Which treatment option

User

Posted 10 Oct 2016 at 19:28

My husband has been confirmed as having prostate cancer ,psa 8, biopsy scores 4/3 and 3/4 = 7. Bone scan clear and mri shows no external spread as far as they can see.
He has been offered choice of robotic assisted surgery with hope of nerve sparing on the better side, followed by radiotherapy if required later or radiotherapy and hormone therapy.
We are concerned about making the right choice and concerned about possible side effects. We are struggling to decide; surgery may be front runner!....or is there a better option available, either NHS or private.

User

Posted 10 Oct 2016 at 20:33

Just to say hello and welcome.

I'll leave others to have their say on treatment as we didn't go either of those paths.

You'll find a lot of help and support on here so ask away any questions.

Perhaps you know by now about the Toolkit, available from publications on this site? Lots of info on there to think about

Best Wishes

Sandra

*******

We can't control the winds - but we can adjust our sails

User

Posted 10 Oct 2016 at 21:15

You need to read the toolkit and taslk to people - the nurses on this site are apparently very helpful. As someone whose husband had the surgery only to end up needing the radiotherapy as well, all I would say in hindsight was that it has seemed pointless living with the side effects that could have been avoided by going straight for the RT/HT. If they are suggesting that your OH would need RT after the op anyway, I would be asking the specialists 'what is the benefit of surgery in our case?'

Edited by member 10 Oct 2016 at 21:16 | Reason: Not specified

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

User

Posted 11 Oct 2016 at 01:51

Hi husband,

There is no one best treatment because one has to take into account not only how successful a treatment is in general but also potential side effects and how you set one against the other. The decision can be more difficult to make depending on the believed position and extent of the cancer as well as the type of cancer - some are more radio resistant than others for example. So the treatment decision is best made by the patient after having discussed his individual case with a urologist and an oncologist and having considered all the pros and cons of different treatments.

Different studies provide slightly varying results but there seems to be little to choose between surgery and radiotherapy in terms of success. However, I have read that surgery plus RT gives slightly better results but at the risk of more severe side effects, furthermore it is quite often done in this order whereas few surgeons will surgically remove a previously radiated prostate.

There are different ways of removing the prostate as well as different ways of administering radiation. This depends on the suitability of the patient and what the treating hospital can provide, although it might be possible to have treatment in a different hospital where there are more options.

There are other forms of treatment which some patients may be suitable for such as HIFU or Cryotherapy for example but these are not widely available in the UK and long term outcomes are not yet known.

Barry

User

Posted 11 Oct 2016 at 08:59

Hello and welcome
There is no rush, as suggested, get the Toolkit, ask lots of questions and chat to other people. Join your local group , after all of this it's your decision
We were hit with the lot, surgery, radiotherapy and ultimately, hormone therapy, drastic and the side effects are life changing but ten years later we're still here
Good luck

User

Posted 11 Oct 2016 at 10:38

I don't think we can advise without knowing exactly what stage the tumour is at; "no external spread as far as they can see" could be a stage I, II, or III - and they're very different situations.

Mine was stage III (locally advanced; no sign of spread), I had the choices you do, and opted for radiotherapy and hormones (22 months into a 36 month course). I have had minor issues, but no irreversible effects (touch wood) - except, of course in sexual function.

If I'd had a Stage I, I would probably have opted for surgery, with a good chance of 'cure' and small risks of nasty side effects.

If I'd had stage II, it would have been a tougher decision (and the surgeon said "Many stage IIIs turn out to be stage II on the table" - silly man!), but I suspect I'd have gone for the RT/H on side effects grounds.

But as others have said, we're all different, our priorities are different. For many, a small gamble on sexual function is a no-brainer, for others, not so. Speak to many, take notes and cross examine your doctors, but do find out exactly what stage of disease it is.

Edited by member 11 Oct 2016 at 13:29 | Reason: Not specified

User

Posted 12 Oct 2016 at 11:21

Hi Husband

I was 52 at diagnosis with a Gleeson 7 (3+4). My PSA was 21 and rose to 30 by the time I had the biopsy, results, urologist appointments and oncologist appointments (3 months).

You may read that PCa is slow growing but that isn't necessarily so for us younger (relatively) men. I wish I had seen the oncologist much quicker. In the end I went for R/T with hormone treatment. 8 months HT, 37 days R/T and then 24 months HT.

What made me decide on R/T was the stats and tables of probability of spread. Although the MRI showed the PCa was contained they are not ultra accurate to cell level around the margins. The tables showed what the chances were of breach of the prostate, of spread to the seminal vesicles and spread to the nodes. Although the scans didn't show any spread I had R/T to all.

My profile details this.

In your OH boots I would see the oncologist asap. By the way the urologist will promote radical surgery. Get both sides and weigh them up.

Gary

User

Posted 12 Oct 2016 at 16:45

Hi, I had almost the same details as you, and was offered thae same treatments. It was only after I had researched lots, that I then asked about Brachyterapy, that I was referred to a different consultant, who then advised me to have HDR Brachy, which I had in July. My last PSA was 0.14!

I really urge you to look at all options, before deciding.

Best of Luck.

Dave.

User

Posted 12 Oct 2016 at 20:56

Hello, my PSA level was 14 , Gleeson score was 7, I had the Robotic surgery instead of the Radiotherapy ,however 11 months post op, my PSA is now 0.5 and I will be having Radiotherapy soon, there is no easy answer to this condition, I wish you both well.

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