RP vs RT

RP vs RT

User

Posted 28 Mar 2023 at 11:03

Hi All

I am 52 and was diagnosed with PC 6 years ago. I was put on AS for 2 years and then due to rising PSA it was decided 4 years ago to have hi fu treatment at UCLH London.

Hi fu Operation went well with no side effects.

Both my father and brother have had PC. Dad had Hifu before me he is OK my brother RP 2 years later and still recovering.

Late Last year I had a MRI, biopsy and Pet scan results 3 + 5 gleeson 4.9 PSA cancer had returned. I am on bicalutamide 50 mg at present Another MRI last month cancer still contained but A decision on treatment now needs to be made.

I have been offered both Salvage RP or salvage RT problem is where I had hifu there is possibly no chance of nerve saving on one side.

I am totally confused which way to turn the more I read the more confused I become. I have spoken to 3 consultants and no one will tell me what is the best option.

I have read about Nurosafe but this is not an option on the NHS.

Has anyone been in the same situation

As I am only 58 should I have RP.

User

Posted 28 Mar 2023 at 12:06

You probably know more about prostate cancer than most people as you have already been through AS and HIFU.

We often get posts from newly diagnosed people and some on here recommend the most aggressive treatment, and others the least aggressive. I would say you have tried the least aggressive approach, and it has presumably served you well in terms of sexual function and continence.The next least aggressive approach is probably RT.

I wonder if you have a gene for prostate cancer? the family history isn't great, but bearing in mind everyman will get prostate cancer, it isn't strong evidence for a genetic cause.

If you have female relatives who have had breast cancer then testing for BRCA gene could be worthwhile. If you have BRCA then maybe you need to have RP, as even if RT works you will still have a prostate with the potential for recurrence.

Do remember I'm just a random guy on the internet with no medical qualifications.

Dave

User

Posted 28 Mar 2023 at 12:35

RP if they get everything is the best chance of a complete remission (check the latest research). Also you will know at your first post OP PSA (if it's super sensitive) if it's a success and you will have a chance of long term remission.

RT including pelvic nodes is probably the best "catch all" and often follows failed RP.

Being young (58) RT will not remove the prostate tissue so the remnants can give problems later on or it may even cause tumours in other abdominal structure's.

User

Posted 28 Mar 2023 at 23:39

Nurosafe is offered on the NHS by the Lister at Stevenage, but I'm not sure how much it would help on the HIFU side.

Salvage prostatectomy is a very specialist procedure. Guys and St.Thomas's have a surgeon who specialises in it and gets good results.

I had radiotherapy at age 57. RP would not have been nerve sparing, and would quite likely have needed salvage RT afterwards.

Edited by member 28 Mar 2023 at 23:45 | Reason: Not specified

User

Posted 30 Mar 2023 at 07:48

Point of interest. The Prof. at the Lister Stevenage told me he is one of the few who performs salvage prostatectomy.

Peter

User

Posted 30 Mar 2023 at 09:23

Losing the nerves on one side shouldn't be a deal breaker - statistically, there is very little difference in erectile recovery between men who had full nerve-sparing and men who had partial nerve-spring.

As Andy says, neurosafe is available on the NHS but at only a limited number of hospitals. I can't really see how neurosafe would help you though - can you clarify what you are thinking?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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