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Just starting the prostate journey

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User
Posted 04 Jan 2021 at 11:04

Had a slightly raised PSA (3.3) back in October. NICE guidelines suggest referral if PSA above 3 so referred to Urology.

MRI Nov 8th

DRE and Biopsy (TP) Nov 27th

Saw MRI results.  DRE suggested cancer.

Telephone consultation with Urology nurse and results partially conveyed.

Da Vinci Prostatectomy or Brachytherapy suggested (slightly surprised by the latter).

18 out of 34 cores cancerous

T3a Gleason score 4+3 Volume 34cc PI-RADS 4

Bone Scan Dec 16th

Anxious....

Face to face (mask to mask) consultation with surgeon Dec 22nd.

Bone scan clear.  He thought Brachytherapy not an option.

He suggested Da Vinci and he would hope to spare 2/3 of nerves as tumour predominantly on one side.  He would also remove adjacent lymph nodes.

RT option would be External Beam therapy plus hormone treatment.

Due to speak to Oncologist on Friday 8th Jan.

As background, my older brother who lives in the US had cyber-knife treatment for his a few years ago.  His Gleason score was 3+4 and I suspect he was T2a/b.  If I had appreciated the genetic link I would have pushed for tests around then and probably caught this at T2.  I am 67 years old and fit and healthy.

Having been through my wife's breast cancer a few years back (full remission) I am not too stressed by the mention of cancer and to be honest found that episode a lot more stressful (so far).

My gut feel at the moment is to go for the Da Vinci RP and see what histology throws up after that but I will see what the Oncologist has to say on Friday.

User
Posted 04 Jan 2021 at 19:45

Best wishes and good luck. There is a “toolkit” available through this site which gives you lots of information.

User
Posted 05 Jan 2021 at 14:13

Hi,

Sorry you're having to join us and with a psa of 3.3 it was a marginal call.   You're making pretty good progress though based on what we hear about treatment.  From October to hopefully starting treatment in Jan or early Feb perhaps.    I visited the GP in September and had the op in December although it nearly went to Jan.

It's surprising the surgeon rejected what would normally have been an option put forward by a Multi Disciplinary Team normally including a surgeon.  Although a T3 would probably lean more towards full RT with hormones as it can cover a wider area than surgery.   Brachytherapy does seem lacking in that respect.

Some people think wanting it 'cut out' immediately is a gut reaction and perhaps it is although that was and still is my feeling.   Given that it is said there is little difference between RT and surgery outcomes it comes down to whether your case is better served by an option due to the size or location of the lesion.

Given that RT and hormones can take over 6 months of treatment and then another year before they know it worked I still prefer the op with it's day of treatment, month of recovery and knowing whether it was initially successful within 2 months.

In your case I think I'd seriously lean towards RT.   If you know where the lesion is located and if it could have affected anywhere else nearby other than the lymphs which the surgeon said he'd take that might influence your choice.   My worry was if any was on or near the bladder but the surgeon said it was on the other side, the apex.

I'd also mention that mine was 4+3 at biopsy but 4+4 with the whole organ on the lab bench.  With 18 pins finding samples they should have a better result as mine was only on 1 pin.

It's a tough decision.  If you choose surgery it is possible to have RT later but not usually the other way round. Also whether the amount of radiation you get is the most you can have or if you can go back for more the oncologist might advise.  On the other hand getting it right first time is obviously the better choice.

Obviously I'm not an expert, I hope that's helpful and others will fill it out.  All the best, Peter

User
Posted 05 Jan 2021 at 20:17
With your diagnosis if you opt for surgery, you should be prepared to additionally have RT and perhaps HT if it is shown to be necessary.
Barry
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User
Posted 04 Jan 2021 at 19:45

Best wishes and good luck. There is a “toolkit” available through this site which gives you lots of information.

User
Posted 05 Jan 2021 at 14:13

Hi,

Sorry you're having to join us and with a psa of 3.3 it was a marginal call.   You're making pretty good progress though based on what we hear about treatment.  From October to hopefully starting treatment in Jan or early Feb perhaps.    I visited the GP in September and had the op in December although it nearly went to Jan.

It's surprising the surgeon rejected what would normally have been an option put forward by a Multi Disciplinary Team normally including a surgeon.  Although a T3 would probably lean more towards full RT with hormones as it can cover a wider area than surgery.   Brachytherapy does seem lacking in that respect.

Some people think wanting it 'cut out' immediately is a gut reaction and perhaps it is although that was and still is my feeling.   Given that it is said there is little difference between RT and surgery outcomes it comes down to whether your case is better served by an option due to the size or location of the lesion.

Given that RT and hormones can take over 6 months of treatment and then another year before they know it worked I still prefer the op with it's day of treatment, month of recovery and knowing whether it was initially successful within 2 months.

In your case I think I'd seriously lean towards RT.   If you know where the lesion is located and if it could have affected anywhere else nearby other than the lymphs which the surgeon said he'd take that might influence your choice.   My worry was if any was on or near the bladder but the surgeon said it was on the other side, the apex.

I'd also mention that mine was 4+3 at biopsy but 4+4 with the whole organ on the lab bench.  With 18 pins finding samples they should have a better result as mine was only on 1 pin.

It's a tough decision.  If you choose surgery it is possible to have RT later but not usually the other way round. Also whether the amount of radiation you get is the most you can have or if you can go back for more the oncologist might advise.  On the other hand getting it right first time is obviously the better choice.

Obviously I'm not an expert, I hope that's helpful and others will fill it out.  All the best, Peter

User
Posted 05 Jan 2021 at 20:17
With your diagnosis if you opt for surgery, you should be prepared to additionally have RT and perhaps HT if it is shown to be necessary.
Barry
User
Posted 07 Jan 2021 at 11:48
Thanks to everyone for your well considered and constructive comments. It really helps.

I am speaking to the oncologist tomorrow which should hopefully put me in a more informed state in which to make a decision.

 
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