I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

<123

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

User
Posted 20 Jun 2022 at 16:28
Update

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

User
Posted 20 Jun 2022 at 17:03

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.

Dave

User
Posted 20 Jun 2022 at 18:02

Originally Posted by: Online Community Member
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.

 

Try levitra - the head ache / leg ache issue seems to be less and it is the tablet of choice in our house

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Jun 2022 at 21:17

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 

User
Posted 20 Jun 2022 at 23:10

Originally Posted by: Online Community Member
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.

 

Give them a chance first - if Caverject or Invicorp injections work for you, they are amazing! The pump is important to maintaining penile health in the short & medium term as the wait for a penile implant could be years. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Jun 2022 at 09:02

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.  

User
Posted 21 Jun 2022 at 14:15
The injections don't need nerves to be effective
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 27 Dec 2022 at 05:05

Thank you for the post. Can you tell me which surgeon you used?

User
Posted 28 Dec 2022 at 03:23

I love your posts Dave, they combine information with experience and humour but delivered with great humility. 

It's interesting because now that I have commenced hormone treatment, I thought why didn't I just cut it out. It has dawned on me that despite the commonly held view that "you don't die from you die with prostate cancer", many die with. I have faced up to my situation, which is that I am buying time, not a get out of jail card. Hopefully radiotherapy and HT will buy me a decade but having looked at the tumours size and anterior lesions of 1.8cm, although it is supposedly N0M0, I have no doubt that time shall prove otherwise.

Gabriel 

 

 

User
Posted 02 Jan 2023 at 17:48

Originally Posted by: Online Community Member

Thank you for the post. Can you tell me which surgeon you used?

 

Sent you a private message

User
Posted 18 Aug 2024 at 21:28

Hi Dave. I’ve been recently diagnosed. I’m 57. Same diagnosis almost identical to you. I’ve also chosen Hormone/BrachyBoost/Radio route because I too couldn’t understand surgery when that option was available to me. I’m reaching out as I can’t private message you yet as I’m new to forum 

User
Posted 18 Aug 2024 at 22:16

Hi JohnJig, I'm guessing, I'm the Dave you're reaching out to. Yes the private message feature isn't available until you have made about ten posts. 

A good place to start is to start a new thread, put in all the details of your diagnosis and your treatment choices. You can also put all of that on your profile so people can find it easily. On your thread ask any questions, that way all your questions and answers will be in one place.

If you click on my profile pick you will find a lot of details about me and my treatment. Six years post diagnosis things are going well.

Edited by member 18 Aug 2024 at 22:17  | Reason: Not specified

Dave

User
Posted 19 Aug 2024 at 10:37

I think that a wide range of factors influence men’s choices on this.

  1. Historically, prostatectomy achieved better cure rates than radiotherapy, although I believe that there is not much in it nowadays.
  2.  
  3. Radiotherapy was also associated with some nasty side effects especially because of the potential for damage through burns to nearby organs. Again, radiotherapy options have become more sophisticated and accurate so this is apparently less of a problem now. In fact, for many men, the side effects of radiotherapy may now generally be less severe than those associated with prostatectomy. ( This is a major factor underlying Dr Scholz’s clear preference for radiotherapy).
  4.  
  5. Radiotherapy has also been associated with a potential for long term damage, e.g. a small increased risk of other cancers.. The extra risk is probably small, but this can be an issue for some younger men.
  6.  
  7. Radiotherapy is also often accompanied by hormone therapy which is dreaded by many. I remember reading that this was a crucial factor in steering Stephen Fry towards prostatectomy.
  8.  
  9. There can also be a tendency for us to think along the lines that this is cancer and, as with any cancer,” I want it out as soon as possible.”
  10.  
  11. In some cases men may be put off by the thought of having to travel to hospital on a daily basis over a prolonged period – this was definitely a factor for me in the middle of the covid era.
  12.  
  13. Partly because of the above, the field has tended to be dominated by surgeons and they are naturally inclined to favour their own field, even at the expense of maybe sometimes being over-optimistic. More generally, there is a danger that we can be swayed by the persuasiveness of the experts that we talk to and so we may be subject to their biases.
  14.  
  15. There are probably various other factors which come into play and each of us ultimately have to make our own judgement of the various trade-offs involved. That is if we have a choice which is not always the case. For example, prostatectomy has not always been offered to older men or those who have other health issues, or sometimes to those with locally advanced cancer.

Edited by member 19 Aug 2024 at 10:38  | Reason: Not specified

 
Forum Jump  
<123
©2025 Prostate Cancer UK