The Thin Blue Line RP vs RT

With a 101cc Prostate I think it very unlikely you will be offered focal therapy. Indeed, your large Prostate also means some types of radio therapy would not be given. Nevertheless UCLH may opine that one of the treatments you have been offered may be better from a clinical viewpoint in your case, although your decision will also need to take side effects into account. If you had EBRT, it could make it more difficult to surgically relieve any pressure on your Urethra that goes through your Prostate should this become a problem in due course, which is more likely with a large Prostate. So you could ask about this.

There is also the usual question to be asked on whether nerve bundles on one or both sides be likely saved in your case.

Do let us know what is said and what you decide.

Edited by member 14 Aug 2022 at 04:21  | Reason: Not specified

Worth asking the question for sure as I do recall the surgeon saying to me before I made my decision to opt for surgery that if my prostate was much larger they would have to shrink it first.

Based on what I know now and how things have progressed (really well in fact) I have to say I would have done nothing differently. I initially went on AS for 3 months after my first biopsy found cancer as it was low grading ( 2: Gleason 3+4=7), was in just a small part of the prostate and was contained within the capsule. After undergoing another PSA test   some  3 months (September 2021) after my first diagnosis  and  the hospital finding that my PSA had increased from 5.74 in April to 6.01, the  decision was then made for me to have another biopsy. That found that although the grading was exactly the same the cancer was throughout my prostate (but still contained within the capsule). I was advised to consider treatment and after deliberating for several weeks plumped for surgery. When the prostate was removed it was cut and spliced and although the Gleason score was still the same it was found that some of the cancer though still within the prostate was starting to bulge out. If I had left it much longer to have had treatment then it is very likely that the cancer would have spread and surgery would not have been such a viable option.

Returning to your question, with hindsight when I first got tested in 2018 when I was 60 ( I had no symptoms but had read that the likes of Michael Parkinson, Billy Connolly, Stephen Fry, Jools Holland, Rod Stewart, Ben Stiller had all been diagnosed with prostate cancer and were urging men to get tested) and it was found that my PSA was 3.58 I should not have left it another 3 years before getting tested again. Leaving it as I did could have resulted in a different outcome to the one I have now.

Ivan

No problem and good luck with whatever your propose to do.

To pick up on the point you raised, Gleason 4+3=7 means that more of the cancerous cells they found were 4 rather than 3. In my case,  more of the cancerous cells were 3 rather than 4, with fewer than 10% of the cancerous cells found being graded 4. My main lesion was 15 mm so quite a bit bigger than yours.

Since around 1 in 5 men 40 & over have evidence of prostate cancer and most men of 60 have it and with many men not even knowing they have it and dying of something else it is for most of us that are diagnosed early enough highly treatable.

Ivan