Now I have to chose. Advice welcome.

User

Posted 11 Jun 2023 at 02:14

I’m 62, working and healthy except for the inherited and medicated high blood pressure.

PSA 6.25. PI-RADS 4 abnormality in right apical posteromedial peripheral zone. Localised. 3 of biopsy’s came back positive. Grade 2 Gleeson 7 (3+4)

My hospital, The Lister in Stevenage, is offering robotic surgery full Radical Prostectomy, Permanent Seed Brachytherapy and 5 day Radiotherapy or Hormone Treatment and lower dose Radiotherapy.

I don’t have a clue. The consultants all think all of them will work 100%. Now I have to make that call.

I’m drawn to the PSB (1st used in 1917) because it’s quick, easy and works. But if the cancer comes back the option becomes RT and HT or very messy 1990s salvage surgery because that 47cc scar ball is not going to plop out like a squidgy fresh prostate.

RP is brutal. 12 to 16 weeks recuperating, the whole catheter thing. It’s medieval and dangerous. But that is kind of re-assuring because the cancer is all cut out.

So I’ve come down to, what is the re-occurance risk with PSB v RP v RT.

Any advice welcome

User

Posted 11 Jun 2023 at 12:19

Good to hear how well you’ve recovered Steve86 and hopefully the ED will start to improve through time. I’ve got another 2 years of this damned HT to look forward to so at least 3 years with these side effects😟 But hopefully the treatment is working and keeping me alive, so I just try and forget about it and get on with living my life to the full.

User

Posted 11 Jun 2023 at 19:49

It is a very tough time for you. I was in a similar situation over 12 years ago. What tipped the balance towards prostatectomy were the following reasons:

The cancer was well contained within the gland with clear margins.

Although I was 71 at the time I was very fit, no other health issues.

The urologist had performed many robotic prostatectomies, he was very kind, careful and exuded confidence without being too pushy. In fact he insisted that I see an oncologist who was a young guy and couldn't stop praising the CyberKnife technique - a new procedure at the time.

Lastly but not the least the psychological aspect of the possibility of removing the beast from my body played a large part in my decision. Of course there was the comfort blanket of RT if the surgery failed; surgery after RT is very difficult and there are't many consultants who do it.

I hope you can make a decision as confidently as one can in this situation. Be optimistic and remember healing takes place in the head as well as everywhere else in your body. Good luck.

Edited by member 11 Jun 2023 at 19:51 | Reason: Not specified

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

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User

Posted 11 Jun 2023 at 09:40

I had rt and 2years off hormone therapy for Gleason 9 with a psa off 24.9 on diagnosis psa been 0.01 after treatment and generally been ok did have some mucus issues that have now subsided 3years since diagnosis pleased with my Choice gaz 👍

User

Posted 11 Jun 2023 at 09:41

The recurrence ridk is almost identical for all three - that's why the MDT isn't recommending one above the others.

In the end, you have to look at the known and potential side effects and make a decision about which ones you can live with

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

User

Posted 11 Jun 2023 at 09:53

For me the RT wasn’t an issue. I finished about 6 weeks ago and ATM no issues.
however HT is a real pain…aching and stiff joints, hot flushes, brain fog at times, zero libido, possible Pyronies disease. If I had had the choice, I would have gone for RP and speaking to the guys in my Maggies group that have had surgery, they are pleased with their choice….it’s a major op though and does have its side effects which can be long lasting in some cases.
how long would you be on HT? It took a year for the aches and pains to start.

Having said all that I am getting on with my life and having fun😊

Good luck with your choice and once you’ve made it you will feel much better.

User

Posted 11 Jun 2023 at 11:11

I am 4 weeks post RARP and I have said on several threads that for me, it was the best choice and far less 'brutal' than I had anticipated. However, others have reminded me that other people haven't been so lucky as me.

Apart from the shoulder pain caused by the CO2 inflation of the abdomen, I have been pretty pain free - I'd call it mild discomfort. Catheter is awkward for 7 days but wasn't really painful, even when removed.

The op was straightforward and everything healed quickly and I now have mild incontinence - a dribble if I don't concentrate when standing up or coughing/sneezing. No erection yet but able to still achieve orgasm quickly.

I have a follow up with the surgeon in 2 weeks to review the histology however I had similar results to you initially.

PSA 11, Pi-rads 4, Gleeson 7 and a 1.4cm lesion on the left side. Oh, and daily Coveram for high BP :)

Everyone will be different but I wanted the cancer removed and was prepared to accept the incontinence and ED as a fair price to pay, fortunately even they are less of a problem than I anticipated and the future might bring further improvement.

User

Posted 11 Jun 2023 at 12:19

User

Posted 11 Jun 2023 at 19:49

It is a very tough time for you. I was in a similar situation over 12 years ago. What tipped the balance towards prostatectomy were the following reasons:

The cancer was well contained within the gland with clear margins.

Although I was 71 at the time I was very fit, no other health issues.

I hope you can make a decision as confidently as one can in this situation. Be optimistic and remember healing takes place in the head as well as everywhere else in your body. Good luck.

Edited by member 11 Jun 2023 at 19:51 | Reason: Not specified

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 12 Jun 2023 at 00:12

Biopsy and MRI generally give a good indication of Gleason score and extent of the cancer but this is not true in 100% of cases. But after removed Prostates are sliced in the lab it is sometimes found that the Gleason score is upgraded, (more often than downgraded). Also, sometimes cancer can be seen to have extended further than appeared to be the case when the surgeon is operating during Proctectomy than was not apparent beforehand. Then, there can be micro cancer cells that are not visible even as the surgeon operates which may extend further than a surgeon can remove. So you can't correctly say a Prostatectomy will remove all the cancer without qualification. This is where the relevance of the comments by member P&JM concerning the position of the tumour is a consideration as if the cancer appears to be well contained the chances of removing it all is improved. Other forms of treatment also have limitations and successes with some failures established at some future stage.

You have been given a number of options and apart from what your consultants have said, you might find it helpful to read/download the 'Toolbox' provided by this charity which provides basic information about PCa and most of the most common ways of treating it.
https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Edited by member 12 Jun 2023 at 00:17 | Reason: to highlight link

Barry

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