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

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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

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 in 2021. PSA rising after surgery. What to do next?

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

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.

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 in 2021. PSA rising after surgery. What to do next?

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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