Hi folks,
I have started a new thread to avoid distracting from Nigel's ( GetThroughThis) similar thread.
My issue and question is slightly different. Like him, my original diagnosis ( May 2020) was T2c N0 M0. The treatment plan was to be RT, but after a lot of faffing about this was abandoned as the team couldn't get a clear enough sight of the goal ( a loop of bowel was consistently in the way). Their best suggestion was a reduced dose EBRT, to avoid too much collateral damage, but obviously with less possibility of a curative solution. So plan B was to switch to RP.
At that point I thought a second opinion might be a good idea. The MDT at the ( private ) second opinion clinic have taken a slightly different view of my MRI pictures (as of Dec 2021). To Quote: 'there was loss of tissue planes between the base of the prostate and the rectum, and between the right seminal vesicle and the rectum; and it looked likely that there was bilateral seminal vesicle invasion'.
Although definitions vary slightly, that seems to me to be a T3B staging. If that's right, then I think it changes the game somewhat: the standard wisdom seems to be that RP is not the preferred primary treatment in those circumstances. So I seem to be in the situation that neither RT nor RP are good curative options.
Both the local and private surgeons are happy to operate on a T3B, though they rightly point out that additional treatment is likely to be needed. That additional treatment would normally be....RP. Catch 22!
I can see some reasons why an RP op might still be useful:
- the position might not be as bad as the MRI interpretation suggests ( say, 20% probability?, though it seems unlikely to come back down to a nicely contained T2C));
- I would have a much clearer picture of what was going on down there, and
- there would at least be a reduction in tumour mass.
It is hard however to know what weight to place on these benefits against the certainty of an invasive procedure, and the probability of a second set of effects from whatever adjuvant treatment is proposed. Putting it at its crudest, if a curative option is not really on the table, am I better off considering going straight to a long term containment strategy?
What started out as a relatively straightforward exercise has become a bit more complicated, and although I am nearly 2 years into this ( with HT currently holding the fort), I don't yet have a proper game plan. Has anyone had experience of navigating these waters?