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Diagnosed T3a - Worried it may have spread

Posted 06 March 2017 19:45:41(UTC)
Hi All

My husband has recently been diagnosed T3a - Gleason 3+4 we have been told that removal is recommended - we are thinking robotics is a good way to go - if anyone has any advice we would love to hear from you - thinking of travelling to London to have it done
Posted 06 March 2017 22:56:08(UTC)

Might be better to find out whether you have a centre of excellence near you - don't assume that going to London will get you the best treatment. Also, there is no research to say that robotic is better than laparoscopic or open RP; in some cases (depending on where the cancer is locally advanced to) open is the best option for T3. In other cases, surgery isn't even offered to T3 patients if it is suspected that the cancer can't all be removed successfully.

My husband had open RP because a) he had a suspect lymph node that could not be removed by keyhole b) the surgeon felt that in this case 'getting his hands in' would give the best chance of recovering erections afterwards and c) he had his appendix removed years ago and the scar tissue was in the way.

Open and LRP/da Vinci all have the same success rates in terms of positive margins, recurrence at 5 years, remission at 10 years. Permanent incontinence and serious ED are slightly less likely with open. The advantage of LRP / da Vinci is shorter inpatient stay and less time off work.

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

Posted 07 March 2017 00:41:45(UTC)

Hi Sarah,

I guess you are thinking, oh my God, T3 Gleason 7, but don't worry yourself too much.

You have plenty of time to consider all options, my advice is to spend a few weeks learning as much as you can, learning as much as you feel you need to know, so that you can make an informed choice about which of the various treatment options you prefer.

I was diagnosed T3 Gleason 9 back in 2007 and I am still here doing just fine.



Thanked 1 time
Posted 07 March 2017 12:03:49(UTC)
I had my open rp in Reading (private) a year ago (couldn't have robotic due to previous stomach surgeries) after being diagnosed with Gleason 7 T3a PSA 49. I'm doing fine now and have 4 consecutive 0.01PSA behind me. No regrets about any of the decisions I made. All the best.
Cheers AL
Posted 09 March 2017 20:01:47(UTC)

I had robotic Jan 4 this year with nerve sparing. My gleeson was 3+4 and after pathology it was T3 and after eight weeks my psa is 0.1 so I may end up getting zapped at some time but I'm continent and my Gentleman's sausage is coming back.
I asked the surgeon how many he'd done and he'd done 70+ last year alone and he was very experienced with open and keyhole and I found his profile on the net .
Had catheter out after two weeks and I actually started doing a few small jobs after three and the seven cuts across my big belly as the surgeon called it (he isn't wrong) healed up quickly .
I had my op at Leicester General hospital and considering these tough times in the NHS my experience was excellent and I've never had an operation before

Thanked 2 times
Posted 31 March 2017 20:14:07(UTC)


I was diagnosed with Gleason 9 (4+5) last December T3b m0n0. My urologist talked me out of surgery because they couldn't guarantee continence or erectile function. I was immediately put on hormone therapy and after 3 months a 20 day course of radio therapy which I am now under going. Even after 3 months of hormone therapy (no testosterone now) I still have full erectile facility and my urinary problems have vanished but achieving climax seems now impossible but I'm glad that I went down this path not the surgical one.


Further to my comments, I'm just about to finish the radio therapy 2 to go. Minor side effects: Sore anus and some difficulty urinating again but coping o/k with steroid suppositories and an increase in Tamsulosin dose. I still have erectile function, the rads do not seem to have effected this so far, but climaxing still a big problem which is beginning to drive me nuts.

Posted 01 April 2017 08:04:50(UTC)

Interesting range of choices above. I was T3a Gleason 4+5 N0 M0 and had the Da Vinci jobbie (also had appendicitis scar, but seems to not be in the way). That was done Jan 17 by a surgeon who has done 400+ da vinci prodedures. Pathology report says it had spread to one lymph node. Two weeks after surgery I was back at work, dry, still have ED issues even though full nerve sparing. Last week, I spent the whole weekend rock climbing, which was great!

Now on HT and RT to start imminently, as the Gleason 9, infected lymph node and 6 week post op PSA didn't feel quite safe enough. The main side effect I am getting at the moment is fatigue, which is somewhat irritating. And ED of course. On the plus side, having woken up to the need for a healthier lifestyle we are now eating more strange and wonderful foods as a daily diet. Beer doesn't work so well for me anymore, but wine is perfectly fine!

Posted 31 July 2017 11:42:58(UTC)

HI, my husband was diagnosed with T2B Gleason 3+4 2 years ago this month. He had very rapid robotic prostatectomy. Pathology report showed one tiny area without 'negative margin' i.e. small area of spread just on edge of that area, so recategorised as T3a. He therefore qualified for a clinical trial (RADICALS) which is running here and so had radiotherapy a few months later - which made us feel a bit safer to be honest.

SO important questions are, I agree - where is nearest centre of excellence if you are considering daVinci robotic prostatectomy - ask how many the surgeon has done - see numbers above to give you an idea of what to listen for - hundreds is what you want to hear. I agree London not necessarily a guarantee of better care/outcomes.Being a research-active teaching hospital is a good sign though - but ask more questions about the specific uro-ooncology service!

And ask what clinical research is going on that you might be eligible for - patients who take part in clinical trials ( in general terms not just prostate) have overlal better outcomes than patients who don't - and even being treated in somewhere which is 'research active' is a plus - tend to attract docs etc who are in touch with the latest evidence, more forward thinking, if in a trial you tend to be more closely monitored and have access (like my husband) to treatement that may be non-standard. By the way it is a ( not very well known) right under the NHS Constitution to be offered the chance to take part in clinicall research relevant to you...

Ask if they have any kind of pre-op patient and partner education session and if it has patient involvement - if not - then they should have and it makes a big difference to how prepared you both are for what lies ahead. It seems to me 2 years down the road that it is very hard to predict the 'other' aspects - incontinence, ED, other side effects -I don't know there is any hard and fast pattern on this on the various treatment options. There are 'generalities' or 'probabilities' but no guarantees. So what lies ahead will be a bit unknown and i would say put getting the best possible chance of getting rid of the cancer now and for the foreseeable future and let that be your guiding principle. Best wishes.

Posted 19 April 2018 15:23:41(UTC)
Think I agree with other replies . Going to London doesn't mean a better outcome There are centres. of excellence outside the Capital. . Not sure that robotic prostatectomy is necessarily better than conventional laproscopic prostatectomy. I took part in a clinical trial to compare the two.
My diagnosis was Gleaston 3+4 pT2c.
I was offered the choice of surgery or brachytherapy. I choose surgery and asked for a referral to a London hospital. I had robotic prostatectomy.
But now have a rising PSA
14 months later I've started hormone therapy and shortly to have salvage radiotherapy.
I still have a persistent UTI and never recovered sexual function. Oh and a umbilical hernia!
Choose wisely.
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