I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

choice of surgery or Radiotherapy

User
Posted 27 Jun 2022 at 08:32

i am 58 years old and have just been diagnosed with T3a , Pirads 5, gleason 3+4 , cancer found in 9/16 cores .

left and right anterior are positve.

Really dont now what to decide. I have an appointment with oncology and consultant next week. my fears of surgery and being in hospital are huge. The consultant that rang me said in his opinion i should have prostate removed as i'm young fit and healthy ( apart from diabetes). he explained that should i decide to have hormone treatment and radiotherapy that surgery afterwards would be a salvage operation .

I'm worried that radiotherapy could damage other areas. 

I'm so worried about surgery and then afterwards have radiotherapy anyhow . 

Advice please

Edited by member 27 Jun 2022 at 09:13  | Reason: duplicated wording

User
Posted 27 Jun 2022 at 09:07

Your diagnosis is remarkably similar to mine.  I had surgery and then salvage RT and HT.  I was 46 at the time.

I have no regrets with the decisions I made.  

You must be guided by your own doctors though.

One piece of advice.  Don't rush into salvage radiotherapy treatment too soon after surgery and try to get a PSMA scan before any salvage radiotherapy treatment begins.

You have every reason to hope.  My PSA is now <0.006.

Edited by member 27 Jun 2022 at 09:10  | Reason: Not specified

User
Posted 27 Jun 2022 at 12:09

Sorry you have to join us. 

I'm also Gleason 3+4 but they only find one core so 4 years ago I was offered Active Surveillance  that will come to an end when cancer is progressing.

In the meantime I kept myself informed about treatments. With localised cancer treatment choice will always be Surgery or RT. 

After surgery if there is cancer recurrence it can be treated by RT.

The size of your cancer, the place where it is and your personal health might help to decide which one is the best choice. Every man and every cancer is different so we can only talk about personal experiences but hopefully your medical team can explain what is the best for you.

All the best

eric

Edited by member 26 Oct 2022 at 13:02  | Reason: Not specified

User
Posted 27 Jun 2022 at 14:43

I know how you feel.  I'd never been in hospital and radiotherapy seemed fairly clean although I wasn't keen on 6 months of hormone treatment and was suspicious of the after effects of radiotherapy.   On the other hand for the op you always think it might be you where something goes wrong.  You need a certain fitness to have the op as they slant the table head down.

To cut a long story short I decided on surgery for reasons many don't agree with.  That is, a feeling of doing something fast. Although I was told it was close to leaving the prostate.  I convinced myself I was going to sleep for a couple of hours and then it would be gone.  It was like that and I felt really good about it.   Although there is a couple of months of healing which if I hadn't been retired might have been more complicated.  I'm also pretty laid back about the after effects.  I'm 99.9% continent, although have quite a bit of ED.

For someone your age I've read that surgery is a good option as you can later have radiotherapy.  Whereas surgery after radiotherapy is usually said to be difficult.  I was sort of impressed by your doctor offering that though.

I've also read that for a T3 radiotherapy is able to reach those areas outside the prostate that might be effected unseen.

It's not an easy choice and it can depend on both your own preferences and clinical diagnosis.  I think knowing what I know now with a T3 I'd be leaning to RT although there could be other factors.  Lastly and perhaps I shouldn't say this but fear is illogical as Spock would say.  Some 10,000 have the op every year in the UK alone.  If that helps.

All the best, Peter

 

Edited by member 27 Jun 2022 at 14:44  | Reason: Not specified

User
Posted 27 Jun 2022 at 16:00

Sorry you find yourself here Colin. 

As already pointed out we can only give our personal stories as everyone is different. My husband opted for surgery (quite a bit older than you), I wouldn’t say it was easy for him but he also didn’t find really difficult either. I think it’s the mental side that we both struggled with more to begin with. He really rested up well for 12 weeks after the op although still went out for evenings and doing walks etc

He was T3a Gleason 4+3. Even though we were told it had spread outside of the prostate into a lymph node and possibly bone, he still wanted his prostate removed and then be able to deal with the rest later. They did start him on HT which he had for 6 months, he really didn’t like being on it and stopped it as soon as op was done. His post op histology changed to T2 Gleason 4+5=9

They took 14 lymph nodes and the bone lesion we were told later was benign. His PSA is currently <0.025 and we’re hoping it will stay there. We know RT will possibly have to come in time though.

Continence is absolutely fine, ED is still a work in progress, although he’s not putting any work into that progress at the moment 🤦🏻‍♀️ so we’re bound to not be seeing any results yet.

Best of luck with your decision 

User
Posted 28 Jun 2022 at 12:58

Hi 

I can't give you advice as that must be your personal choice but this is the Brachytherpy version i took.

I had no symptoms but microscopic blood in my urine at a private medical for the renewal of my 7.5 ton driving license so was sent for PSA that came out at 2.19 and after further treatment they found 5 cores out of 20 positive with Gleason 3+4=7.

I had the choice of robotic removal but took the brachytherpy option.The hospital side was easy in on a Sunday night operation next day and released home the following, very easy no fear no great pain just a couple of pills.

I think i had a good run no great pain no incontanence just getting up three times a night but no leaks or accidents. I am coming up to six years with PSA 0.05 and was signed of in 2020.If you click on my Avatar you can see my journey so far.

Regards John.

User
Posted 28 Jun 2022 at 17:08

I was T2a ( so contained within the prostate) when I opted for surgery a little over 2 years ago. Happy with my decision. However at T3 I am assuming its less likely to be nerve sparing and with a higher chance of reoccurence.? This would make me look at RT very closely. Good luck with whatever path you choose

User
Posted 28 Jun 2022 at 19:48
When I was undergoing the diagnostic tests for prostate cancer in 2018 the MRI found that I had a (completely unrelated) stage T3 kidney tumour, the result of which was that I had to have my left kidney removed - a surgical procedure very similar to an RP in terms of where it's done and what the recovery procedure involves. I'd never been in hospital before either and I was absolutely petrified. Much to my surprise - and this may sound weird - I thoroughly enjoyed my 3 days in hospital. Not the side-effects of the surgery, obviously, but everything else. Being looked after, the company of the other five men on the urology ward - even the food! I was quite sorry to be discharged. Hospital is honestly nothing to get stressed about if you decide that surgery is right for you.

I ended up having RT for my prostate cancer because that was strongly recommended in my case, and that was fine too.

Very best wishes,

Chris

User
Posted 23 Jul 2022 at 15:08

I am 72 and had been on active surveillance for 9 years, my PSA had been below 10 for most of that period, but went up to 13 last November. I underwent Stereotactic Ablative Radiotherapy 3 months ago and my PSA is already down to below 3. Stereotactic does not involve months of hormone therapy, simply 5 minutes treatment for 5 days. 

I felt lethargic for 3-4 days after and experienced bowel and urine issues for a couple of weeks, but now fine. This treatment tends o be for focused, localised issues, but worth discussing with your Oncologist. You may not have centre near you that offers it, mine was The Freeman, Newcastle. I would have travelled anywhere for the ease of the procedure.

User
Posted 23 Jul 2022 at 15:35

Great post Jonnie.

I always try and advocate that people have the minimum treatment for this cancer, of course sometimes its not appropriate, but 9 years of AS is great, and indeed 5 days of SABR to then sort the problem is also great.

It may be yours was a very special case and there is the possibility it will need further treatment in the future (but historically your cancer is a very slow growing one).

The best thing is you have got a further nine years through your life, without having the side effects of radical treatment, and probably won't have bad side effects from SABR.

 

Dave

User
Posted 23 Jul 2022 at 17:55
OH opted for surgery as recommended by the urologist. He is 68 and otherwise fit and healthy. Had RARP 19th May 2022, fully recovered now. If you opt for surgery be aware that even if the doc recons he can do nerve sparing there is a good chance it might not happen and the other thing that can happen is that you can pick up a UTI (and before anybody says anything - that happened to my OH which delayed his recovery and return home)

Otherwise OH is happy with his decision, ED is currently WIP

User
Posted 26 Jul 2022 at 10:20

Update , 

The decision was not mine to make however oncologist and surgeon were fantastic and to the point .

I am having RARP in early september. not looking forward to it but who would . Thanks to everyones thoughts and advice . wishing you all well .

 

Edited by member 26 Jul 2022 at 10:21  | Reason: Not specified

Show Most Thanked Posts
User
Posted 27 Jun 2022 at 09:07

Your diagnosis is remarkably similar to mine.  I had surgery and then salvage RT and HT.  I was 46 at the time.

I have no regrets with the decisions I made.  

You must be guided by your own doctors though.

One piece of advice.  Don't rush into salvage radiotherapy treatment too soon after surgery and try to get a PSMA scan before any salvage radiotherapy treatment begins.

You have every reason to hope.  My PSA is now <0.006.

Edited by member 27 Jun 2022 at 09:10  | Reason: Not specified

User
Posted 27 Jun 2022 at 12:09

Sorry you have to join us. 

I'm also Gleason 3+4 but they only find one core so 4 years ago I was offered Active Surveillance  that will come to an end when cancer is progressing.

In the meantime I kept myself informed about treatments. With localised cancer treatment choice will always be Surgery or RT. 

After surgery if there is cancer recurrence it can be treated by RT.

The size of your cancer, the place where it is and your personal health might help to decide which one is the best choice. Every man and every cancer is different so we can only talk about personal experiences but hopefully your medical team can explain what is the best for you.

All the best

eric

Edited by member 26 Oct 2022 at 13:02  | Reason: Not specified

User
Posted 27 Jun 2022 at 14:43

I know how you feel.  I'd never been in hospital and radiotherapy seemed fairly clean although I wasn't keen on 6 months of hormone treatment and was suspicious of the after effects of radiotherapy.   On the other hand for the op you always think it might be you where something goes wrong.  You need a certain fitness to have the op as they slant the table head down.

To cut a long story short I decided on surgery for reasons many don't agree with.  That is, a feeling of doing something fast. Although I was told it was close to leaving the prostate.  I convinced myself I was going to sleep for a couple of hours and then it would be gone.  It was like that and I felt really good about it.   Although there is a couple of months of healing which if I hadn't been retired might have been more complicated.  I'm also pretty laid back about the after effects.  I'm 99.9% continent, although have quite a bit of ED.

For someone your age I've read that surgery is a good option as you can later have radiotherapy.  Whereas surgery after radiotherapy is usually said to be difficult.  I was sort of impressed by your doctor offering that though.

I've also read that for a T3 radiotherapy is able to reach those areas outside the prostate that might be effected unseen.

It's not an easy choice and it can depend on both your own preferences and clinical diagnosis.  I think knowing what I know now with a T3 I'd be leaning to RT although there could be other factors.  Lastly and perhaps I shouldn't say this but fear is illogical as Spock would say.  Some 10,000 have the op every year in the UK alone.  If that helps.

All the best, Peter

 

Edited by member 27 Jun 2022 at 14:44  | Reason: Not specified

User
Posted 27 Jun 2022 at 16:00

Sorry you find yourself here Colin. 

As already pointed out we can only give our personal stories as everyone is different. My husband opted for surgery (quite a bit older than you), I wouldn’t say it was easy for him but he also didn’t find really difficult either. I think it’s the mental side that we both struggled with more to begin with. He really rested up well for 12 weeks after the op although still went out for evenings and doing walks etc

He was T3a Gleason 4+3. Even though we were told it had spread outside of the prostate into a lymph node and possibly bone, he still wanted his prostate removed and then be able to deal with the rest later. They did start him on HT which he had for 6 months, he really didn’t like being on it and stopped it as soon as op was done. His post op histology changed to T2 Gleason 4+5=9

They took 14 lymph nodes and the bone lesion we were told later was benign. His PSA is currently <0.025 and we’re hoping it will stay there. We know RT will possibly have to come in time though.

Continence is absolutely fine, ED is still a work in progress, although he’s not putting any work into that progress at the moment 🤦🏻‍♀️ so we’re bound to not be seeing any results yet.

Best of luck with your decision 

User
Posted 28 Jun 2022 at 12:58

Hi 

I can't give you advice as that must be your personal choice but this is the Brachytherpy version i took.

I had no symptoms but microscopic blood in my urine at a private medical for the renewal of my 7.5 ton driving license so was sent for PSA that came out at 2.19 and after further treatment they found 5 cores out of 20 positive with Gleason 3+4=7.

I had the choice of robotic removal but took the brachytherpy option.The hospital side was easy in on a Sunday night operation next day and released home the following, very easy no fear no great pain just a couple of pills.

I think i had a good run no great pain no incontanence just getting up three times a night but no leaks or accidents. I am coming up to six years with PSA 0.05 and was signed of in 2020.If you click on my Avatar you can see my journey so far.

Regards John.

User
Posted 28 Jun 2022 at 17:08

I was T2a ( so contained within the prostate) when I opted for surgery a little over 2 years ago. Happy with my decision. However at T3 I am assuming its less likely to be nerve sparing and with a higher chance of reoccurence.? This would make me look at RT very closely. Good luck with whatever path you choose

User
Posted 28 Jun 2022 at 18:11

Thank you for all you thoughts/comments everyone . I have hospital next Tuesday to discuss my options , still unsure what I will decide is the best choice for me. Thanks again . 

User
Posted 28 Jun 2022 at 19:48
When I was undergoing the diagnostic tests for prostate cancer in 2018 the MRI found that I had a (completely unrelated) stage T3 kidney tumour, the result of which was that I had to have my left kidney removed - a surgical procedure very similar to an RP in terms of where it's done and what the recovery procedure involves. I'd never been in hospital before either and I was absolutely petrified. Much to my surprise - and this may sound weird - I thoroughly enjoyed my 3 days in hospital. Not the side-effects of the surgery, obviously, but everything else. Being looked after, the company of the other five men on the urology ward - even the food! I was quite sorry to be discharged. Hospital is honestly nothing to get stressed about if you decide that surgery is right for you.

I ended up having RT for my prostate cancer because that was strongly recommended in my case, and that was fine too.

Very best wishes,

Chris

User
Posted 23 Jul 2022 at 15:08

I am 72 and had been on active surveillance for 9 years, my PSA had been below 10 for most of that period, but went up to 13 last November. I underwent Stereotactic Ablative Radiotherapy 3 months ago and my PSA is already down to below 3. Stereotactic does not involve months of hormone therapy, simply 5 minutes treatment for 5 days. 

I felt lethargic for 3-4 days after and experienced bowel and urine issues for a couple of weeks, but now fine. This treatment tends o be for focused, localised issues, but worth discussing with your Oncologist. You may not have centre near you that offers it, mine was The Freeman, Newcastle. I would have travelled anywhere for the ease of the procedure.

User
Posted 23 Jul 2022 at 15:35

Great post Jonnie.

I always try and advocate that people have the minimum treatment for this cancer, of course sometimes its not appropriate, but 9 years of AS is great, and indeed 5 days of SABR to then sort the problem is also great.

It may be yours was a very special case and there is the possibility it will need further treatment in the future (but historically your cancer is a very slow growing one).

The best thing is you have got a further nine years through your life, without having the side effects of radical treatment, and probably won't have bad side effects from SABR.

 

Dave

User
Posted 23 Jul 2022 at 17:55
OH opted for surgery as recommended by the urologist. He is 68 and otherwise fit and healthy. Had RARP 19th May 2022, fully recovered now. If you opt for surgery be aware that even if the doc recons he can do nerve sparing there is a good chance it might not happen and the other thing that can happen is that you can pick up a UTI (and before anybody says anything - that happened to my OH which delayed his recovery and return home)

Otherwise OH is happy with his decision, ED is currently WIP

User
Posted 26 Jul 2022 at 10:20

Update , 

The decision was not mine to make however oncologist and surgeon were fantastic and to the point .

I am having RARP in early september. not looking forward to it but who would . Thanks to everyones thoughts and advice . wishing you all well .

 

Edited by member 26 Jul 2022 at 10:21  | Reason: Not specified

 
Forum Jump  
©2024 Prostate Cancer UK