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Treatment options - surgery or brachytherapy

User
Posted 09 January 2018 17:08:20(UTC)
Hi

I’m 47 and was diagnosed just before Christmas.

My PSA is 6.6 and Gleason score 7. I don’t have my t stage diagnosis, though am trying to find it out.

I’ve just spoken to a surgeon and oncologist about treatment options.

Basically oncologist has suggested that They’d rather treat it than do active monitoring (and I’m not that keen on active monitoring anyway).

They’ve talked me through the options and brachytherapy or surgery seem to be the preferred options.

But i’d like to get some opinions from anyone around my age that’s head gone through them.

In particular I’d like to understand what the side effects and long term issues/risks are really likely to be.

From what has been said to me so far it seems like both have similar levels of success, but brachytherapy has shorter recovery time.
However there is a slightly increased risk of secondary cancer in later life because of the radiation.

Would be grateful for any input I can get.

Thanks!
User
Posted 09 January 2018 20:51:27(UTC)

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.

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


User
Posted 09 January 2018 21:35:46(UTC)

Hi Mark,

Welcome to this forum but sorry for the reason that brings you here.

I was diagnosed when much older than you and had different treatment to that which you are considering. However, since joining this forum in 2008, I have read the stories of many men diagnosed and treated for PCa, some of them young like you. I hope my small contribution may therefore be of some interest.

Outcomes of men however treated for PCa can vary considerably as regards success in dealing with the cancer and side effects in the short and long term. So replies from men here may differ considerably from those you would experience for a form of treatment, although there are some generalizations as you have already observed. For example we have had a man who had a Prostatectomy by a leading surgeon but has been left permanently incontinent but this is rare. At the other extreme some men are dry very quickly. Also, in respect of surgery, some men go on achieve erections quite quickly with or without chemical or mechanical help whereas for others this is a slow process which in some cases may never be really satisfactory. Much depends here on the skill of the surgeon and whether one or both of the two main nerve bundles have to be removed as part of the op.

There are two forms of Brachytherapy, high dose and radioactive seeds either of which can if deemed advisable be supplemented with External Beam radiation. The risk of incontinence is lower with radiation as is ED for some time. However, radiation is usually preceded by Hormone Therapy which can continue for months or even up to 3 years after radiation as part of the radical treatment. This HT usually results in a loss of libido and erections tend to become less over time. When considering radiation one should ask also about the proposed length of HT because where this is introduced it will also have it's own varying side effects to add to those of the radiation, whatever form this takes.

It is more often the case that young men have surgery. This means men can sometimes escape some of the side effects of RT+HT or the small risk that in later years they may experience another cancer developing as a result of the RT. However, should it be found that not all the cancer could be removed by surgery, follow up RT can be given. (It is very difficult to remove the Prostate after RT and few surgeons will attempt it).

I would advise you to research the options you have been given in more depth and if you have not yet done so download or obtain a copy of the 'Toolkit' from the publications section of the main area of this charity.

There is no best treatment only what you feel is best for you. Whatever you decide, I hope it goes well.

Barry
User
Posted 09 January 2018 22:49:31(UTC)

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?

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


User
Posted 15 January 2018 22:29:23(UTC)

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.

 

Thanked 1 time
User
Posted 15 January 2018 22:30:00(UTC)

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.

 

User
Posted 16 January 2018 07:58:58(UTC)

I was diagnosed on the 26th October last year T3A, PSA of 7. I chose surgery as this seemed the quickest way to get the cancer out of me. I had the robotic surgery on the 13th December. I was out of hospital the next evening. Pain was not to bad and stopped painkillers after the first week. The catheter was uncomfortable but not painful, I was relieved to get it taken out two weeks after the op. A month on I still have stress incontinence and no sign of an erection, but I am now walking for a hour day and have returned to work this week. I've got an appointment with the consultant on the 6th February to see how successful the op has been.

Obviously you will need to do what you think is best for you. Good luck with whatever decision you make.    

User
Posted 16 January 2018 18:44:49(UTC)
Thanks all for the replies so far.

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.
User
Posted 16 January 2018 18:54:30(UTC)

My husband had the permanent seed brachytherapy but then he is in his 70s so any long term effects from it are only likely to appear when he is in his 80s.

Remember, if you have radiotherapy first then although there may be other treatments available should there be a recurrence, surgery won't be one of them.

My husband had very few problems with the Brachytherapy. Obviously, at his age, ED is not as important as it is to a younger man.

Good luck whatever you decide to do

We can't control the winds - but we can adjust our sails
User
Posted 02 February 2018 16:37:06(UTC)
Sorry to hear your reason for being here.
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.
 
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