There are are a number of things to remember concerning the diagnosis and treatment of PCa. Scans have improved considerably over recent years and better guided biopsies can be done but notwithstanding this the full extent of PCa remains unknown until the surgeon gets to see during a Prostatectomy how far the cancer has extended. He/she may wish to remove nerve bundles on one or both sides and possibly some lymph nodes. Sometimes a surgeon will have the lab test a sample during the operation. Even then, when all appears to be well contained, there is a small risk that some cancer cells have have escaped. With RT, the Oncologist can only rely on scans and biopsy findings which leaves more room for doubt. However, RT can be used to treat areas further from the Prostate.
Sometimes, having considered a case, a Multi Disciplinary Team may not recommend any particular treatment but just tell a man the options that are open to him and let him decide which he wants to go with.. This is because it is considered that each one of the options could treat as well as another. What could determine which option the patient selects may come down to the way he regards potential side effects, potential because these can vary in range and intensity from one patient to another though more generally from one treatment to another. A man may decide he wishes to lessen the risk of incontinence for instance or there may be other reasons, wishing to be rid of a cancerous Prostate rather than have it subjected to radiation for example. Then radiation is often given if surgery does not remove all the cancer but Prostatectomy after RT is not something many surgeons will do as it makes what is already an intricate operation even more difficult. With focal therapy as a primary treatment, it might need to be supplemented by RT or surgery down the line. These are just some of the reasons why you should have an input in treatment choice. So let's assume you do find this top and impartial consultant well versed in Urology and Oncology; what are you going to say if he leaves the choice of treatment down to you just like the MDT might do?
In my opinion, it is worth considering all treatment options that may be open to you and having considered these, have surgery by a well experienced surgeon of high repute, or a hospital that is able to offer various forms of radiation using advanced equipment or focal therapy by a top oncologist, assuming you have these choices.
In summary, remember that with the tools available to him/her the consultant or MDT may be unable or unwilling to make a firm recommendation for one form of treatment over another as a case can be made for and against them all in general, but your situation may be different. Therefore, it would be helpful for you to consider the pros and cons of each form of treatment. There are not many places that do Proton Beam should you consider this and it is new to us in the UK. There are several centres in Germany that offer it but it seems to be less expensive in Prague. Prostatectomy using different methods and various forms of RT are generally available in major hospitals in Europe, with focal therapy to a lesser extent.
PS I think it may help you get a better grasp of PCa if you download the 'Tool kit' from this charity which provides impartial information about the disease and treatments.
Edited by member 24 Jul 2021 at 12:39
| Reason: for clarity