Advice please re my thought process. Aged 67, retired and pretty fit and have been recently diagnosed: Psa 11, Gleason 4:3, T3a with bone scan, lymph nodes all clear. (more details on Profile). Hence, I’m intermediate/high risk. I have studied the threads on this excellent board and after having meetings with surgeon and oncologist have put together following summary that I’d welcome sense checks/ comments as to any incorrect assumptions etc.
RP. Has been offered as an option using Da Vinci. 80% of men stay in for 1 night. Left side nerves bundle would be removed together with local lymph nodes on that side. Surgeon has completed at least 300 operations in 5 years and quotes 50% of men on 1 pad after 6 weeks and 85% ok after 1 year. (Seems to equate to national figs). Seems ok but means 1 in 6 chance of urinary issues after 1 year…which is a major issue to me. At least 50% chance of losing erections due to nerve loss. I feel pretty squeamish re. operation but accept keyhole surgery is less invasive.
HRT/ EBRT. Has been offered. EBRT for ~ 4weeks. This includes brachytherapy options of LDR/ HDR. LDR using permanent seeds, and HDR being a recent initiative in hospital in which the specialist has considerable experience. Brachy requires a GA, but less invasive than RP. Various side effects from the combined approach as expected (hot flushes, increased urinary frequency/urgency etc) but hopefully just short term. No semen after radiation. Less than 5% of men have long term issues?
He can’t do brachy on its own due to T3 rating. Apparently Space Oar gel not available nor possible as would affect brachy technique.
He feels HDR is the better RT option as less acute side effects as lower radiation to surrounding area. In this case this would be total of a year of HRT with EBRT/ Brachy timing somewhere in the middle. I live near the hospital so regular trips not a major issue.
I understand that the success rates for the two options are equivalent for my particular profile. i.e. 80% chance of not having recurrence after 5 years. Oncologist says brachy lifts EBRT % by 10% compared to EBRT alone, making equivalent to RP. Neither specialist would come off the fence re. recommended choice. It’s all down to me…which has been extremely challenging but forcing me to think through all of the issues involved.
As of now I’m leaning towards the HRT/ EBRT -HDR route. My feeling is that as I’m T3a, if I have the prostate removal via surgery, then I may still need HRT/ EBRT anyway so why go through all the bother? (to quote an excellent statement by a main poster, Lyn). Also believe that I am less likely to have long-term urinary issues. Am I missing anything...?
Thanks in advance