Please help ! treatment options

I had similar gleeson scores, and had HDR Brachy. in July. If available, i would highly recomend.

Thank you for the advice. Do you suffer with long term side effect? I think that this is what my dad is worried about in a the most in particular with incontinence.

Having read my original post I see it was really long winded sorry about that!

Claire

Hi Claire,

There are pros and cons of each treatment and how well any man appears to have done may not be truly representative of the treatment he had. Also, any treatment that may appear to have been successful may a few years down the line require further treatment. There are so many factors that can be relevant, a man's age, other health problems, how much cancer there is and how close it is to be to the margin, the type of cancer, (some are more radio resistant than others) and how much weight is given to varying side effects being some of them. I note your dad is very keen to avoid incontinence and as a generalization men who have one of the forms of RT have a lower risk of this than men who have surgery.

Men who are diagnosed early tend to have one of the 3 types of surgery, as they are more likely to be physically stronger and are expected to live longer for the cancer to develop. This gradually changes so that as they are diagnosed in say their seventies, more have RT (as usually do men who have more advanced cancer), rather than surgery, thereby avoiding a major operation and greater risk of incontinence. There is a a greater risk with RT that it may initiate further cancer many years later and there are other potential side effects, the later further increasing if Hormone Therapy (HT) which is often given before, during and after RT is part of the treatment plan.

So making a treatment decision can depend on so many things and even men with very similar diagnosis and other considerations might arrive at different conclusions. Another factor is that not all hospitals offer all the forms of surgery or RT so Dad might have to have treatment elsewhere if he wanted one his present hospital did not provide and this could be complicated by the relevant commissioning body not approving it.

I feel it would be helpful for you to prepare a list of questions for the urology and oncology consultants including what options would be most appropriate for him and which of these they can offer. You may then consider in details the pros and cons of these with specific reference to Dad.

I see Dad suffers from Dementia and I suggest somebody accompanies him and notes what is said. It may be necessary for this person to explain possibilities to Dad at home where things can be repeated and put in other ways until grasped and a decision made.

Do let us know how you get on.

Edited by member 20 Sep 2016 at 23:15  | Reason: Not specified

Hi, I hope I can help and I can only relate to you my own experience.  You and your father will have to make your own decision, but I hope that you will find my experience useful.

I am currently recovering from radical prostatectomy.  I had the operation on Sept 1st.  I will try to put your mind at rest.

My diagnosis on June 16th after my biopsy was a Gleason score of 7 (3+4) on the right side and the left side was clear.  I was also told that the cancer was touching the nerve bundle but just on one side.  There were only two options available to me, radiotherapy or the radical surgery.  I didn't really fancy six months of hormone treatment followed by 28 days of radiotherapy, especially as I was told by the consultant that if it "didn't work", a prostatectomy as a follow-up would be very unlikely indeed as it is much more difficult to safely remove a prostate when it has been "shrivelled" by the hormone treatment and radiation.  In addition, the side effects such as diarrhoea and fatigue as a result of the radiation did not really appeal to me.  Although the consultants did not influence my decision either way, once I had made it, they did all say that they agreed that the prostatectomy was likely to provide the most successful outcome in my case.

I went for a pre-op assessment towards the end of August and went in for the op at 7am on Sept 1st.  I was out of theatre and on the ward just before midday.  By this time the catheter was in place that drained directly into a bag at the side of my bed, and I had a morphine pump that I was able to control via a push button to control any pain when necessary.

I was discharged the following day at 2pm after having the catheter connected to a bag attached to my leg.  I was given precise instructions on how to drain the bag etc.  I had to wear compression stockings (and will have to for another ten days) and also have to inject anti-clotting agent into my stomach every day, BUT this is very easy to do and does not hurt at all.

Pelvic floor exercises are a bit of a moot point with regard to speed of recovery, but I started doing them six times a day for a month before my op. I am still doing them now, six of ten repetitions every day.  

Ten days after my op, I went back to the hospital to have the catheter removed. I had to stay there and drink water and pass urine so they were satisfied that I could pee properly.

Now for the good bit:  I was totally "dry" at night after my first day at home and have been since!  I am still wearing a pad but only 11 days after having the catheter out, with the exception of "stress leakage" as a result of sudden movement putting pressure on the weakened bladder, I am also now dry during the day.  I put this mainly down to the Pelvic Floor Exercises!

Tomorrow I have an appointment with the urology nurse to check my progress and give me advice etc.  Next week I am having my PSA blood test which I hope will be as close to zero as possible.  I will see the consultant for the results and prognosis in about three weeks.

So, that is my story so far.  I cannot advise you which route your father should take and as Lyn has said, you do need to talk to the experts . . . . but also find out from men who have had all the various treatments as only they have personal experiences of their journeys.  In the end, it is your father's decision and his alone.  I wish him all the best and yourself too.

Good luck,

Glen