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Treatment advise

User
Posted 20 Sep 2023 at 17:41

I've recently been diagnosed , my urologist told me it's stage 1 with a score of 6. I've been offered surgery or active surveillance.  The urologist as told me it's my choice as I'm only 51. My initial thoughts were get it out remove it. Then after a few days of reading lots of literature they give you. I did start thinking is surveillance best. But can't get it out my head that I have cancer growing inside me and I want it removed. 

I have been told about what side effects may happen after surgery,

I was wondering if anyone on here as had the prostate removed and how well they removed 

User
Posted 20 Sep 2023 at 17:56

Sorry you found yourself here Tonks but there are many accounts of surgery on this forum which could answer 6th question. All the men in my Maggies Support Group who’ve had surgery are more than happy with their choice.

User
Posted 20 Sep 2023 at 18:40

I had the op a week ago (I’m a similar age to you) and did a lot of reading / research beforehand. I wasn’t offered AS though as Stage 3, Gleason 7, so choices were HIFU or RO as they ruled everything else out. 

HIFU was front runner for a while (because of the less potentially problematic side effects) but the more digging, the less enamored I was with the a) likelihood % of reoccurrence down the line (and potential issues of RP in the future in terms of nerve sparing etc) and, b) there was talk of HT to shrink the prostate before treatment and I didn’t fancy that at all. 

So with relatively young age on my side (in terms of hopeful recovery prospects) I went RP last Tuesday. Early days yet and recovering well in terms of pain / wounds etc but of course we’re not into the side effect zone yet. Catheter comes out tomorrow and then, well, I guess we shall see. 

It’s a tough decision and no-one wants to be in this position but I ultimately decided ‘get the whole thing out, deal with the aftermath’. 

I found this forum very helpful indeed as I lurked early on, so happy to share if it helps anyone else.

Wishing you all the best. 

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User
Posted 20 Sep 2023 at 17:56

Sorry you found yourself here Tonks but there are many accounts of surgery on this forum which could answer 6th question. All the men in my Maggies Support Group who’ve had surgery are more than happy with their choice.

User
Posted 20 Sep 2023 at 18:40

I had the op a week ago (I’m a similar age to you) and did a lot of reading / research beforehand. I wasn’t offered AS though as Stage 3, Gleason 7, so choices were HIFU or RO as they ruled everything else out. 

HIFU was front runner for a while (because of the less potentially problematic side effects) but the more digging, the less enamored I was with the a) likelihood % of reoccurrence down the line (and potential issues of RP in the future in terms of nerve sparing etc) and, b) there was talk of HT to shrink the prostate before treatment and I didn’t fancy that at all. 

So with relatively young age on my side (in terms of hopeful recovery prospects) I went RP last Tuesday. Early days yet and recovering well in terms of pain / wounds etc but of course we’re not into the side effect zone yet. Catheter comes out tomorrow and then, well, I guess we shall see. 

It’s a tough decision and no-one wants to be in this position but I ultimately decided ‘get the whole thing out, deal with the aftermath’. 

I found this forum very helpful indeed as I lurked early on, so happy to share if it helps anyone else.

Wishing you all the best. 

User
Posted 20 Sep 2023 at 20:27

Is the 6 your Gleason or PSA score, and what's the other one?

With your current diagnosis, you probably don't need to do anything in a hurry. You could take Active Surveillance for 3 months, and see how you handle it mentally, and also see how quickly your PSA is changing (should be PSA tests every 3 months in the first year on AS), assuming your PSA is raised in the first place. You could also use the time to learn more about prostatectomy and how it might impact you. While on Active Surveillance, you have the right to change to active treatment at any point.

Active surveillance is not entirely risk-free - sometimes there's more significant cancer than they found, and occasionally this leads to it spreading elsewhere, but the chance of this happening in 3-6 months is quite low.

Do you have any additional risk factors, such as being a Black African or Caribbean man, or having a father or brother with prostate cancer? I would factor those in to the decision too if so. Also, the percentage/size of tumour and location in the prostate (e.g. near the edge?) would be things to factor in too, which you haven't mentioned.

User
Posted 20 Sep 2023 at 20:50
Ultimately it has to be your decision based on the information that you have available. As someone who has had RP (May this year) I am very comfortable with my decision - mine was worse than the biopsy suggested and so I have permanent ED (but have found other ways to enjoy bedtime!) but the incontinence is now all but over.

AS is an option but you hit on what drove me to RP - the mental knowledge of having it gone rather than always sitting wondering. But at 51 you really need to consider the side effects and how it will impact you and your partner at this stage in your life.

Godd luck

User
Posted 20 Sep 2023 at 21:05

I don't have any of the risk factor but been having PSA tests for nine months and they have risen each time, originally 9 months ago I was told it was  BHP, but after a second set of biopsies taken because of the rise in levels I was diagnosed with prostate cancer, they said it was a 3on the left side and 3 on the right side giving it a score of 6

User
Posted 21 Sep 2023 at 08:53

Originally Posted by: Online Community Member
 I was diagnosed with prostate cancer, they said it was a 3on the left side and 3 on the right side giving it a score of 6

In which case you really have 3 choices

AS - sit and wait it out knowing it won't get any better so eventually you will have to do something.

RP - get it out but then have to deal with ED (which is likely to be temporary but could be permanent depending on the surgeons skill) and incontinence (likely temporary but can be psychologically tough)

Brachy - might be an option with minimal side effects but if it isn't successful then it can lead to very complicated surgery later.

Not a great place to be in but at least they have found it early - 3+3=6 is not a bad place to be in.

Good luck

User
Posted 21 Sep 2023 at 10:59

Hi Tonks 

Sorry to hear about the diagnosis. It’s a bit of a roller coaster ride for sure.

just be mindful in ~45% cases histology is usually upgraded with post surgery histology. I was very much in the same place with stage 1 Gleason 6 prostate cancer in September 2019. Based on the fact that even low grade cancer has all the mechanisms to potentially migrate (metastasise) I took the decision to act quickly. Pleased I did as I found a top high volume professor to do the work at a flagship hospital. As I turned out my cancer was more extensive than scans and the biopsy had shown and it was very close to breaking out of the prostate capsule. Histology came back Gleason 7 (3+4) T2C N0 MX. This far my PSA are coming back as undetectable and have my  4yr blood test scheduled for November so fingers crossed.

ED was never an issue for me other than if I’m tired so I count myself fortunate in that regard. Continence has always been excellent once it settled 5 weeks post op. I do get the odd minor drip now and again on a full bladder but it’s nothing more than that so pretty much normal. I never have issues lifting heavy weights in the gym etc 

fyi I had a Retzius sparing robotic assisted radical prostatectomy + neuroSAFE at London Guys (private) with the expert hands of the Prof whocantbenamedonhere and his sidekick Da Vinci Xi robot 🤖 

User
Posted 21 Sep 2023 at 11:55

Originally Posted by: Online Community Member

AS - sit and wait it out knowing it won't get any better so eventually you will have to do something.

I am always reluctant to make definitive statements on here. I am even more reluctant to post articles where something is true in about 1 in 100000 cases, for fear people may put false hope in probability rather than medics. This article does discuss cancers and has a section on prostate cancer.

https://www.nytimes.com/2009/10/27/health/27canc.html

It mentions how few men have AS, but remember this is because many men need to address a psychological desire rather than the cancer cells.

This is far more sensationalist reporting from the BBC.

https://www.bbc.com/future/article/20150306-the-mystery-of-vanishing-cancer

I often advocate for AS if it is in the menu of options but forward by a patients medics. Peoples immune systems are constantly dealing with cancer cells. About half the world's population will never develop cancer, not because they never had a cancer in their body, but because their immune systems suppressed it.

So AS can be viable; cancer probably won't get any better, but it may not get any worse. If it does progress it will be at least a little bit worse than if you had treatment earlier, and in a few cases a lot worse.

 

Dave

User
Posted 21 Sep 2023 at 12:25

Thanks for your reply, my head is saying remove it, As I keep thinking with the state the NHS is at the moment , with strike etc , if I went for surveillance are my appointments blood tests etc gonna get cancelled then they miss something.

User
Posted 21 Sep 2023 at 13:25

Originally Posted by: Online Community Member

...if I went for surveillance are my appointments blood tests etc gonna get cancelled then they miss something.

That is a very valid concern. I know someone on AS, and he is constantly chasing up his consultant who is a surgeon, and really can't be bothered with the mundane treatment of AS, rather than the cut and thrust of surgery.

Dave

User
Posted 21 Sep 2023 at 13:30

Originally Posted by: Online Community Member
So AS can be viable; cancer probably won't get any better, but it may not get any worse. If it does progress it will be at least a little bit worse than if you had treatment earlier, and in a few cases a lot worse.

Dave
I think the day will come when treatments based around T cells are sufficiently developed to allow AS to be a viable treatment option. Unfortunately we are still some way away from making that a reliable alternative and the natural body's ability to fight off cancer is extremely hit and miss.
I suspect (without evidence) that AS is offered to allow patients to live side-effect free for as long as possible until more drastic measures are needed as well as to balance the workload of hospitals and surgeons. But then again, maybe I am just a cynic :)

 
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