Treatment options - surgery, brachytherapy or radiotherapy (SABR)

Hi,

Sorry, but the question you pose is only one you can answer having considered all the factors needed to make a choice. You don't tell us your staging but we can assume your cancer is thought to be contained as you have been given the surgical option. (Be aware that sometimes micro cancer cells may have already escaped the Prostate and are not sufficiently concentrated to be seen or may be liberated in the process of removing the Prostate, so RT of one sort or another will be be needed subsequently particularly if in the MRI the cancer only just appears to be contained. So if you have a Prostatectomy only the passage of some time shows any wider development and the need for further treatment). Your being healthy and young, clinicians would normally favour surgery unless there are other contraindications or indeed you had an aversion to surgery, don't want the down time because it is a major operation that means you are restricted in what you can do for some weeks. Conversely, some men are more happy to have radiation, particularly as many men who have surgery experience a measure of incontinence for some time and in a few cases this is permanent. There is also a different pattern and time scale between surgery and RT. Also, apart from some other different side effects, HT is usually given with RT, so this compounds potential side effects. I suggest you have a read of the 'Tool Kit' which will help you learn in more detail about PCa and pros and cons of various treatments as here.

https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Perhaps your Dad's PCa was found rather late so it had advanced before his RT treatment had a better chance of success. Don't think you will necessarily be the same as Dad as apart from the degree of advancement there are likely to be other differences that go to make this a very individual disease.

Edited by member 26 Jan 2025 at 17:49  | Reason: to highlight link and to correct some of my spelling

A gleason 7, 3+4  is ok as scores go but your psa is high, particularly for your age. [Psa scores can go up into the thousands so your's is not greatly outside the normal range.]

Do you know why your father's initial RT did not succeed? It could be worth finding that out and passing the information on to your specialist. The obvious reason would be that there was spread that was not detected at the time of his treatment.

It would be helpful to ask your advisors if your biopsy confirmed that the cancer is entirely within the prostate and they are confident that there has been no spread of any sort. The size of your prostate might have some bearing on the highish psa score. Spread within the prostate can be determined by a biopsy but spread elsewhere cannot.

Incontinence varies enormously between individuals and if you do a search on this forum you'll get a better idea of the range of outcomes and speed of recovery.

Jules

Edited by member 27 Jan 2025 at 00:10  | Reason: Not specified

Good information Ret. On its own a G9 doesn't necessarily mean there's been spread, though spread is often associated with a G9. Your father almost certainly had cancer in his bones before his RT and it had not been picked up. It's possible to have a G9 without spread or a G7 with spread, even if they're not typical situations. Also, any HT will cause a PSA to drop, usually to a very low level because it suppresses testosterone which in turn starves cancer.

Have you had a bone scan? If not, ask your specialist about having one. They're a fairly normal part of any detection treatment now and under the circumstances it could be useful to rule out bone spread for you.

For a comparison, I was G9 but spread to lymph nodes was picked up by a PSMA PET scan. The RT I had after that was directed at both the prostate and the lymph nodes and now, a couple of years later, there's been no recurrence. If I'd simply had RT to the prostate I would definitely have had recurrence shortly after the RT/HT.

Barry has outlined the factors that might influence whether you go for a prostatectomy or RT and usually, as he says, the first option if you're young will be surgery. There's been discussion on here recently about why you aren't just told which option is best for you but while both paths have similar success rates the side effects do differ, so you get some choice as to which you reckon you could put up with better.

Jules

Edited by member 27 Jan 2025 at 04:26  | Reason: Not specified

I'm guessing Gleason 9 had a high chance of spread to lymph nodes and or bones despite what the MRI and CT scan said. 

Gleason 7 (3+4) probably would have made the MRI believable. 

It seems that PSMA is more useful in higher risk cancers. 

I will ask about CT scan for bones and the PSMA option. 

It seems that a PSMA scan would cost around £2500 privately. 

So many decisions! 

Edited by member 27 Jan 2025 at 11:07  | Reason: Not specified

WARNING: a fair amount of personal opinion here ...

If you choose a prostatectomy you have the option of RT later if you get recurrence. A PSMA PET scan might be useful for recurrence but not so much for making decisions about a prostatectomy. The best outcome with a prostatectomy is that all the cancer will be contained within the prostate and removing it removes all the cancer.

Radiotherapy can deal with cancer outside the prostate, in the prostate bed, where the seminal vesicles are involved and with nearby lymph nodes, so it's useful if the cancer has escaped the prostate. This might not be the case for you but because RT can deal with some cancer outside the prostate a PSMA PET scan prior to treatment can help help with mapping the cancer for precise attack.  SABR is worth asking about and it's certainly an advancing technology.

Given your father has bone cancer, if you  haven't told your specialist about this aspect of family history you really should. For the same reason ask about a bone scan [they're a common part of early diagnosis] and if the Dr says "no", ask for his reasoning.

Jules

Edited by member 28 Jan 2025 at 01:54  | Reason: Not specified