Which option is best for my Cancer?

This is such a personal choice it's hard to advise. My OH was given a choice of surgery or RT by the MDT. He was a T3 but the surgeon wasn't fazed by that so he went for surgery. His attitude was get the bugger out asap. He had to have hormones for a couple of months as surgery was delayed by covid. Not sure if this is the case now or whether things are going smoothly. Surgery is radical as I'm sure you've read, side effects are ED and incontinence. Most men do eventually recover in both areas ( indeed some lucky fellows are continent almost immediately)but it has to be said a proportion don't. Some men would be bothered by this and some would say it's a price they are prepared to pay for the chance of being cancer free. Again, it's down to individual men.

I don't have any experience with seeds, someone will come along soon but my OH has no regrets about choosing surgery.

Good luck

LW

Hi Robert

Sorry to read of your diagnosis.  Reminds me of being in the exact situation at the beginning of 2019 at the age of 59. I was a 4:3 with a PSA of just below 6 with no symptoms.

I chose surgery - RARP.  

Almost 2 years post Op my PSA is undetectable and continence is just normal.  The only negative impact on my life is ED and this is improving each month and a few small scars on my abdomen.

My recovery post op was good.  First couple of weeks are just awful with catheter and general soreness and a fair degree of apprehension.  Within three months I was back to normal and now I can do anything I could before the Op.

I have no regrets about my decision and would make the same decision again.  If anything the whole process has re-defined how I live my life and it made me make decisions and plan better for retirement in 6 years time.  I have started a new business which is successful, profitable and rewarding.  I have no boss.  My wife and I down sized our property and are mortgage free with plenty in the bank and have good pensions well invested.  I would not have been this organised / savvy if I had not had PC.

I don't have experience of Brachytherapy but there are many on this site that do.

This site is just amazing.  I don't contribute very often as there are so many very helpful contributors that just have an amazing knowledge of PC and all it's different facets and give their time tirelessly.

Good luck with your decision and your journey and I hope you will see that there can be a silver lining even in the most difficult of journies and in unusual times.  You can define yourself and don't let this horrible disease define you.

kind regards and good luck

Steven

Hi Robert,

Sorry for the reason you join us.

There are possibly 4 approaches you might consider and there are pros an cons for all of them.

1) It may be a good option for you to defer any radical treatment until your Consultant considers this necessary which would spare you from potential side effects for a time by just being monitored (Active Surveillance or AS). This means there would be a small risk that the cancer has advanced further than thought.

2) One of several types of Focal Therapy which has mild side effects but might need to be repeated or be followed by Surgery or radiotherapy

3) Surgery Prostate removed by one of several means but potentially some severe effects, for a time or in some cases long term. Additionally, it may be found necessary to follow up with RT if some cancer has been found or thought likely. Surgery is more often the option when men are young but there is a greater chance of temporary or long term incontinence. Erectile disfunction is also a greater possibility.

4) Older men tend to have one of several kinds of RT, most often with a Hormone Therapy (HT). These together compound side effects and over time can cause Erectile Disfunction. It is also much more difficult and rare to have a Prostatectomy after RT. There is also the possibility that the RT may initiate another cancer in due course.

I suggest you download or obtain a hard copy of the 'Tool Kit' as this covers all the foregoing and more in greater detail and may help you come to your decision from options that are open to you. https://prostatecanceruk.org/prostate-information/our-publications/publications/tool-kit?_ga=2.206109653.795867346.1564408880-1013787081.1564408880

Edited by member 01 Jan 2021 at 18:11  | Reason: to highlight link

Hi Bobby,

Sorry you find yourself on here but many have gone before you and this forum has a huge amount of information to help you come to the decision which suits you best.

I have an ongoing post in treatments and the details are here:

My LDR Permanent Seed Brachytherapy Journey by DRAMCF

Basically I am 58 diagnosed on 14th February 2020 with G 7 3&4 Prostate cancer and was offered 3 options, surgery, External beam radio therapy or brachytherapy, after much head scratching and research I elected to go the brachytherapy. I had my treatment on a day procedure on the 22nd July 2020 in at 07:30am  out again at 4:30 pm ,catheter removed prior to discharge and home that evening. I was uncomfortable for a few days and visited the toilet frequently but I was prescribed tamulosin tablets to help with the urine flow and i am still taking them. 

So how are things 5 months on ? things are good, I might get up once at night to go to the toilet and maybe not at all, my PSA on 1st December 2020 was 1.27,  my erections are as strong as before but no ejaculation but it still feels the same but no actual fluid if you know what I mean. % months on I am sure I made the right decision for me.

There is a brachytherapy group which is administered by Andy62, the next meeting is by zoom on 14th January 21 and it is a group of people who have undergone brachytherapy or are thinking about it and you may find it beneficial.

good luck with with your decision making.

Regards 

David

Hi Robert,

 I am in a similar situation: T2C; Gleason 3+4, same weight and reasonably fit ( I had been training for my first marathon before Covid cancelled everything,   and my Hormone treatment kicked in-but more on that later). I am however 10 years older , and there is a bit of  significance to that.

As you have found, there is a huge amount of anecdotal information out there; and quite a bit of data. BUT, and it's a big but, the data is extremely hard to navigate and almost impossible to use as a basis for decision making. I have been looking for months, and have not found what I would regard as a sound basis for  choosing between the options.  One of the first things you will encounter is that the medical outcomes (measured as  crude survival; and- more usefully- as time to recurrence ) are pretty similar across the main first line treatments; certainly over a 5 year period, and pretty much up to 10. But the data sets do have some inherent biases ( for example, radical surgery tends to be offered to the younger, healthier part of the PCa population) and invisible variations ( for example relating to the skills of the surgical/radio team dealing with you).  And at 58, you really want a 30 year prognosis, since that is likely to be  your 'normal' life expectancy.

What is boils down to in practice, as others above have pointed out, is a rather subjective reaction to the risk of, and your feelings about, the various possible side effects. Probability data exists but it is pretty broad brush and very difficult indeed to map to your own circumstances to give you a properly weighted assessment. Have a look at the Tackle Prostate Cancer site ( treatment options) for a one page summary of the data.

There is ( sort of) a way through this. What I eventually did was to sit down and put some numerical weightings on how I felt about the various side effects ( this is, and has to be, entirely personal) ; then I multiplied that by the probability of each ( best estimate I could find for my age); then multiplied again by how long I might have to live with it. I can't pretend that this is as scientific as it sounds; but it does help cut through the fog and bring a bit of objectivity to a mish mash of information. I ended up with a basis for a decision ( which in my case was to go for RT preceded by Hormone treatment). I have no idea if it will prove to be the best answer. But it's one I can live with. And this is perhaps the one bit of advice I would give- make sure you are at peace with whatever decision you make. There will be doubts and dark days* whichever way you go, and you don't want to waste energy and emotional strength on misplaced regret. Fact is, there are few bad decisions here- just good outcomes if all goes well, and bad outcomes if it plays out that way.

Wishing you the very best of luck   

* eg- it's already clear that my Prostap is not working as intended!