Can't understand why anyone would choose surgery over Brachytherapy? I must be missing something?

Hi Philip,

Good to see your post and it reminded me of the confusion I went through about a year deciding which route to take. You've come to the right place as there's some very helpful people here. I've just posted a 6 week update on my EBRT/LDR experiences. 

One research item helped me a lot was the following link for a study which compared life expectancy outcomes of 12 types of treatment for Low, Intermediate and High risk patients. It seemed to be pretty thorough and mirrored another study that I paid for. EBRT/Seeds seemed to have the edge over surgery. Of course there's also the Quality of Life issues to consider which give another dimension to the data.

https://www.prostatebrachytherapy.org.uk/2016-presentations/A-Law-170516.pdf

After reviewing this document I then asked the exact question that you posted. 

Hope that helps...

Vince

In some cases , surgery is the only option, I was offered either surgery or RT, I chose surgery, on the understanding that after RT surgery was a bit more of an issue, turns out that my final results were it was my only option, had I not had surgery I would probably not make old age, which I would quite like to (other health issues excepted). But I do appreciate it' snot for everyone!

I think how long it takes is as variable as everything else; some of us have little choice.

"> Prostatectomy - suffer a bit more now maybe, feel pretty confident that you're in the clear if you make it to 5 and 10 years of clear PSA tests

> Brachy - suffer less now maybe, have a bit more of a risk of secondary cancers many years later perhaps"

Just to give that some balance, my dad had undetectable PSA for 13 years - he even got a letter from the NHS at the 10 year mark telling him that he was in full remission - but it still came back.

The risk of RT or brachy causing a new cancer further down the line is tiny

Edited by member 16 Jan 2021 at 20:57  | Reason: Not specified

Hi,

That's a great challenging post that brought out a good response.  Most people just ask which is best.  The question you pose above is could be answered by saying:

With surgery you go to the hospital are put to sleep and wake up two hours later job done and in only 2 months you know if it's done the job.   Then you join those who hope their psa test comes in good every few months.  Whereas with RT of any kind you don't know for a year or more and have had months of hormones and with full RT 30 daily sessions at the hospital. 

Brachytherapy sounds the most attractive of the treatments if taken with minimal hormone treatment.  I might be wrong but it also seems the weakest and most likely to need further work unless chosen for the lowest risk cases.

I might also be wrong in saying that a T3 is taking a chance having Brachytherapy.  Full RT will cover a wide area beyond the prostate.

It's always a tough call and some reflect if it was the right one.   Although I never had any doubt about choosing surgery.

Hope all goes well, Peter

Hi Barry 

Thanks for your kind Comment 

Yes sadly I was forced to have a surgery operation..and it took from beginning to end only 6 months maybe less.

NO ! A big NO ! 

hands on they did not give any leaflets about risks of The surgery. 

Only the risks I was told about ED.thats all.

They did not mention about risks of Catheter users catching infections. 

They did not mention about adhesions 

They did not mention about long term effects of not to lift up heavy items.

They did not mention about any kind of internal pains.

There are so much to talk about but I'm right now in so much anger this time of the night.

I was framed up that's all I can say

My ex girlfriend  to be undercover she played a big role in it!

Thanks for your kind comments 

Let me explain and add more about my case please. 

I have inconsiderate neighbours nextdoors and below my apartment flat. I could hear noises where I shouldn't hear ,my nextdoor neighbour he plays music 7 days a week from 8 am until 8pm sometimes later than that.

I Walker into a police station 4 years ago I asked them to help me stop me being a criminal person. 

I waited for my nextdoor man to come put days after day but he did not so I could talk to him civil ways  or none civil ways.

He just says he has rights to play music's even on Christmas days,new years eve new years days

I'm a social house tenant  I'm unemployed I have got physical disabilities had surgery operation for my leg .

Have contacted with Housing associations but received no help.i even attended their open days to raise my issues guess what they offered me a flat but where? Steveange!! Miles away from London 

All my life I lived in London dont know anyone from stevenage why should I relocate there?

Anyway Before I attended to that meeting at housing associations I had maybe 10 times meetings regarding the noises with Housing area manager.I invited him to my place he came around and he heard still nothing had been done.

I contacted with a local MP still nothing done.

A friend of mine who works for CAB citizen advise bureau he wrote them letters,Emails but no actions taken.

I'm not a psychopath with anger butcher people for nothing, so I taken calming tablets such as Amitriptyline and aroprazol with their help I sleep longer and keeps me calm...so why I'm telling you about all these.

You mentioned that why I did not do my research?

Well my mind was everywhere I cannot think healthy ways.even now days I got to watch my phones calendar to know what days I'm having .

Those medicines made me not to think healthy way. And stupidly I took the decision and go ahead with that Surgery operation. 

Ohhh by the way the nurse at the hospital whom told me that I have a cancer she also said IM your nurse from now on if you wish to contact with me here is my numbers  blah blah blah blah yes I contacted with her but couldn't reach her at all left messages many times than had recieved nothing heard nothing. 

My ex girlfriend to be B.....h is a civil servant so she destroyed my life .she was even on nextdoors side as well she was kinda defending them

Also she was keep saying ohhh you got to go ahead with surgery for me.for us blah blah.

Anyway ...she is history now

Hope you can understand my feelings mate.

But when this (NHS) people arranges pre operation MEETINGs 

I want to go and infrom about the untold stories to those people whom will be attending the meetings. 

I dont want them to be disappointed like me.

That's an interesting piece Barry.   My Gleason was 8 which puts me in high risk even though the other 2 measures are low risk.

I compared RP with RT on the ellipses.   RP looked worse but I'm not so sure it is when looking at the individual samples.    It looks like there are more RP specimens especially in the later years.  That might be because of the type of patient, the state of the technology, or that RP patients last longer and that might be because of age, etc.

Should we take the ellipses as a genuine summary or just a convenience?  It needs more looking at.  There is a button for looking at the study and I might get to that.  Good piece.

Regards
Peter

A brief update for you all - Decided to go for the surgery option. Being totally honest with you and myself I never really liked the idea radiotherapy, regardless of how simple! It was all made out to be. The whole concept it has never sat well with me and being an engineer by profession the thought of just getting rid of something that’s gone wrong as opposed to trying to mend it seems a much more sensible idea, rightly or wrongly. Given my age (51) and the total lack  of any previous problems with ED and my waterworks I’m hoping that with time and a bit of good luck things should go well.  I’m in a very fortunate position as I have private health cover through my wife’s work policy, so have been able to get things rolling very quickly. I have spoken to 2 surgeons about the operation, the first one in Manchester, got on very well with him and felt confident he and his team would do as good a job as they were able to , unfortunately he was unable to give me a definite date due the covid situation, he didn’t seem to think a short delay would impact the outcome but impatient me had already made his mind up so didn’t want to wait any longer than necessary. Info on here and some time on the net lead me to another in  Birmingham. I managed to get an appointment within the week and again I’m super impressed and super happy with the surgeon and clinic so far.  After looking at the scans and biopsy results he is confident he can spare both nerve bundles and has given me a high probability of being able to remove all of the tumour during the operation. I realise that surgeons are most definitely more Tigger than Eeyore but he’s done 3000 of them with a good degree of success, so I guess he knows what he’s talking about. The clinics before and aftercare also appears to be of a high standard and the operation will be at a Covid green/free hospital in Solihull so that’s hopefully one less thing to worry about. 

My first counselling session with a nurse specialist is in a couple of weeks, MDT review on the 9th , Pre op and covid swab the week after that then surgery on the 22nd of February, what a rollercoaster start of 2021 ! 

Edited by member 30 Jan 2021 at 20:47  | Reason: Spelling

The risk group classifications there rank T2c as high-risk: I've seen it ranked as intermediate risk (e.g. this 2015 paper), and was wondering what is it about the cancer being in both sides that makes it high-risk?

The Predict Prostate tool also groups it with all T2 stages.

I'm GG2 - Gleason 7 (3+4) in two cores, 3+3 in one - nothing on DRE, 6.7 PSA, ok PSA density and doubling rate, contained (N0, M0), asymptomatic...it's just the T2c that seems to be much less favourable risk.

Any update, Philip? Am a little behind you in the process, with a not too different diagnosis, and the same mental battles between the options. Curious to hear your post-op reflections if you are up to it...

- Chippers, 54, husband, dad, brother and normally Chief-fixer (but not this time).

co-founder of The stoPCock Club, www.stopcock.club

Edited by member 20 Jun 2022 at 14:25  | Reason: .

Update

Nerve sparing Open RP - 1/3/21 In Solihull 

TWOC - 8/3/21

Follow up review with surgeon - 21/3/21, Histology showed clear surgical margins. No evidence of spread outside of the prostate, so the early signs are promising.

12 week PSA test in a couple of weeks !

It’s just over 10 weeks since surgery, recovery going very well. The wound is healing nicely, easily able to walk about 2-3 miles a day after about 4 weeks, very tired at first but loads better now. Up to about 5-6 miles now in one go but not every day. Lots of weird aches and pains, and a couple of really painful areas (not all the time only when i bend down) a couple of inches either side of my big scar. No infection so I'm guessing it's just muscle/nerves repairing and will hopefully get better.

I was dry pretty much the day after the catheter came out. Had one little accident but that was 100% my fault as i was doing something i was warned not to do (bending, twisting and pushing all at the same time !!). Before the surgery I was way more concerned about the incontinence side of things , but thankfully that doesn’t seem to have caused me much of a problem. However (unsurprisingly I suppose) there is absolutely nothing there erection wise. Having never had a problem before the surgery I was stupidly expecting at least something fairly soon after surgery. But after trawling this site for info I now realise I have unfortunately, vastly underestimated the issue. This side of the recovery it is starting to get me down a bit but hopefully things will improve with time. I'm on 5mg Tadalafil daily and getting to grips with Somaerect vacuum device. After 3 weeks of steady use I'm back to almost full size so it does work, but its brutal and you certainly know you have done a work-out when you're finished, and there is no way one of those rings is going anywhere near it, the high tension ultra rings look like they would cut it clean off!!! Can't see me ever using it for anything other than the rehabilition side of things.

No stirrings from the Tadalafil so might try a Viagra as well to see if that has any impact.

So bloods in a couple of weeks and hopefully a good result so i can reduce my stress level a bit. I have blood cancer as well (under control and responding very well to some insanely expensive treatment) and the covid thing is a real risk for me so I'm fit to burst with stress at the moment, having one less thing to worry about can only be a good thing.

All the best

Finally :-

A message to all those 'younger men' with no previous ed issues reading this, who are currently doing what i did. The ED side effects are a real problem and WILL more than likely (unless you are very lucky) take many months to resolve themselves, maybe years. Do not underestimate it, like i did. Prepare yourself for the real possibility that he won't be working for a while. I didn't and I'm sure that's part of the reason i feel so down now.

16 months on from open RP - Still here, has it gone - more than likely, will it ever come back – who knows !

PSA at 3 months 0.014

PSA at 6 months 0.012

PSA at 12 months 0.013

So within the realms of testing tolerance still all ok – a ‘less than’ symbol in front would be even better but I’m kind of ok with it.

Waterworks wise I was continent almost the day after the catheter came out – the odd dribble here and there after I’ve been for a wee which can be annoying but not the end of the the world, but on a normal day to day basis I have full control.

Erection wise still nothing of any consequence to speak of – using the vacuum device 2/3 times a week and on 5mg of tadalafil daily – these tablets make a small improvement and when coupled with the infamous durex ring I can muster a rather un-impressive semi - but the tablets make my legs ache really badly so I do have breaks from them and when I don’t take them there’s nothing there at all.

Tried a full dose of tadalafil - no further improvement and a full dose of sidenafil made my head feel like it was going to explode so haven’t bothered again.

I frequently question my decision to go for the RP – as physiologically the loss of erections is massive for me at the moment – Its having a much bigger impact on me mentally than I ever thought it would - but at the time of having to make the choice I didn’t ever think it would be an issue for me as I was only 51, had never suffered with ED before at all plus the surgeons didn’t really see it as being that much of a problem - the emphasis was much more on the possible incontinence side effects.

Would Brachytherapy have been any different - I don’t know, and never will? Erection wise things would probably be better now but who knows what it would be like in the future? Plus could I cope with the knowledge that ‘it’ was still inside me – when the engineer in me knows the best thing to do with a bit that’s gone wrong is get rid of it as soon as possible. Again I don’t know.

So if your reading this thread looking for some guidance/advice, I think the only thing that I can say for sure is whichever way you go it’s going to be a lot tougher than you imagine and things are unlikely to ever be the same ever again.

As a side note – I’m kind of wishing the surgeons had been a little more realistic with me up front – not sure it would have changed my decision but it might have levelled my expectations of my ED recovery - if it’s really going to take 2 years plus to see any improvements , then just says so. All this 3 months then you should start to see something is in my mind (and lots of other people I have spoken to and read posts from) not really being honest – yes some lucky guys may see improvements early on but in my research the vast majority don’t.

Phil

Thanks for the update Phil. Those PSA results look very good. I had HDR brachy and HT. It has taken me a long while to get good erections avanafil works for me but I get heart burn, so I take an omazaprole (spelling?) as well. Trying to get the dose and the timing right is still a work in progress.

I always bias my posts away from surgery (I try and let people know I am biased though). My reason for the bias is to counteract the very strong pro surgery bias: from internal emotions, friends who know nothing (but have the same emotions) and surgeons who have personalities which cause over confidence in their own abilities.

Anyway, you are probably cured of cancer, you may find a way to get erections back even if it takes a lot of experimenting. Brachy may have gave you a worse experience. Keep posting.

Hi Phil, Nice honest update and hope your PSA stays low.  I am just 7 weeks post open RP which was non nerve sparing.  In my case I have no erections and they ain't coming back.  I agree with you about the ED.  The post surgery incontinence is frustrating (but mine is improving so not too concerned at this point), but ED at the age of 50 cuts deeper and is a bit depressing.

I am meeting my uro next week one of the main items to discuss is a prosthesis.  I know it is another operation but I can't see how injections and pumps are going to work long term.  Already my massively supportive wife is frustrated and I can't say I really blame her.

Take care 

Thank LynEyre

Good advice.  I have been using the pump twice a day for exercise purposes, just not for sex itself. I found then rings too painful and just not worth the effort. 

Will definitely try the injections if they are recommended (will try anything at least once!).  Was not sure if they work after non nerve sparing surgery so let's see what they say.