Completely understand and thanks again for responding so promptly. I'll just avoid going into the kind of hospital-related detail I might have done privately. So, a quick snapshot of medical treatment, all of which has been conducted at one centre of cancer excellence in England. Apologies in advance for the length.
First diagnosed in 2009 with T3 disease (Gleason 4+4) and treated with nearly three years of androgen suppressant and prostate and pelvic radiotherapy.
Recurrence of disease in May 2015 and because it was said to be contained within the prostate a salvage prostatectomy was offered and performed. But the op left me with complete urinary incontinence and impotence. Since then I've had three-monthly PSA tests and despite me having no prostate the cells left behind have seen my PSA rise slowly and sporadically and registered at 2 at the last but one test. During that period I had two PSMA Pet scans which failed to pinpoint any disease.
Then a couple of months ago an unrelated MRI scan to do with sorting out the incontinence revealed evidence of disease at the bladder neck and a susbsequent Pet scan showed that my ureters were blocked and kidneys engorged. I had bilateral nephrostomies, one of which is still in place.
Intitially, the plan was to remove the bladder which because it's redundant I was fairly content with. But another MRI scan revealed the bladder to be pretty much fused to the rectum making separation impossible and therefore a colostomy as well as a urostomy required.
Interestingly (perhaps) the PSA test was repeated a couple of weeks ago and it was 0.6, presumably as a result of the biopsy.
Anyway, so urology surgeon and oncologist both in agreement that surgery offers the best oncological outcome and I have been put on a six-weekly course of 150g bicalutamide with monthly zoladex injections principally, as I understand it, to prepare for the surgery. Because of the lifestyle implications, the surgery doesn't sit easily with me which is why, at your suggestion, I'm exploring focal therapy treatment and, perhaps, lifetime HT. At one point the surgeon did say that the HT drugs I'm now on might well clear the blockage in the ureter meaning the nephrostomy could be removed. On the other hand he might also say this is why surgery is necessary. Isn't always easy to get consistent and definitive guidance from consultations, although I have absolutely no complaints on that score. So there in longer form than I intended is my medical history.
Based on that synopsis if there's any guidance on kicking back on surgery in favour of HT in all its forms I'd be grateful, because I'm currently floundering