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Treatment Options - what next

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User
Posted 31 Mar 2018 at 05:42

Hi all

So I have recently been diagnosed with Gleason Score 7 (3+4), grade group 2 cancer. They found only cancer in 1 core sample and this  was 5mm. My most recent PSA before my biopsy was 4.3 (rising over 5 months). I have been referred to a surgeon and oncologist to discuss treatment options. All 3 consultants I have seen believe I am not a candidate for active surveillance primarily due to my age (50) and the presence of 'enough 4 to make them think I will need some intervention at some point'.

The options presented to me are surgery and seed brachytherapy - both with the same long term cure rate of 80 - 90%. I am a candidate for nerve sparing surgery on one side of the prostate given the location of the tumour.

As they have the same long term chances of cure I am in a real dilemma over which path to choose as the short and long term side effects are different. My prostate is pretty small - c18cc which led to the oncologist to suggest that I am at slightly increased risk of stricture but I have a very good flow rate. He also said the size can make it difficult to hit the 95% of the prostate they would want the seeds to affect but he has done smaller without any problems (or poorer outcomes). I have 2 very young kids which also plays into my thinking re the radiation risk.

The surgery could be done as open or robot assisted.

Any advice would be appreciated..

Cheers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

User
Posted 31 Mar 2018 at 10:22

Good morning Oxon and welcome to the site.

Treatment choice is always difficult. It's a very personal decision to make. If you go to Publications on this site you can download the Toolkit which you might find useful.

You could click on my avatar which recounts the journey my husband has taken with his seed brachytherapy.
However, he was in his early 70s when he had it done and we didn't have to worry about radiation and young children.
The radiation precautions are temporary but if you have very young children you would find it difficult to explain that they can't sit on Daddy's lap for a while.

Just make sure you do your research and don't jump in feet first. Whatever path you choose,it will have side effects, some short term,some permanent. You have to be prepared that at 50 some of them could be life changing.

Hopefully you'll get advice from others too.

(PS, as a wife I would also advise that you include your other half in your discussions. Not all men do)

Best Wishes

Sandra

We can't control the winds - but we can adjust our sails
User
Posted 31 Mar 2018 at 11:46

Hello Oxon
Click my picture and read my journey if you like. I was 48 at surgery. Despite my horrendous fear and negativity about surgery and the side-effects , I decided to go for it for the sake of my wife and children. My little boy was 6 at the time. My stats were a lot worse than yours and unfortunately it hasn’t led to cure, but I do want to tell you that you CAN come out of it all healed and regain erectile function and continence. It’s different for each man , and a slog , but possible. Communication and closeness with your partner is a must. I wish you well in your choice

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User
Posted 31 Mar 2018 at 10:22

Good morning Oxon and welcome to the site.

Treatment choice is always difficult. It's a very personal decision to make. If you go to Publications on this site you can download the Toolkit which you might find useful.

You could click on my avatar which recounts the journey my husband has taken with his seed brachytherapy.
However, he was in his early 70s when he had it done and we didn't have to worry about radiation and young children.
The radiation precautions are temporary but if you have very young children you would find it difficult to explain that they can't sit on Daddy's lap for a while.

Just make sure you do your research and don't jump in feet first. Whatever path you choose,it will have side effects, some short term,some permanent. You have to be prepared that at 50 some of them could be life changing.

Hopefully you'll get advice from others too.

(PS, as a wife I would also advise that you include your other half in your discussions. Not all men do)

Best Wishes

Sandra

We can't control the winds - but we can adjust our sails
User
Posted 31 Mar 2018 at 11:46

Hello Oxon
Click my picture and read my journey if you like. I was 48 at surgery. Despite my horrendous fear and negativity about surgery and the side-effects , I decided to go for it for the sake of my wife and children. My little boy was 6 at the time. My stats were a lot worse than yours and unfortunately it hasn’t led to cure, but I do want to tell you that you CAN come out of it all healed and regain erectile function and continence. It’s different for each man , and a slog , but possible. Communication and closeness with your partner is a must. I wish you well in your choice

User
Posted 31 Mar 2018 at 13:33

I suggest you go for second opinions from both a surgeon-Urologist and another oncologist, possibly from a different hospital, before you make your difficult decision.

Moreover, research your surgeon’s outcomes, because it is proven that the more experienced the practioner is (which I suppose applies to most professions), the better the end result.

Best of luck.

John

User
Posted 31 Mar 2018 at 20:15

Thanks all for your welcome and the advice. I’m currently on private healthcare and the various consultants I have seen are all supposedly at the top of their respective games. The surgeon has done ‘hundreds’ of prostatectomies and the oncologist a highly recommended name to me. Of course this starts to give you some confidence in the consulting room but there again they aren’t the one making the decision.
I got the impression that I was being gently steered towards brachytherapy by the oncologist because of the longer term side effects and the practically identical survival stats. I had begun to gear myself up for surgery prior to that meeting hence the dilemma....

User
Posted 31 Mar 2018 at 22:55

HI, my reply may not be particularly helpful, so these are just my thoughts and experiences since undertaking my treatment journey since last February. Although I'm far older than you ( 71 ) my scores at diagnosis were similar, although I was borderline whether my problem was confined to the gland or had broken out of the capsule

I attended UCLH and saw three "specialists" all of whom had a different take on my treatment options, robotic surgery being the first one, this was however contradicted by another specialist who said urinary problems would be almost certain due the location of my tumor, I didn't pursue why three specialists came to different conclusions. 

The third consultant immediately put me on a hormone deprivation drug to as he put it " stop it in it's tracks" quite why the first consultant didn't do that is a mystery and yet another question that I did not ask ! 

After surgery was ruled out I was then referred to have 20 weeks of radiotherapy, along with Androgen deprivation therapy, via a 3 monthly injection to suppress Testosterone production, the treatment notes I have in my possession stating the treatment goal being "curative".  I have just gone for my first post treatment check up, and was told my PSA levels were now undetectable.although I'll have to stay on hormone therapy for three years ( although I'm going to question this at my next check up ), but this varies, for a friend of mine it was just 6 months, and nearly ten years on he's still fine.

 

So what's the point I'm making, and in some ways talking to myself as I write, but I don't think it's an exact science, otherwise why would one specialist suggest surgery, whilst at the same time on the face of it, ( and fingers crossed) a non surgical route apparently can have the same result, with non of the risks associated with surgery....... this is absolutely the question I would be asking should I be starting all over again on this journey. 

At the end of the day only you can make the decisions, but as you are doing ask, and read as much as you can before opting for anything, at least you should then be making a better informed choice, it's your body, and your life, not theirs................good luck, Eric

User
Posted 01 Apr 2018 at 07:21
I believe the rule of thumb is the younger you are and earlier the cancer is caught the better the long term outcome for surgery.

Once you are fully healed from surgery that should be the end of it. Long term side effects of radiation are less predictable and tend to emerge over time.

Un-fortunately (or maybe fortunately) prostate cancer treatment gives you lots of choices! It's vital to understand the tradeoffs if you want to avoid the "what ifs" later!

You will find protagonists for all treatments and strategies on this forum!

 
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