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RP or EBRT

User
Posted 05 Jul 2018 at 16:49

I see the urologist in a week or so, after my last PSA of 9.8 I am aware that if it is over 10 this time then treatment will be suggested.


Since my PCa is localised and "only" 3+3  I have been offered "all options" for treatment and am currently on AS.


So, I might need to make my mind up shortly as to what to go for, if it's surgery it will probably be open, there is a Da Vinci in a local hospital but the surgeon who is recognised nationally as very good prefers open surgery as does my own urologist.


I have considered External Beam Radiotherapy and my second opinion (yep. I had one!) suggested that this could be the best option.


I am aware of the side effects of either options, and whilst I don't really want open surgery ( I am 75 but reasonably fit) I do want the thing out and biopsied so I know exactly what I have. So I am leaning towards open surgery.


Your thoughts will be most welcome. Of course my PSA might have dropped to some low figure and I can go back on AS, and pigs might fly!


My prostate is 41cc in size which I believe is not that big compared to some, but is somehow making a lot of PSA for a localised Adenocarcinoma left side only. What does this indicate?


 


Thanks   John


 


 


 


 

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8

User
Posted 06 Jul 2018 at 09:13
How much higher was the latest PSA compared with your previous one John.

Before having this latest one done had you had any extra exertion, cycling, intercourse etc?

Good luck and i hope somebody else will be along to help you.

Since you want the "thing" removed there's no point in me mentioning my husband's (now 77) treatment of low dose Brachytherapy Eh?
We can't control the winds - but we can adjust our sails
User
Posted 06 Jul 2018 at 11:45
'Have it out' is a natural and understandable reaction.
But, with your prostate size and Gleason, it's likely not the best option.
User
Posted 06 Jul 2018 at 12:06
Having had robotic surgery recently and being amazed at the speed of my recovery, I would think very carefully about open surgery. I could have walked out of hospital the next day if I had lived closer (115 miles away).

I had next to no pain, only requiring the odd paracetamol for a day or so, and seven tiny punctures where the keyhole implements went in. Compare that to a massive abdominal gash and a hospital stay of five to seven days.
User
Posted 06 Jul 2018 at 12:46

John,


 


While you alone have the right to choose the kind of surgery you want for the removal of your prostate gland, I urge you to think through your options once more to ensure that the choice you are making is the right one.


 


I had a Retzius-sparing robotic radical prostatectomy last February and I suffered no major pains and my continence is normal - the only exception was drips when sneezing or coughing but these were overcome quickly using pelvic floor exercises. The catheter was not inserted in the penis and this went a long way to maintain good continence and eliminated discomfort. I am amazed at my own recovery and I am still in awe of the surgeon's skill and professionalism. I have no major scars that one would get with open surgery.


 


I am just informing you of my experience and I never regretted my choice of operation. I wish you good luck in your choice and I hope you will recover well without any averse consequences.


 


Rafael


 


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

User
Posted 06 Jul 2018 at 12:51
User
Posted 06 Jul 2018 at 13:16

As has been said a natural reaction is " I want it out" and if that remains your opinion should indications be that radical treatment is advised soon your decision is clear. Just be aware that Prostatectomy can cause more severe and ongoing side effects. Also, regardless of whatever treatment you have it is contended that there is a small chance that 'seeding' could mean cancer cells not visible to the eye have gone outside the prostate. The risk of this is small but is slightly increased by multi punctures of the Prostate at biopsy and during Prostatectomy which involves cutting. So although surgery, particularly at an early stage provides a very good chance of eradicating PCa 'once and for all', this is not 100% the case.        


This covers seeding via tracking quite well but with PCa there is also a small risk of seeding via blood or the lymphatic system so men should be optimistic but never complacent   


https://sperlingprostatecenter.com/truth-biopsy-track-seeding/


 

Edited by member 06 Jul 2018 at 13:41  | Reason: Not specified

Barry
User
Posted 06 Jul 2018 at 13:24

Hi John,


My PSA was 2.19 with Gleason 3+4 =7 and was offered robotic surgery or Brachytherapy and decided  that Brachytherapy  was less invasive with possibly lesser side affects and at 70 at the time and with some experience of a friend that had the same procedure.It seem that you have already decided on the operation you want but open surgery does seem a bit old fashioned to less invasive  robotic job.I am 21 months on with PSA down to 0.39 and blood tests every six months.


None of us can guarantee  the out come of any of the operations so i wish you well with your choice.


 


John.

User
Posted 06 Jul 2018 at 17:34

Some interesting points have been made. My PSA at diagnosis was 8.8 so a rise of 1 in 6 months. I have just had my blood taken so I will see next week what the result is. No sex and no cycling or whatever so the results should be a true indication.


I think I can have robotic surgery at another hospital, but the main man there does 90% of his ops by open surgery. Brachytherapy is definitely available, but alas, not retzius sparing.


You have all given me something to think about, maybe Brachytherapy is the way to go, 


I will have a good think about it tonight  whilst I lay in bed at about 4.00 am, I do my best thinking then, the blackbirds will sing me back to sleep at about 5.00am (after toilet visit number 3 ).


John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8

User
Posted 06 Jul 2018 at 20:35
My OH sought a second opinion from our family urologist (lots of urological cancer in our family, unfortunately) and although he is one of the so called Golden Boys for da Vinci RP he recommended that in John’s case, open RP would be the best option. Despite the fashionable view that robotic is best, all the data shows that outcomes are slightly better with open surgery; basically, a man is asked to choose between a longer recuperation with better outcome v a rapid recovery and shorter time in hospital but higher risk of positive margins, incontinence, permanent ED and recurrence.

There are a number of practical reasons for open being best in some cases ... previous abdominal surgery, heart problems, higher than normal risk of GA complications being a few.

If you trust your surgeon and he is recommending open despite being competent in LRP, I would consider his advice very seriously. Brachy would have seemed a sensible option so it might be interesting to ask why this was not offered. However, if you are determined not to have HT then radiotherapy may not be a good option as you are putting yourself into a largely toxic situation with only half a treatment - all recent research shows that RT with adjuvant HT is far more successful than RT alone.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 06 Jul 2018 at 20:45

If I may add another thought.  From what I've read 75 is regarded as near the oldest for a prostatectomy.  Although it depends on fitness to a large degree.  The operation is performed with the body tilted head down which puts strain on the heart.   I'm not sure if an open operation is different as far as tilting is concerned but it is a much more vigorous operation than keyhole.  So if you don't need treatment soon it could be that the option of an operation will not be available in a year or so.   You could ask about that.


Like you I was keen to have robot surgery but was offered a fairly quick manual keyhole op and was very happy about that.  Also I knew the surgeon was experienced.  I haven't regretted it and as you said, I know my true gleason, which was worse, and margin.   I thought a manual op could give a better result as the surgeon can see and feel what he is doing although the long stay in hospital and long healing time plus the vulnerabilty that could incur didn't seem attractive for any marginal, if any, improvement in result.


There are people on here to advocate every method.  I had written that there is someone who would advocate open surgery but is on holiday, but notice that as I was about to click 'post' she has written.  


Regards


Peter

User
Posted 06 Jul 2018 at 23:03

Deciding what radical treatment to have when there are several different options to chose can be very difficult. There are many factors to consider, a man's age, the type of PCa he has and the location as well how as how many prostates the surgeon  has removed and regularly removes and how good results have been. All surgeons using the robot first learn to work without the aid of it and then have to adapt and gain new skill and experience using it. Indeed, as has happened on rare occasions when either the robot has developed a problem or this aid becomes inadequate, surgeons have to revert to the open method. Certainly, a growing number of Prostatectomies are undertaken using the Robot which means a shorter time in hospital and some would say that if a Trust have paid for the machine and all that this involves there is an expectation to use it but overall discounting short term advantages of the robotic method, longer term outcomes are comparable with open surgery.


Brachytherapy, seems to be becoming increasingly administered for suitable men.  Studies show it gives better results where appropriate than EBRT and it can be augmented by EBRT where the location and the extent of cancer suggest that a wider area needs to be radiated. HT improves results of RT however administered.


Whilst it is true that RT can be given to back up surgery so some would question why not just opt for this in the first place, thereby obviating potential side effects of surgery. Clearly, supplementary RT is less likely to be required in situations where it is believed the cancer is well contained.

Edited by member 07 Jul 2018 at 22:52  | Reason: Not specified

Barry
User
Posted 07 Jul 2018 at 19:03
Hi Peter, your instinct is correct - it is the tilting head-down that makes LRP unsuitable for some men with heart problems. Open surgery involves no tilting.

It isn't so much that I am an advocate of open RP- simply that I get why it is the best option in some cases and am irritated by the media machine that promotes LRP as the 'gold standard' despite all recent reliable data.

France is lovely - I will be sad to come home.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 08 Jul 2018 at 21:37

 I have made a decision, it will be Brachytherapy.


Not sure what sort high/low etc or whether any concurrent treatment will be offered but at least I know my path now.


Thanks for the input and helping me to make up my mind, I do find making up my mind difficult !


 


John


 


 


 

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8

User
Posted 10 Jul 2018 at 13:01

I am just back from the urologist appointment. PSA is now 10.5 and treatment is to start. I asked about brachytherapy and he agreed it is a good option. The only problem is, there is limited availability in my area (Worcestershire) and he will try to refer me to another hospital 1.5 hours away, but they "may or may not" accept me!!


Anyway, we will wait and see. He has also sent me for another MRI, checking to see if it is still contained maybe?


So there it is, no robot in my area, no brachytherapy leaving just open RP or external Beam RT.


I will start another post soon and relate my experiences, it might help someone else.


John


 

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8

User
Posted 10 Jul 2018 at 14:20

Hi John,


Had my Brachytherapy at Mount Vernon  just outside London very pleased with results' bit of an old hospital not pretty but done the job.


 


regards John.

Edited by member 10 Jul 2018 at 14:21  | Reason: Not specified

User
Posted 11 Jul 2018 at 18:24

Originally Posted by: Online Community Member


Hi John,


Had my Brachytherapy at Mount Vernon  just outside London very pleased with results' bit of an old hospital not pretty but done the job.


 


regards John.



 


OK John,  the Hosptital I am trying for is the Royal Berkshire. I will have to wait and see.  By the way 30 years in printing on the presses, plate making and even digital stuff!


 


John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8

User
Posted 12 Jul 2018 at 10:06

Hi John,


Hope it goes well for you with the Brachytherapy as it did with mine and yes I'm an old reprographics guy from Letterpress in the 60s then litho in the 70s onwards  my own scanning and platemaking company then onto digital reproduction and ended up on digital presses before retiring.


Good luck John.

User
Posted 12 Jul 2018 at 10:57
Hi John (Sparrow) ...
Your stats are very similar to mine and like John (the print) I had low dose permanent seed Brachy at the end of Jan last year (1917). However, a short course of HT was required to reduce the size of my prostate from 70 to 40cc before they would proceed with the operation.
Please click on my avatar for a more detailed description of my journey so far.
Good luck and I look forward to following your progress.
Regards Tom
 
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