Choice RP or HT and RT

As you have realized, there are pros and cons to each form of treatment and to get a better idea of these I also recommend you download or obtain from the publications section of this charity a hard copy of the 'Toolkit'

Incidentally, if the RT being offered is External Beam, it is sometimes administered in 20 higher doses (called fractions) rather than the more largely given standard 37 fractions each of 2Gy. This obviously reduces the number of attendances, one of the drawbacks to RT. However, it is becoming more usual for HT to be given for 6 months prior to RT and often for anything up to 3 years after RT depending on circumstances and response. Brachytherapy (Low or High Dose) is another way of administering RT and involves an operation. The need for 20 or more fractions of EBRT is therefore avoided, although sometimes Brachytherapy is augmented by a fewer fractions of EBRT. Brachytherapy is becoming more widely adopted but not all hospitals offer it.

There is no easy way to decide between the treatments, if the consultant believes that your outcome will be just as good with either route. If not already done so, download or order the toolkit from this charity and work down the list of side effects - decide which ones would be most tolerable (or least intolerable) to you.

My husband spoke to PCUK who put him in telephone contact with a couple of men that had already had treatment; he found it very reassuring to speak to someone about what it is really like after treatment. But he was only 50 and even having spoken to other men, he didn’t believe that any of the side effects would happen to him so the reality was a shock.

Hi John,  Sometimes it seems my opinion is unsophisticated on this, but for me cutting it out must be the most positive thing you can do.  Yet it also seems from what we're told the results of RT aren't much different, and we take their word that like is being compared with like.  The combined variations being almost unique to each man.

With an operation you get a more accurate pathology report with your true Gleason (mine was increased to 4+4) and a measure of margin invasion and effects on other organs. Knowing this can reduce your risk and give greater happiness.  Your psa level becomes a pretty accurate representation of your health, i.e <0.0X is happiness.  If fortunate you may need no drugs, except perhaps de-coagulant for a month, ED drugs being the other most probable.  The catheter for a week isn't too great.  You may need to wear continence pads for up to a few months but after a few weeks mainly as safety first when you go out.  Usually within 6 weeks you can live more or less normally except for blood tests every few months.  Of course there is a risk that any of those things might go wrong.

RT seems attractive in that you don't have an operation and it's all out-patient.  But it seemed like hard work and wouldn't start for 3 months when it becomes 5 days a week for 6 weeks plus on-going hormone treatment and possible side effects on your colon and long term risks.  I don't know much about RT so I hope writing those things about the op doesn't paint it worse than it is.  Your Gleason and margin aren't too relevant once you've had RT but it might have been relevant before the treatment so it's good to know if the risk is lower.  Basically you've lost that evidence.  Also once you've had RT you don't get any more, whereas a person having an op can have RT for salvage and pain relief.

I decided I would sleep for 3 hours and wake and it would be largely over.  That's how it was.  I was fortunate in having no pain from the moment I woke and the morning after was walking round. Basically I hid away for a week to get great healing, with my wife driving me round and sometimes feeling a bit amused about wearing a catheter and a bag and no-one knowing.  I've never regretted it and my only worry is it might come back which is something we all have forever,  you think you could be lucky and that gets you over it.  Although I still have significant ED but have taken no treatment for it and expect it to come back to some measure.

I haven't painted too rosy a picture but have given my opinion, hope that is some help or may stimulate another opinion.

Regards

Edited by member 30 Jul 2018 at 23:47  | Reason: Not specified

I had RARP 18 months ago. I considered RT and Bracky but my Uro and Surgeon talked me out of it. What swung it for me was they both said:

"future surgery would be difficult if RT didn't work, at least with surgery the prostate is gone and hopefully the cancer too, you get a full pathological report and future PSA results are a good marker for the future."

Added to that I had long term been suffering from IBS so was afraid to aggrevate that.

I had an MRI scan before the Biopsy and the surgeon said he could only spare the nerves on one side and as it turned out from the Path. report I had extracapsular extension, but microscopic negative margins, so just in time I think.

Having said that right up to the aneasetic going in I was not sure and afraid of the possible out come I felt panicked and remember struggling as they put me out. My concerns were the ED and Incontinance. So take your time with your decision and make sure you are as happy as you can be with it.

My recovery has been good. I was dry over night as soon as the catherter was removed and during the day after about six or seven weeks. On going I have slight urge and frequency which are both manageable and ED which is still frustrating me, but I still hope for improvement. I am using a vacuum pump daily and 100mg viagra 16 per month.

It is a difficult decision and the Op turned out ok for me but perhaps RT would have also.

As soon as I knew I was having the Op I decided to improve my fitness which I believe helped my recovery. I am now 2.5 stone lighter and walk, jog and cycle almost every day. I believe excercise is good for your long term outcome.

See my profile for more info and keep reading on this sight.

All the very best of luck to you what ever you decide.

Cheers

Bill

John,

I was under Mr C's care when he was at Guy's (5 years ago). He was one of the top dooderino's then for robotic surgery, and for me, I couldn't have asked for more. Sheer brilliance - and I say that even with all the side-effects!

Flexi