Which treatment? Help!

I agree with Lyn - if the MDT (which is the collective view of the hospital oncologists, radiographers, urologists, etc) recommended radiotherapy, why is a surgeon disagreeing with them? If sexual function is important to you, you need to ask about the prospect of nerve sparing. Even with full nerve sparing, this might not recover. Also ask him what effect the aggressive surgery would likely have on continence. I'm not trying to put you off prostatectomy, but I would want to understand why the surgeon is perhaps not towing the line from the MDT. You could also try asking what he thinks your chances are of needing radiotherapy after the prostatectomy. This is required in 30% of all prostatectomies anyway, but your risk may be higher.

My diagnosis wasn't that different to yours (although you haven't said what your PSA was at diagnosis). I went for a radiotherapy protocol called HDR Boost, which is good for high risk patients with no known spread to lymph nodes, but being high risk, there's a chance of micro-mets (mets still too small to show on scans). This consists of external beam radiotherapy to prostate, prostate bed, seminal vesicles and optionally pelvic lymph nodes done too (I had them included). This is done at a lower than full dose which tends to produce fewer side effects, but the prostate where the known cancer is is topped up using HDR Brachytherapy to a higher dose than can be achieved with external beam radiotherapy alone. This is thought to be a good compromise on hitting the cancer hard, cleaning up where it might have spread unseen, and relatively low side effects considering how hard the cancer is being hit.

If I'd had a prostatectomy, it was unlikely I'd have any nerve sparing, and quite likely (well above 30%) that I'd need radiotherapy. So the urologists, who would have done a prostatectomy if I really wanted it, said why not go for radiotherapy in the first place and avoid having both sets of side effects. Radiotherapy can also impact sexual function, but the chances are less, particularly if prostatectomy wouldn't be full nerve sparing.

A negative point for radiotherapy is your age, and to a slightly lesser extent, that was the case for me too, at 2-3 years older than you at diagnosis and treatment. I may live long enough (with luck) for a risk of cancer in the bowel or bladder to double (typically 20 years later), but we're still talking about a small risk. Some 3 years after my radiotherapy, I'm still pleased with my choice, and everything still works, but there are of course no guarantees - it's mostly just risk levels and luck.

Edited by member 04 Jul 2022 at 14:25  | Reason: Not specified

As you are T3 you are classified as advanced PC with the tumours having broken out of the prostate.

My take on it is that a prostectomy is a bit like shutting the stable door after the horses have escaped.

No, T3 doesn't imply advanced prostate cancer (and neither does T4 by itself), although they both mean at least locally advanced.

Advanced prostate cancer is a staging with M1 (metastasis away from the prostate) as opposed to M0 (no metastasis).

Hi All, 

So I've now heard from Urology that it's going to be a month before I can see the Radiotherapy Oncologist at Western Park. 

All this waiting is literally killing me!

I'm down for RP in about 6 weeks. 

In my own mind I'm thinking do I just say yes to Radiotherapy and start my HT now or wait until the additional 4 weeks while my Cancer is growing. 

I suppose its down to the state of the NHS.

It's really difficult to know what to do. 

Jon,

As Gaz says it is generally very slow growing so shouldn’t make too much difference.

If you are feeling really anxious….Rob had bicalutamide for 4 weeks and 2 prostap 3 injections before his operation, so even if you wanted to start HT in the meantime it wouldn’t mean that you definitely have to take the RT route….could be an option?

Of course Rob was originally diagnosed advanced hence why he was put straight on to HT. His post op histology changed from T3a to T2 (not sure if HT had anything to do with this). I would say the downside to having the HT first is that we can’t be sure at the moment how successful the RALP was….his PSA is undetectable <0.025 but is that because all the cancer has gone or HT…it’s a waiting game now he has stopped HT.