What are the options?

Flow problems mean that a prostatectomy would have the additional advantage of sorting those out too. Conversely, radiotherapy (particularly brachytherapy) might make flow issues worse during treatment, although that's resolvable with a catheter. However, a prostatectomy with a T3a G9 diagnosis is the highest risk of recurrence needing salvage radiotherapy. If he's T3b,* they won't offer surgery.

If you go for radiotherapy (and hormone therapy), they would usually fix the flow problems first, because fixing them afterwards has a higher risk of damage to urinary continence. However, with a T3 G9 diagnosis, they might not want to wait to do that unless they can fit it in immediately as you start on the hormone therapy.

You don't have the full diagnosis yes, and in particular, it's very significant if it's T3a or T3b * which you haven't said. This means there are pros and cons for both, and not an obvious winner. Make sure you talk with both surgery (prostatectomy) and oncology (radiotherapy), and compare what they both recommend.

I would certainly ask oncology about HDR Boost, which is a combination of external beam radiotherapy and high dose rate brachytherapy, which in my view is a good fit for many T3{a or b} G9 cases, and can even cope with a little bit of N1 (one or two local lymph nodes). It can optionally include radiotherapy to all the pelvic lymph nodes at a low prophylactic dose to kill off any micro-mets (mets too small to show on any scans) which have already got into pelvic lymph nodes which is a significant risk with T3 G9. HDR Boost is only done at the large radiotherapy treatment centres, so you might need referring somewhere else for that treatment. If your centre doesn't do, the oncologists there might not know much about it, but you can ask for a second opinion from a centre which does. If there is more extensive N1, then they would probably treat it all with external beam radiotherapy.

*T3a means broken out of the prostate or significantly bulging the prostate, but not grown as far as other organs. T3b means grown into seminal vesicles.

Edited by member 08 Sep 2024 at 14:23  | Reason: Not specified

Peter

Hi Kazzy60,

Bracytherapy Boost was ruled out for me because of my poor flow rate. I didn’t think it was too bad actually but they were concerned that I might need long term catheter. I have a friend who had this treatment, went into retention after it and it caused a lot of problems.

Kazzy, I’m not medically trained so am just describing my experiences on my journey. Andy62 describes what might happen with HDR Brachytherapy so I guess it’s up to your consultant to decide if it’s worth the risk?

I regarded my optimum treatment(having had surgery being ruled out by the MDT) was HDR Boost, followed by 37 sessions of RT to treat the prostate and the pelvic bed. In the end, both these were ruled out so I ended up with only 20 sessions to treat the Prostate and Seminal Vesicles only. This disappointed me but I take some comfort in the fact that my Oncologist (not allowed to name him on here) thought the risk to my health was too great to attempt it. I just have to live with this and hope it’s done the job…I guess I’m going to find out soon🤞

My Oncologist told me not to ‘overthink’ things and ATM I think you’re just going to have to play the waiting game. I know it’s not easy so just try and distract yourself as best you can.

All the best to both of you,

Derek

Kazzy, I did reply yesterday but doesnt look like it 'went'. I was diagnosed Oct 2015, went on the HT etc right away. Ended up having abiraterone, enzalutimide, prednisolone added to Zoladex as part of trial. I had the TURP in May 2016. RT started 1 Dec 2016 which is obviously a fair bit longer than normal. I could have had the RT sooner but it was delayed simply by choice as I got married in November. Oncologist quite happy with this as there was no evidence of any threat and the ADT working as it should. When first diagnosed you're in panic mode and want everything now but I accepted the consultants comments saying no rush in my case, Zoladex etc good until we're ready. Admittedly I am on the laid back side of things and fortunate that treatment was doing what it should.

Peter