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Confused about treatments

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User
Posted 14 Dec 2024 at 08:11

Hi all

I am 57, have mild angina and COPD.  I have no symptoms but I had a PSA test due to older brother having prostate cancer many years ago.

I had a slightly high PSA, so had an MRi and then a Biopsy, 3/29 cores taken were affected. I have just been diagnosed 11/12/24 and even though it was sort of expected my heads a bit all over the place. I have a Gleason Grade of 3+4, grade group =2, PSA =4.4 and Staging =T2aNO. Not sure what all that means?

 

I have been offered surgery (RALP) or Radiotherapy with hormone treatment. Consultant said he is confident that they will clear the cancer with either option. They have said if I did have radio and had issues later on, surgery becomes more complicated after having the Radiotherapy. If i have surgery and have issues later on I would be able to have Radiotherapy no problem. The sensible option seems to be surgery but if I'm honest, surgery really scares me. Firstly because I don't like hospitals and operations scares the sh!# out of me and secondly the side affects. These are worrying me because ED is fairly common and there will be no fluid when I cum? I have also read that Viagra is not an option due to my angina. Feels a bit like game over for any kind of sexual pleasure but as I say, I'm confused so struggling to decide which option to take. 

Any advice or your experience would be really appreciated 

Steve

 

User
Posted 14 Dec 2024 at 13:32

Originally Posted by: Online Community Member

...or are there sound reasons why more sessions are offered ?

The reasons for more but smaller doses are sound, but not very sound.

Disclosure: I'm not a medic, and though I am quite good at science, the particular topic of "cancer alpha/beta ratio" is not one I understand.

Effective use of radiotherapy dates back to the 1950s, it is used on many types of cancer. The dose rate will have been found by trial and error in those early days; one can assume a lot of people died. At some point it will have been found that 35 doses at about 2Gy per day seemed to work. That will have been an average over all cancers. 

Clinical trials for cancer take a long time, particularly for slow growing cancers. A decade or two is not an unreasonable time period before postulated benefit is either proven or dismissed.

With EBRT being in existence for 70 years, trials taking 20 years, it is not too surprising that it is only now that we are refining doses to particular types of cancer.

Apparently, prostate cancer has a very low alpha/beta ratio; that means that a small number of high doses is an effective treatment for it. 

So to answer your question more sessions is sound because it has been effective for 70 years, but not very sound because fewer doses has been found to be just as effective on some cancers over the last 20 years.

 

 

Dave

User
Posted 14 Dec 2024 at 09:48

Hi Steve.

Sorry to see that you've had to join the Club but welcome mate.

Whether to have radiotherapy or surgery is probably the most asked question on here.

There is no definitive answer. When you compare the recovery of thousands of patients, there is very little difference between either treatment. Whichever treatment you have you'll be lucky to escape with some sort of side effects which include incontinence or erectile dysfunction.

The problem is, individual outcomes can vary enormously. Some sail through either treatment with only slight side effects. Others struggle enormously with each treatment and have big long-lasting side effects.

I had surgery. This link outlines my recovery.

https://community.prostatecanceruk.org/posts/t30214-Almost-a-year-on-after-RARP

Like you, I almost have a phobia, about hospitals. They offered me 7 weeks of radiotherapy, 35 visits, which I'd have struggled with. I decided a one night hospital stay for surgery was less disruptive to me. However, it appears that now, they are reducing radiotherapy to just five visits. Had this been available to me, I may have chosen it.

Best of luck, mate, with whichever you choose.

 

 

 

Edited by member 14 Dec 2024 at 12:59  | Reason: Typo

User
Posted 14 Dec 2024 at 12:36

Hi sscrabble.

Two years ago, when I needed radical treatment, the only radiology treatment on offer was 35 visits, over 7 weeks plus hormone therapy. I believe the new reduced 5 session radiology is available now on the NHS, but I'm not sure at which hospitals. and I think it is without hormone treatment, but I'm not sure. This hadn't been an option when I needed radical treatment. If it had have been I'd have seriously considered it.

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User
Posted 14 Dec 2024 at 09:48

Hi Steve.

Sorry to see that you've had to join the Club but welcome mate.

Whether to have radiotherapy or surgery is probably the most asked question on here.

There is no definitive answer. When you compare the recovery of thousands of patients, there is very little difference between either treatment. Whichever treatment you have you'll be lucky to escape with some sort of side effects which include incontinence or erectile dysfunction.

The problem is, individual outcomes can vary enormously. Some sail through either treatment with only slight side effects. Others struggle enormously with each treatment and have big long-lasting side effects.

I had surgery. This link outlines my recovery.

https://community.prostatecanceruk.org/posts/t30214-Almost-a-year-on-after-RARP

Like you, I almost have a phobia, about hospitals. They offered me 7 weeks of radiotherapy, 35 visits, which I'd have struggled with. I decided a one night hospital stay for surgery was less disruptive to me. However, it appears that now, they are reducing radiotherapy to just five visits. Had this been available to me, I may have chosen it.

Best of luck, mate, with whichever you choose.

 

 

 

Edited by member 14 Dec 2024 at 12:59  | Reason: Typo

User
Posted 14 Dec 2024 at 11:43

I do not see my consultant until next week , but have been told by one of the prostate nurses that I will be getting 20 doses of radiotherapy in about 3 months , after I have had about 3 months of hormone therapy to shrink my prostate.

 

Adrian , you have been offered a course of 35 visits.    I read that some courses now are only five visits , and work as well as the 20.   Is the amount of visits down to the health authority and/or cost - or are there sound reasons why more sessions are offered ?

User
Posted 14 Dec 2024 at 12:36

Hi sscrabble.

Two years ago, when I needed radical treatment, the only radiology treatment on offer was 35 visits, over 7 weeks plus hormone therapy. I believe the new reduced 5 session radiology is available now on the NHS, but I'm not sure at which hospitals. and I think it is without hormone treatment, but I'm not sure. This hadn't been an option when I needed radical treatment. If it had have been I'd have seriously considered it.

User
Posted 14 Dec 2024 at 13:32

Originally Posted by: Online Community Member

...or are there sound reasons why more sessions are offered ?

The reasons for more but smaller doses are sound, but not very sound.

Disclosure: I'm not a medic, and though I am quite good at science, the particular topic of "cancer alpha/beta ratio" is not one I understand.

Effective use of radiotherapy dates back to the 1950s, it is used on many types of cancer. The dose rate will have been found by trial and error in those early days; one can assume a lot of people died. At some point it will have been found that 35 doses at about 2Gy per day seemed to work. That will have been an average over all cancers. 

Clinical trials for cancer take a long time, particularly for slow growing cancers. A decade or two is not an unreasonable time period before postulated benefit is either proven or dismissed.

With EBRT being in existence for 70 years, trials taking 20 years, it is not too surprising that it is only now that we are refining doses to particular types of cancer.

Apparently, prostate cancer has a very low alpha/beta ratio; that means that a small number of high doses is an effective treatment for it. 

So to answer your question more sessions is sound because it has been effective for 70 years, but not very sound because fewer doses has been found to be just as effective on some cancers over the last 20 years.

 

 

Dave

 
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