Radiotherapy vs Radical Radical Prostatectomy

User

Posted 18 May 2024 at 19:34

I was diagnosed with a gleason score 3+3 just under a year ago and decided to do active surveillance. Last week I got results from a second biopsy showing the cancer had now turned aggressive 4+3 and now need treatment. I am only 51 and the surgeon is recommending surgery because he says radiotherapy is higher risk due to my age I guess due to secondary cancers. By pure coincidence my work colleague in his 60s was diagnosed with similar Gleason score just a year ago but chose radio therapy via MRIdian MR linac in Oxford and was treated successfully with no significant side effects. Given the apparent higher risk of incontinence with surgery I am going to explore both options but wondered if anyone had experience of making this decision at a younger age i.e. 51, and is secondary cancer due to radiation a significant issues especially with this focused beam therapy.

User

Posted 20 Jul 2024 at 10:13

Hi there. I thought I'd post an update following my RALP surgery that might help men just about to go through this journey. As a reminder, I am 52, had a 4+3 Gleason with a 1cm tumor on one side of the prostate and PSA of 5. My surgery was just over three weeks ago now. Nerves were removed on one side but spared on the other.

The robotic surgery went fine (fantastic job by Ed Rowe and the team at Southmead Bristol).

On waking up after 4 hours of surgery there are those mixed emotions of being ecstatic the surgery is over and hopefully, the tumor that I have been living with for what seems like an eternity has finally left the building, while at the same time seeing a catheter and lots of wounds and realizing the recovery is only just beginning.

I spent one night in the hospital and home the next day. Because you are operated on for 4 hours laying 45 degrees downwards, my shoulders ached badly for about 4 days afterward but fine after that.

I quickly got used to living with a Catheter and found using a coat hanger sandwiched between the mattress and bed frame with the lower velcro strap attached worked a treat to hold it while sleeping. I was up on my feet for small stints during the day, and made a little walk to park after just a week. Only forget to close the catheter tap once typically on the last day after emptying it!

The catheter came out after 2 weeks and was nothing to worry about, a 2-second weird discomfort then all over. I had heard some horror stories on this site about men needing 20 pads a day initially so bought loads of pads and nappies but I am pleased to report I just used one pad on the 1-hour car journey home. No leaks while sitting or sleeping from day 1 of removal.

Just under 3 weeks after surgery I made my daughter's graduation, a 1 hour drive, on my feet for a lot of the day but just needed one pad. I assume my leaks are caused by pulls on the wound between the urethra and bladder which is still healing as they come occasionally while walking, coughing, or bending and are a little bloody.

No sexual sensations down below yet, on drugs to stimulate the nerves but the consultant says it can take up to 2 years and may never come back so just need to be patient on that one.

The biopsy of tumor came back as 4+3 i.e. same as before and although it had broken out on one side because nerves were also removed the consultant thinks it has safe margin and lymph node was clear. So now just need to wait on PSA results in 3 weeks time.

So there we are, I know the journey for each of us is different but hopefully this is a positive story that we all need when going through this.

User

Posted 19 May 2024 at 13:56

Hi Skier

Incontinence was definitely a big factor of concern for me. The way to mitigate it as much as possible is finding a high volume surgeon. The chap I was very fortunate to find blew most people’s stats out of the water and is regarded as a pioneer in the field. retzius sparing RARP made sense in terms of quicker recovery plus NeuroSAFE. NeuroSAFE is a fantastic concept where while you are open a pathologist takes frozen sections of your prostate for rapid analysis.. this was particularly useful for me because I had some suspicious margins initially so they were about to resect additional tissue… thankfully however, when these went to post op histology for detailed analysis ruled out any positive margins which was very good news indeed.

A key point to consider with the Gleason 6 (cell grade 3) is that in histology after surgery in about 44% of cases you will be upgraded as mine was.

prior to surgery I made a point of reading a number of research reports similarly on early stage PCa and the dynamics of pathology where clinicians debated why some doctors consider type 3 cells as not truly cancer and can be safely left….the general view amongst pathologists appears to be that grade 3 cells are indeed cancer in every accepted classification of the term and perfectly capable of metastasis. This was one of the fundamentsl points that pushed me towards acting sooner rather than later in the knowledge that mets can migrate and sit happily in a distant site and remain dormant for decades. Technically I might be too late also in that regard but hope by the time they reactivate, if ever….next gen treatment will be online.

The cancer journey is very much a rollercoaster ride of step-by-step blood tests and review with fingers crossed. Surprisingly the brain appears to adapt well over time from a psychology perspective and these days I only really get anxious near annual PSA bloods.

User

Posted 19 May 2024 at 15:21

Hi Skeir,

It is very likely that you were always Gleason 7 and that the more aggressive cells were missed or misdiagnosed on your first biopsy. My understanding is that the character of the cancer does not change. I was diagnosed G3+3 on my first biopsy in just two cores. Two years later in a perineural biopsy I was diagnosed G3+4 in 15 cores out of 20 and staged at T2b. I readily accepted the recommendation for surgery. Post op pathology (to my mind the only one that can be truly accurate) staged me at T3a. So, I was pleased I had it out at that time.

Peter

User

Posted 21 May 2024 at 11:00

Thanks Richard much appreciated. , Thats the consultant I am seeing so let's see how I get on Thursday.

User

Posted 24 May 2024 at 21:53

Skeir, you have a dilemma most of us have faced. And you have summarised the issues well.

As Adrian says, a biopsy is only a sample and the difference a year later means the difference is more likely in the sampling than in cancer progression. And if you choose to have surgery, pathology will be done on the whole prostate which may change the grading again.

On paper both approaches have roughly similar success rates, and both have side effects. Although if you receive radiotherapy on the latest machines the risk to nearby organs should be less than it used to be. The decision is personal.

As you recognise age matters, which is why surgery tends to be favoured among younger patients and radio among older. The younger you are the better you recover from what is pretty serious surgery, and you are more likely to live long enough to experience a secondary cancer (though as said above, those risks should be reducing). And following surgery you have radio still available should cancer return while the reverse is rarely the case. On the other hand the worst side effects of surgery, incontinence and erectile dysfunction - which not everyone gets to a debilitating extent - are going to be worse with a lot of your life before you.

It is tough for all of us making the decision. There are men here who have chosen both with good success, and others who are suffering from ongoing side effects or recurrence whichever they chose (to be fair, successes are under-represented, those happy folk stop following the forum and posting).

User

Posted 24 May 2024 at 23:10

Thanks all for the posts this week. It’s been very supportive and really appreciate you sharing your own experiences. For me it’s still not quite sunk in yet given I only found out a week ago but at least I can start to see a path forward albeit a challenging one.

User

Posted 25 May 2024 at 13:34

Adrians advice is spot on skier, it comes as a real shock to all of us to be faced with our mortality. However now that your treatment plan is in place you should be in a better place and come to terms with the disease. Focus on getting yourself in the best possible physical and mental shape before your Op, do your pelvic exercises, and finally be good to yourself, do lots of nice things and give yourself treats to keep your mind from wandering.

I wish you good luck with the Op and that your recovery will be good and steady.

Derek

User

Posted 25 May 2024 at 15:25

Originally Posted by: Online Community Member

easier said than done but try and focus on beyond the surgery. My chocolate starfish was twitching like a rabbits nose beforehand. Like exams nerves amplified to infinity. When I woke up from surgery relaxed and relieved it was over and pondered the fact that I need not have worried at all. Next stressed bit was waiting for the surgeons report which was in my inbox (cc gp) 2.5hrs post op and then 7 days until histology buzzed my inbox delivering favourable results.

its a hell of a roller coaster ride but i found surgery not really much more uncomfortable than when I had my tonsils out.

hope everything goes well and ride out the occasional wobbles as the surgery is over in a blink 😀🙏

Edited by member 25 May 2024 at 16:08 | Reason: Not specified

User

Posted 20 Jul 2024 at 10:52

Cheers and thanks for the update. Good luck with your histology results and first post op PSA. I hope that you continue to have a speedy and full recovery.

You're sixteen years younger than me. Loss of erections were a major setback for me. I attended an ED clinic 6 months post op and was prescribed Invicorp injections, they worked for me. Giving a good enough erection for penetrative sex. Later, if you don't get erections, it might be worth giving it a try.

User

Posted 22 Jul 2024 at 13:07

Hi Skeir,

Thanks for sharing your journey - I have just read the whole thread as I have got a similar decision to make, and reading your posts was very helpful.

I have just returned from the surgeon, who was checking my MRI results. I am 42, so a bit younger than you, and diagnosed with a Gleason score of 3+3. My PSA level was actually low/normal, and they only discovered the tumour while dealing with something minor and unrelated. I believe there was only one core that came back positive in the biopsy.

Anyway, now the surgeon has told me I must make that decision between radiotherapy and surgery with a robot (he believes surgery is best, but admits that is because he's a surgeon). I will speak to a radiologist, but I'm leaning towards surgery because of the fear of the cancer returning. I'm very scared of the operation and the side effects, but somehow having a choice between two treatments has given me a better feeling of control over the situation, if that makes sense.

All the best for you and I hope the recovery continues to be positive.

C

User

Posted 22 Jul 2024 at 22:47

Originally Posted by: Online Community Member

CC Brun,

Have you not been offered the possibility of ' Active Surveillance, with a Gleason score of 3+3?

JedSee.

I asked CC Brun the same question, a couple of months ago, on his conversation https://community.prostatecanceruk.org/default.aspx?g=posts&m=297211#post297211

I'm mystified why he has been advised that he is too young for active surveillance.

Edited by member 22 Jul 2024 at 22:58 | Reason: Link

User

Posted 23 Jul 2024 at 04:44

Hi Adrian,

I'm not sure either - but if I could find someone to strongly advise AS, I would probably go with that! But I'm yet to find anyone who doesn't believe RP is the best option.

(Apologies for hijacking someone else's thread here :-) I'll update mine if I hear anything else or need more advice soon)

User

Posted 23 Jul 2024 at 17:16

Originally Posted by: Online Community Member

Hi Skeir,

Thanks for sharing your journey - I have just read the whole thread as I have got a similar decision to make, and reading your posts was very helpful.

hi CC

My initial diagnosis was 3+3 but as it fairly common place the biopsy/scans don’t always tell the full story. Very much the case with mine as had I waited any longer it would have gone T3 and breached the prostatic capsule plus higher chance of mets etc. AS is all very well and something I was offered. Pleased I decided to opt for surgery ASAP… fundamentally the longer the cancer is in there (even type 3 cells) the higher chance of spread plus be mindful that in ~44% cases the cancer staging is upgraded with post op histology.

User

Posted 29 Jul 2024 at 14:26

Originally Posted by: Online Community Member

She also added you'll be 72 in 15 years, how long do you want to live? You are aware we have euthanasia here.

She sounds a bundle of joy. Perhaps she has shares in Dignitas. 😁

Show Most Thanked Posts

User

Posted 19 May 2024 at 01:16

Hi Skier,

I was 52 and had to make the same decision. My surgeon and clinical team discussed all treatment options at length however gave me a good push towards surgery again because of my age and for the same reason as yourself.

I am guessing you are concerned about incontinence and ED. Did you discuss whether the surgery was nerve sparring or if the position of the legion was likely to lead to long term incontinence? Even with nerve sparring there are no guarantees, some are able to have erections straightaway however for others it takes much longer.

Read my profile if you want to see where I am on this journey.

User

Posted 19 May 2024 at 10:03

Hi skier

This whole journey is like a double diamond mogul field.

I had same issue as was about your age when going through this process late 2019.

The risk of secondary primary is real but normally raises its head 15-20yrs down the line I think.

I hear stenosis (scaring) can be more of an issue with urethra/bowel etc although the tech is improving this with more focused beams.

i went down the surgical route as general consensus was to get it out for best outcome probability. I accepted ED and incontinence issues as being cancer free was primary goal. I’ve been lucky with the ED even though one side nerves were removed. I can get near normal potency and if not I just pop a PDE5 inhibitor like tadalafil. Urology is settled and only get the odd drip now and again but I don’t need pads and the drips are very predictable ie when I lean forward on a full bladder over the sink. I do a lot of weights in the gym and never have any issues.

hope that adds some reassurance.

User

Posted 19 May 2024 at 10:33

Many thanks for that info. The surgeon also said he would aim to save nerves on one side so guess I have a similar prognosis as you. To me the fear of incontinence is the big one as it impacts everyday life, ED would be a real bummer but I could live with that, I have 3 lovely kids but don't need anymore :) The radio beam therapy I am investigating is only done in Oxford and Milton Keynes and looks like it may be more advanced and targetted than more traditional radio therapy hence I have arranged a meeting with the consultant there to discuss it. As I say it's only because by pure coincidence my work colleague in his 60s was successfully treated with this a year ago and never had to use a single pad or has suffered any big side effects at least yet, I am exploring it although in reality, like you, I will probably end up with surgery due to my age.

But as you say there is no easy decision when it comes to this. I thank myself lucky a private specialist pushed for a second biopsy due to the PSA rate given only 6 months earlier showed just 3+3 and again looking on the web the strong message seemed to be if it's 3+3 you can forget it as it very rarely becomes aggressive but that's certainly not my experience so maybe I'm just one of the unlucky ones.

User

Posted 19 May 2024 at 10:46

Thanks Jim, useful advice.

User

Posted 19 May 2024 at 13:56

Hi Skier

A key point to consider with the Gleason 6 (cell grade 3) is that in histology after surgery in about 44% of cases you will be upgraded as mine was.

User

Posted 19 May 2024 at 15:21

Hi Skeir,

Peter

User

Posted 19 May 2024 at 22:36

I was 53 when diagnosed but the stage of the cancer left only one sensible treatment choice, so I did not have the unenviable position of having to make a choice.

There may be other options for you like HIFU, but for simplicity let's assume it's just RP or RT. The chance of cure from either treatment is about the same, usually quoted as 70% but your cancer being identified at an early stage it is probably a better than 80% chance of being cured. The side effects are the main thing for you to balance the risk and severity of. I would say the worst side effects of surgery are worse than the worst side effects of RT, but most people don't get very severe side effects from either treatment.

I think the risk of RT causing other cancers is minimal, but a strong argument for removing your prostate is that by the age of 51 it has already developed cancer once, assuming you live another 40 years what is the chances of it developing cancer again? I would say moderately high.

For a 60 year old, with perhaps 30 years to live post treatment the odds of developing another cancer are stacked more in their favour.

How much weight one should place on prostatectomy as a precaution against future cancer I do not know.

Dave

User

Posted 20 May 2024 at 08:33

Thanks all for the comments this weekend. I did a bit more digging into the Linac MRI treatment and the main difference from traditional directed beam is that the scanner monitors the tumour in realtime and if it moves by just a mm the beam stops for re-adjustment whereas I believe with a more traditional one you have a scan in a fixed position then they treat it. Hence basically there is less chance of damage to healthy tissues and interestingly they claim they can use this as a second treatment if traditional radio therapy fails. Also it is so accurate health insurance companies won't pay to have protective spaces inserted to protect surrounding regions i.e. you can have them but you have to pay yourself. There is actually one at the Royal Marston NHS hospital as well as other private hospitals covered at least by my bupa. As I say I was amazed with the treatment my colleague had in that he was basically back in office next day after having just 5 zaps over a period I believe of a week with some hormone treatment 3 months earlier. And for me at 51 that's what's making the decision so hard as it just seems to be general acceptance I am to young for radio therapy although I guess most research is based on the traditional targeted approach. Hopefully have a chat with the radio therapy consultant early this week so will report back what his view is as not surprisingly there is a degree of bias between surgeons and radiologists.

User

Posted 20 May 2024 at 20:05

Hi Skeir,

I had the MRILinac treatment 2 years ago. It was 5 days over a couple of weeks ( Monday, Wed, Fri, Tues and Thursday. The treatment was a breeze- most of my side effects related to the HT, which for a variety of reasons I had been on for quite a while. I can attest to the fact that the device is pretty sensitive in real time- one of my treatments was paused as a gas bubble made its way round the firing zone!

For obvious reasons it's way too early to say whether or not the 5 day treatment has any effect on the likelihood of radiation- caused cancers down the line.

Good luck with whatever course you decide upon

User

Posted 21 May 2024 at 02:59

Originally Posted by: Online Community Member

Also it is so accurate health insurance companies won't pay to have protective spaces inserted to protect surrounding regions

The accuracy factor for LINACs also makes it possible to deliver a higher concentration of radiation to the targeted area, without causing collateral damage.

In some situations it's almost impossible to choose the "best" treatment but skills and technology vary from place to place so see what you can dig up about the quality of whichever experts you go with.

Jules

User

Posted 21 May 2024 at 09:31

Thanks again for replies and yes only heard positive things so for for the MRI Linac which is making it so difficult as the problem for me is age at just 51 its the long term radiotherapy effects relating to secondary cancer especially with a history of bowel cancer in my family. And I guess there is just not the long term data yet for this approach given it' only been in active use for several years. Got a consultation with the Linac specialist in Oxford who is one of the experts in the field on Thursday so let's see how that goes.

User

Posted 21 May 2024 at 10:46

Hi skeir I’m a little older than you at 59 but had the same dilemma. I’m lucky enough to have private health insurance and opted for the MRIdian radiotherapy at Genesis Oxford. I’m 3 sessions in out of 5 and finish Thursday. For me I didn’t fancy going through surgery and the increased risk of ED and incontinence. As an ex firefighter I have a lot of ex colleagues that have suffered from PC. Of those that elected to go down the surgery route they have been by far the ones with the most side effects. So far my treatment has been fuss and trouble free with absolutely no pain or other issues. [Drs name removed by moderator] is my consultant there. He’s a great guy. Good luck with whatever you decide to go for and feel free to reach out at any time.

Edited by moderator 24 May 2024 at 14:54 | Reason: Not specified

User

Posted 21 May 2024 at 11:00

Thanks Richard much appreciated. , Thats the consultant I am seeing so let's see how I get on Thursday.

User

Posted 24 May 2024 at 02:02

Also in the same boat in re the choices. I have been told by both the surgeon and the radiation oncologist that I am a good candidate for both, with the surgeon saying surgery is the best option and radiation the second best option. I am leaning toward the radiation therapy (having met the radiation doc today) because of how comprehensive the doctor was, having spent over an hour with me walking through the process and answering my questions. The surgeon, whilst not unpleasant, took 10/15 minutes to let me know what his option was like.

The incontinence issue is a big one for me: catheter, incontinence pads……. Slightly less risk of PED with radiation as well is a benefit. So that’s where I am at. They want to start treatment soonish, as 14 of the 16 core samples showed cancerous, with a Gleason of 7 and a PSA of 15 at last test. They did another PSA today so I’ll know if it has elevated since the last PSA.

Thanks to all of you, and best wishes to you for good health and on your journey.

User

Posted 24 May 2024 at 09:16

Skier, One of the issues for 'younger' men like us is the lack of large scale studies on our age group. Upon diagnosis I was told I likely had 15 years to live if I had treatment. My wife broke into tears and I was left to explain that the stats are skewed very much to men 10 years or more older than myself. Makes the decision some what more difficult as to which treatment if you are looking at long term outcomes.

As an aside here is one benefit of RP that my wife pointed out the other day - sex is less messy... 😁

User

Posted 24 May 2024 at 09:37

I think a lot of men on here given the choice of RP or RT/HT would have opted for RP….I certainly would. It’s not the RT that’s caused me issues, but 2 years on HT has seriously affected my QOL. However with 5 session of RT and NO HT, I think the choice is much closer and more difficult to make.

Good luck with whatever you decide!

Derek

User

Posted 24 May 2024 at 09:43

Originally Posted by: Online Community Member

As an aside here is one benefit of RP that my wife pointed out the other day - sex is less messy... 😁

But only when you've managed your climacturia (peeing yourself when you come.) 😄

Edited by member 24 May 2024 at 12:45 | Reason: Additional text.

User

Posted 24 May 2024 at 10:17

So I spoke yesterday to the Radiologist who is an expert in the field of MRI Linac based in Oxford a very nice guy.

Although he said I would be a suitable candidate for treatment at just 51 he was honest to say there are other factors to consider.

1) After the Radiotherapy the remains of the prostate effectively stick to bladder and other organs so can't be removed by surgery and hence it is re-occurs in the remaining tissue it is not good.

2) But after surgery if cancer returns you can treat it with the MRI LInac

3) You are typically are only offered Radio therapy once on your pelvis region due to secondary risks

4) Secondary cancer probability generally caused by radio therapy even at my age is around 1% so not as I high as I imagined.

5) But given my young age recurrence is more likely to reoccur.

So after taking all these things into account like most men at my age I have opted for Surgery end of June just to keep as many future options on the table if all doesn't go well so wish me luck.

Just very scary how it has gone from a biopsy of 3+3 with PSA of 5.5 to 4+3 in just 5 months i.e. don't just assume because its 3+3 it will stay like that for a while. I am just thankful based on just an increasing PSA of 5.8 my urologist insisted I got another biopsy just to be on the safe side.

User

Posted 24 May 2024 at 10:43

Skier,

I am glad you have set out this reasoning so clearly. It comes up time and again this question. Good to explore the options but you just have to trust the experience of the professionals.

User

Posted 24 May 2024 at 11:30

Originally Posted by: Online Community Member

Morning skeir.

Biopsies are not infallible. It is rare for your Gleason score to progress. As plexx09 stated earlier it is far more likely that your first biopsy missed the more aggressive cells.

I speak from experience. My first biopsy showed Gleason 6 (3+3), only 2 from 14 cores, only 10% cancerous, T2a. Based on Iow grade, low volume, and well contained cancer, I selected AS.

18 months later, a follow MRI and biopsy, revealed Gleason 8 (4+4), 20 out of 24 cores, all at least 40% cancerous, capsule breached T3a.

I had a prostatectomy and the pathology of the prostate was upgraded it to Gleason 9 (4+5)

I've been informed that the Gleason score was very unlikely to have progressed in this time, and that it was more a case of the first biopsy missing the the most cancerous cells. It appears the bloke who did that first biopsy must have been a lousy darts player. 🙂

User

Posted 24 May 2024 at 11:53

Yes should have got Luke Littler doing the biopsy :)

User

Posted 24 May 2024 at 12:52

Originally Posted by: Online Community Member

Yes should have got Luke Littler doing the biopsy :)

Or a urologist, Amy Goode. Who was as accurate as her name. 😂

Edited by member 24 May 2024 at 14:56 | Reason: Additional text

User

Posted 24 May 2024 at 21:53

Skeir, you have a dilemma most of us have faced. And you have summarised the issues well.

User

Posted 24 May 2024 at 23:10

User

Posted 25 May 2024 at 10:39

Originally Posted by: Online Community Member

As an aside here is one benefit of RP that my wife pointed out the other day - sex is less messy... 😁

nailed it! No cleaning up needed these days and the orgasms tend to be longer and more intense….her loveliness is a bit envious 🤪🫢🤣

User

Posted 25 May 2024 at 11:03

Originally Posted by: Online Community Member

For me it’s still not quite sunk in yet given I only found out a week ago but at least I can start to see a path forward albeit a challenging one

It's very early days mate but you'll cope. Please keep us updated. It makes it easier for you and us if you continue to use this conversation. It saves a lot of repetition.

Good luck pal.

User

Posted 25 May 2024 at 13:28

Originally Posted by: Online Community Member

As an aside here is one benefit of RP that my wife pointed out the other day - sex is less messy... 😁

nailed it! No cleaning up needed these days and the orgasms tend to be longer and more intense….her loveliness is a bit envious 🤪🫢🤣

Actually I think it can be MUCH more messy for those who spurt urine at orgasim (i.e., at that point they are FAR from dry). I believe such individuals are not entirely small in number post RP - at least according to many of the reports on these boards. This may well be because the sphincter is relaxed if NOT COMPLETELY ERRECT. From what I read it is suggested that you relieve yourself prior to engaging in sex and use the appropriate tools to get a full and complete erection to guard against this - if indeed you find that is required - which I understand for many it is.

User

Posted 25 May 2024 at 13:34

I wish you good luck with the Op and that your recovery will be good and steady.

Derek

User

Posted 25 May 2024 at 15:19

Originally Posted by: Online Community Member

As an aside here is one benefit of RP that my wife pointed out the other day - sex is less messy... 😁

nailed it! No cleaning up needed these days and the orgasms tend to be longer and more intense….her loveliness is a bit envious 🤪🫢🤣

had exactly this. I empty my bladder beforehand and problem self mitigates.

User

Posted 25 May 2024 at 15:25

Originally Posted by: Online Community Member

its a hell of a roller coaster ride but i found surgery not really much more uncomfortable than when I had my tonsils out.

hope everything goes well and ride out the occasional wobbles as the surgery is over in a blink 😀🙏

Edited by member 25 May 2024 at 16:08 | Reason: Not specified

User

Posted 20 Jul 2024 at 10:13

The robotic surgery went fine (fantastic job by Ed Rowe and the team at Southmead Bristol).

I spent one night in the hospital and home the next day. Because you are operated on for 4 hours laying 45 degrees downwards, my shoulders ached badly for about 4 days afterward but fine after that.

No sexual sensations down below yet, on drugs to stimulate the nerves but the consultant says it can take up to 2 years and may never come back so just need to be patient on that one.

So there we are, I know the journey for each of us is different but hopefully this is a positive story that we all need when going through this.

User

Posted 20 Jul 2024 at 10:52

Cheers and thanks for the update. Good luck with your histology results and first post op PSA. I hope that you continue to have a speedy and full recovery.

User

Posted 22 Jul 2024 at 13:07

Hi Skeir,

Thanks for sharing your journey - I have just read the whole thread as I have got a similar decision to make, and reading your posts was very helpful.

User

Posted 22 Jul 2024 at 13:57

Skiers post sums it up pretty well on decision process for us 'younger' men.

At 52 I was actually nudged towards the treatment the clinicians thought was the best option, so for me it was easy to decide.

Edited by member 22 Jul 2024 at 13:59 | Reason: Not specified

User

Posted 22 Jul 2024 at 20:28

CC Brun,

Have you not been offered the possibility of ' Active Surveillance, with a Gleason score of 3+3?

JedSee.

User

Posted 22 Jul 2024 at 21:24

Hi JedSee,

No I haven't - apparently I'm considered too young for it.

User

Posted 22 Jul 2024 at 22:47

Originally Posted by: Online Community Member

CC Brun,

Have you not been offered the possibility of ' Active Surveillance, with a Gleason score of 3+3?

JedSee.

I asked CC Brun the same question, a couple of months ago, on his conversation https://community.prostatecanceruk.org/default.aspx?g=posts&m=297211#post297211

I'm mystified why he has been advised that he is too young for active surveillance.

Edited by member 22 Jul 2024 at 22:58 | Reason: Link

User

Posted 23 Jul 2024 at 04:44

Hi Adrian,

I'm not sure either - but if I could find someone to strongly advise AS, I would probably go with that! But I'm yet to find anyone who doesn't believe RP is the best option.

(Apologies for hijacking someone else's thread here :-) I'll update mine if I hear anything else or need more advice soon)

User

Posted 23 Jul 2024 at 17:16

Originally Posted by: Online Community Member

Hi Skeir,

Thanks for sharing your journey - I have just read the whole thread as I have got a similar decision to make, and reading your posts was very helpful.

hi CC

User

Posted 29 Jul 2024 at 14:07

I'm 56 same diagnosis as you except mine is on the left side and the surgeon said no possibility of sparing and therefore I'd have no feelings in penis afterwards, my UK doctor recommended surgery as radiotherapy causes issues in 15 years time.

I'm fortunate to have access to Spain's medical system, the surgeon there said, you should consider radiotherapy because, with surgery 1. No penis use 2. Very high risk of incontinence because I'm overweight 3. Because with surgery it's unlikely to capture 100% and I'll need radio.

With radiotherapy, some ed, lower risk of incontinence, I can have the op later on if my PSA rises. She also added you'll be 72 in 15 years, how long do you want to live? You are aware we have euthanasia here.

I've started hormone treatment and I start my radiotherapy in October (scheduled around me looking after my granddaughter)

User

Posted 29 Jul 2024 at 14:26

Originally Posted by: Online Community Member

She also added you'll be 72 in 15 years, how long do you want to live? You are aware we have euthanasia here.

She sounds a bundle of joy. Perhaps she has shares in Dignitas. 😁

User

Posted 29 Jul 2024 at 21:47

Andy Muir, good luck as you go through the decision that most of us here have agonised over.

At 56, assuming the weight isn't too much of an issue, you should be young enough to recover well from surgery. But if the nerves can't be spared you are likely to have erectile dysfunction (not loss of sensation though, that might be a translation issue). Radiotherapy has been improving massively with the latest generation of machines, so the longer term adverse effects should be less than they used to be, but I think it is still true to say that if you have recurrence then RT following surgery is much more likely to be a realistic option than surgery after RT.

I will turn 72 in a few weeks, and I am still hoping to enjoy a reasonably fit life into my eighties. However I do know from helping my own and my wife's elderly relatives that very few of us avoid a decline in our late eighties and certainly in our nineties.

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Radiotherapy vs Radical Radical Prostatectomy

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