It doesn't really matter which research you look at - they all find more or less the same thing. The largest scale research is the EU one from 2019 which showed, as all the others do, that if you have a G6 T1 or T2a / b adenocarcinoma, the outcomes will be the same whether you go for surgery, EBRT or brachy. The outcomes are measured in terms of:
- % likelihood of recurrence at 5 year point
- % likelihood of remission (no evidence of disease) at 10 year point
- % chance of still being here in 10 years
The difference tends to be in side effects so the challenge is in working out a) which treatment gives you the best chance of achieving remission b) whether you can live with the potential and known risks of that treatment and c) if you can't, working out which treatment side effects you can live with that still give you a decent chance of remission.
Known side effects of prostate cancer treatment:
- dry orgasm - all treatments
- infertility - all treatments
- penile shrinkage - very common whichever treatment
- ED - very common whichever treatment - generally with surgery it gets better over time, generally with RT / brachy it starts off fine but gets worse over future years
- incontinence - more likely with surgery than any other treatment - for most men, it improves over time
- bowel damage - more likely with RT than surgery - usually a problem towards the end of the RT treatment & then improves over time.
The side effects of HT are a different kettle of fish but in France, I understand that it is less common for men to be put on HT automatically. You would perhaps want to clarify that with your oncologist.
The NHS says that 90% of men can get an erection 12 months after RP but this may be natural or by using mechanical aids or medication / injections. They don't gather data on whether the erection is sufficiently firm for penetration. The NHS also says that at least 90% of men are using one continence pad per day or less; those who are left with serious incontinence at 12 months will probably have permanent damage. There is no reliable correlation between the age of the patient and the likelihood of permanent ED or incontinence - it is rather more down to luck on the day.
Some men go for focal treatments fully aware that they may not achieve remission and the treatment may need to be repeated in the future (or other treatments might have to be tried) because the risk of unacceptable side effects is lower. That's fine for realistic men and those who can afford to pay for a repeat treatment (where applicable) but for any man to go into focal treatment with unrealistic expectations, the emotional impact of the treatment failing can be significant. Focal options include cryotherapy, focal laser treatment, HIFU, proton beam therapy. We have a member who flew to the USA for FLA because it wasn't available in the UK - he has since had salvage treatment in the UK. We also have members who have travelled to Prague for focal treatments. The important thing is to understand that focal treatments are not as successful and there are still potential side effects, just not as many as with the radical treatments.