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RALP, am I doing the right thing?

User
Posted 29 Jan 2021 at 17:29

When I was diagnosed a few months ago with 4+3 intermediate cancer I was told the best options were RALP or possibly HIFU. After reading the HIFU I was pretty much sold, less complex, potentially less side effects etc.. But I then saw a few posts on here and other groups about people facing recurrence 3 to 5 years later and needing more HIFU, radiation or prostate removal. I thought about that and it felt like RALP was the best solution to give me a long term cure...


My partner threw a spanner in the works today saying are you sure HIFU isn't a better solution as your young and still have an active sex life. My logical side of the brain says yes RALP is right, I've a 10mm tumour and a smallish prostate so it's not a lot to work with when HIFU needs to remove healthy tissue around the tumour, surely it's easier to miss some cancerous cells that way?


My emotional side says yes HIFU might allow you to keep erectile function and not need 3-4 hours of general surgery which with my heart condition is an added risk...


Now I'm in a bit of a state as this is all happening very quickly all of a sudden, I know there's no magic wand or standard approach but now I'm questioning whether RALP is using a sledgehammer to crack a nut.

User
Posted 29 Jan 2021 at 21:46

Truthfully, when it comes down to it, only you can answer that, and you never really know whether you rolled the dice and won until the end (when it's too late to change course, but hopefully a long way in the future).


All treatments carry risks. The only thing you can do is weigh them all up and decide which potential side-effects seem the least unbearable to you (and then hope you don't get them).


Then decide. And then stick to your guns and don't look back.


Everyone has a different story and different set of circumstances. Whilst it's useful to hear other people's stories, none will be an exact match to your life.


Surgery seems to have worked for me in that it hasn't stopped me from doing anything I want to do. But, we're not there yet. It is possible I could have a recurrence (was told 10-15% chance), so it's too early to know for sure if I won my 'bet' on surgery.


I wasn't offered anything other than HT/RT or Robotic Surgery. I found the idea of hormone therapy and 28 visits to hospital during the beginning of the COVID pandemic very unappealing.


The 40% chance of erectile failure was unappealing, but less unappealing than dying. Same for the small chance of permanent urinary incontinence. I didn't really like the idea of the small possibility of death or blindness from the anaesthetic, but it was time to roll the dice.


First thing I thought when I woke up in recovery and opened my eyes was. "Yay I can see."


What are your most important things to consider?

_____


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


Prost was the strongest, so Prost ate Ectomy.

User
Posted 29 Jan 2021 at 21:50

I wonder how good the follow up is after hifu? I like the idea of a minimally invasive treatment, and I wouldn't mind if it had to be repeated every 5 years; just as long as you didn't go for a five year treatment and get told "sorry its now locally advanced". 

Dave

User
Posted 30 Jan 2021 at 13:32

Originally Posted by: Online Community Member


I wonder how good the follow up is after hifu? I like the idea of a minimally invasive treatment, and I wouldn't mind if it had to be repeated every 5 years; just as long as you didn't go for a five year treatment and get told "sorry its now locally advanced". 



I would check out how you would be monitored post HIFU.  I had HIFU within the NHS in 2015 as a salvage treatment for failed RT.  I have been monitored by PSA and then in 2020 by MRI and biopsy.  I have been booked in for an MRI next month and a decision will be taken on whether to repeat HIFU.  Last time this was followed by a Transperineal Biopsy and I hope this is not necessary this time.  Particularly as the Prostate ages, there can be increasing calcification which makes HIFU more difficult, as can increased scar tissue from previous treatment.  I have managed without HT since 2008 and will try to avoid having it still preferring another HIFU procedure if this is an option and needed.

Barry
 
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