Hello, I’m new to this forum as a participant, although I have gained a lot from it in recent months as a reader. I was diagnosed with PCa towards the end of June. My last (and so far only) PSA reading was 3.68. Gleason is 3+4, stage is T2. The cancer is 7mm and is contained within the capsule, located near the apex. I am scheduled for RALP in a week and a half. I’m 47 years old. My father also had PCa, diagnosed when he was 86, at a stage when it was already untreatable. He died from it just over a year later.
It is probably just last-minute nerves, but I am starting to wonder whether I have made the right treatment decision. The multi-disciplinary team that reviewed my case recommended radical prostatectomy. However, the consultant who gave me the diagnosis said that he had not been part of that meeting and that he had a different view. He had been involved in a large study that showed that although RP is usually recommended for younger men, active surveillance actually has just as good outcomes for younger men as for older ones and should have been included as an option in my case. He said that it might be a decade or more before I would need treatment. In fact, there was even a very slim chance that I might never need it. He said that others would disagree and that I should speak to the full range of specialists and get all of the views. The next person I spoke to was a specialist in focal therapy. He did not recommend that for me (I could see why when he explained the rate of recurrence) but instead clearly favoured surgery. He said I would be extremely borderline for AS and, although I might get one, or at the most two years of delay, I would not avoid treatment for this cancer. He also said that there was peri-neural invasion (within the capsule) and that this was a worrying sign, as it is one of the ways in which the cancer can spread. I then spoke with two surgeons. The first dismissed AS completely, saying that 20% of the cancer was pattern 4 and that was too high. The second said that it would be playing with fire and that since the tumour is close to the nerves (the external nerves necessary for erections) I should not delay too long. I had a strange meeting with an oncologist, who essentially just told me how lucky I was to have this particular cancer. In the follow-up letter (though not in the meeting) she explicitly said that she recommended surgery. On this basis, I opted for surgery. It was probably the peri-neural invasion that was decisive for me. The surgical plan prescribed interfascial nerve spare on both sides. I have opted (as in paid) to have Neurosafe, as this might allow for intrafascial nerve sparing instead.
However, I am now starting to wonder whether I have just been overly cautious and whether this is a classic case of screening (at me request) for something that was not causing any issues and might otherwise have sat there for a long time without needing treatment. It seems like a huge thing to undergo if it is not really necessary. I know there is no right answer here, but I would be interested in any opinions. I never got to talk again to the consultant who recommended AS, and perhaps I should have insisted on it. But I notice that the Cancer Research UK online Predict tool gives fairly similar outcomes for survival at 10 years for people in my situation through conservative management and through RP. But then it doesn’t take into account peri-neural invasion or the site of the tumour close to, but not necessarily yet involved with, the external nerves. Of course, it could be that I am just freaking out as the operation approaches.