Treatment options - surgery or brachytherapy

If you have been offered surgery, AS, external beam radiotherapy and brachytherapy then you are presumably T1 or maybe T2a - I don't think many oncologists would offer AS to someone at T2b or above and at many hospitals being T2b or higher would rule out brachy as well. However, that is only my guess and I don't see how you could make a proper treatment choice without knowing for sure how extensive the cancer is - is it not written on your diagnosis letter from the consultant to the GP?

Also would be useful to clarify how long you would be on hormones if you opt for brachy. There is a small increase in risk of bowel cancer about 15 - 20 years after brachy - I think it upped the risk from 0.5% to 0.8% or something like that. Really, I think my husband would have taken the chance on the basis that when you get diagnosed with cancer the idea of surviving 15 - 20 years seems like a good outcome!!! As it happened our hospital would not offer brachy because he was 'too young' at 50 so things have moved on a lot since then.

Also worth noting that anecdotally (based on men on here) young men seem much more likely to have a recurrence and need further treatment after surgery while older men seem more likely to have successful treatment and then live long lives. Perhaps the younger you are at diagnosis, the more persistent the cancer turns out to be?

Hi

I was diagnosed last April after having no specific symptoms of any prostrate trouble. I just kept getting an occasional pain when I passed urine. I went to the doctor who sent me for blood tests and they came back with a raised PSA of 4.3

Following this I had a biopsy and then went in the body scanner and discovered I had the early stages of PC on both sides of the prostrate Gleason 4 and 3.

After discussions with the Surgeon and Radiotherapist and being only 55 years of age I was recommended for robotic surgery. You can have surgery and if that's not successful you can follow with radiotherapy, but if you have radiotherapy first you cannot have surgery after.

The surgery was ok no real bad pain, after an overnight stay I was sent home with a blood drain, catheter in place and blood thinning injections and pain killers.

I had to keep measuring the amount of blood coming from the drain (sounds worse than it was) and then when it had slowed down I went back to the hospital for the drain to be removed.

Don't worry about the thought of injecting yourself its very easy and doesn't hurt.

I had a complication as I had a leak in my bladder and needed 4 cystogram's so the catheter stayed in for 9 weeks, It was a bit uncomfortable but the majority of cases the catheter usually only stays in for 10 days max.

I was dry after 3 weeks.

I'm so glad I made the decision to have the operation and today I got the good news, my PSA is less than 0.01 for the third time.

Hope my experiences help you make the right decision for you and I wish you all the best with whatever you decide.

Interesting that most people here went for surgery. So my t stage has been confirmed as 2a. Also the brachytherapy recommended to me is permanent seed brachytherapy.

Still not sure which way to go, except that I won’t go for AS.

I was diagnosed with PC in Sept 2015 at age 58, T3a, PSA 13, Gleeson 7 (3-4) and 7 out of 10 samples came back positive. I shopped around for best solution, seeing 5 consultants in 3 hospitals, think my GP was feeling guilty for missing my raised PSA 3 years before. Finally went with HDR Brachy combined with 6 months hormone therapy and 23 doses of external radiotherapy afterwards.

My original consultant had recommended I look at other options to surgery if I wanted a quality of life afterwards, meaning he would have to remove bladder syphincter and both nerves if surgery.

Almost 2 years on I have not had any incontinence issues at all, erection disappeared after 4 months but returned after 15 months with help from Viagra and pump. Pump no longer needed and Viagra down to 25 mg from 100mg now.

Only set back was I suffered prostitus after 8 months but that went at second attempt after a few months.

I am still working, get much more tired these days, but not during day. Other than that seem to be pretty fit. My PSA is slowly dropping, now at 0.5.

My advise is get advise from as many sources as possible before committing to treatment, its too late for second thoughts afterwards and that it what I have found as the biggest regret from speaking to other patients I have spoken with. They went with whatever was first offered.

Good luck and hope all goes well for you both.

Thanks Mike glad you are doing well and it’s really reassuring to hear that your treatment has worked out for you, I had a Tele consultation with my Oncologist on 9th April 2020, I asked about Brachytherapy and he asked me that all Brachytherapy treatment had been suspended due to Covid 19 and he deferred me for three months to 9th July 2020. I then heard through a friend who is having radiotherapy that cancer treatment was back up and running from 15th May so I contacted my Consultants Secretary last Monday and I had a consultation with on Wednesday so in 2 weeks time I am going for my mapping session and as soon as my seeds are prepared I will have them inserted ( probably 3 weeks after the mapping session ). I pushed the point that I wanted treated before a second peak in Covid 19, glad my friend gave me the heads up.