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surgery vs radiotherapy

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User

Posted 11 May 2017 at 16:22

I was recently ,in last 2 weeks been diagnosed with prostrate cancer , Gleason3+4-3/6 cores-20% on right and gleason3+3-2/6 cores on left less than 10%. MR1-T2,psa 6.9 .

I have been told I now have 2 options , 1 removal of prostate and where I live we have a da vinci robot surgery system or 2 radiotherapy , 5 times a week for approx 7 weeks ./

My prostate is very large apparently at 140 cc .

having looked at side effects I am completely at a loss to know which way to go . my wife wants me to get it taken out with all the side effects this can cause but hopefully a very good out look , reading up on radiotherapy there seems less immediate side effects and possibly a quicker recovery but some long term effects.

I am really at a loss .

can anybody offer any advice please

anybody with a similar scenario ?

User

Posted 11 May 2017 at 19:32

Hello Bill1 and welcome

I can't advise because we went a different route, however, if you go to publications on this site you can download information on both the operation and on RT which might help you.

Hang int there, I'm sure somebody will be along to advise you

Best Wishes

Sandra

We can't control the winds - but we can adjust our sails

User

Posted 11 May 2017 at 20:22

I don't think anyone can really advice you as it has to be a personal choice. As Sandra says get the toolkit and research both treatments. What I will say is if you decide on RP make sure the surgeon is very experienced in the operation. Ask what their success rate is both in terms of removing all the cancer and minimising side effects. They are obliged to tell you
Read my profile to see my journey.

It's a hard decision but has to be right for you.

Bri

User

Posted 12 May 2017 at 10:41

Hi Bill,

Unfortunately I don't think anyone will or should tell you what option to choose it has to be your decision based on your circumstances. I will advise you to discuss every concern you have with your prospective surgeon and oncologist and when you feel you have all your concerns answered then you are in a better position to make a choice.

I had a similar profile to you but am 2 years down the line so please check out my profile.

I wish you well and,having been there, really do appreciate the anxiety and fear you will be experiencing.

Paul

THE CHILD HAS GROWN, THE DREAM HAS GONE

User

Posted 12 May 2017 at 12:08

Sadly, there's no 'right' answer.

You are right to look at the downsides; both have possible effects that will last for life, despite both having very similar outcomes in terms of 'success'.

But you don't just have to make a choice, you need to be comfortable with that choice. No point in tossing a coin and regretting it later!

Have you seen BOTH teams? I saw both an oncologist and surgeon. I was fairly sure before I saw either, and after the interviews (I was lucky - both on the same day), I was absolutely certain, and have never once wished I'd done different.

Hear both sides, talk it over with your wife, sleep on it.

Oh, and toss a coin - not because you should choose that way (ever!) - but while the coin is in the air, you'll know which way you want it to fall!

User

Posted 12 May 2017 at 16:08

Hi Bill

Firstly , welcome and secondly they are more than 2 options in your case.

Have a look at my profile also; my brother has opted for RT and starts next month, I had RP over 2 yrs ago.

To keep it very simple and make the decision far easier, what are you and your wife looking for post treatment ?

Have you listed and both rated (independently or together) the key differentiators of your options ?

No need to rush in my humble opinion. Nothing is predictable as you know.

The key difference that I find quite easy to deal with is, and I would not want to influence your decision at all (indeed I spoke at length with my brother for over 3 months before he finally opted for RT)

Surgery will offer you a known 'success or not' by 3 months post op (and a very good indication 6 weeks post op) - ie PSA quarterly monitoring, which some folk find more comfortable knowing, others maybe not. ie PSA should be undetectable . Removed tissue does allow accurate staging of your cancer. However it is a major op and has risks.

RT - Modern techniques allow far far better targeting. However no staging information after treatment. My brother has had gold seed implanted last week and SpaceOAR* ( it's a hydrogel 'spacer' to move bowel away).

Again he is comfortable being retired and living close by to the treatment centre , that each RT session doesn't take him a whole day for 9 weeks. He has a simulation session and mpMRI 4 weeks before actual treatment starts, I assume to line everything up and get you used to procedure. (He is medicare not privately funding by the way ).

Hope this helps , the key issue we found is to ask as much as possible and question everything in a positive way.

Gordon

User

Posted 12 May 2017 at 19:44

Hi Bill
Sorry to find you here on this site, I was diagnosed with very similar numbers to you, my prostate was also large humungus as the surgeon put it and also gave me only two options, Da- Vinci surgery or radio therapy, I had already decided on surgery, I had my OP on 29th Sept 2016, I was in for 3 nights, I had no real pain just discomfort from the gas they pump into you for the OP but that goes after a few good farts, I had a catheter in for 3 weeks, you have to make your own mind up but as I understand it if you have radio therapy most surgeons will not operate on a fried prostate, any questions please ask,
best wishes
Paul

User

Posted 12 May 2017 at 22:09

Hi Bill,

I went through the phase of thinking RT seems less invasive and people say it has good results. Although needing hormone treatment for 2 months and then 4 weeks of RT seemed hard work and it would be months before treatment was completed. I couldn't help thinking it was better to remove as much as possible as fast as possible whatever the side effects. Also if it's cut out you can still have RT later, whereas RT precludes surgery.

My op went without incident and I spent 2 nights in hospital just before Christmas. The surgeon at the clinic later said I'd made a good choice as the Gleason score was increased from 4+3 to 4+4 post op.

Your prostate is a lot bigger than mine which was 37mm and I don't know what implications that has.

Regards

User

Posted 13 May 2017 at 21:05

Hi there,

Awful situation for you I know but one a lot of us here have faced

I was diagnosed nearly 3 years ago, Gleason 7, 3+4 (later upgraded after OP to 4+3 T2c )PSA 8.4, age 45.

I opted for Da Vinci as I reckoned I wanted any cancer removed, and also I figured that if my prostate cells became cancerous once, then they would likely become cancerous again in the future

Anyway I can't advise you but can only tell you of my journey since my decision

2 months later I was fully continent and 6 months later sexual function returned (well a slow gradual process )

Now everything is pretty much normal except it seems to take longer to end a pee as small dribbles happen but only for a minute or 2

PSA < 0.1 still (and fingers tightly crossed)

Plus, if - and I know it's possible - the PSA rises again I can have RT

Take your time, discuss with your partner and choose the path that you feel is right for you

I edited this post as I had put T3 instead of T2c

Edited by member 24 May 2017 at 16:07 | Reason: Not specified

User

Posted 23 May 2017 at 22:18

Hi I had a prostatectomy in January so if you have any questions I may be able to help. I would say one thing though, if you choose radiotherapy and this doesn't work it isn't possible to then go for the prostatectomy. So think carefully about your decision.

Regards,

Craig.

User

Posted 23 May 2017 at 23:33

That isn't a good way to make a decision - whichever treatment you choose, if it fails and you need salvage treatment the outcome is less likely to be okay. Statistically, the best bet is to choose the treatment you believe gives you the best chance of remission first time round rather than choose a treatment based on what happens if it fails.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 24 May 2017 at 01:30

Craig,

Surgically removing a prostate that has been previously radiated is indeed extremely difficult due to the damage caused by RT.
There are very few surgeons that will do it but it is done occasionally. In fact one of our past members had this.

Barry

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