Treatment options dilemma

Hi Tony,

I was diagnosed at 70 with PSA 2.19 Gleason 3+4=7 and 5 out of 20 cores positive.I had choice of Robotic surgery or Brachytherapy and went for brachytherapy as i felt the side affects sounded better and less intrusive and i had never had any big operations.

Four years on i am doing well with PSA at 0.08 and have been signed off by my specialist .If you click on my Avatar you can see my journey so far.

I am happy to answer any questions but i don't think i should advise you to go one way or the other as i think it is a  personal choice  and  you have 50/50 chance with no Guarantees.

  Good luck John.

Hi Tony,

It could be that your Gleason was 4+3=7  and mine was 3+4=7 so more level 4 positive cores than the 3.

The first specialist i spoke to in the Lister hospital offered me Robotic removal and started to go through it with me expecting me to accept it there and then but i asked if i could see the Brachytherapy specialist that was at the hospital at the same time so he agreed and said come back to see him afterwards.

The Brachytherapy specialist looked at my notes and said there was no reason in his view why Brachytherapy could not do the job but i would have travel to his hospital at The Mount Vernon Hospital.

John.

I was 68 last year when I had my RARP. I didn't really have a choice, due to having colitis (albeit mild), but probably would have chosen surgery anyway. But then I'd already had two surgical operations in the last few years while my wife had RT for cancer some years ago which hadn't gone well.

Basically things are fine except for the ED, as it could only be nerve-sparing one side. The positive of RP is that it's all over and done with quite quickly.

One thing I would say - I wouldn't go for surgery unless you're reasonably fit, e.g. you're not obese and you don't smoke. But I'm guessing that if they're offering you surgery at 70 then that's not an issue.

Your first radical treatment is the most important one (hopefully your only one), so it makes sense to fully consider your preferences, of course being mindul of what your consultant's say about your suitability.

According to this article on the US NIH website, around 60% of men who have an RP experience a biochemical relapse and require follow-up treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860423/

Edited by member 15 Feb 2021 at 20:12  | Reason: Not specified

Apparently, 1 in 3 men in Scotland have a recurrence

https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/prostate-cancer#treating-prostate-cancer 

Hi Tony

I was faced with the same dilemma in November, being offered (non-nerve sparing) surgery or hormone and radiotherapy.  I spent days reading up on both options, doing research, asking questions and speaking to people who had undergone wither pathway, including hers on the PCUK Forum.

I found it was important to speak to each specialist oncologist as they gave additional information I did not get at the initial diagnosis.  For surgery, I was told there was a 50% chance I would have to go on and have radiotherapy as there was the likelihood of the prostate bed still being infected after surgery.

You also need to take care who you speak to about the side effects of hormone and radiotherapy as the treatments have improved considerably in the last 2-3 years and, generally, people experience less side effects than those undergoing treatment earlier than this.

I concluded that the side effects from a prostatetectomy were highly likely and pretty permanent; I did not like the idea of wearing pads or convenes as this does not suit my naturist lifestyle.  OTOH the side effects from hormone and radiotherapy are more or less likely depending on the individual and tend to be temporary.  So I opted to take my chances and fingers crossed the side effects will not impact on my life to any great extent.

Three months in after starting on Bicalutamide (for 4 weeks) and Decapeptyl the only side effects (so far) are overheating (3-5 times at night and 1-3 times during the day), dry mouth and muscle ache in left or right arm., all now daily occurances.    I can put up with these but may ask GP if there is any medication that can reduce/address the overheating and muscle ache.

Start radiotherapy at the end of March so will know what side effects decide to kick in then.

Good luck with your decision.

John

Hello there. 

My story 

Diagnosed Oct 19.  64 yes old fit active,no symptoms Psa 6.1. Gleeson 7

I opted for surgery.  Never had surgery, been in hospital, had anaesthetic before.

Due to covid didnt get my surgery till 29 July 20.

No after effects post surgery. Walking with catheter after 3 days. No pain ,issues with catheter. 

Walking further 3-4 km after 3 weeks,  running, jogging 3km after 6 weeks.  Back to work late oct 20.

No issues since. Minimal use of pads for incontinence after 4 weeks.  Hardly any dribble nowadays. 

I was more concerned of going into hospital with covid around and having anaesthetic than the surgery. I need not have worried.

Difficult decisions, but I dont regret having surgery. 

What I would say is get yourself fit for surgery, physical and mental.  Do the exercises and every day, they really do make a difference 

Take care 

Tony ,telford