Localised gleason 8: prostatectomy or radiotherapy?

User

Posted 24 Nov 2021 at 22:32

Hello folks,

I've been diagnosed with high risk (gleason 8) prostate cancer in september 2021. It's localized without any metastasis in lymphe nodes or bones or organs. I get to choose between 2 options: prostatectomy and radiotherapy.

I'm 76 but very vital with a pretty young step-kid. So for me the best treatment is the one that gives me the biggest chance on long term survival without reoccurance of the cancer. I know about the side effects like impotence and incontinence but to me the most important factor for my decision is really the chance on long term survival. I care less about the side effects, I really do. I've thought about that really well.

I've been looking for scientific publications on the topic to decide what is best for me. Does anyone have tips here or any good reads?

Thanks.

User

Posted 25 Nov 2021 at 00:24

Hi man75

No scientific publications, but I was diagnosed with prostate cancer with a Gleason of 9 and metastasis in 1 lymph node in 2019. Had 5 rounds of chemo and 37 rounds of radiation therapy ending in May 2020. Had a 6 month review today and PSA down to 0.1. Not sure if it helps but there is hope.

User

Posted 25 Nov 2021 at 01:23

I am assuming that the RT would be with hormone therapy? Have they confirmed that?

All of the research suggests that your outcome will be the same regardless of whether you go for surgery or RT / HT - so it really does come down to your life style. My instinct would be to coax you towards RT / HT but how would you feel about being at the hospital every day for 4 - 7 weeks, with a young child? What might the impact be for your partner of you being tied up daily for a few weeks or having surgery and then not being able to lift, drive, help around the house for a few weeks?

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

User

Posted 25 Nov 2021 at 01:28

Sorry - forgot to say, if you are interested in likely outcomes based on thousands of previous patients with similar stats to yours, try the Memorial Sloan Kettering nomograms - link below. Keep in mind that MSK is in the US and outcomes tend to be slightly worse in the UK but still a very interesting tool.

https://www.mskcc.org/nomograms/prostate/pre_op

There is also this NHS version

https://prostate.predict.nhs.uk/

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

User

Posted 25 Nov 2021 at 03:50

From what you say about your diagnosis and your attitude towards side effects, I would say the best chance of attaining your objective would be by surgery backed up by HT/RT as/when necessary. Whatever of these treatments you have, it might be necessary to have Chemo or other treatments further down the road but hopefully not. If you had HT/RT first, it makes it much more difficult to remove the Prostate thereafter, should this be decided and only a small number of surgeons will do it for this reason.

Barry

User

Posted 25 Nov 2021 at 06:33

At 74 I am much the same age as you are and when I made my decision I had the same goals, probably for the same reasons :-). I had a Gleason score 9 with 3 nearby mets.

I went with 45 sessions of RT followed by HT [for 3 years] and nearly a year after the HT my PSA is 0.01. No guarantee forever but a good start.

RT is not easy and at the end of the treatment you feel pretty washed out. It is normally followed by HT which has its own challenges but diet can help manage that.

The way RT is delivered seems to vary from place to place so it would be worth checking out the success rating of potential RT oncology people, if you go that way. Similarly, you'll find a lot of posts in this forum on the topic of selecting an expert for a prostatectomy if that's what you choose.

Not having any mets is a great help.

Edited by member 25 Nov 2021 at 06:40 | Reason: Not specified

User

Posted 25 Nov 2021 at 10:57

I am 74, and always fit and active. In September this year, following MRI and perineal biopsy, my PCa was diagnosed as Gleason 7 (3+4) across 75% of cores taken from my prostate. There was no evidence of spread outside of the prostate. The same options with which you are grappling were put to me and I attended a urology clinic where I saw a consultant oncologist (to discuss RT) and a consultant surgeon experienced in RALP.

The oncologist described in great detail the RT journey and also stated the possibility (and I stress 'possibility') of collateral damage, some of which may not become apparent for several years. She knew I was going to see the surgeon next and it was apparent to both myself and my wife (if you are able, always have someone with you - these are emotional times and your recall and presence of mind may not be what you expect), that she was not madly enthusiastic on the RT option for me.

The surgeon believed that my PCa being localised, me being a fit and active person (BMI of 22) and wanting to minimise the chance of invasive procedures in the future. I was an ideal case for RALP. Whilst he didn't actually advise against RT, he did say that if salvage surgery was required after RT, it could be very difficult whereas, if salvage RT was required after surgery, it would not be a problem. This was a view also expressed by the consultant urologist who we saw on my initial attendance at the hospital when he was explaining all available procedures prior to my subsequent tests.

I had my surgery November 5th with intra-operative Neurosafe that confirmed clear margins and my nerves were spared.

Far too early for me to comment on success and suchlike. The purpose of this post is merely to describe events that led to my decision. Hope it is f some use.

One more thing I have learned and of which some on this forum will be aware from my previous posts. Whatever decision you make, you are likely to question later. Try not to. Once done, just get on with it. And thank you Dave and Lyn for pointing me in that direction.

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