Hi Mickey,
Those figures are useful. Gleason 7 means it is not extremely aggressive, but it is sufficiently aggressive that it needs treatment fairly soon. T3 and 85% means it has grown to a reasonable size and has breached the prostate wall, so it has not spread significantly (it is all contained within one lump but it is a biggish lump). The PSA is not very high which is good news, that on its own would suggest it was not an aggressive cancer and has not spread, however the other information suggests the opposite so we will have to assume a medium aggressiveness and a largish cancer but all contained in one lump.
I think I am right in saying any focal therapy such as HIFU or Cryotherapy would be unlikely to work as the cancer is too large. Prostatectomy is a good option but there is the possibility of leaving cancer cells in the prostate bed (the area around the prostate, this is because T3 means the cancer has already breached the prostate wall). If after the surgery you still have a psa over 0.1 and rising it means that some cancer cells were left behind and you will need further treatment probably radiotherapy to kill them.
None of your medics have suggested spread to lymph nodes, or spread to bones or other organs, this is all good news. There is always the possibility of undetectable spread of the cancer this is called micro metastasis (mico-mets), none of us who have had treatment know whether this has happened to us we all hope it hasn't; if it has the cancer will reappear in some part of the body, in either months, years or decades and it will be impossible to kill it, but may be kept under control for a few years by more and more aggressive drugs. There is no point in worrying about micomets, it has either happened or it hasn't you are best assuming it hasn't and plan your treatment based on that assumption.
Surgery is one option for you. If it gets all the cancer you are cured if it doesn't you have the option of radiotherapy later to try and get the remainder. with one side of your prostate almost clear of cancer they may be able to save the nerves on that side and sexual function should be possible (ask them if it will be nerve sparing). Incontinence is a possibility but most people who post here seem to have been able to recover successfully.
Three types of radiotherapy are possible:
Brachytherapy seeds (LDR) may be a possibility, it depends on whether it is available at your hospital. The fact it has not been mentioned may mean it is not suitable for some clinical reason, but you should probably ask if it is an option.
Brachytherapy needles (HDR) may be a possibility, it depends on whether it is available at your hospital. The fact it has not been mentioned may mean it is not suitable for some clinical reason, but you should probably ask if it is an option.
External Beam Radiotherapy (EBRT) may be a possibility, most hospitals have access to the equipment for this. This treatment covers a wider area then Brachytherapy so has the potential to do damage to other part of the body such as the colon, it has the advantage that it can get in to the prostate bed and nearby lymph nodes, so if there is any spread of cancer it may kill it before it spreads further.
If you go for one of the brachytherapies EBRT may be given as well but at a reduced dose, just to catch any cells missed by the brachy.
If you go for any of the Radiotherapy options Hormone Therapy (Androgen Deprivation Therapy) may also be given for anything between six months and three years, this weakens the cancer cells and makes them more susceptible to radiation. ADT has side effects but they usually finish after the ADT stops.
All the radiotherapy options may have side effects such as ED, incontinence etc. but they may not show for many years probably ten years or may not happen at all. If surgery has side effects they will happen pretty much immediately.
It is not easy to make a decision, and it seems your medics have already decided surgery is best for you, so I would probably go with that, but the idea of this post is to give you more information so your decision is informed rather than just blind.
Edited by member 10 Jan 2021 at 16:24
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