Mine was multifocal in all four quadrants of the prostate. Biopsy picked those up and then post op histology found it was a higher grade and more than was thought although thankfully hadn't breached the prostate capsule.
In a multifocal scenario my local team and the London MDT plus the prof said focal therapy really isn't a viable option for me. On the table was AS, Radio Therapy in its many forms although caveats are potential secondary primaries which are very relevant at a person <60yrs. Surgery is more complex post focal therapy. I know the prof mentioned he had done a number of HIFU patients where recurrence had taken place. It was more complex and harder to get defined margin apparently.
My ex works in cancer research for one of the big pharmas running drugs trials and she is an immunologist by trade. From conversations with her AS was high risk and even gleason 6 there is early research showing over time its not quite as 'in situ' as we would like to believe. Whether this is due to smaller tumours in the area undetected causing issues its undetermined. The prof had seen this research too and nodded when I mentioned it.
I was dubious about surgery as my local consultant said there is a fair risk of incontinence plus ED issues. Talking to folks who had been to the Prof at London Bridge and had retzius sparing RARP + Neurosafe put my mind at ease. I figured it was a no brainer and just rolled the dice. Six weeks in my continence is fine and drips pretty much resolved but stress leaks can occur. And happy to report no ED are getting better day by day. I'd say in last 24hrs I'm pretty much back to pre-op mojo levels and my good lady is very happy with that. Although I think I'm fortunate with this thus far talking to others. I had no issue pre-op and strong drive etc which can be an indicator of how things will be after surgery.
Still very much early days but happy with my decision and it was worth visiting the Prof for a second opinion. At worst case it was worth a couple of hundred pounds for reassurance. In reality for me the best decision I ever made and a bonus it was fully covered by my insurance.
John makes a good point in that although we have 'field knowledge' gained en route during our journey it's important to listen to the experts. Although don't be afraid of getting a second or third opinion. I very nearly didn't go to see the Prof at London Bridge due to distance etc but I'm glad I made the effort.
Edited by member 08 Jan 2020 at 14:59
| Reason: Not specified