Treatment options for localised cancer

Hi Adrian thanks for the reply and sharing your journey. The dilemma is if I have radiotherapy as my initial treatment and there is a reoccurrence then I can’t then have surgery or further radiotherapy.

hope you don’t mind me asking how was it after surgery? How long did it take you to have control over your bladder.

many thanks Dave

Thanks for the reply Adrian. I have my pre-operation visit on Monday so have a little bit more time to decide.

best of luck for the future Dave

Hi Dave,

 my diagnosis was similar to yours, though I was on the edge between T2b and T2c. I ended up having the 5 day treatment and I have to say it was a breeze. I had about a week immediately afterwards of wanting to be sure where the nearest loo was, but after that it was straightforward. 

The argument for starting with RP, and keeping RT in reserve as a salvage treatment should it be needed, is frequently aired, and there's a sound logic to it. But equally - since you  are planning for a curative solution-  it makes sense to have as your first treatment the one which is best ( for you) in its own right. As you will have discovered, the hard statistical data doesn't point conclusively towards either of the main treatment strategies, so you have to look inwards, and determine your emotional response to the various options and implications.

Best of luck

As you say, the possibility of salvage RT if PSA rises after surgery is a case for surgery, as is the very sensitive detection of recurrence since PSA should be zero once you don't have a prostate.

But it is a personal decision and you also need to think about side effects. Surgery takes the cancer right out (if everything works and they were right about no spread) but creates a risk of ongoing problems with urinary continence and erectile function - and there will certainly be short term issues. Radio will again have short term effects but functions should largely recover, but there is a long term risk of raised cancer risk in the bladder and colon, and no one enjoys the hormone therapy which has previously been involved. While 5 session RT is too new to have longterm follow up the most modern RT machines should minimise radiation spillover to adjacent organs and I would hope those risks are now less than in the published studies (if you think about it, any study with 10 year follow up has to have used older technology). Your age makes a difference, if you are under 60 you will more likely have good recovery from the trauma of surgery and a theoretical risk 20 years hence is a bigger issue.

There isn't a right answer, you just need to decide what you are happy with yourself. The PCUK resources are very helpful and there are nurses to talk to if that helps.

Hi Dave,

I had surgery and have never regretted it although I've often wondered if RT would have been better for side effects or certainty of cure.

I was unaware the 5 day RT is being offered as standard and that it's offered without hormones.  The 5 day treatment is very interesting but I'd be wary about having RT without hormones.  It's normally said hormones shrink and weaken the rogue cells making them more susceptible.

I'd want the doctor to explain why only 5 days and why no hormones.

I wouldn't delay treatment to make up my mind, if you get a fast surgery date I think I'd tick that box right away.  Although 5 days RT and no hormones would be great if you are a very low graded risk.  A 4 in your Gleason isn't normally very low but I'd want the doctor to explain that.   You may never be certain it was the right choice.

All the best Peter

p.s. I like to add a caveat that this is just an untrained opinion.