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49 and facing treatment choices, Focal Beam therapy vs. Removal/surgery

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User
Posted 21 Nov 2025 at 11:32

I'm 49 (Gleeson 3+4 - tumour of concern) and facing treatment choices , Focal Beam therapy vs. Removal/surgery to reduce risk of tumor growth. I'm leaning towards removal - due to my age (able to recover quickly hopefully) and impact on urinary and sexual function might be manageable. 

I wondered what the thoughts were out there and whether anyone's faced into this choice and what swayed it?

Edited by member 21 Nov 2025 at 11:43  | Reason: Not specified

User
Posted 22 Nov 2025 at 08:10

Hi, again Ben.

Another excellent prostate cancer site is

https://prostatematters.co.uk/

If you are considering surgery, in my opinion, this is a must view video

https://drive.google.com/file/d/1fyYTLZpxnB9HaR7O4xQ5Ff58Pj4Cn6ZB/view?pli=1

The Rolls-Royce of RARP is Retzius sparing, NeuroSAFE. This type of surgery is done by the most experienced and highly skilled surgeons. The problem is I think you'd have to go private to get the full package.

User
Posted 24 Nov 2025 at 09:29

Hi Ben,

I was 48 when diagnosed, Gleason 3+4 T3b so a bit further progressed. I was suggested surgery by one surgeon, then RT/HT by another! (I went RT/HT) What swayed it for me was I was told surgery would be none nerve sparing and I would more than likely need salvage therapy.

It seemed like a double wammy of side effects!

I'm one year on from EBRT and HDR Brachytherapy and have about 8 months left of HT. Side effects from HT haven't been too bad, but will be glad when I'm off it!

Had the cancer been more contained I think I would have chosen the surgery route. However I'm happy with my choice and remain functional, more so hopefully once off HT!

Prognosis is pretty the same either way. Side effects so far have been mostly HT related which will hopefully ease off once it finishes. RT side effects reduced slowly over about 6 months or so. There are potential long term effects. slight increase in other cancers in this area, very slight though. ED can set in as can urinary strictures, but these can also occur with surgery.

Choosing which route to take was the most difficult part of all this, however I did fell a lot better once I had. 

All the best

John

User
Posted 21 Nov 2025 at 15:30

Hi, Ben.

I'm sorry that you've had to join us, especially as you're a bit younger than most of us old codgers, but welcome to the forum, mate.

He's an excellent video on treatment options, including focal therapy and surgery and possible side effects

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

Good luck, mate.👍

Edited by member 21 Nov 2025 at 18:57  | Reason: Typo

User
Posted 21 Nov 2025 at 17:21

Hi Ben.   I had surgery 13 weeks ago.  My initial biopsy results were T2n0m0.  Gleason 3+4 less 10 % pattern 4.   My final path results were T3a so quite different. I had an invasion of my bladders neck     Luckily my psa has been undectable and my margins were negative but I think that has been down to th skill of the surgeon.  I had bilateral nerve spare as well and have been really lucky to be continent since TWOC.     I’ve been happy with the surgery 

User
Posted 21 Nov 2025 at 19:42

hi Ben

Sorry to hear you have joined the club.

I went down the surgical route but it’s quite important to be able to find a top high volume surgeon as it makes a difference. If you have private medical or a spare ~20k it it’s well worth going down that route.

If you’re on the NHS route I would try and get referred to UCLH in London because most of the surgeons there are at the top of their game. 

if you find a highly experienced high volume (>100 procedures pa)surgeon with great stats it can really turn things in your favourite and minimise any other side effects cause chances are they use things like the retzius sparing approach with neurosafe plus latest surgical robots.

it gives you radiotherapy as a back stop if you have to have salvage treatment.

Focal treatment can be interesting as I looked at it quite extensively until I realised that prostate cancer tends to be a multifocal disease so at best you may be just kicking the can down the road a bit. a few chaps have have had focal therapy but ultimately needed to to have surgery or additional treatment a few years down the road.

hope that helps but shout out if you have any more questions.

simon

Edited by member 21 Nov 2025 at 19:44  | Reason: Not specified

User
Posted 22 Nov 2025 at 07:18

Hi Ben, sorry to hear your diagnosis. I opted for surgery in September 24’ and have recovered well from side effects. Possibly one advantage of being younger is a good recovery although it’s a bit anecdotal.

I’d echo what Simon said with regards to finding a good high volume surgeon. One other thing is I’d definitely recommend getting a second opinion if you haven’t already done so, it really helped me with the decision making process. 

Hope you and family are coping well, mentally it’s a real challenge and if you need some help along the way don’t hold back from seeking it out.

Rob

User
Posted 22 Nov 2025 at 14:49

Surgery is a more certain way, especially in a relatively young person like yourself where there is more years for another tumour that could grow and you might need a further application of Focal Therapy or even more radical follow up treatment. Even after surgery, some men need further treatment if some cancer cells have escaped the prostate and set up microscopic colonies. Having surgery can also increase the risk of short or long term incontinence and erectile disfunction. You may be able to get more advice from your surgeon on how s/he consideres your chances on this .

Edited by member 23 Nov 2025 at 02:48  | Reason: spelling

Barry
User
Posted 22 Nov 2025 at 19:01

I was 52 when I was diagnosed. I was nudged down the surgery route by the clinical team. The reason was because of age, I guess the long life ahead of you means the cancer could could return and you are giving yourself more potential treatment options for the future.

User
Posted 23 Nov 2025 at 08:29

Morning Ben,

There's tons of good advice and relevant experiences here - I hope it all helps and you feel supported.

If you have a quick read through my posts you'll see I opted for Brachytherapy LDR. This was not offered or even mentioned by my local NHS when I was diagnosed mid-2025.

All the best.

User
Posted 23 Nov 2025 at 08:51

Hi Ben.

I was 51 when I was diagnosed, Gleeson 3+4 , the urologist said most men your age get it out, I took a step back and did a s*** load of research, I opted for ldr brachytherapy in the end and so far so good.

There is no right or wrong decision which is a conundrum , sit back take your time do your research and make your decision, also have a look at big stans aka Paul's posts on here, highly informative and covers all the ups and downs of brachytherapy.

Sorry you're here and the very best of luck.

Bryan

User
Posted 23 Nov 2025 at 10:24

Hi Ben, 

All of the advice above re being confident in the surgeon's experience is very sound.

I was fortunate in that my local NHS hospital is the regional centre for Urology and staffed by some of the leading surgeons in this field. My recovery from a NeuroSAFE RARP in 2023 couldn't have been any better.

I was 62 at the time of surgery, at your age I'd certainly be leaning toward the "once and done" option if you have access to good NHS facilities.

Good luck with whichever route you settle on. 

Mark

 

Show Most Thanked Posts
User
Posted 21 Nov 2025 at 15:30

Hi, Ben.

I'm sorry that you've had to join us, especially as you're a bit younger than most of us old codgers, but welcome to the forum, mate.

He's an excellent video on treatment options, including focal therapy and surgery and possible side effects

https://youtu.be/zYTU94-8pTc?si=1Z29_l8rbTwF6DHl

Good luck, mate.👍

Edited by member 21 Nov 2025 at 18:57  | Reason: Typo

User
Posted 21 Nov 2025 at 17:21

Hi Ben.   I had surgery 13 weeks ago.  My initial biopsy results were T2n0m0.  Gleason 3+4 less 10 % pattern 4.   My final path results were T3a so quite different. I had an invasion of my bladders neck     Luckily my psa has been undectable and my margins were negative but I think that has been down to th skill of the surgeon.  I had bilateral nerve spare as well and have been really lucky to be continent since TWOC.     I’ve been happy with the surgery 

User
Posted 21 Nov 2025 at 18:18

Thank you. I don't know what to do - Nanoknife/Focal Therapy looks like it's worth a try because it'll be more likely to preserve normal sexual health/urinary health - but could cause scar tissue making it harder to operate later.

Removal now is being offered because they think I'd bounce back from it quicker. It feels like surgery is the best option instinctively, but I don't know tbh.

User
Posted 21 Nov 2025 at 19:42

hi Ben

Sorry to hear you have joined the club.

I went down the surgical route but it’s quite important to be able to find a top high volume surgeon as it makes a difference. If you have private medical or a spare ~20k it it’s well worth going down that route.

If you’re on the NHS route I would try and get referred to UCLH in London because most of the surgeons there are at the top of their game. 

if you find a highly experienced high volume (>100 procedures pa)surgeon with great stats it can really turn things in your favourite and minimise any other side effects cause chances are they use things like the retzius sparing approach with neurosafe plus latest surgical robots.

it gives you radiotherapy as a back stop if you have to have salvage treatment.

Focal treatment can be interesting as I looked at it quite extensively until I realised that prostate cancer tends to be a multifocal disease so at best you may be just kicking the can down the road a bit. a few chaps have have had focal therapy but ultimately needed to to have surgery or additional treatment a few years down the road.

hope that helps but shout out if you have any more questions.

simon

Edited by member 21 Nov 2025 at 19:44  | Reason: Not specified

User
Posted 22 Nov 2025 at 07:18

Hi Ben, sorry to hear your diagnosis. I opted for surgery in September 24’ and have recovered well from side effects. Possibly one advantage of being younger is a good recovery although it’s a bit anecdotal.

I’d echo what Simon said with regards to finding a good high volume surgeon. One other thing is I’d definitely recommend getting a second opinion if you haven’t already done so, it really helped me with the decision making process. 

Hope you and family are coping well, mentally it’s a real challenge and if you need some help along the way don’t hold back from seeking it out.

Rob

User
Posted 22 Nov 2025 at 08:10

Hi, again Ben.

Another excellent prostate cancer site is

https://prostatematters.co.uk/

If you are considering surgery, in my opinion, this is a must view video

https://drive.google.com/file/d/1fyYTLZpxnB9HaR7O4xQ5Ff58Pj4Cn6ZB/view?pli=1

The Rolls-Royce of RARP is Retzius sparing, NeuroSAFE. This type of surgery is done by the most experienced and highly skilled surgeons. The problem is I think you'd have to go private to get the full package.

User
Posted 22 Nov 2025 at 14:49

Surgery is a more certain way, especially in a relatively young person like yourself where there is more years for another tumour that could grow and you might need a further application of Focal Therapy or even more radical follow up treatment. Even after surgery, some men need further treatment if some cancer cells have escaped the prostate and set up microscopic colonies. Having surgery can also increase the risk of short or long term incontinence and erectile disfunction. You may be able to get more advice from your surgeon on how s/he consideres your chances on this .

Edited by member 23 Nov 2025 at 02:48  | Reason: spelling

Barry
User
Posted 22 Nov 2025 at 19:01

I was 52 when I was diagnosed. I was nudged down the surgery route by the clinical team. The reason was because of age, I guess the long life ahead of you means the cancer could could return and you are giving yourself more potential treatment options for the future.

User
Posted 23 Nov 2025 at 08:29

Morning Ben,

There's tons of good advice and relevant experiences here - I hope it all helps and you feel supported.

If you have a quick read through my posts you'll see I opted for Brachytherapy LDR. This was not offered or even mentioned by my local NHS when I was diagnosed mid-2025.

All the best.

User
Posted 23 Nov 2025 at 08:51

Hi Ben.

I was 51 when I was diagnosed, Gleeson 3+4 , the urologist said most men your age get it out, I took a step back and did a s*** load of research, I opted for ldr brachytherapy in the end and so far so good.

There is no right or wrong decision which is a conundrum , sit back take your time do your research and make your decision, also have a look at big stans aka Paul's posts on here, highly informative and covers all the ups and downs of brachytherapy.

Sorry you're here and the very best of luck.

Bryan

User
Posted 23 Nov 2025 at 10:24

Hi Ben, 

All of the advice above re being confident in the surgeon's experience is very sound.

I was fortunate in that my local NHS hospital is the regional centre for Urology and staffed by some of the leading surgeons in this field. My recovery from a NeuroSAFE RARP in 2023 couldn't have been any better.

I was 62 at the time of surgery, at your age I'd certainly be leaning toward the "once and done" option if you have access to good NHS facilities.

Good luck with whichever route you settle on. 

Mark

 

User
Posted 24 Nov 2025 at 09:29

Hi Ben,

I was 48 when diagnosed, Gleason 3+4 T3b so a bit further progressed. I was suggested surgery by one surgeon, then RT/HT by another! (I went RT/HT) What swayed it for me was I was told surgery would be none nerve sparing and I would more than likely need salvage therapy.

It seemed like a double wammy of side effects!

I'm one year on from EBRT and HDR Brachytherapy and have about 8 months left of HT. Side effects from HT haven't been too bad, but will be glad when I'm off it!

Had the cancer been more contained I think I would have chosen the surgery route. However I'm happy with my choice and remain functional, more so hopefully once off HT!

Prognosis is pretty the same either way. Side effects so far have been mostly HT related which will hopefully ease off once it finishes. RT side effects reduced slowly over about 6 months or so. There are potential long term effects. slight increase in other cancers in this area, very slight though. ED can set in as can urinary strictures, but these can also occur with surgery.

Choosing which route to take was the most difficult part of all this, however I did fell a lot better once I had. 

All the best

John

 
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