Unsure which way is best

Hello Martin,

Sorry you find like many men your original treatment did not permanently put an end to your cancer. Unfortunately, other than what you have told us we don't know details of you diagnosis or histology. It seems highly likely to me that because you had brachytherapy (Profile doesn't say in combination with EBRT), that your PCa was thought to be confined to your Prostate, although one can never be certain of this. That you have now been offered a Prostatectomy suggests it is still thought that your cancer is most likely contained within your Prostate. If this is correct, it may be possible alternatively to treat you with one of the forms of Focal Therapy. There are other types but the most used in the UK is HIFU for suitable men. In some situations Cryotherapy can be more suitable. There are also other forms of Focal Therapy too. If you would like to consider this you should speak with Focal Expert who will be in the best position. He/she will need full details of your diagnosis scans and general histology and if you are accepted may well want to do further scans etc.

I was in a somewhat similar position to you but having failed EBRT rather than Brachytherapy. I was referred by the Royal Marsden to UCLH for possible HIFU. UCLH are the UK leaders in Focal Therapy although there are a few other places in the UK now doing the procedure, some trained by UCLH. Not wishing to have permanent incontinence with salvage Prostatectomy, something I was told was highly likely, and wanting to avoid HT, I agreed to HIFU, which I had in 2015. Unfortunately, my PSA after dropping initially, began to slowly increase and I had a second HIFU in December 2021. A high quality scan a year on didn't show any cancer and my PSA has been low and stable since. I have been told I am in remission, although I know PCa can come back with any treatment regardless. Side effects are far milder with Focal Therapy which as in my case is usually repeatable. Where it is too big an ask for Focal Therapy to eradicate the cancer it can usually be followed by Prostatectomy, although this is going to be a more difficult operation where RT was previously given.

I have never advocated a man have a particular form of treatment, They all have pros and cons, but what I can say is that to me it makes sense to consider all treatments, even though it may be necessary to go to a different hospital, as not all hospitals can offer all treatments.

Edited by member 23 May 2023 at 01:15  | Reason: Not specified

Some scans are better than others or are better in some ways than others. It may be that your MRI was not a multi parametric one for instance, Also, not everybody draws the same conclusion from examining scans as I have found. Success of a Prostatectomy is judged by how successful surgery was in eradicating the cancer rather than the degree of side effects of which various levels of incontinence for various times up to permanent is concerned. Of course, the patient may look look at this differently and not consider his operation was a success if he has to wear pads long term or is left with Erectile Disfunction that even chemicals and pumps will not necessarily overcome.

I agree with Lyn's post about HT but the side effects of HT can be quite debilitating among other things for some men and many of us try to avoid it or get the time on it reduced if possible. (Suggest you research it). As we often recommend to new members, the 'Tool Kit' gives good basic information about PCa and various treatments :- https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Edited by member 23 May 2023 at 11:44  | Reason: to highlight link