 65 and thinking if HT can give me perhaps 5 years of reasonable life that might be better than a slim chance of 15 years of a more difficult life. I recently had a biopsy and had a catheter for several days. That I found a nightmare - painful, constantly in the way. Unsure how to walk normally and totally unable to dig allotment, go to theatres, go to restaurants etc - all the things I enjoy. Anyone any thought or experience ?

User

Posted 01 May 2017 at 20:22

Hi Laurence

Sorry to read the comeback. Wed's I'm down for Gastroscopy in morning and uro in afternoon as it seems I could be out of remission. Hoping throat is not connected to PCa I'm considering if need be what treatment path to go for - the old HT Path or something newer. It's unlikely I would go down the salvage surgery route as success rate is too low plus the risk of permanent incontinence too high.

Could be worth you reading Old Barry profile for latest treatment he has strived for.

As regards my own profile could you tell me if my PSA fluctuations was anything like yours?

Ray

User

Posted 02 May 2017 at 00:12

Hi Laurence, Firstly, you say you are concerned that surgery will mean no more erections which I take it means that you still have them notwithstanding having had two courses of RT, so good for you.

I am wondering whether the option of surgery is just your idea or has been suggested by the Marsden because it is fairly rare for this to be offered after RT as the removal is made so much more difficult that most surgeons will not do it. In fact RT has been repeated in your case. If surgery is to provide a good outcome it has to be within the prostate, nodes or other parts that can be be removed as part of the operation. Surgery is not of itself going to complete the job if the cancer has gone elsewhere. What is important is to have a good scan and if not offered ask about having one. What your options are after this may be more clear. If the cancer is confined to the Prostate, you might be a suitable candidate for HIFU. (I see you are aware of this possibility as you commented on 5th August on my thread about HIFU). Also, an alternative here might be Cryotherapy. It was the Marsden who referred me to UCLH for Focal Ablation so they should be able to advise. There is the possibility that you might not need HT, at least immediately unless the cancer cells are establishing further afield.

Let us know what the Marsden say and what you decide to do.

Edited by member 02 May 2017 at 00:20 | Reason: Not specified

Barry

User

Posted 02 May 2017 at 11:22

Ray, my initial PSA in 2009 was about 20. After the second dose of radiotherapy in 2013 it dropped down to hardly anything. In 2015 it had risen to 2.5 and the Marsden did a battery of tests which revealed no sign of cancer. In early 2016 it rose to about 4 and it was suggestd that maybe.it was part of the normal recovery process. However at end of 2016 it had risen again to about 6.5 so this year I have had PET/Choline scan, MRI and biopsy which showed cancer is back. Today I go to discuss another PET scan to test has the cancer spread outside Prostate.

I think my profile is therefore different t to yours ?

User

Posted 02 May 2017 at 11:25

Thanks for all the information - and for still being here ! It gives me hope ! It is mR Mayer at Marsden who is talking about possible surgery and I think he will be there this afternoon to discuss further. My brother in law is Dutch and has said I should look at the Martini clinic in Hamburg which has the best Prostate surgery facility and the best record in Europe. I think you once mentioned Heidelberg in your write up, do you know anything about tis place ?

User

Posted 03 May 2017 at 01:13

Hi Laurence,

There are few rules on this forum but one is that you must not name consultant's so best you remove the Drs name you gave. It may seem pedantic but there are good reasons for this.

Sorry I can't advise on how Heidelberg University Hospital rates on surgery for Prostate Cancer or if they will do RP after RT. I know they are one of the leading European Hospitals for Pancreatic Cancer and have possibly the most advanced Hadron Treatment facilities in the world. They were the first hospital to do Stem Cell implantation and with the DKFZ developed the 68 Gallium PSMA test so have a good and far reaching track record. You can get an idea of this from this video : https://www.youtube.com/watch?v=2cRYaIJXbvI

I do know that there is close liaison between Heidelberg University hospital and Dutch colleagues as it was mentioned to me whilst I was there so maybe your contact can help you.

Just as food for thought, when the Marsden referred me to UCLH for possible salvage HIFU, I asked about having my previously radiated Prostate removed instead . I was told this risked an 80% chance of permanent incontinence and it was not recommended. How glad I am that I had HIFU instead. Your body your choice but maybe worth exploring before proceeding with RP.

Barry

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