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surgery - why anything else

User
Posted 22 Nov 2018 at 14:45

PSA - 16 GLEASON 7(4+3) TN 3A NO M0

HAVE BEEN OFFERD RAD PROS - WITH EXTERNAL BEAM RADIOTHERAPY

HIGH DOSE RATE BRACHO -  +HORMONE - EXTERNAL BEAM RADIO THERAPHY

MY SURGEON SAYS BOTH THESE ARE ABOUT CURE - I HAVE READ THAT BOTH HAVE THE SAME % SUCESS RATES

 

MY INITIAL INSTINCT HAS ALWAYS BEEN - GET IT OUT- I,M NOT IN THE LEAST BIT WORRIED ABOUT SIDE EFFECTS CONCERNING ERECTILE DYSFUNTION.

My surgeon hinted that high dose might be the way to go and I am seeing a radiologist tomorrow

BUT why would they recommend High dose -over surgery ( obs I will ask that ) Interested in views ?

 

 

 

User
Posted 22 Nov 2018 at 15:16
Hi

Each has pros and cons. RT has slower longer term effects and surgery has more immediate effects.

As to success rate, there does seem to be consensus here that both have similar success rates.

RP has the advantage that you can follow up with RT+HT if it fails.

Salvage after RT is a lot harder.

I suggest you do some detailed research on the relevant side effects to help understand the options better.

It may depend on your particular pathology. Talk to your medical team and ask if there is anything that suggests one way or the other may be better.

I won't make a suggestion as that has to be down to you.

Cheers

P

User
Posted 22 Nov 2018 at 15:18

Because of your staging there is every chance that even if you have surgery there is every chance of extra-capsular extension (spread) and then you would end up on hormones and radio-therapy anyway, so why go through the trauma of surgery?

Your staging is very similar to mine once they did the post-op biopsy, and I am clear following surgery.....for now. They thought they could remove a T2a completely, which turned out not to be the case.

But hey, ho, keep breathing!😉

Cheers, John.

Edited by member 23 Nov 2018 at 03:12  | Reason: Not specified

User
Posted 22 Nov 2018 at 15:34
My decision was based on if I do suffer from any of the side effects which could I live with.

I went with HT/RT as I could not live with incontinance, I can live without sex

User
Posted 23 Nov 2018 at 01:29
My belief is that where there is a very good chance of surgery alone dealing with PCa, a surgeon will make it clear he would be happy to deal with it. If surgery of itself is unlikely to be successful, he/she is putting a patient through a procedure that could be avoided if the HT/RT route is followed. This happened in my case with PSA of 16 and T3A NO MO but my Gleason was 3+4 =7. The surgeon who headed the MDT said he would remove my Prostate if I pressed for it but said he doubted he could remove all the cancer and thought I would do better by having HT/RT. In more recent years the two forms of Brachytherapy supplemented by External Beam where appropriate, has increased in effectiveness and use. I understand that there is less risk of incontinence with RT than with Prostatectomy.
Barry
User
Posted 22 Nov 2018 at 16:17

I had surgery.....but my clincal staging etc was different to yours.... 

Looks like there is a significant possibility that surgery alone will not get it all ...and that's why you've been offered EBRT to go alongside it.. 

My thinking given your stats would be, why risk 2 lots of potential side effects when RT HT and High Dose Brachy offer you the chance of a cure anyway? 

Whatever path you choose ...always choose the primary treatment that you feel will give the best chance of a 'cure' first time around.. 

Best Wishes 
Luther


User
Posted 23 Nov 2018 at 01:16
I never really get why anyone would opt for surgery with adjuvant RT / HT - recovering from one treatment is tough so choosing to go into it knowing that you will need both seems odd.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 22 Nov 2018 at 15:16
Hi

Each has pros and cons. RT has slower longer term effects and surgery has more immediate effects.

As to success rate, there does seem to be consensus here that both have similar success rates.

RP has the advantage that you can follow up with RT+HT if it fails.

Salvage after RT is a lot harder.

I suggest you do some detailed research on the relevant side effects to help understand the options better.

It may depend on your particular pathology. Talk to your medical team and ask if there is anything that suggests one way or the other may be better.

I won't make a suggestion as that has to be down to you.

Cheers

P

User
Posted 22 Nov 2018 at 15:18

Because of your staging there is every chance that even if you have surgery there is every chance of extra-capsular extension (spread) and then you would end up on hormones and radio-therapy anyway, so why go through the trauma of surgery?

Your staging is very similar to mine once they did the post-op biopsy, and I am clear following surgery.....for now. They thought they could remove a T2a completely, which turned out not to be the case.

But hey, ho, keep breathing!😉

Cheers, John.

Edited by member 23 Nov 2018 at 03:12  | Reason: Not specified

User
Posted 22 Nov 2018 at 15:34
My decision was based on if I do suffer from any of the side effects which could I live with.

I went with HT/RT as I could not live with incontinance, I can live without sex

User
Posted 22 Nov 2018 at 15:39

because as I see it you get two shots with surgery - original op gets it all - if not you can blitzt wats left with rt

if the course of bracho/external/ hormones -doesn,t get it all ...whats next ?

 

congrats on success so far

Edited by member 22 Nov 2018 at 15:41  | Reason: Not specified

User
Posted 22 Nov 2018 at 16:17

I had surgery.....but my clincal staging etc was different to yours.... 

Looks like there is a significant possibility that surgery alone will not get it all ...and that's why you've been offered EBRT to go alongside it.. 

My thinking given your stats would be, why risk 2 lots of potential side effects when RT HT and High Dose Brachy offer you the chance of a cure anyway? 

Whatever path you choose ...always choose the primary treatment that you feel will give the best chance of a 'cure' first time around.. 

Best Wishes 
Luther


User
Posted 23 Nov 2018 at 01:16
I never really get why anyone would opt for surgery with adjuvant RT / HT - recovering from one treatment is tough so choosing to go into it knowing that you will need both seems odd.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Nov 2018 at 01:29
My belief is that where there is a very good chance of surgery alone dealing with PCa, a surgeon will make it clear he would be happy to deal with it. If surgery of itself is unlikely to be successful, he/she is putting a patient through a procedure that could be avoided if the HT/RT route is followed. This happened in my case with PSA of 16 and T3A NO MO but my Gleason was 3+4 =7. The surgeon who headed the MDT said he would remove my Prostate if I pressed for it but said he doubted he could remove all the cancer and thought I would do better by having HT/RT. In more recent years the two forms of Brachytherapy supplemented by External Beam where appropriate, has increased in effectiveness and use. I understand that there is less risk of incontinence with RT than with Prostatectomy.
Barry
User
Posted 23 Nov 2018 at 19:09

gone for hormone /etc etc 

User
Posted 23 Nov 2018 at 21:46

Originally Posted by: Online Community Member
My belief is that where there is a very good chance of surgery alone dealing with PCa, a surgeon will make it clear he would be happy to deal with it. If surgery of itself is unlikely to be successful, he/she is putting a patient through a procedure that could be avoided if the HT/RT route is followed. This happened in my case with PSA of 16 and T3A NO MO but my Gleason was 3+4 =7. The surgeon who headed the MDT said he would remove my Prostate if I pressed for it but said he doubted he could remove all the cancer and thought I would do better by having HT/RT.

Sounds as if we’re in a very similar situation, Barry. I‘m officially T2C N0 M0 G3+4=7, but my PSA at the time was 32, and my urologist suspects undetectable T3 and, like yours, said he’d operate if that was what I wanted, but his strong recommendation would be HT/RT, because that could treat a wider area and be more likely to represent a curative treatment. I’ve now been on HT for a little over 3 months, and PSA has fallen to 15.3. I see my oncologist again this coming Monday at which time I hope to find out more about my RT, which I’m expecting to take place in February.

Cheers,

Chris

 

User
Posted 24 Nov 2018 at 00:56

On the basis of several months of heavy research I opted for the treatment route that I felt would afford the best chance of dealing with my cancer paying little regard to potential side effects. (For some men the latter would carry more weight in their evaluation.) The problem for me and for many is that we can't be certain in many cases whether the cancer is well contained or has migrated even in microscopic form and where there is spread/mutation how any such spread will become a serious problem within the likely natural lifespan of an individual. Even after 10+ years since treatment I don't know whether I did the right thing. Had my cancer really spread outside the Prostate and if not might surgery have done the job completely? But subsequent scans have shown that there is no evidence of cancer outside my Prostate so was there never a migration or did the HT/RT deal with this? However, scans years after the primary HT/RT treatment have shown that either some cancer cells were radio resistant and lived on or that new cancer cells had grown within the Prostate. So in my case, in retrospect, it might have been better to have had surgery to remove the Prostate and RT to deal with any real or likely immediate spread even if the RT might have been over treatment.

With a low but rising PSA and scans again showing a small tumour in my Prostate, I did consider a Prostatectomy - a few surgeons will do this after RT but I decided against because at that stage I was told there was almost 100% chance of permanent incontinence which was a major concern for me. In the event I opted for HIFU in 2015 as salvage treatment for failed Radiotherapy. However, one or more tumours have again been identified in my Prostate by PSMA and MRI scans. Whether this/these tumour(s) is/are new or the HIFU did not do the job I don't Know but will ask next week when I am due to have another Template Biopsy. There is then the possibility of further Focal Therapy, probably further HIFU or Cryotherapy if what is found merits further treatment.

The foregoing illustrates how difficult making a treatment decision can be, particularly for men at a more uncertain stage rather than for those diagnosed at a very early stage where the cancer is believed to be well contained or for those whose cancer is strongly believed to be advanced and RT if given at all is needed to be dealt with by systemic treatment.

Edited by member 24 Nov 2018 at 01:00  | Reason: Not specified

Barry
 
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