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Gleason 4+3, considering robot surgery, how to find best surgeons in EU?

User
Posted 03 Jul 2021 at 14:47

Male, 58, Gleason 4+3=7.

Considering treatments including Da Vinci robot.

I'm from EU, my country has no Da Vinci robot and no robot surgeons.

How should one go around finding best robot surgeons in EU? Is there a registrar, a list?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 03 Jul 2021 at 21:00
https://www.santishealth.org/
User
Posted 03 Jul 2021 at 22:16
Agreed Santishealth.org at London Bridge Hospital or the Royal Marsden. Both the Prof and his partner ( who did me this week) . High volume surgeons . DM me if you want a name and contact details. Jeremy
User
Posted 03 Jul 2021 at 23:30

Correction,  I was operated on this week by the Head of Urology Unit at the Royal Marsden. Google that and you will find him. He is absolutely excellent and a high volume surgeon with great results. He also has his own website once you've found his name. Check out my thread on my journey as Im only a little further ahead than you. Also check out TechGuy and his thread. I found that very useful. Good luck

User
Posted 04 Jul 2021 at 00:41

For good surgeons and frontline practice in the EU you will do well to look to Prague and  a number of German centres. 

Also keep in mind that men who had good outcomes will cheerfully recommend their surgeon but you may not have the same outcome. There are members here who feel their life has been ruined by or had dreadful aftercare from a surgeon that others think is wonderful. And some surgeons have big marketing budgets.

Bollinge has apparently got rid of the cancer but posts regularly about his shrunken penis and total erectile dysfunction. Jeremys doesn't know yet how his recovery will be or whether the cancer has been removed successfully. Techguy has had a good result all round. My husband went with one of the top surgeons at the time but the cancer still came back. 

The rule of this forum is not to name medics or hospitals - posting links to or flagging their private company is no different to naming them directly.

Edited by member 04 Jul 2021 at 00:51  | Reason: Not specified

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

User
Posted 04 Jul 2021 at 05:32
I asked my surgeon, Professor Whocannotbenamedhere, where he would go if he needed a prostatectomy, and quick as a flash he said: “Heidelberg, Germany”.

Apparently there is a klinik there which is a centre of excellence in this field.

Cheers, John.

User
Posted 04 Jul 2021 at 13:50

The prof whocannotbenamedonhere was epic with me. My cancer was very close to breaching the capsule so timing was critical in my case….pleased I didn’t wait. London Bridge Hospital was very good and gave great support plus superb team who followed up with me during the 2 weeks until my catheter was removed. 

Also important  to consider how private and NHS/public_health_system co-exist. I have a fantastic and fully supportive GP. Following treatment had there been an issue with my catheter that required urgent care then the best advice is to check into your local A&E. I guess kinda makes sense as I wouldn’t be up for jumping on a train into London with a potentially urgent medical issue. Routine PSA’s are also carried out by my GP practice which works really well.

As with any cancer there is always a chance it will return and current research is revealing increasing evidence that metastasis can occur much earlier than first assumed. In effect seeding at distant location(s) but remaining dormant for an unspecified time. 

This is worth a read: https://www.the-scientist.com/features/new-understanding-of-metastasis-could-lead-to-better-treatments-68572

Edited by member 04 Jul 2021 at 22:13  | Reason: Not specified

User
Posted 04 Jul 2021 at 21:21

He lives in Estonia Techguy, he isn't going to have access to our NHS

Edited by member 04 Jul 2021 at 21:22  | Reason: Not specified

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

User
Posted 04 Jul 2021 at 23:51
If Interested in Results is searching for best surgeon in Europe, presumably he has the means to pay regardless of country. There may be a problem in travelling to some countries at present due to Corvid restrictions. I would have thought a highly regarded surgeon (using da Vinci robot if that's method wanted, although it's not always best) would do what's required. How on earth can one surgeon be the best when there are excellent ones in most European Countries doing Prostatectomy? How could the best be determined?
Barry
User
Posted 05 Jul 2021 at 13:15

I am 56 and  thanks to Techguy and others on this group had a Retzius-sparing and bladder neck sparing robotic radical prostatectomy with consultant PS who is partner of Prof whocannotbenamedonhere in London March 2020. My Gleason score was 3+4=7 and stage pT3a. Very pleased with results and had 'undetectable' psa results since. All the very best with your search and good luck. 

User
Posted 05 Jul 2021 at 13:38

Originally Posted by: Online Community Member

The rule of this forum is not to name medics or hospitals - posting links to or flagging their private company is no different to naming them directly.

Online Community Member wrote:

You agree that you will not post any material that names individual healthcare professionals, and you will not name individual hospitals and medical practices when making negative comments . Please use descriptive terms like “my doctor”, “my specialist”, and “my nurse” rather than specific names.



Pretty sure positive recommendations for hospitals/clinics (but not individual surgeons) are allowed according to https://prostatecanceruk.org/get-support/using-the-online-community/terms-and-conditions

 

Edited by member 05 Jul 2021 at 13:38  | Reason: to enable the hyper-link

_____

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

Prost was the strongest, so Prost ate Ectomy.

User
Posted 07 Jul 2021 at 06:49

To answer the question, Surgeons will want to do surgery. There can be a tendency for this, but sometimes both surgeon and oncologist advise the same treatment. You will want to see both a good surgeon and a good oncologist and see what they say.

There is also Brachytherapy (I don't think HIFU sounds suitable, but am ready to be corrected by those who know more). In all cases the outcomes are similar, but the side effects are different. Also, with regard to surgery there is the question about whether you can have nerve-sparing.

Finally, there is the question of your general health. Are you overweight; do you smoke? If so, that could mean surgery is more dangerous for you. Do you have other conditions? They may preclude one treatment or another.

You really need a full consultation with the experts who would perform the procedures.

User
Posted 28 Jul 2021 at 22:28

EBRT is still focused on the prostate. I know it will hit some cells on the way in and out, but you probably need to research whole pelvis RT. If you want to get lymph nodes outside prostate. Of  ourse if you go for whole pelvis many more organs will suffer collateral damage. 

Dave

User
Posted 28 Jul 2021 at 22:56

Yes modern EBRT can be focused very much on the area of interest. But there are lymph nodes all over your pelvis and any of them may have cancer so the area of interest is the whole pelvis. If they try and focus away from the rectum they will miss lymph nodes near the rectum. So if you want to RT all lymph nodes in the pelvis you need to irradiated the whole pelvis.

It takes about 15 minutes to deliver the targeted RT. If you were absolutely certain you knew where each node was, and there are probably about 100, you would be on the treatment table for 25 hours per day. Quite literally there aren't enough hours in the day for that level of treatment.

Targeting every small lymph node individually would be impossible. They are too small and unless you know the position exactly you would keep missing them and just hit healthy tissue.

Dave

User
Posted 28 Jul 2021 at 23:25

Its a very difficult decision and there isnt really any correct answer. I think you have to go with your gut in the end. My stats were not that different to yours. 57M multifocal Gleason 3+4 T2bN0M0 and I chose surgery because all the experts said that was the right decision for me. My high volume surgeon (180 plus a year RP’s) and my Oncologist both said my chances of a recurrence ( pre surgery) were 17% -20% and post the histology report ( which showed negative margins ) was only 7%. I was prepared to accept those odds but I have no idea whether these figures are relevant or accurate and Im still only 4 weeks post op so am waiting for the 8 week PSA test to confirm if I am clear or not. As for the side effects of surgery so far Ive been one of the very lucky ones with only a few dribbles and Im having erections and orgasms almost the same as before. So i dont regret surgery but accept that there is a risk ( 7% apparently if you believe the surgeon) i will need salvage RT. I could not face weeks of hormone or RT treatment when it seemed there was a good chance of curing it once and for all albeit with surgery and what was an uncomfortable 2 weeks. Good luck with your decision and the important thing is to feel confident you are making the right decision for you. 

User
Posted 29 Jul 2021 at 00:35

Originally Posted by: Online Community Member
 

I read that modern RT can be adjusted for it to avoid organs and focus only on the are necessary.

I must admit I know too little of this, of course I will rather trust the doctors.

Trying to understand if its better to go with Cyberknife or the Brachy+EBRT treatment.

The bowel (and possibly the bladder) will still get some radiation with brachy and/or EBRT - that's why some men get side effects like urge incontinence, constipation and / or fecal incontinence. You might find a surgeon who will implant SpaceOar to reduce the impact on the bowel but then some of the prostate and certainly some lymph nodes may not get sufficient RT dose. 

Cyberknife doesn't treat the whole prostate, just the most significant area of tumour, so the treatment may need to be repeated. 

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

Show Most Thanked Posts
User
Posted 03 Jul 2021 at 21:00
https://www.santishealth.org/
User
Posted 03 Jul 2021 at 22:16
Agreed Santishealth.org at London Bridge Hospital or the Royal Marsden. Both the Prof and his partner ( who did me this week) . High volume surgeons . DM me if you want a name and contact details. Jeremy
User
Posted 03 Jul 2021 at 23:30

Correction,  I was operated on this week by the Head of Urology Unit at the Royal Marsden. Google that and you will find him. He is absolutely excellent and a high volume surgeon with great results. He also has his own website once you've found his name. Check out my thread on my journey as Im only a little further ahead than you. Also check out TechGuy and his thread. I found that very useful. Good luck

User
Posted 04 Jul 2021 at 00:41

For good surgeons and frontline practice in the EU you will do well to look to Prague and  a number of German centres. 

Also keep in mind that men who had good outcomes will cheerfully recommend their surgeon but you may not have the same outcome. There are members here who feel their life has been ruined by or had dreadful aftercare from a surgeon that others think is wonderful. And some surgeons have big marketing budgets.

Bollinge has apparently got rid of the cancer but posts regularly about his shrunken penis and total erectile dysfunction. Jeremys doesn't know yet how his recovery will be or whether the cancer has been removed successfully. Techguy has had a good result all round. My husband went with one of the top surgeons at the time but the cancer still came back. 

The rule of this forum is not to name medics or hospitals - posting links to or flagging their private company is no different to naming them directly.

Edited by member 04 Jul 2021 at 00:51  | Reason: Not specified

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

User
Posted 04 Jul 2021 at 05:32
I asked my surgeon, Professor Whocannotbenamedhere, where he would go if he needed a prostatectomy, and quick as a flash he said: “Heidelberg, Germany”.

Apparently there is a klinik there which is a centre of excellence in this field.

Cheers, John.

User
Posted 04 Jul 2021 at 13:50

The prof whocannotbenamedonhere was epic with me. My cancer was very close to breaching the capsule so timing was critical in my case….pleased I didn’t wait. London Bridge Hospital was very good and gave great support plus superb team who followed up with me during the 2 weeks until my catheter was removed. 

Also important  to consider how private and NHS/public_health_system co-exist. I have a fantastic and fully supportive GP. Following treatment had there been an issue with my catheter that required urgent care then the best advice is to check into your local A&E. I guess kinda makes sense as I wouldn’t be up for jumping on a train into London with a potentially urgent medical issue. Routine PSA’s are also carried out by my GP practice which works really well.

As with any cancer there is always a chance it will return and current research is revealing increasing evidence that metastasis can occur much earlier than first assumed. In effect seeding at distant location(s) but remaining dormant for an unspecified time. 

This is worth a read: https://www.the-scientist.com/features/new-understanding-of-metastasis-could-lead-to-better-treatments-68572

Edited by member 04 Jul 2021 at 22:13  | Reason: Not specified

User
Posted 04 Jul 2021 at 21:21

He lives in Estonia Techguy, he isn't going to have access to our NHS

Edited by member 04 Jul 2021 at 21:22  | Reason: Not specified

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

User
Posted 04 Jul 2021 at 23:51
If Interested in Results is searching for best surgeon in Europe, presumably he has the means to pay regardless of country. There may be a problem in travelling to some countries at present due to Corvid restrictions. I would have thought a highly regarded surgeon (using da Vinci robot if that's method wanted, although it's not always best) would do what's required. How on earth can one surgeon be the best when there are excellent ones in most European Countries doing Prostatectomy? How could the best be determined?
Barry
User
Posted 05 Jul 2021 at 13:15

I am 56 and  thanks to Techguy and others on this group had a Retzius-sparing and bladder neck sparing robotic radical prostatectomy with consultant PS who is partner of Prof whocannotbenamedonhere in London March 2020. My Gleason score was 3+4=7 and stage pT3a. Very pleased with results and had 'undetectable' psa results since. All the very best with your search and good luck. 

User
Posted 05 Jul 2021 at 13:38

Originally Posted by: Online Community Member

The rule of this forum is not to name medics or hospitals - posting links to or flagging their private company is no different to naming them directly.

Online Community Member wrote:

You agree that you will not post any material that names individual healthcare professionals, and you will not name individual hospitals and medical practices when making negative comments . Please use descriptive terms like “my doctor”, “my specialist”, and “my nurse” rather than specific names.



Pretty sure positive recommendations for hospitals/clinics (but not individual surgeons) are allowed according to https://prostatecanceruk.org/get-support/using-the-online-community/terms-and-conditions

 

Edited by member 05 Jul 2021 at 13:38  | Reason: to enable the hyper-link

_____

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

Prost was the strongest, so Prost ate Ectomy.

User
Posted 06 Jul 2021 at 15:05

Thank you so much for all the replies guys!


I'm sorry for making two threads, I'm overwhelmed by all this.

Originally Posted by: Online Community Member

He lives in Estonia Techguy, he isn't going to have access to our NHS

So that means I won't be able to have surgery in UK?

I'm ok with any EU country as long as the docs and hospital is really good.

One thing:
I don't know if surgery is best option.

 

All surgeons will want to do surgery (mostly). But what if there are other better options for my case?

 

What do you think?

Here is my info:

PSA is 7.

Biopsy results 2021:
One in 12 cores is with Gleason 4+3, two cores Gleason 3+4, three cores Gleason 3+3.

Year ago biopsy: the six cores were Gleason 3+3. So there is progression.

 

Do you think surgery is best route or radiation therapy or proton beam or seed implant or hormone therapy or combination or something else?

 

Where can I get option from a highly regarded oncologist who is neutral and has no interest in pushing any particular treatment? Sort of like a third party evaluation.


My idea is to consult a few world class oncologists in terms of treatment options and see which treatment is most recommended, then focus on finding best doctor for that treatment in EU, then proceed with the treatment.

 

What do you think of this strategy and what would you recommend me to do next?

i'm sorry for communication errors

 

Finally: What are your thoughts on fasting/starving method while maintaining enough nutriment input to function? Basically starving cancer of food. Anecdotal experiments of some people have shown it to work, but they went super extreme with the starving. 

And any advice in general in terms of diet would be great.

Thank you so much once more.

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 06 Jul 2021 at 15:22

That’s cool

if you are not UK citizen then I suspect you would have to pay for private treatment. As Bollinge suggested I’d be tempted to check out the Heidelberg clinic in Germany as maybe closer as has a good reputation. In England some of the leading urological surgeons are the Prof Whocannotbenamedonhere or or maybe check the team out at UCLH Hospital where there are very good leading skills for all sorts of prostate treatments. Royal Marsden is another top cancer hospital worth noting. Although I suspect there must be other options closer to you.

In terms of starvation diet from what I gather these don’t really work as cancer cells are just regular cells that have mutated and start growing out of control. However, a low saturated fat and low dairy diet can be beneficial including fresh vegetables plus of course moderate exercise. It won’t cure the cancer but will ensure you are fit and healthy for any treatment. 

I tend to avoid red meat and dairy these days apart from when out on socials. There have been formal/informal studies as you mentioned showing benefits in terms of cancer but the goal posts and recommendations are constantly changing. On the flip side eating healthy will hopefully have other positive benefits.

Edited by member 06 Jul 2021 at 15:26  | Reason: Not specified

User
Posted 06 Jul 2021 at 15:27

Your case And age is pretty similar to mine. I had all the same questions. In fact in my case (multifocal T2bN0M0), three top specialists ( My consultant urologist, my surgeon and my oncologist both from Royal Marsden) all recommended surgery which made my decision easier. Its too early to tell if it was the right decision but I am happy with it so far and recovering well from surgery last week.  I suggest you contact The Royal Marsden and seek appointments with their leading prostate surgeons and  their radiologists - sadly we cant name names here

as for water fasting to starve the cancer I have done this several times myself  - the longest was 12 days- but it did not seem to make any difference and my PSA continued to rise.

User
Posted 06 Jul 2021 at 16:31

Like you I researched all the treatment options available and one of the useful things for me was contacting the online nurses on this website who emailed me lots of updated useful information for me to consider. In terms of diet/health there are loads of different opinions online regarding this, however I try to maintain a healthy weight,  physical activity, not smoking, and eat high consumption of tomatoes, fatty fish, and fresh veg. I have reduced my intake of processed meat, dairy products and sugar. This works for me. 

User
Posted 06 Jul 2021 at 17:35

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

The rule of this forum is not to name medics or hospitals - posting links to or flagging their private company is no different to naming them directly.

Online Community Member wrote:

You agree that you will not post any material that names individual healthcare professionals, and you will not name individual hospitals and medical practices when making negative comments . Please use descriptive terms like “my doctor”, “my specialist”, and “my nurse” rather than specific names.

That's interesting - that has been changed / updated since I last looked. Thanks. 

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

User
Posted 07 Jul 2021 at 06:49

To answer the question, Surgeons will want to do surgery. There can be a tendency for this, but sometimes both surgeon and oncologist advise the same treatment. You will want to see both a good surgeon and a good oncologist and see what they say.

There is also Brachytherapy (I don't think HIFU sounds suitable, but am ready to be corrected by those who know more). In all cases the outcomes are similar, but the side effects are different. Also, with regard to surgery there is the question about whether you can have nerve-sparing.

Finally, there is the question of your general health. Are you overweight; do you smoke? If so, that could mean surgery is more dangerous for you. Do you have other conditions? They may preclude one treatment or another.

You really need a full consultation with the experts who would perform the procedures.

User
Posted 07 Jul 2021 at 08:39

Originally Posted by: Online Community Member

To answer the question, Surgeons will want to do surgery. There can be a tendency for this, but sometimes both surgeon and oncologist advise the same treatment. You will want to see both a good surgeon and a good oncologist and see what they say.

Yep. In my case, the oncologist started the appointment with...

"Before I start, I have to say that in your case because of your age and fitness, surgery is almost certainly a better option for you." (Honest salesman). 😀

_____

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

Prost was the strongest, so Prost ate Ectomy.

User
Posted 07 Jul 2021 at 18:58

Hi,

I was keen on Robot surgery but in 2016 the hospital I was referred to didn't have one and suggested another hospital 25 miles away.  That also meant waiting for another assessment so I went with the laparoscopic keyhole surgeon.  I'm not sure there is a lot of evidence robot is so much better.  The surgeon I used has a good record.

In the UK there is a website called BAUS (British Association of Urological Surgeons) that contains their records.  In the UK most surgeons do private treatment and public treatment.  Checking a group such as Spire or BUPA will list the same surgeons as operate in the NHS and often give you a short write up of the surgeon.

As others have said Germany seems a popular destination but there are options on the internet in the UK.

All the best, Peter

 

 

 

User
Posted 28 Jul 2021 at 21:28

After researching statistics it seems that brachytherapy combined with EBRT (external beam) has way better recurrence results (less recurrence) than surgery alone.


This is the reason why I'm heavy leaning either to Bracy+EBRT or Cyberknife(SBRT).

 

Any idea why I might be making a mistake?


The logic is: according to nonograms, high risk of lymph node mets after surgery. Which will require radiation anyway, also heavier side effects from surgery, also more invasive. If radiation might be required after surgery, not not start with radiation from get go? 

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 28 Jul 2021 at 22:28

EBRT is still focused on the prostate. I know it will hit some cells on the way in and out, but you probably need to research whole pelvis RT. If you want to get lymph nodes outside prostate. Of  ourse if you go for whole pelvis many more organs will suffer collateral damage. 

Dave

User
Posted 28 Jul 2021 at 22:32

Originally Posted by: Online Community Member

EBRT is still focused on the prostate. I know it will hit some cells on the way in and out, but you probably need to research whole pelvis RT. If you want to get lymph nodes outside prostate. Of  ourse if you go for whole pelvis many more organs will suffer collateral damage. 

I read that modern RT can be adjusted for it to avoid organs and focus only on the are necessary.

I must admit I know too little of this, of course I will rather trust the doctors.

Trying to understand if its better to go with Cyberknife or the Brachy+EBRT treatment.

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 28 Jul 2021 at 22:56

Yes modern EBRT can be focused very much on the area of interest. But there are lymph nodes all over your pelvis and any of them may have cancer so the area of interest is the whole pelvis. If they try and focus away from the rectum they will miss lymph nodes near the rectum. So if you want to RT all lymph nodes in the pelvis you need to irradiated the whole pelvis.

It takes about 15 minutes to deliver the targeted RT. If you were absolutely certain you knew where each node was, and there are probably about 100, you would be on the treatment table for 25 hours per day. Quite literally there aren't enough hours in the day for that level of treatment.

Targeting every small lymph node individually would be impossible. They are too small and unless you know the position exactly you would keep missing them and just hit healthy tissue.

Dave

User
Posted 28 Jul 2021 at 23:25

Its a very difficult decision and there isnt really any correct answer. I think you have to go with your gut in the end. My stats were not that different to yours. 57M multifocal Gleason 3+4 T2bN0M0 and I chose surgery because all the experts said that was the right decision for me. My high volume surgeon (180 plus a year RP’s) and my Oncologist both said my chances of a recurrence ( pre surgery) were 17% -20% and post the histology report ( which showed negative margins ) was only 7%. I was prepared to accept those odds but I have no idea whether these figures are relevant or accurate and Im still only 4 weeks post op so am waiting for the 8 week PSA test to confirm if I am clear or not. As for the side effects of surgery so far Ive been one of the very lucky ones with only a few dribbles and Im having erections and orgasms almost the same as before. So i dont regret surgery but accept that there is a risk ( 7% apparently if you believe the surgeon) i will need salvage RT. I could not face weeks of hormone or RT treatment when it seemed there was a good chance of curing it once and for all albeit with surgery and what was an uncomfortable 2 weeks. Good luck with your decision and the important thing is to feel confident you are making the right decision for you. 

User
Posted 29 Jul 2021 at 00:35

Originally Posted by: Online Community Member
 

I read that modern RT can be adjusted for it to avoid organs and focus only on the are necessary.

I must admit I know too little of this, of course I will rather trust the doctors.

Trying to understand if its better to go with Cyberknife or the Brachy+EBRT treatment.

The bowel (and possibly the bladder) will still get some radiation with brachy and/or EBRT - that's why some men get side effects like urge incontinence, constipation and / or fecal incontinence. You might find a surgeon who will implant SpaceOar to reduce the impact on the bowel but then some of the prostate and certainly some lymph nodes may not get sufficient RT dose. 

Cyberknife doesn't treat the whole prostate, just the most significant area of tumour, so the treatment may need to be repeated. 

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

User
Posted 29 Jul 2021 at 07:05

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
 

I read that modern RT can be adjusted for it to avoid organs and focus only on the are necessary.

I must admit I know too little of this, of course I will rather trust the doctors.

Trying to understand if its better to go with Cyberknife or the Brachy+EBRT treatment.

The bowel (and possibly the bladder) will still get some radiation with brachy and/or EBRT - that's why some men get side effects like urge incontinence, constipation and / or fecal incontinence. You might find a surgeon who will implant SpaceOar to reduce the impact on the bowel but then some of the prostate and certainly some lymph nodes may not get sufficient RT dose. 

Cyberknife doesn't treat the whole prostate, just the most significant area of tumour, so the treatment may need to be repeated. 

That is one concern with my Brachy doc and Cyberknife doc, none of them use SpaceOAR. 

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 02 Sep 2021 at 19:52

I’ve read your post with interest. My husband was Gleason 7 in July opted for robotic prostate removal . Operated on in July . Today follow up histology showed high grade lurking in there so glad we opted for surgery . 

User
Posted 03 Sep 2021 at 14:38

I went to Leipzig, Germany after the Professor there was recommended by my NHS surgeon

he has done 10,000 nerve sparing prostatectomies in his career so far

User
Posted 04 Sep 2021 at 07:19
Haven’t you found a great surgeon yet?

If not it won’t be for the want of trying!

Good luck.

Cheers, John.

 
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