Decision to make considering other health issues

And I am curious why lab tests for pneumonia might include PSA, but what do I know?

With no evidence of cancer outside the prostate, I would have thought radiotherapy and brachytherapy are as likely to treat the cancer successfully as surgery (though not everyone turns out to be suitable for brachytherapy). The only thing is actually being able to measure the success, radiotherapy is typically combined with hormone therapy and PSA measurements aren't definitive until normal testosterone has returned which can easily take 9 months.

Hi Nig14

I am in a similar boat as you, diagnosed last week with locally advanced and Gleason of 3+3 T3 N0. 
Just had my full body bone scan yesterday and hoping for next appointment with consultant next week to discuss which treatment to take. 
I have been massively confused by having to make a choice of treatment, though I was only offered two, RP or RT. 

I am only 54 so they said that as I am young (certainly don’t feel it I have to say!) then surgery could be the way to go initially as I can always have salvage RT afterwards if/when it returns. As it has broken out of the prostate I’m guessing there may be a higher chance of it returning. 
I habe also been very worried about the after effects of surgery but over just the last couple of days my mind has slowly come to accept that  the choice is black and white. No grey areas. 
The first priority is to obviously get rid of the cancer, whichever way I end up going with, and then I can deal with the after effects as time goes by. 
In my first post someone kindly suggested I read the book Saving Your Sex Life by John Mulhall M.D. 

I bought it on Kindle and read it yesterday and today. It is an excellent resource and explains things so clearly. I do believe it is helping me make a choice and has definitely given me a long list of questions to ask the consultant in my next appointment. 

I am also dealing with some other chronic health conditions, the worst of which is an autoimmune inflammatory arthritis condition called psoriatic arthritis. PsA for short! … must have been a sign! :)

I have been receiving weekly biological injections to suppress my immune system functions as it is attacking my joints (and organs) I’ve had this for 9 years now and been on the injections for 8 of those. They changed my life and gave me some independence and movement back. I understand that the condition is not as serious as your kidney disease but I have been off my injection for 4 weeks now and already I can feel the arthritis activity increasing across the whole of my body already so I am, like you, considering a RP as the quickest way to be able to get back to managing my arthritis. 

I of course don’t have the insight of having been through the RP as many people here have but I hope I can offer you some morale in saying you’re not alone in dealing with the stress of this diagnosis and a current chronic health condition. 
The book by John Mulhall is definitely worth a read and should give you plenty of questions to take in to your next appointment. 
I hope that helps in some way at least. 

Take care

Greg. 

Thank you so much for your reply - Im beginning to feel Im not alone on this after all.  Struggling a bit with emotions tbh and can't even talk about it much let alone make a decision.  In any event, hope it works out somehow for both of us - it's just a complete shock and seems so unfair with everything else......  thank you again for taking the time to reply and good luck.

Nigel

It’s difficult isn’t it Nig. Like I said, I’m right there at the same place as you are now. 

From what I’ve read we should never decide our choice of treatment based on what we think will be our best chance of best sexual performance in the future. 
As I understand it, RP will give ED issues immediately but RT has been reported as giving issues 3-5 years down the line so essentially the same problems just delayed a little. 

It would be great to hear people’s experiences of ED after RT, once they are several years past their treatment, to see if real world experiences match up with the research data. 

One of the many questions I’ve gathered to ask the consultant at my next appointment is:

What treatment does he believe will give the best results in beating my particular cancer (based on stage/position/spread etc)?

I’m going to ask him to forget about only being able to offer me RP or RT at my local hospital, out of all the treatments available, in his experience, what does he think will give me the best chance of being cancer free. Then if he suggests a treatment that is not offered by my local hospital I can look to going further afield or investigate private treatment. 
The aim for me is to be cancer free, everything else (like side effects) I will have to deal with as they come. 

The problem with specialists is that ... they specialise. Urologists focus on surgery, oncologists on radio/chemo/hormone therapy, and the kidney specialist on something that for you is a crucial part of the equation. You are in the middle and need one approach.

The way I see it (this isn't medical advice) is that surgery could be undertaken fairly quickly with the success in terms of PSA levels known a few months after that. There would be something to work on for the kidney specialist thinking of treatment and possible transplant surgery - with the question being how soon they are prepared to consider a second major surgical procedure (don't under-estimate how those set you back).

With radiotherapy, the best that seems to be realistic under current protocols might be 6 months hormone therapy to cover the radio treatment, and 9 months before the PSA success can be reliably estimated. But you would need to find out from the oncologist whether that relatively accelerated treatment would be workable in your case. Much longer and there would be anxieties about having the kidney problem dealt with.

And that is without worrying about the side effects, which can significantly change your quality of life. It isn't an easy decision, good luck.