Treatment for 54 year old

Hi RadicalRob,

I agree that you need to wait for ALL your tests as the choice might be taken away from you. I was all set for RARP but then at the MDT they changed my staging which meant it was taken off the table.

Both treatment have side effects, I wouldn’t say RT is the easy option, especially if you need  HT as well. Some men seem to get off lightly, but for others like me it is the spawn of the devil!

Good luck with your treatment.

Derek

Hi RadicalIRob

I would wait till you get more information following PSMA. Ideally what you want to know is whether the cancer is confined to the prostate gland and also whether there is a clear negative margin. If this is the case the balance begins to shift towards RP but not definitely because targeted RT may still be a better option depending on how the cancer is distributed within the gland and other factors. If you have RP and than RT, if necessary, RT would be a good back-up. But generally speaking if you go for RT than RP as a back-up is not a good idea although there are consultants who specialise in prostatectomy after RT treatments. This is my reading of the situation about  RT versus RP but, of course, nothing is simple. I have probably confused you further!

I had prostatectomy 12 years ago when RP was a clear choice for me because relatively speaking, RT options were not as advanced as they are now. Would I choose RP now?  I really don't know but with hindsight I am pleased with my decision not withstanding the fact that I suffer from very minor incontinence and ED which is due to my age and the surgery did not help! Generally speaking penile function post surgery - and possibly RT as well - is unlikely to be the same as pre-surgery. But there are many options to help one with ED if you happen to be unlucky.

If I were you I would closely examine the expertise and experiences of the consultants you have excess to and whether jointly they can help you to make a decision. 

I feel that much as I try to be objective about choices it is likely that I am biased towards RP because in spite of the side effects I suffer it has provided me a curative path so far!

Finally, you are young and fit therefore be optimistic about whichever treatment you choose and good luck.

I am 54 and was recently diagnosed. PSA 34.6, no previous tests, T2A, Gleason 4+3. As per the forum topic, the cancer is localised although NHS do intend for me to get a PSMA scan. The oncologist strongly recommended the surgery option for me, primarily "because of my young age". At first I was resigned to this, and I have an uncle who had RP in 2011 with a good outcome. But after a lot of research online, admittedly including a lot of YouTube videos from "experts" who are usually in the US, I was strongly drawn towards RT which appears to have equal results but with reduced side-effects in all areas. However, the one great advantage of RP is the much lower chance of recurrance and I think that's where my age and life exptency come into it.

I'm left confused and it feels an impossible choice. I've mostly talked myself out of the surgery option, everything about RT nowadays seems better, although I understand 10+ years ago that wasn't always the case. Both RP and RT are offered to me, it was just that RP was the recommended route. If I take RT, I just worry that it might be a stupid choice that I will regret. Can anyone offer reassurance about RT? And especially, is there anyone here diagnosed in their 50s (or younger!) who can talk about the choice they made?

Although I don't have private medical insurance, I would consider paying for the procedure, within reason, if it was going to give me greater peace of mind. But from what I read on other threads here, the main draw would be a reduced number of RT fragments (5 instead of 20+), plus potentially no need for hormone therapy, but apart from that the outcomes would be pretty much the same.

I think you have been befuddled by google - the differences you have set out above are nothing to do with going private or NHS - they are just different approaches to RT based on a man's diagnostics and his onco's preference. 

Thanks so much for this Dave. I haven't gone through your story yet but I shall. Yes, the choice does seem impossible. It feels empowering to have a choice, but then the choice becomes impossible.

I shall enquire about Brachy. It sounds like as you say I should push for the PSMA quicker. I have chased a couple of times, but only in an enquiring kind of way. I'll see if it can be brought forward.

I am in the Birmingham/Sandwell area, the QE would be the best in the area and that was already mentioned I think in relation to RP but I'm not sure about where was intended for RT. Luckily my diagnosis was handles pretty speedily (although I had pestered for a PSA scan in the past and pretty much talked out of it. And this time around was chasing a PSA since Sept but took multiple pushes till Jan before it actually happened). The PSMA and treatment were promised speedily also, but like I say, still waiting on the former.

Regarding the private route, it was only something I looked into in the past 24 hours and looked very tempting, particularly in relation to the MRIdian machine. Since discovered it's £32k - £42k though.