Brachytherapy OR Prostatectomy

Hi Johnny,  You haven't provided much information about staging, psa, scan results, breakdown of Gleason etc.  My own theory as frequently said is that getting rid of the tumour by removal as soon as possible is the best policy.  I'd think especially with a Gleason 9.  Although at your age you might think alternative procedures will preserve continence and erection better and you might think those very important.  For me they didn't even come into it compared with the risk of carrying a biggish lesion growing at a moderate pace said to be near the edge of the prostate.

It could be that your lesion is very small and that might take some urgency from it.  Each case has these subtle differences.

There are people who won't agree with my simplistic opinion which is mainly derived from my own particular case and hopefully some other people will respond to your note.

All these things can cause mental stress that effects each of us differently and perhaps you'd like to expand on what worries you the most.  People are very open about their condition.

Ultimately the decision is yours and we all have this choice to make.  Although if a consultant is offering you surgery it's a good sign as that is the route closed off first.

Regards
Peter

Edited by member 24 Mar 2018 at 22:03  | Reason: Not specified

Certainly, not enough information provided even for a professional, which we arn't, to provide an informed opinion. Sometimes, Brachytherapy, of both kinds, is supplemented by external beam. Was that offered?

We are biased but went for surgery and fingers crossed it seems to have been successful.

In the NHS you should have a Multi Disciplinary Team who will give their recommendation. I don't know ( but may be wrong) of any other cancer where such a huge decision has to be made by the patient. It is good to be involved but most of us are not experts on medical matters so it behoves us to research and find out as much as we can before making the decision.

We thought it helpful to go on the YANA website where you can input your stats and a list of other similar stage men comes up. You can then compare what treatments they chose and how they have fared since over the years.

Good luck with whatever you choose

Ann

It is true, in my opinion, that surgeons always want to surge at you with a scalpel, or these days buddied up with their mate called Da Vinci and his laser, and that there is invariably pain involved.

But sometimes surgery is the best option, which is why I have chosen it.

Edited by member 25 Mar 2018 at 11:13  | Reason: Not specified

So it’s not about money then? “The same NHS consultant recommended a template biopsy” after an inaccurate TRUS biopsy, once he realised it could be paid for by private health care.

Yes it's a three way procedure - HT ,HDR brachytherapy and external beam radiation

Appreciate your comments

Clear that the golden rule of managing prostate cancer is ....that are NO rules , limited good data , many options all similar with wide opportunity for success , failure and side effects

You's pays your money and it's only you's that makes the choice

Thxs

J

You must be a Scots lad like me

In fairness - he was going to do the template on NHS but waiting list too long so did Trus ( obv no good to get the whole diagnosis ) instead . WAS going to do the template after on NHS which I had a date for , but chose to invoke private medical so could chose a more suitable date and time and hospital for me

Cheers

J

Thanks for that

Distance not too bad as my mum lives in ripon nearby and as I'm invoking medical insurance I've got that support

I love the NHS ( best thing about this country in my view ) s d I've always used but the time allocated is helpful

The surgeon couldn't guarantee / almost definitely can't save nerves , hence the prognosis

It's not the aspect that will make the decision but it's a factor for sure

Thxs again

John

Edited by member 25 Mar 2018 at 14:09  | Reason: Not specified

Well hopefully the MRI and Template biopsy correctly signified to consultant that the Cancer was contained and in reality it is. Should this be the case there is a very good chance that surgery would provide a successful outcome.

There have been great improvements in the way RT is delivered and results with Brachytherapy, especially augmented by External Beam give very good results which compare well with surgery. However, there remains a concern that RT may induce another cancer even many years later. Also, whilst there is still a Prostate, albeit a radiated one, there is a possibility for a new tumour or one that was not completely dealt with becoming a problem - happened to me!

There are all sorts of statistics comparing success of various treatments which come up with differing figures of success. These are all well retrospective and treatments have moved on, just one reason to partly explain discrepancies. Another, is the timescale, 5 years is quite inadequate and it is likely that there would not be a great difference in mortality over this period from d for men that had treatment of any type and those who had none in terms of PCa if it was diagnosed at a fairly early stage. What is needed is more accurate long term comparison of results, say for 15 years but as stated individual and multiple treatments will have moved on.

It makes it very difficult for a man to decide what is best for him.

Hi Johnny, we don't have many rules on this forum but naming your doctors is a no-no ... best to edit your post :-/

Ha ha - you could have just edited his name - I usually refer to him as Mr B. Top guy though - he has done brilliantly by us :-) 

Edited by member 27 Mar 2018 at 16:27  | Reason: Not specified

Just to clarify a point. I did not have either low or high dose Brachyrtherapy but largely IMRT which is a way administering External Beam radiation. However, whether, one of the two forms of Brachytherapy or External Beam, all are ways of administering radiation as is Cyberknife, yet another variation. (I also had a Carbon Iron boost which is Hadron, like Proton Beam but packing a greater punch), all within a study as detailed in my Bio.

Due to a very slow but persistent rise in PSA, my consultant at The Royal Marsden thought it likely that there was some cancer within my Prostate years later. An MRI showed this was the case. I was referred to UCLH as a potentially suitable patient for salvage HIFU. Further scans and a template biopsy showed one out of 50 cores contained cancer. This was done when immediately before the HIFU treatment my PSA was 1.99, ie still below the generally accepted figure of 2 plus nadir which in my case would have been 2+0.5=2.05 for biochemical failure of RT. This demonstrated that is not just a matter of PSA being a little high but the way the PSA rises over time that is important. Often men are told that no further scans or treatment will be given until PSA reaches 4 or more post RT. So as far as I am aware, the HIFU dealt with the small tumour in the Prostate. It will be interesting to learn whether a PSMA scan I am having privately shows this is the case or it is a suspect iliac lymph node which is responsible for my slowly rising PSA again. This could make the difference to just having HT as a systemic treatment or radiating the suspect iliac node.

Didn't want to divert your thread but thought explanation necessary and to answer your question.

Edited by member 28 Mar 2018 at 01:49  | Reason: Not specified

Hi Johnny,

Best of luck with your choice. I am going to see an oncologist, but I suspect I will still go with the operation, especially as my PSA this week is up to 18 odd from 16 odd when raised PSA was first noted last November.

I find it very strange now when people ask “How are you?” I used to say “fine thank you”. Which I am, despite what doctors tell me! So now I just reply with a cheery “Still breathing”, instead of “I’ve got the Big C”.

You also find out who your true friends are when you let them know the diagnosis, either in person or on social media, some think you are at death’s door, (which I probably would be with liver, pancreatic or lung cancer), others ask “How are your results?”, “How did your consultation go?”. Some others don’t give a f***!

And they come out of the woodwork, two of my very closest friends around eighty years old confided in me they both have PCa, who knew? And two others in their sixties admitted they have waterworks problems and are awaiting the results of tests.

The whole thing so far has been a fascinating experience on many levels, and hopefully there is a “happy ending” in about eighteen months time, (in my dreams 😂😂😂😂)

Cheers, John

Edited by member 30 Mar 2018 at 15:04  | Reason: Not specified

They say it takes a year to eighteen months to regain erectile function after RP, if at all, if I am not mistaken.

Amazing you've had that experience

But do like your answer to ' how are you ?'!

I always mention PC and say I was lucky to be tested early and have they thought of it ?

Rafael

He who lives, loves and knows what it means to die - Jiddu Krishnamurti.

Galfano, 2013 - over 40% of men had penetrative sex within 4 weeks of retzius sparing RP.

Eden also makes a similar claim in his response to a query on the Santis website. He also says that the EF results are being analysed but are expected to be in line with the continence results.

It isn't just retzius sparing - we have two members on here who had their RP in Liverpool and were able to get erections immediately post op.

Edited by member 03 Apr 2018 at 15:31  | Reason: Not specified

Hadn't heard that one since I left college!