Choosing surgery or radiotherapy?

Surgeons tend to want to surge....

With a high-risk G9 cancer such as yours there is a good chance that if you had surgery you would have to undergo adjuvant hormone and radiotherapies subsequently anyway.

You are on the right track consulting an oncologist, and you are entitled to second opinions from each speciality.

Best of luck whichever path you choose.

Cheers, John.

If the surgeon is saying no nerve sparing then it suggests that the % of each core is quite high and / or the cores show that the cancer is already close to the edge. Radiotherapy (assuming it is IMRT and even better if it is IGRT) can target those edges and the adjacent nerve bundles while hopefully leaving other nerves intact.

It varies a bit by area / region but where I live, you would not be offered brachytherapy. Common criteria are a Gleason of 7 or below, a PSA of 10 or below and a small gland; although the bicalutimide may have a dual effect of reducing your prostate volume, it is not going to reduce your G9.

If by ’narrow beam’ RT you mean proton beam therapy, you are unlikely to get that for prostate cancer in this country although you might wish to travel to Germany, USA or other countries as a very small number of other members here have. Proton beam has excellent results as a salvage treatment but trial data was very disappointing as a radical treatment so the couple of proton machines are reserved for hard to reach tumour such as optical myeloma, some head / brain tumours and very small children who would not be able to cope with normal RT. 

What was your PSA at diagnosis?

Edited by member 10 Mar 2019 at 19:31  | Reason: Not specified

IMRT is by nature a multitude of very narrow beams targeted to the area of need via a computer programme - your target area may be wide to include the lymph nodes, John's was wide in that it included the bottom of his bladder - but the beams were narrow.

Thanks for the feedback folks!

My terminology is probably inaccurate. I'm learning fast though.

My Macmillan nurse describes the Musgrove's therapy as "somewhere between IMRT and 3D", and I will find out more when I meet the oncologist. No I'm not talking proton beam and in any case can't see any evidence that's any better.

My biopsy showed 3/12 cores positive - 2 in a palpable lump near the surface but also 1 in the body of the organ. All G4+G5.

The organ is large, around 100ml in volume, and this has been cited as making me unsuitable for low dose seeds. I am having some retention and flow problems, which is why I was PSA tested in the first place. My PSA was just over 4 in 2016, now just over 11.

I'm hoping I can go the high dose brachytherapy route, but being obese and with Type 2 diabetes the risks with any general anaesthetic are higher, as with the surgical option. I'll ask about an epidural.

I know I'm jumping the gun asking you kind folk for opinions before I've spoken to the oncologist. Naturally enough I'm worried, and keen to get on with it!

Edited by member 11 Mar 2019 at 08:17  | Reason: mis spelling

I missed the question about the bone scan. My first MRI did show a couple of suspicious lesions in my pelvis, so in the new year I had a PET-CT scan using 18F-labelled cytosine* and looking for it's rather prostate-specific uptake, and that showed no "hotspots" either in the bone or anywhere outside of the organ.

Touch wood it's been caught early...

*as a former scientist I was fascinated by both the MRI and PET-CT scans. The quantum theory explanation of positron emission is completely mind-blowing!