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robotic prostatectomy or external beam radiotherapy?

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User
Posted 02 Jun 2020 at 23:25

I was recently diagnosed with prostate cancer with a PSA of 10.5 and following MRI scan and a biopsy a Gleason score of 7. There are 2 areas, one with 4+3s and the other 3+3s. Apparently still contained within the capsule - just!.

My consultant said my options are prostatectomy or radiotherapy. However due to coronavirus nothing is going to be done until whenever so in the interim he said I should go on hormone therapy to keep it at bay. I'm now just into the 2nd month on Bicalutamide tablets.

Having researched the side effects of both options and because my hospital didn't have the da Vinci robot, I decided on radiotherapy. I'm 62 and still working full time so the possibility of urinary incontinence is an issue as I have to drive a lot. I was also concerned about ED following surgery.

Due to the coronavirus situation my consultant has only spoken to me on the phone and I didn't find the discussions to be very helpful so I asked for a 2nd opinion.

Well today I had a telephone consultation with a top urology consultant from Guys Hospital in London and I'm now undecided. This man has carried out over 1000 robotic procedures and was the person who operated on Stephen Fry so I guess he knows his stuff.

He confirmed the diagnosis and that there were only the 2 options but unlike my consultant he fully explained the reasons why. He has offered to take my case on if I want the surgery. He said there was not a lot of point if I still decide on radiotherapy as my local hospital has the same equipment.

I would be interested to hear other people's views and experiences especially regarding any side effects.

Thanks

User
Posted 03 Jun 2020 at 07:39

Hi Silkie

I had a prostectomy (open surgery not robotic) on March 23rd this year. The surgeon felt he could spare the nerves which he did.

I had a small level of incontinence to begin with but 10 weeks in everything is fine apart from the odd very slight leak sometimes if I cough/break wind. I am running/cycling without any issues. If I am going on a long hike I might slip a pad in for a bit of reassurance but honestly it really isn't a problem and I expect it will improve further. I am taking a small dose of cialis for ED but was able to have sex from 5 weeks in. Its not back to what it was but again I expect further improvement. 

Hope that helps

User
Posted 03 Jun 2020 at 08:20

Hello Silkie,

I had my surgery at Guys - "top" hospital,"top" surgeon. I couldn't fault either. 

re. side effects, and I can only talk about my own experience, it does depend on a lot of things - whether you've had nerve sparing (I did, both sides), your age and general health (mine I'd say was average for a 50 year old office worker), how well the body heals after surgery (I healed quickly) and how lucky you are.

I was continent within a few weeks and was able to have penetrative sex within six months. I now though have to self-catherterise to keep the waterworks open (but not a common side-effect from surgery). Hope that helps.

 

Flexi

 

User
Posted 03 Jun 2020 at 08:27
Well, that is the £64,000 question.

My diagnosis was very similar to yours. I had a prostatectomy done two years ago tomorrow by a top London surgeon, and apart from him or his robot nicking 2” off my dick and leaving it only useful for pissing through😉, I have been fine with undetectable PSA ever since😀.

However three friends also had RALP, but all had recurrence and have had to undergo what’s called adjuvant hormone and radiotherapies. Two are OK now but the third has a rising PSA so he still has some cancer somewhere. I wonder if they all wished they had gone straight for RT and skipped their surgery?

I have no regrets, but in your case you might as well flip a coin with your fingers crossed🤞

If you do opt for surgery, go for the London guy. It’s only one or two nights in hospital.

Best of luck.

Cheers, John.

User
Posted 03 Jun 2020 at 12:14

Hi Silkie,

I was offered a choice of Robotic surgery but after talking to the Brachytherapy specialist and reading up on the options risks of both procedures decided to go for Brachytherapy as i thought it might have less side affects.

In April 2016  at 70 after a private medical for my 7.5 ton licence the doctor picked up microscopic blood in my urine and sent me for PSA test that came in at 2.19 so had a MRI and other procedures that gave me a Gleason 3+4=7.

Treatment was at Mount Vernon in outer London and was no problem at all and i was in and out in two days.

I am 44 months on with PSA dropping after every test and on yearly blood tests i feel i have been very lucky so far some ED but get 4 blue pills a month to help with it.If you click on my Avatar you can see my journey so far.

John.

 

 

User
Posted 03 Jun 2020 at 18:42

Hi Silkie...

I am 53, have localised prostate cancer with a Gleason score of 7 (4.3). I have had the same debate and following consultations with both surgeons and oncologists I have taken the route to go for a combination radiotherapy treatment.  Hormone therapy to start (3 months) then LDR Permanent seed Brachytherapy followed by external beam radiology for 4 weeks.  The hormone therapy will continue through the radiotherapy treatment (so about 6 months in total).

A key concern for me was that I was likely to lose nerve endings on the right hand side due so ED was likely to be more likely and incontinence was a concern given I am an active runner and tennis player

I was very undecided but following the consultations I felt the radiotherapy would give a good curative treatment and the side effects are less problematic, especially for incontinence and ED.  I made my decision purely on what I perceive to be a better post op daily life routine and that the treatment is less invasive

Never an easy decision. I read lots on the community pages but there's never someone in exactly the same position as you, so listen to all the advise from the experts and go with what feels right for you

Good luck..

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User
Posted 03 Jun 2020 at 07:39

Hi Silkie

I had a prostectomy (open surgery not robotic) on March 23rd this year. The surgeon felt he could spare the nerves which he did.

I had a small level of incontinence to begin with but 10 weeks in everything is fine apart from the odd very slight leak sometimes if I cough/break wind. I am running/cycling without any issues. If I am going on a long hike I might slip a pad in for a bit of reassurance but honestly it really isn't a problem and I expect it will improve further. I am taking a small dose of cialis for ED but was able to have sex from 5 weeks in. Its not back to what it was but again I expect further improvement. 

Hope that helps

User
Posted 03 Jun 2020 at 08:20

Hello Silkie,

I had my surgery at Guys - "top" hospital,"top" surgeon. I couldn't fault either. 

re. side effects, and I can only talk about my own experience, it does depend on a lot of things - whether you've had nerve sparing (I did, both sides), your age and general health (mine I'd say was average for a 50 year old office worker), how well the body heals after surgery (I healed quickly) and how lucky you are.

I was continent within a few weeks and was able to have penetrative sex within six months. I now though have to self-catherterise to keep the waterworks open (but not a common side-effect from surgery). Hope that helps.

 

Flexi

 

User
Posted 03 Jun 2020 at 08:27
Well, that is the £64,000 question.

My diagnosis was very similar to yours. I had a prostatectomy done two years ago tomorrow by a top London surgeon, and apart from him or his robot nicking 2” off my dick and leaving it only useful for pissing through😉, I have been fine with undetectable PSA ever since😀.

However three friends also had RALP, but all had recurrence and have had to undergo what’s called adjuvant hormone and radiotherapies. Two are OK now but the third has a rising PSA so he still has some cancer somewhere. I wonder if they all wished they had gone straight for RT and skipped their surgery?

I have no regrets, but in your case you might as well flip a coin with your fingers crossed🤞

If you do opt for surgery, go for the London guy. It’s only one or two nights in hospital.

Best of luck.

Cheers, John.

User
Posted 03 Jun 2020 at 12:14

Hi Silkie,

I was offered a choice of Robotic surgery but after talking to the Brachytherapy specialist and reading up on the options risks of both procedures decided to go for Brachytherapy as i thought it might have less side affects.

In April 2016  at 70 after a private medical for my 7.5 ton licence the doctor picked up microscopic blood in my urine and sent me for PSA test that came in at 2.19 so had a MRI and other procedures that gave me a Gleason 3+4=7.

Treatment was at Mount Vernon in outer London and was no problem at all and i was in and out in two days.

I am 44 months on with PSA dropping after every test and on yearly blood tests i feel i have been very lucky so far some ED but get 4 blue pills a month to help with it.If you click on my Avatar you can see my journey so far.

John.

 

 

User
Posted 03 Jun 2020 at 18:42

Hi Silkie...

I am 53, have localised prostate cancer with a Gleason score of 7 (4.3). I have had the same debate and following consultations with both surgeons and oncologists I have taken the route to go for a combination radiotherapy treatment.  Hormone therapy to start (3 months) then LDR Permanent seed Brachytherapy followed by external beam radiology for 4 weeks.  The hormone therapy will continue through the radiotherapy treatment (so about 6 months in total).

A key concern for me was that I was likely to lose nerve endings on the right hand side due so ED was likely to be more likely and incontinence was a concern given I am an active runner and tennis player

I was very undecided but following the consultations I felt the radiotherapy would give a good curative treatment and the side effects are less problematic, especially for incontinence and ED.  I made my decision purely on what I perceive to be a better post op daily life routine and that the treatment is less invasive

Never an easy decision. I read lots on the community pages but there's never someone in exactly the same position as you, so listen to all the advise from the experts and go with what feels right for you

Good luck..

 
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