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Not sure whether to choose surgery or radiotherapy?

User
Posted 03 Aug 2020 at 19:44

I have today been diagnosed with locally advanced moderately aggressive cancer (T3b) and am waiting for a consultant appointment to discuss treatment.

It seems that the two available are surgery or radiotherapy+hormone therapy.

Neither looks much fun - I think I am inclining towards surgery and wondered how others have decided about treatment? 

Not sure if it makes much difference but I am 60 years old!

Thanks.

Derek

User
Posted 03 Aug 2020 at 21:20

Hi Derek, sorry you are here. Your diagnosis is similar to mine, you can see my details if you click on my avatar and look at my profile. The medics pretty much ruled out surgery for me, the view was that surgery would not remove all the cancer so radiotherapy would be required in addition to surgery so two lots of side effects to contend with.

There is a strong emotional desire in most people, myself included to want to be rid of the cancer with the most aggressive treatment possible, that was ruled out by the medics, and in hindsight I am glad of that. I think the HT and RT I had was probably the best option but only time will tell. 

Both surgery and HT/RT apparently have more or less equal success rates. Surgery probably has worse side effects (but not for all), with surgery if it hasn't worked you find out sooner. 

Hope that gives you a bit more insight. I'm sure others will be along soon, but none of us can decide for you. 

 

Dave

User
Posted 03 Aug 2020 at 21:43

I was T3a, Gleason 3+4, PSA 57 (click avatar for details).

I initially said I wanted surgery, but that was from a position of naivety. They noted that as my preferred choice, but said it would probably not be nerve sparing, and it would probably need radiotherapy afterwards anyway, i.e. both sets of side effects. Sexual function was important to me, so I went for radiotherapy (exactly a year ago), and not regretted it yet. However, I won't really know how well it dealt with the cancer until I come off hormone therapy, probably some time next year.

Each person has different considerations and priorities, and that can mean two people faced with identical diagnosis would choose different treatments.

You probably need to wait until your consultation when they'll tell you what treatment options you have and what they would recommend, before you can dig too deeply into treatments.

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User
Posted 03 Aug 2020 at 21:20

Hi Derek, sorry you are here. Your diagnosis is similar to mine, you can see my details if you click on my avatar and look at my profile. The medics pretty much ruled out surgery for me, the view was that surgery would not remove all the cancer so radiotherapy would be required in addition to surgery so two lots of side effects to contend with.

There is a strong emotional desire in most people, myself included to want to be rid of the cancer with the most aggressive treatment possible, that was ruled out by the medics, and in hindsight I am glad of that. I think the HT and RT I had was probably the best option but only time will tell. 

Both surgery and HT/RT apparently have more or less equal success rates. Surgery probably has worse side effects (but not for all), with surgery if it hasn't worked you find out sooner. 

Hope that gives you a bit more insight. I'm sure others will be along soon, but none of us can decide for you. 

 

Dave

User
Posted 03 Aug 2020 at 21:43

I was T3a, Gleason 3+4, PSA 57 (click avatar for details).

I initially said I wanted surgery, but that was from a position of naivety. They noted that as my preferred choice, but said it would probably not be nerve sparing, and it would probably need radiotherapy afterwards anyway, i.e. both sets of side effects. Sexual function was important to me, so I went for radiotherapy (exactly a year ago), and not regretted it yet. However, I won't really know how well it dealt with the cancer until I come off hormone therapy, probably some time next year.

Each person has different considerations and priorities, and that can mean two people faced with identical diagnosis would choose different treatments.

You probably need to wait until your consultation when they'll tell you what treatment options you have and what they would recommend, before you can dig too deeply into treatments.

User
Posted 03 Aug 2020 at 22:47

Originally Posted by: Online Community Member

I have today been diagnosed with locally advanced moderately aggressive cancer (T3b) and am waiting for a consultant appointment to discuss treatment.

It seems that the two available are surgery or radiotherapy+hormone therapy.

Neither looks much fun - I think I am inclining towards surgery and wondered how others have decided about treatment? 

Not sure if it makes much difference but I am 60 years old!

Thanks.

Derek

Generally the younger and fitter you are, and the smaller the spread of your cancer, the more likely they will recommend surgery. I visited oncology and surgery before deciding and at age 50, rather fit, and with T2c (although surgery wrote me up as T2a) oncology suggested surgery to me. The main reason being "we expect you to live a long time, so you will almost certainly get long-term side effects from radiotherapy". 

Since you are 60 and T3b, that equation might stack up differently for your situation.

They did say I could choose whichever I wanted, but surgery seemed a better fit for me as I hated the idea of hormones.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 03 Aug 2020 at 23:50
The first question that you need to get an answer on is whether surgery would be nerve sparing on both sides. That considerably increases your chance of a successful outcome with regard to side-effects from surgery.
User
Posted 04 Aug 2020 at 09:10

I took the RT + HT route, & have no regrets. Whilst I was having my RT, quite a few other patients I spoke to, were having RT in addition to Surgery, as cancer cells had been left behind.
Why have TWO lots of side effects would be my thought as well.

OK, the RT/HT route, takes a lot longer, but it usually clears it up 100%. Side effects, not too bad, no General anasthetic (Unless tumours at front for biopsies) 

Addenbrooks in Cambridge, I cannot praise enough.

Edited by member 04 Aug 2020 at 09:15  | Reason: Not specified

User
Posted 04 Aug 2020 at 14:25

It is such a difficult decision. From what I have read, both treatments give similar outcomes.

I chose surgery (25/6/20). In the end I was encouraged by the confidence of the surgeon. He expected to save nerves on at least one side. 

The other reason I went this route, is that the oncologist advised that hormone treatment would be for 3 years. I didn't fancy this although many manage it fine. In the end I did have 10 weeks on HT and very quickly had no libido what so ever.

My surgery was six weeks ago and I have been pretty much continent from day one. Nerves fully spared on right side, and partially on left side. ED is the main issue for now and I have no erection at all. Hopefully this will change. Felt rough after the surgery for a few days but I am very pleasantly surprised by how quickly I have recovered.

One last thought. It is possible to have RT after surgery. Much more difficult going the other way. 

Take care and good luck with your decision.

Jim

 

User
Posted 04 Aug 2020 at 15:50

Hi Derek,

See my profile.

What Gleason are you ?

In very simple terms, you take the option that gives you the most effective 'single' solution.

Surgery has served me extremely well. My brother RT.

Gather all info and ask questions re. T3b.. 

Ie  What impact re.  SV invasion ?

 

Regards Gordon

 

 

User
Posted 04 Aug 2020 at 16:10
As well as trying to ascertain from the surgeon if s/he thinks nerves on one or both sides can be spared, you can also ask whether s/he thinks your cancer can all be removed or if there is a strong possibility the RT will be needed to complete the job. If s/he feels it's very likely that additional RT will be needed, quite possibly together with Hormone Treatment and additional side effects. This may influence whether you just go for RT instead. It has to be said that there are almost no certainties when it comes to PCa and it's treatment. Sometimes surgeons find whilst removing the Prostate that things differ quite considerably from what they were led to believe from scans and tests. In the same vein, side effects of RT can vary from one man to another and a further tumour can still grow again while you have a Prostate. There is also a small risk that RT can initiate another cancer elsewhere years later. It really does come down to gathering as much info on your individual situation as you can and then plumping for what you feel is the least worse option for you.
Barry
User
Posted 04 Aug 2020 at 21:32

Hi, 

This question is often asked and many wonder if they picked the right one right up to the day of treatment and sometimes later.   Although almost everyone thinks they chose the right one.

My tumour was said to be close to the edge and fairly high grade(4+3) T2a/poss T3.   It was the close to the edge that was most worrying.   With that information I was keen to get it out and the surgeon saying it was away from the bladder made me keener to have it cut out asap.

I was offered RT with hormones but it seemed like a prolonged treatment with 30 days of travelling to the hospital every day except weekend and no result for months.   Although RT might be better if the tumour has a chance of being on parts outside the prostate that can't be certain to be removed such as the bladder, seminal vesicles or nerves.

Within 3 weeks of the decision I was out of hospital.  The op went well and I'd no pain at all, just standard recovery although I still have ED to a large degree.   It was upgraded to 4+4 after the op but the margin was negative and psa undetectable which is knowledge you get in 6 weeks after the op.

You can have your head filled with doubts.  Some people have strong opinions about side effects. Some say beware of over treatment, others say PCa grows slowly so don't be rushed.

My opinion is it's better to make up your mind at the interview and then go for it. If you wish to see both a surgeon and an oncologist try to get a date out of the surgeon to hold onto. If they know you might not take surgery that might be hard.   The oncologist can start you on hormones almost immediately if you went that way.

If you delay you might hit another delay as you never know what's coming up.  Like winter flu or A&E surges or a pandemic.

All the best, Peter

Edited by member 04 Aug 2020 at 21:32  | Reason: Not specified

User
Posted 05 Aug 2020 at 13:11

Hi Derek.  I was diagnosed in the new year with a PSA of 36 and Gleason 9 but as there was no evidence of a spread further than the prostate I was deemed a T1. I commenced hormone therapy immediately after diagnosis which brought my PSA down to 1.4.

When I saw the oncologist because of this and high possibility of no spread outside the prostate plus the fact that otherwise I was fit and healthy and 'young' ( 66!!)  she recommended surgery. I was aware that surgery could not guarantee that all the cancer would be removed but all along I had decided that surgery would be my first option as the cancer was aggressive and I just wanted rid of it. I had open surgery 3 weeks ago with lymph nodes  and nerves from one side removed  also. Surgery went well and I was discharged after 3 days. I am recovering well and am out and about walking and gardening etc.  Main problem currently is incontinence but over the last couple of days there has been some steady improvement with this .I just have to be patient and recognise that this problem can take some time to resolve as others have advised.

The hormone therapy had some unpleasant  side effects ( hot flushes/ED/ fatigue ) but I have now ceased this so this will improve . I await my follow up appointment in a few weeks time to get feedback on how the surgery has gone and know that I may need further treatment (eg RT) if any cancer cells have remained. I am Ok about that ...just relieved the main protagonist has gone !

As others have said it really depends  on what your priorities are and weighing up all the pros and cons. For me I just hated the idea of leaving an aggressive tumour inside me if I could get rid of it. At this stage at least I have no regrets at choosing this option .

I wish you luck and that you can come to a balanced and informed decision that is successful for you.

All the best.

 

User
Posted 05 Aug 2020 at 15:29

I think it comes down to whether the surgeon feels he has a good chance of saving at least some nerves and of being able to remove all of the cancer and therefore avoiding salvage treatment.

Without the above (and you will need to decide on confidence levels) RT may be a better option.

I went the surgery route but wouldn't have done if the had said salvage treatment was also going to be likely

 

User
Posted 06 Aug 2020 at 13:30

It was a bit more clean cut for me as I was T2c. If you go for surgery try and get NeuroSAFE as part of the operation. Its a game changer for visibility as there is a pathologist operating in real time analysing the tissue samples as they come out. For me it identified potential focal involvement in the capsule margin so the Prof whocannotbenamedonhere took a bit more tissue. As its turned out histology reported all clear with negative margins. I believe NICE are evaluating NeuroSAFE with a view to making it available on the NHS in ~5yrs or so.

 
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