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

Notification

Error

Robotic prostectomy Vs Radiation

Email this conversation Print this conversation
User
Posted 28 Jan 2024 at 15:31

My husband who is 50 years old is diagnosed with prostate cancer with gleason score of 6 but perineural invasion shows cancer spread in 16 pit of 17 cores. The urologist initially recommended monitoring but when we questioned regarding perineural invasion and risk of spreading the cancer outside he advised surgery. We also met a radiologist who advised surgery.  We are in Canada and talked to another radiologist in USA. Who highly recommends radiation and assures us that there are no side affects associated with it as compared to surgery and the chance of recurrence is less as compared to robotic prostectomy. And if it does recur a surgery can be performed at later stage. We are so confused. Please guide. 

Edited by member 28 Jan 2024 at 21:53  | Reason: Not specified

User
Posted 29 Jan 2024 at 01:19
In the UK men in their fifties where the cancer is contained within the Prostate, mostly have surgery. This gradually swings towards HT/RT as men age, so by the time they are into their seventies more have HT/RT. There are a few reasons why this is so, primarily because a man in his fifties has a longer life expectations than a man many years older, so if surgery fails at some point any mets can be radiated. Also, RT can initiate further cancer in many years time in a small number of cases. Furthermore, while a man still has a Prostate, even one treated by RT, there is still potential for PCa to grow in part of it. Men in their fifties are in general better able to cope with Surgery than much older men. There are of course several other reasons why men would favour one treatment over the other, differences in type and extent of side effects being one of them. Others include just wanting the cancer removed asap, not wanting surgery or HT/RT for various reasons or the long time frame with HT/RT and not knowing how good the result is because the damage inflicted to cancer cells continues for 18 to 24 months. Sometimes Consultants steer a man towards one form of treatment over another but in many cases which option to plump for is up to the individual having weighed up the pros and cons of both types of treatment.
Barry
User
Posted 29 Jan 2024 at 22:33
I think your question has already been answered for you by the Canadian medics and this USA radiologist is throwing in a red herring :-(

If your Canadian radiologist advised that surgery was the best option, it would be wise to listen to him. As a rule, radiologists (oncologists) will recommend RT and urologists will recommend surgery so if both doctors are saying surgery, they probably know what they are talking about.

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

User
Posted 28 Jan 2024 at 20:05

If the cancer is completely contained within the prostate then surgery is usually the recommended pathway with a follow up of SRT if needed. If it has spread outside of the prostate then the pathway is typically HT/RT.

There are side effects with both of course and anyone who says different needs to be questioned about their level of experience.

Just to add, you will find that Urologists recommend surgery and Radiologists recommend RT :)

Surgery AFTER RT is far more complex and likely to be 'open' rather than robot assisted. Someone described RT as turning the prostate gland into concrete - not sure how accurate that is but you get the idea.

Edited by member 28 Jan 2024 at 20:10  | Reason: Not specified

User
Posted 28 Jan 2024 at 20:09

There is certainly no straight forward answer to your question. Modern radiotherapy machines are able to considerably reduce side effects but I have never seen a claim that radiotherapy can be carried out without any side effects. RT treatment is often carried out in conjunction with hormone therapy treatment which can last up to three years and has its own set of side effects. Salvage prostatectomy following RT is possible but it is far from straight forward. It is very rarely performed in the UK. Most surgeons don't do it. I am by no means suggesting which treatment option to go for here but it does sound like the USA Radiologist might be overselling it a bit.

User
Posted 28 Jan 2024 at 21:08

In many videos related to prostate cancer in US, Doctors support now more radiotherapy vs surgery.  They say it has a higher rate of success, especially if combined, in case of negative PET PSMA, with short HT. 

I assume they consider RT+HT as best option having in mind centers of excellence and very prepared professionals there, with the most advanced technology available

In Europe I noticed the orientation is more towards advising  surgery as first option in case of localized cancer. In my case my German urologist told me explicitely that in case there is a need of a second round,  RP  taken as second option after RT would mean an almost 100% risk of being incontinent. 

As my PCa was staged as fully localized, I went for the surgery. 

So there isn't one definite answer to the question, in US the trend is to prefer RT over RP.

Edited by member 28 Jan 2024 at 21:08  | Reason: Not specified

User
Posted 29 Jan 2024 at 09:40

 Old Barry

You have summed up the treatment options very well. One of the reasons I opted for surgery at the age of 71 was that I suffered from prostatitis/BPH for many years and I thought that if I undergo prostatectomy my other symptoms will disappear; I was overjoyed that I no longer have the problem of urgency, frequency, stinging pain etc. 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 29 Jan 2024 at 10:00

Hi Isamaeya,

If you know the PSA level, Gleason score and cancer staging, which will indicates whether your hubby is low, medium or high risk.

You could use the tool on this site to compare the various treatments and outcomes to help you decide.

https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/?gad_source=1&gclid=CjwKCAiAtt2tBhBDEiwALZuhAAovzrfm6v5LWCQ-AimYZxSOJWjIYTRHcAAgz5pmTZiI3sb5kxXuYRoCK88QAvD_BwE

Adrian

Edited by member 29 Jan 2024 at 10:02  | Reason: Typo

User
Posted 01 Feb 2024 at 22:45
Surgery after RT makes what is already an intricate operation more difficult but there are a small number of surgeons that will do it and also as a salvage treatment for failed HIFU which also poses a challenge to surgeons.
Barry
User
Posted 12 Mar 2024 at 16:08

Hi Bilmant

I had terrible trouble with BPH/Prostatitis. I was delighted that following the prostatectomy all my symptoms just  disappeared and no further sign of them in the past 12 years.  I suppose it is reasonable to assume that the prostate gland is the cause but I don't think there is any scientific evidence of that..

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

Show Most Thanked Posts
User
Posted 28 Jan 2024 at 19:47

Hello and welcome to the forum.

RT v surgery is a question that is asked here numerous times and there never seems to be a definitive answer. The outcomes seem very similar.

How old is your hubby?

Adrian

 

 

User
Posted 28 Jan 2024 at 20:05

If the cancer is completely contained within the prostate then surgery is usually the recommended pathway with a follow up of SRT if needed. If it has spread outside of the prostate then the pathway is typically HT/RT.

There are side effects with both of course and anyone who says different needs to be questioned about their level of experience.

Just to add, you will find that Urologists recommend surgery and Radiologists recommend RT :)

Surgery AFTER RT is far more complex and likely to be 'open' rather than robot assisted. Someone described RT as turning the prostate gland into concrete - not sure how accurate that is but you get the idea.

Edited by member 28 Jan 2024 at 20:10  | Reason: Not specified

User
Posted 28 Jan 2024 at 20:09

There is certainly no straight forward answer to your question. Modern radiotherapy machines are able to considerably reduce side effects but I have never seen a claim that radiotherapy can be carried out without any side effects. RT treatment is often carried out in conjunction with hormone therapy treatment which can last up to three years and has its own set of side effects. Salvage prostatectomy following RT is possible but it is far from straight forward. It is very rarely performed in the UK. Most surgeons don't do it. I am by no means suggesting which treatment option to go for here but it does sound like the USA Radiologist might be overselling it a bit.

User
Posted 28 Jan 2024 at 21:08

In many videos related to prostate cancer in US, Doctors support now more radiotherapy vs surgery.  They say it has a higher rate of success, especially if combined, in case of negative PET PSMA, with short HT. 

I assume they consider RT+HT as best option having in mind centers of excellence and very prepared professionals there, with the most advanced technology available

In Europe I noticed the orientation is more towards advising  surgery as first option in case of localized cancer. In my case my German urologist told me explicitely that in case there is a need of a second round,  RP  taken as second option after RT would mean an almost 100% risk of being incontinent. 

As my PCa was staged as fully localized, I went for the surgery. 

So there isn't one definite answer to the question, in US the trend is to prefer RT over RP.

Edited by member 28 Jan 2024 at 21:08  | Reason: Not specified

User
Posted 28 Jan 2024 at 21:52

Thanks for your response. He is 50 years old. 

User
Posted 29 Jan 2024 at 01:19
In the UK men in their fifties where the cancer is contained within the Prostate, mostly have surgery. This gradually swings towards HT/RT as men age, so by the time they are into their seventies more have HT/RT. There are a few reasons why this is so, primarily because a man in his fifties has a longer life expectations than a man many years older, so if surgery fails at some point any mets can be radiated. Also, RT can initiate further cancer in many years time in a small number of cases. Furthermore, while a man still has a Prostate, even one treated by RT, there is still potential for PCa to grow in part of it. Men in their fifties are in general better able to cope with Surgery than much older men. There are of course several other reasons why men would favour one treatment over the other, differences in type and extent of side effects being one of them. Others include just wanting the cancer removed asap, not wanting surgery or HT/RT for various reasons or the long time frame with HT/RT and not knowing how good the result is because the damage inflicted to cancer cells continues for 18 to 24 months. Sometimes Consultants steer a man towards one form of treatment over another but in many cases which option to plump for is up to the individual having weighed up the pros and cons of both types of treatment.
Barry
User
Posted 29 Jan 2024 at 01:36

He is 50 years old

User
Posted 29 Jan 2024 at 09:40

 Old Barry

You have summed up the treatment options very well. One of the reasons I opted for surgery at the age of 71 was that I suffered from prostatitis/BPH for many years and I thought that if I undergo prostatectomy my other symptoms will disappear; I was overjoyed that I no longer have the problem of urgency, frequency, stinging pain etc. 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 29 Jan 2024 at 10:00

Hi Isamaeya,

If you know the PSA level, Gleason score and cancer staging, which will indicates whether your hubby is low, medium or high risk.

You could use the tool on this site to compare the various treatments and outcomes to help you decide.

https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/?gad_source=1&gclid=CjwKCAiAtt2tBhBDEiwALZuhAAovzrfm6v5LWCQ-AimYZxSOJWjIYTRHcAAgz5pmTZiI3sb5kxXuYRoCK88QAvD_BwE

Adrian

Edited by member 29 Jan 2024 at 10:02  | Reason: Typo

User
Posted 29 Jan 2024 at 22:33
I think your question has already been answered for you by the Canadian medics and this USA radiologist is throwing in a red herring :-(

If your Canadian radiologist advised that surgery was the best option, it would be wise to listen to him. As a rule, radiologists (oncologists) will recommend RT and urologists will recommend surgery so if both doctors are saying surgery, they probably know what they are talking about.

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

User
Posted 01 Feb 2024 at 22:45
Surgery after RT makes what is already an intricate operation more difficult but there are a small number of surgeons that will do it and also as a salvage treatment for failed HIFU which also poses a challenge to surgeons.
Barry
User
Posted 12 Mar 2024 at 15:09

Originally Posted by: Online Community Member

 Old Barry

You have summed up the treatment options very well. One of the reasons I opted for surgery at the age of 71 was that I suffered from prostatitis/BPH for many years and I thought that if I undergo prostatectomy my other symptoms will disappear; I was overjoyed that I no longer have the problem of urgency, frequency, stinging pain etc. 

very interesting discussion that relates to me.

Hi @pratap,

Did you find this to be the case?

I also suffer from bad BPH and is one of the reasons I'm actually considering surgery at some stage in the near future.

https://community.prostatecanceruk.org/profile/13373-Pratap?jeannie%20mehta= 

 

User
Posted 12 Mar 2024 at 16:08

Hi Bilmant

I had terrible trouble with BPH/Prostatitis. I was delighted that following the prostatectomy all my symptoms just  disappeared and no further sign of them in the past 12 years.  I suppose it is reasonable to assume that the prostate gland is the cause but I don't think there is any scientific evidence of that..

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 31 Mar 2024 at 06:06
Hello everyone,

I am unhappy to be diagnosed PC but happy to find this nice forum, I was reading all night here...

I'm 56, I live in Lebanon, and I am diagnosed PC psa 76.4 when I had a urine retention, gleason 9, pet psma show that cancer did not spread to other parts of the body but gland itself is enlarged enough and one lymph node is affected and probably the rectum wall could be affected as no visible edge there. I saw 3 doctors, first one about 60 yo want radio therapy, he is affraid that surgery punch the rectum;

On another hospital, they have latest da Vinci robot, the doctor and the professor (who visit from Europe every month and operate the robot) want me to start a severe HT immediately for 4 to 6 month and they say I must have great results in shrinking the gland so we can remove it, according to them using this robot they can preserve the erection nerves and the bladder muscle..

So sever HT and we re-evaluate and new pet psma and if Operation is possible we do it.

I need ur opinion on this because I have another problem, the country here have sever financial issue from few years. No gov assistance whatsoever, The RT is covered by my health insurance but if I opt HT the drug itself is so expansive and if we could get to robotic surgery, also it's not yet covered by health insurance here.. (they cover only old butcher operation!!!!) I can post all details if needed..

Thank you all.

User
Posted 31 Mar 2024 at 08:59
Dj Kenzo

It might be better to start your own thread on your issues so that you have all of the specific answers relating to you.

Good luck

 
Forum Jump  
Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.




MenuTop ▲
©2024 Prostate Cancer UK