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prostatectomy after R/T

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User

Posted 30 Jan 2015 at 15:02

Does anyone have any experience with having a prostatectomy as a salvage treatment AFTER brachytherapy?

I had brachytherapy treatment 6 years ago for localised prostate cancer; it appeared to be successful but two years ago my PSA started to rise. Recent tests have shown the presence of prostate cancer (Gleason hi 7) but still confined to the prostate and with no evidence of spreading elsewhere.

My urologist is one the top-ten in the UK and has recommended a prostatectomy since there is a good possibility of being cured.

However, my concerns relate to continence and recovery time, both of which are likely to be more problematical when a prostatectomy is performed as a salvage treatment.

Any thoughts????

User

Posted 30 Jan 2015 at 19:42

Hi Captain Bob

Sorry to hear that you are in this situation.

My Robotic op was May 2013 and I was told then that if I opted for anything other than the op first it was off the table for any future salvage treatments. Since then apparently even though treatments may make the gland squishy, "squishy" is the Latin medical term, and more difficult to remove intact there have apparently been advances in techniques.

If your Urologist is confident, and if you are confident in her or him, go for it. What have you got to lose?

You are facing the decisions that we all face when first diagnosed and confronted with PCa, and that is a choice between potentially extended life with consequences, or less life.

If it were me facing the choice you are facing I would look at my life expectancy according to family history. Bluntly, if your likely life expectancy is a few years then maybe you would opt for another treatment option rather that take the chance on the potential side effects? Ot you may choose no treatment?

Whatever you choose a potential consequence of your treatment is LIFE. Incontinence can be lived with, if you are alive in the first place.

ATB

Dave

User

Posted 31 Jan 2015 at 03:53

Hi Bob, I suppose the decision about whether to go for the RP has to take into consideration the alternative. You are concerned about continence and recovery time - what will your treatment be if you don't have surgery? Have they discussed this with you?

If they are recommending that you go onto hormone treatment straight away, then the risk of incontinence has to be weighed against the risk of urinary problems when the tumour grows and starts to affect flow, for example, and the time you are in a weakened state after the op needs to be considered alongside the fatigue, muscle loss and debilitation of the hormone treatments. If they are proposing that you would be monitored for a period of time until the cancer has progressed to a point where HT is introduced, you need to consider how you will cope with the emotional stress of this; even if it is many years before you need further intervention, PSA anxiety may be overwhelming in the meantime.

My understanding is that RP after brachy or RT is unlikely to be nerve-sparing, particularly if the prostate has lost its shape and form, and the likelihood of leaving some cancer behind is higher. But your choice is not surgery or no surgery, it is surgery or no curative treatment. Not an easy decision :-(

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

User

Posted 31 Jan 2015 at 19:48

Hi Bob

I am scheduled for Brachy in about 3 months and my understanding is that hormone therapy, surgery, cryotherapy and HIFU are all options. With all treatments best to get an expert to do it, especially I would say with salvage treatment.

I concur with the above comments, if it were me (and I might find myself in the same position one day as I understand that in about 1 in 3 men with localised prostate cancer returns at some time after radical treatment) I would weigh up all the options including whether I am likely to die of the cancer or with it! You haven’t given your age etc but the younger one is then I guess the more likely one would decide to have radical salvage treatment.

If your urologist is one of the top 10 urologists in the country the chances are his/her advice is the best …. however, beware, if your urologist is one of the top 10 urology surgeons in the country then he/she is most likely to recommend surgery over a different treatment. Anything else would be like an oil company recommending you change your heating to gas! Also – if the treatment you eventually decide you would like to have is not available at your local hospital then you should be able to get referred to another hospital that does it.

Good luck ……. stay positive, keep us up to date, you’re not alone and the wonders of medical science suggest that all will be 'well' ….. if not quite the same!

User

Posted 31 Jan 2015 at 23:55

Well I think Capitalman might disagree, having been left permanently incontinent by one of the supposed 'top 10'. It's all relative. Also important to be clear that HT is not a salvage treatment, it is a delaying tactic.

Although the comment about surgeons recommending surgery is usually true, it is not so likely when looking for a surgeon to undertake salvage RP. They have to publish their success data and the increased risk of side effects would put many off. Captainbob, you are fortunate to have found one willing to consider it with you so it is certainly worth exploring. You might also be able to find a trial for HIFU or cryotherapy but whether you will meet the trial criteria is another matter.

Edited by member 01 Feb 2015 at 00:03 | Reason: Not specified

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

User

Posted 01 Feb 2015 at 10:22

Many thanks for the comments.

My urologist ( a surgeon) offered a number of options; Surveillance, HIFU, Cryotherapy and Prostatectomy; he preferred the last but admitted this also carried the highest risk of continence problems.

Having investigated these options I have decided to opt for cryotherapy and fortunately, I do tick all the boxes for the criteria required.

I am coming up to 66 years old and quite active being a very keen sailor; I understand that cryotherapy does not seem to have quite the same success rate of a cure as RP but that's a chance I'm prepared to take.

User

Posted 01 Feb 2015 at 16:29

Well done you Captainbob

I'd have probably made the same choice and I'm nearly 7 years younger!

Good luck -let us know how it goes.

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