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Prostatectomy v Radiotherapy

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User
Posted 02 Mar 2023 at 19:20

Apologies if this is covered on another thread, but any thoughts/advice would be welcome.

I'm a 65 year old male and was referred by my GP in September for an MRI scan after my PSA readings increased from 4.5 (Dec 2020) to 4.9 (June 2022) then 5.9 (Sep 2022) and finally 6.4 (Dec 2022). My prostate was examined twice by my GP during this period and seemed normal to him. The MRI in September stated PIRADS 4, prostate volume 37cc, PSA density 0.16 T2 CN0MX. I was then referred for a biopsy in December. This resulted in a Gleason 7 (4+3), 3 out of 9 cores on the left, 8 out of 12 cores on the right, maximum core involvement 90% of 10mm. When I received the biopsy results in January the consultant told me I had a choice between prostatectomy or radiotherapy. I said I would consider the pros and cons of each and asked to speak to both teams before making up my mind.

On 20 February I met the clinical oncology lead who informed me that RT would start with 3 months of Hormone Therapy, followed by 20 sessions of RT (5 days a week x 4 weeks) and then a further 14 months of HT, so an 18 month treatment "window" in total. I asked if I could have RT without HT as the HT side effects sound potentially grim, but she more or less ruled that out as an option. I have a telephone consultation with the urology surgeon on 4 March to discuss surgery, and will decide which way to go after that.

I initially thought RT sounded the slightly more appealing route, as I am fit and active and generally healthy - I do lots of walking/running and play tennis and golf, and didn't like the thought of being fairly immobile for 4-6 weeks following surgery. However I'm now wondering, subject to speaking to the surgeon on Saturday, whether surgery might not be preferable - the thought of HT for 18 months doesn't appeal at all. 4-6 weeks of doing very little is at least likely to go relatively quickly compared to 18 months of HT! If anyone else has had a similar dilemma, or views on the relative merits of surgery v RT/HT, I'd be very interested to hear from you!

 

User
Posted 02 Mar 2023 at 22:21

i’m slightly older and going down the HT/RT route…surgery was ruled out.

It’s a difficult decision to make but what I would say is from the men in our cancer support group that I know and have had surgery, I think 4-6 weeks is a bit optimistic for being able to resume your active life. Maybe other on here have had a different experience.

User
Posted 02 Mar 2023 at 23:02
I’m 66 and my results were very similar to yours. I was also given the same choices.

Took a lot of soul searching, but in the end I opted for surgery. Mainly because I didn’t want to face extended treatments.

I walked out of hospital within 24 hours after surgery. Five days later, I was driving. Catheter out at day 10, and started short walks. Wounds healed and continence regained in six weeks. I’m now six months down the road, PSA is 0.3 and falling, so they’re reasonably confident it’s all gone.

I’ve restarted gardening, cycling, and hiking, but still doing the pelvic floor exercises and using the vacuum pump for ED, which is also improving.

While it’s all worked out well for me, I do appreciate that others haven’t been as fortunate.

At the end of the day, it’s your decision as to what route you take.

User
Posted 02 Mar 2023 at 23:05
You might be back running and playing golf within 3 months of RP and playing tennis, etc within 6 months, assuming you recover well physically and are not struggling too much with incontinence - at least with these sports, you can wear a pad without it being noticeable. However, the decision making might be better focussed on which treatment is most likely to achieve remission - no point going for RP if there is a high risk of it being unsuccessful. The second consideration is the known and potential side effects - if the treatment most likely to be successful carries a risk of side effects that you do not think you could live with, you end up going for the treatment that is possibly less effective (or just as effective but less attractive) but carries a lower risk.

From your diagnostics, you do have a lot of cancer on the right side and 90% positive in a core is significant - did the surgeon say whether he believed nerve-sparing surgery would be possible? If you know that it would be non nerve-sparing, RT / HT becomes much more attractive!

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

User
Posted 02 Mar 2023 at 23:13

I had HT I won't say it was great, but it would not have stopped me playing tennis or golf, though it may stop you from winning if that is important to you.

 

RT might affect your sporting ability for a few weeks.

 

The main benefit of HT is prior to and immediately after RT. You can stop early but this would be against your doctor's advice, and I would consider that foolish. However we have had people on here for whom the HT really was a serious problem, and it was definitely in their best interests to stop HT early and accept a slightly higher risk of recurrence.

 

Do you know if the surgery will be nerve sparing? There seems to be quite a lot of cancer so I'm guessing not. At the moment whether you're impotent after treatment is probably of less importance than surviving cancer, but after treatment when the threat of imminent death is lifted you may realise life without erections is a high price to pay, when RT with far less chance of impotence was available.

 

Similarly, continence may be an issue, particularly when playing golf or tennis.

 

I think it will be six months before you're playing these sports. Less aggressive exercise like long walks in the four to six week time frame.

Edited by member 03 Mar 2023 at 01:00  | Reason: Not specified

Dave

User
Posted 03 Mar 2023 at 05:53

At 62, and given the choice, I opted for surgery in November. There were two main reasons; I wanted radiotherapy has a fallback and I didn’t want to make daily hospital trips (I live abroad and have no where easily reached on a daily basis). Like you, I was fit and active with frequent half marathons, lots of walking and swimming. 3 months on, and despite being readmitted with retention for a few days, I am fully back to pre op levels of fitness. Yes, it was a challenge for a few weeks not to over do it (which seems to be very important) but it doesn’t take too long following robotic surgery to recover.

 

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User
Posted 02 Mar 2023 at 22:21

i’m slightly older and going down the HT/RT route…surgery was ruled out.

It’s a difficult decision to make but what I would say is from the men in our cancer support group that I know and have had surgery, I think 4-6 weeks is a bit optimistic for being able to resume your active life. Maybe other on here have had a different experience.

User
Posted 02 Mar 2023 at 23:02
I’m 66 and my results were very similar to yours. I was also given the same choices.

Took a lot of soul searching, but in the end I opted for surgery. Mainly because I didn’t want to face extended treatments.

I walked out of hospital within 24 hours after surgery. Five days later, I was driving. Catheter out at day 10, and started short walks. Wounds healed and continence regained in six weeks. I’m now six months down the road, PSA is 0.3 and falling, so they’re reasonably confident it’s all gone.

I’ve restarted gardening, cycling, and hiking, but still doing the pelvic floor exercises and using the vacuum pump for ED, which is also improving.

While it’s all worked out well for me, I do appreciate that others haven’t been as fortunate.

At the end of the day, it’s your decision as to what route you take.

User
Posted 02 Mar 2023 at 23:05
You might be back running and playing golf within 3 months of RP and playing tennis, etc within 6 months, assuming you recover well physically and are not struggling too much with incontinence - at least with these sports, you can wear a pad without it being noticeable. However, the decision making might be better focussed on which treatment is most likely to achieve remission - no point going for RP if there is a high risk of it being unsuccessful. The second consideration is the known and potential side effects - if the treatment most likely to be successful carries a risk of side effects that you do not think you could live with, you end up going for the treatment that is possibly less effective (or just as effective but less attractive) but carries a lower risk.

From your diagnostics, you do have a lot of cancer on the right side and 90% positive in a core is significant - did the surgeon say whether he believed nerve-sparing surgery would be possible? If you know that it would be non nerve-sparing, RT / HT becomes much more attractive!

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

User
Posted 02 Mar 2023 at 23:08

Originally Posted by: Online Community Member
I walked out of hospital within 24 hours after surgery. Five days later, I was driving. Catheter out at day 10, and started short walks. Wounds healed and continence regained in six weeks. I’m now six months down the road, PSA is 0.3 and falling, so they’re reasonably confident it’s all gone.

 

Rob, do you mean that your PSA is 0.03? If it is 0.3 you should have been referred to oncology for salvage treatment by now! 

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

User
Posted 02 Mar 2023 at 23:13

I had HT I won't say it was great, but it would not have stopped me playing tennis or golf, though it may stop you from winning if that is important to you.

 

RT might affect your sporting ability for a few weeks.

 

The main benefit of HT is prior to and immediately after RT. You can stop early but this would be against your doctor's advice, and I would consider that foolish. However we have had people on here for whom the HT really was a serious problem, and it was definitely in their best interests to stop HT early and accept a slightly higher risk of recurrence.

 

Do you know if the surgery will be nerve sparing? There seems to be quite a lot of cancer so I'm guessing not. At the moment whether you're impotent after treatment is probably of less importance than surviving cancer, but after treatment when the threat of imminent death is lifted you may realise life without erections is a high price to pay, when RT with far less chance of impotence was available.

 

Similarly, continence may be an issue, particularly when playing golf or tennis.

 

I think it will be six months before you're playing these sports. Less aggressive exercise like long walks in the four to six week time frame.

Edited by member 03 Mar 2023 at 01:00  | Reason: Not specified

Dave

User
Posted 03 Mar 2023 at 05:53

At 62, and given the choice, I opted for surgery in November. There were two main reasons; I wanted radiotherapy has a fallback and I didn’t want to make daily hospital trips (I live abroad and have no where easily reached on a daily basis). Like you, I was fit and active with frequent half marathons, lots of walking and swimming. 3 months on, and despite being readmitted with retention for a few days, I am fully back to pre op levels of fitness. Yes, it was a challenge for a few weeks not to over do it (which seems to be very important) but it doesn’t take too long following robotic surgery to recover.

 

User
Posted 03 Mar 2023 at 09:09

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
I walked out of hospital within 24 hours after surgery. Five days later, I was driving. Catheter out at day 10, and started short walks. Wounds healed and continence regained in six weeks. I’m now six months down the road, PSA is 0.3 and falling, so they’re reasonably confident it’s all gone.

 

Rob, do you mean that your PSA is 0.03? If it is 0.3 you should have been referred to oncology for salvage treatment by now! 

Sorry, yes. Should be 0.03.

I seem to have caught the getting numbers wrong bug from a former Prime Minister. 😉

 
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