Radiotherapy or Prostatectomy?

That seems very rushed. Although I made up my mind quickly I was under no pressure to do so.

Prostate Cancer tool kit might help 

https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

It's free

Agreed, it seems a bit rushed. So you need to read up on side effects, outcomes etc etc regarding 3+4. Both have side effects. However the main side effect hopefully is that you will be free of cancer with either option

The experience of a man you know or any individual who responds to your request may be quite different to yours so I suggest you bear this in mind.

In your situation, I would want to know more about whether in as far as seems to be the location of the cancer, whether the surgeon feels how confident s/he is that your nerve bundles on both or one side can be preserved as this will greatly influence ED. With RT how many fractions (sessions) would you have and would this be with HT and if so for how long? Would one of the types of Brachytherapy be suitable, even if you had to go to a different hospital for it? It may be that you might be suitable for focal therapy as another option, so would you like to investigate this?

You will have read the pros and cons of the various treatments and it really comes down to how adverse you are to any aspect because the outcome for each in terms of dealing with cancer is pretty similar, although a repeat focal treatment might be required if you were able to have this form of treatment.

I went the RT/HT route. I initially said I wanted a prostatectomy which they said they'd do, but didn't think it would be curative, so I'd probably need RT afterwards. Also, I found it probably wouldn't be nerve sparing. This caused me to choose RT/HT, and avoid having both sets of side effects.

I'm now 3 years since the RT and 18 months since finishing the HT. A month or two back, I was able to tell my oncologist I now almost wouldn't know anything had been done, which is not at all what I was imagining from the outset.

It's still too soon to know how well the treatment worked and I'm well aware I'm a high risk patient, so recurrence is a possibility.

The HT will cause penile shortening, both through lack of Testosterone and lack of frequent erections. Regular erections, using the pump if necessary, may reduce or prevent that.

This is slightly flawed thinking - if the first treatment fails, the chances of achieving full remission with a second treatment are much lower, regardless of which radical treatment you choose. A better way of thinking about it is to determine which treatment is most likely to get you to remission and then decide whether the certain and potential side effects of that treatment are acceptable to you. If not, which is the next best treatment with side effects that you are comfortable with.

As stated above, most men experience some loss of length and / or girth after RP but the testicles usually remain unchanged. HT also leads to loss of length / girth but also (usually) the testicles shrink as well.

The first three weeks or so I was absolutely fine. I then started to have difficulty peeing, which is very common - the radiation makes the prostate swell. I was prescribed Tamsulosin which completely sorted that out.

Towards the end of treatment I started passing large amounts of green slime from the rear end. This again is common: radiation irritates the bowel and makes it produce more of the mucus which lubricates things. Frequent and loose bowel motions in general. Also an increased urgency to pee (again, radiation irritates the bladder) until I was having to "go" every 40m or so, 24h a day, which was exhausting. I bought a urine bottle (Amazon) which was a big help. You get back to sleep much faster if you don't have to get out of bed.

Finished treatment. Side-effects reached their worst about 10 days later. Peeing frequently rapidly subsided. Back to normal within a few weeks. Bowel issues took much longer. At least three months to start stabilising and probably a year to return to any sort of normality. If I went out for the day I took at Imodium tablet. It didn't disrupt my life.

I'm probably making it sound worse than it was! It really wasn't too disruptive and I managed fine. I'm now three and a half years after RT. I'm still on Tamsulosin and will be for life, but no issues. Bowel is different to before, but not troublesome.

Hope that's of some help to you,

Chris

hi tony I went down the rt/ht route diagnosed psa 24.9 gleeson 9 now 14 months on psa remaining at 0.01 found whole experience very tolerable good luck with your choice gaz 👍

On the face of it your diagnosis seems similar to mine. However i was given the choice of active survillance as well- which I did for a couple of years or so. I can only assume the PCa is close to the edge of the prostate but I'm not a doctor. I elected in the end for open surgery and was happy with my decision. Good luck with your choice 

Hi Tony,

I was diagnosed February 2022

I went down the  HDR Brachytherapy route which went well and was tolerable, you are in hospital all day for the procedure + an overnight stay. The procedure is pain free and I didn`t have any side effects. I am halfway through my 15 radiotherapy sessions which has also been ok. 

I urinate more in the night and have ED, but a small price to pay  if it all works in the end, and I am cancer free.

I am also on HRT injections for 2 years.

Happy to answer any questions

best of luck with your choices

Pete

If you opt for surgery make sure your surgeon is high volume and has got good stats on the BAUS website. Also make sure you ask about nerve sparing and ask the surgeon how confident he is and how far he is willing to go to spare nerves.