EBRT v RP

To be fare I have been on the sauce, but now I'm sober I'd still say AS is the best course. This cancer has every chance of laying dormant for a long time, treatment now will cause side effects which could be avoided for many years.

Edited by member 28 Dec 2022 at 13:51  | Reason: Not specified

Thanks Chris.

EBRT v RP is tricky for me as I dont want the potential side affects at 60 years old.

My prostate being very large at 114 by volume means that internal radiation is a NO.

The case study information on EBRT seems to be 10 years old.

RP seems to be all about nerve sparing.

My case seems to be more about the side affects than the cancer.

With regards to psa doubling I have 4 years before it breaks out as long as not aggressive.

I am working on a 2 year period so keen to know my treatment plan next year.

They both seem to come with roughly the same side affects re ED and Water works issues.

Maybe a trail will be available soon that has less side affects than the options available to me.

Thanks for listening.

Thanks Jules.

I would rather have EBRT BUT being told that roughly the same side effects as RP and if the PCa comes back then I cant have radiation twice and then RP is VERY complicated and side effects can br very severe and potentially I may not even be 70 by then.!!

So tricky for me!! 

What are the available treatments for a prostate that is 114 by volume.?

I can understand that when diagnosed men can take different views on having AS or a more radical form of treatment early or to leaving it as long as they possibly can and we sometimes may think what we would do in similar circumstances, perhaps even saying so . But what I do not accept is telling a man he is lucky that his cancer diagnosis is PCa because it is generally slow in progressing and that he might get run over by a bus before he needs treatment, even if that may prove to be the case. PCa should never be treated a a trivial disease. It can sometimes take off quite quickly.

Also, the post was headed EBRT V RT so the member was clearly looking ahead and expecting an answer on that, not about the AS he was on.

Edited by member 30 Dec 2022 at 01:00  | Reason: Not specified

I had an almost identically large prostate (115), so my experience may be helpful. I was diagnosed with a Gleason of 3+3 in 2014 aged 58 and opted for Active Surveillance.

A biopsy in 2021 moved the score to 3+4 (with one of the cores being 80% grade 4 cancer). My consultant said usually he felt there was little to choose between RT and RP, but in my case he recommended RP (with continuing AS being a definite third choice). His preference for RP was because the size of my prostate was such that even if there was no cancer, some treatment may be necessary to prevent problems with my waterworks (I had completed a questionnaire about problems like waking during the night, difficulty urinating etc and scored 37.5 where the highest category of problems was anything over 30).

I was on the NHS and had a meeting with a surgeon and radiotherapist to discuss the pros and cons of RT and RP. I was lucky in that the surgeon was the one I would have wanted to do the surgery anyway. I asked whether the size of my prostate created any problems for surgery and he said no, though it might have done if I was overweight.

I had RP in March 2022 and nine months after surgery I am fully continent and am able to have intercourse without aid from rings, injections etc. I count myself as one of the lucky ones, as it is clear that individual experiences vary considerably.

If you are like me and may need treatment for the size of your prostate (irrespective of PCa), then the possible side effects from that, make RP less of a risk. Something to discuss with your consultant.

That sounds good. The obvious advantage of having treatment in a year's time as opposed to five years is that you are that bit younger, so you should recover sooner with hopefully fewer side effects. I hope you are as lucky as I have been.

Some brief comment on penile rehabilitation after RP in case you want to bear these in mind. 

Prostate Cancer UK produce a leaflet called "Treating erectile dysfunction after surgery for pelvic cancers", with the sub heading "A quick guide for health professionals: supporting men with erectile dysfunction".

For Tablets (PDE5-Is) (sildenafil, tadalafil, vardenafil and avanafil) it says "Early initiation (after catheter removal or within 14 days) promotes early recovery and preservation of erectile function".

For a Vacuum Erection Device (pump) it says:

Early use (within one month after surgery) linked with better outcomes. Can be initiated 4-8 weeks after surgery.

I had no problem being prescribed tadalafil and a vacuum pump, but various factors outside my control meant I didn't get the pump until 4 months after surgery. I had already bought and was using a cheap pump (£25ish from LoveHoney) and that worked fine and still does. If (having had an RP) you face a wait for an NHS prescribed pump then I would buy a cheap one to use now, bearing in mind the remark above about early use being linked with better outcomes.

Thanks Chris.

I am on psa blood tests every 12 weeks and they are def keeping an eye on me.

I am swaying towards RP as I can have RT afterwards if there is cancer  re-occurrence.

My surgeon who is also my lead urologist is telling me that surgery after radiotherapy is particularly challenging and not recommended.

What swayed you to having RT +HT?