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Prostatectomy V Hormone Treatment

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User
Posted 09 Jul 2023 at 21:16

Hello All,

I've been advised by Urology that by having Prostatectomy would leave my totally incontinent (as the cancer is abutting the urethra) and there is no margin. So I've been referred to Oncology for Hormone Treatment for life.

I had Brachytherapy in 2016 and PC Reoccurrence 2023.

My Question is, If the Prostate Gland was removed would this stop the production of cells.

User
Posted 09 Jul 2023 at 23:09
What a rotten decision to have to make!! Quite frankly, I think iyour question is best addressed to your consultant who is better placed to answer it because there is a chance that some cancer cells may escape the knife in your situation. it might slow or stop advancement but at the price of incontinence. in your situation i would enquire whether a form of focal therapy might achieve what would be hoped of RP but with lower risk of incontinence.
Barry
User
Posted 09 Jul 2023 at 23:45

Salvage prostatectomy is a very specialist procedure, in particular for minimising QoL issues, and only a few surgeons specialise in it. I would ask for a referral to a centre which does specialise in it such as Guys and St.Thomas's, and see if their specialist thinks they could achieve a better outcome.

I'm not sure why cancer abutting the urethra is an issue for continence after RP - urethra inside the prostate is removed in any case. Was it perhaps cancer down in the apex (bottom of the prostate) which could be too near to the external urinary sphincter to save that?

I also wonder about doing some focal brachytherapy, but I'm not aware of anywhere which routinely does that in the UK. You could ask one of the specialist brachytherapy centres, such as Mount Vernon Cancer Centre if it's something they might consider.

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User
Posted 09 Jul 2023 at 23:09
What a rotten decision to have to make!! Quite frankly, I think iyour question is best addressed to your consultant who is better placed to answer it because there is a chance that some cancer cells may escape the knife in your situation. it might slow or stop advancement but at the price of incontinence. in your situation i would enquire whether a form of focal therapy might achieve what would be hoped of RP but with lower risk of incontinence.
Barry
User
Posted 09 Jul 2023 at 23:13

I think you are in a very difficult position. 

The fact you have been offered prostatectomy means that the medics are almost certain the cancer has not spread. If they are right then prostatectomy will cure your cancer but leave you incontinent. If they are wrong prostatectomy will not cure your cancer, it will leave you incontinent and then you will have to go on HT anyway.

If you go down the HT route, it doesn't matter whether they are right or wrong because HT will stop the cancer wherever it is in your body. The problem is that HT can only slow down the progress of the cancer usually for about five years, though occasionally for more than a decade.

So as far as I can see if you go for HT you will probably live to 70, but probably not live to 75. If you have prostatectomy you will probably live you natural life (about 85, unless you have other conditions), have none of the problems of HT like weight gain, hot sweats, fatigue, but you will have to manage incontinence, presumably with a permanent catheter.

Have you had a PSMA scan? You want to be absolutely sure the cancer is only in your prostate before you choose prostatectomy.

Dave

User
Posted 09 Jul 2023 at 23:45

Salvage prostatectomy is a very specialist procedure, in particular for minimising QoL issues, and only a few surgeons specialise in it. I would ask for a referral to a centre which does specialise in it such as Guys and St.Thomas's, and see if their specialist thinks they could achieve a better outcome.

I'm not sure why cancer abutting the urethra is an issue for continence after RP - urethra inside the prostate is removed in any case. Was it perhaps cancer down in the apex (bottom of the prostate) which could be too near to the external urinary sphincter to save that?

I also wonder about doing some focal brachytherapy, but I'm not aware of anywhere which routinely does that in the UK. You could ask one of the specialist brachytherapy centres, such as Mount Vernon Cancer Centre if it's something they might consider.

User
Posted 10 Jul 2023 at 20:35

Thanks Dave. How you have read my situation is the same as I am reading it.  As for the PET CT and MRI scan suggestive of recurrence within the glans. Its just there is no margin, which makes it more than likely regarding the incontinence issue.

Thanks for your reply. 

Martin

User
Posted 11 Jul 2023 at 18:35

Thanks Barry, I will look into Focal Therapy.

Martin

User
Posted 11 Jul 2023 at 19:49

Surely lack of 'margin' and certainty of incontinence rules prostatectomy out, or does it?  I think your best bet is to try and get the urologist, HT/RT, focal therapy etc consultants jointly help you to make a decision.  Is it possible for these guys to talk to one another and help you?

 '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 Jul 2023 at 01:52
It seems from the first post that the urologist has already ruled RP out - it is Nitram himself who is questioning whether it would be an option.

The answer to your question Nitram is that removing the prostate would not stop the cancer from growing wherever else it is in your body - it might slow down the progression but would not stop it entirely. That is why they are sending you to oncology to talk about lifelong HT. When you see the oncologist, you can ask a) whether they believe it has spread to other parts of your body and b) whether there are any other options such as targeted RT (cyberknife), salvage HIFU or chemotherapy.

If you are really keen to explore surgery, you could ask for a referral to one of the few surgeons who specialises in salvage RP as Andy has suggested. S/he may also be of the opinion that you will have complete incontinence but at least you would know for sure. I am only guessing but it sounds to me like your cancer has spread and removal would damage your bladder, not just the urethra - but that really is just a guess based on the 'total incontinence' comment

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

User
Posted 13 Jul 2023 at 20:06

Thanks for your reply.  I can and will at least  get the Urologist to chat with me about, possible options. 

Martin

User
Posted 13 Jul 2023 at 20:27

Thanks for the reply Lyn.

I didn't think to ask those questions, they will certainly clear a few things up for me.

You are right it's more myself that's questioning to Why? is surgery not an option. 

At my first appointment with the Oncologist I just listened and really didn't hear much, apart from the words, incontinence, and tablets for life. I just thought. Oh well that's alright then? 

It wasn't until a few days later and reading up on things I started to think differently and still do.

My Specialist Nurse has been really great and supportive, like wise in learning so much more in PC UK.

I have a telephone appointment 9th August with Oncologist, once they see my latest PSA test results, which will determine when I and I start HT. At this point I have a list of questions to ask, which I hope will clear my mind a little more.

I will update after that.

Thanks once again 

Martin

 
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