Which Treatment would you suggest

User

Posted 18 Apr 2026 at 09:18

Hi,

I have been diagnosed with prostate cancer for over 2 years Gleason 4+3 = 7

Was on close surveillance which checks my bloods every 3 months.

My PSA kept climbing so I was advised to take a 2nd biopsy. This showed no change, as did the 2nd and 3rd MRi.

However my PSA keeps climbing, and I have now been advised I need treatment, either surgery or Radiotherapy.

I don't particularly like the thought of the surgery so am tending towards Radiotherapy. Can anyone offer any thoughts, suggestions advice? Also (just as an aside) no consultant has been able to explain to me what the rising PSA means if my actual cancer has not increased or changed? Maybe I am being thick here?

User

Posted 18 Apr 2026 at 12:03

This thread will get you started.

https://community.prostatecanceruk.org/posts/t26986-Can-t-understand-why-anyone-would-choose-surgery-over-Brachytherapy--I-must-be-missing-something

Dave

User

Posted 18 Apr 2026 at 13:21

Hello, mate.

Welcome to the forum.

Here's an excellent video on treatment options and possible side effects.

https://youtu.be/zYTU94-8pTc?si=xW83bOb0AVFQFD2l

Good luck with whatever you chose.👍

User

Posted 18 Apr 2026 at 16:29

Hi,

People might hazard an opinion on your state if you let us know what your psa results are and what the MRI summary is. The psa level, Gleason score and stage are the basic figures.

Radiotherapy is better if there's a risk of it having spread near the prostate, called locally. I was a 4+3 and they offered radiotherapy with hormones. I was least keen on hormones, the explanation is too long to write.

I opted for surgery as I liked the idea of it being gone immediately as mine was said to be near the edge of the prostate with risk of coming out. It was over 9yrs ago and it didn't completely go but I've had over 9yrs of no treatment and no physical effects, except for semi-ED and very rarely a tiny bit of incontinence. I've been offered RT but told I could perhaps wait 4 more years plus or minus a few.

The op was a doddle, in at 9.30 and out at 12 without realising anything had happened except for a couple of tubes. I think I was unusual at having no need for pain drugs the way the nurses went on trying to make me have them. There's a week of being very careful and a few weeks of being careful with a catheter as well.

I've never regretted my choice but I could be persuaded easier to go for RT nowadays as I think it's better than it was and there are other RT options like Brachytherapy. There are also psma pet scans that can detect lower levels than before if you can persuade them it's worthwhile.

All the best, Peter

User

Posted 18 Apr 2026 at 18:12

Hi Bagsboy

Needless to say you pose a difficult question. All others can do here is to relate their experiences which may help you or not. My cancer was well contained with a very good negative margin and Gleason score 3+4. I had prostatectomy at the age of 71 nearly 16 years ago and I'm lucky to be declared 'cured'! However I suffer from ED and arousal climacturia (leaking urine when sexually excited and at orgasm!) which we had to deal with to re-establish our sex life and we did with some unexpected benefits. Would I choose the same option today? I don't really know - what was an obvious choice then may not be now because of the improvements in other treatments. A factor that played a big part in my decision was that I liked the idea of getting rid of the prostate gland which may have caused urinary problems in my old age. You are older than I was at the time of my surgery. My urologist was quite confident in offering me prostatectomy because I was fit with no other health issues - this is something that your consultants would talk to you about and give you the appropriate advice. Good luck.

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 19 Apr 2026 at 17:41

As mentioned, to make suggestions, we need to have your detailed diagnosis.

People moving from Active Surveillance to an active treatment usually have quite low grade cancer, because they've been monitored closely so things are less likely to have moved to higher risk cancers before treatment. A common treatment in such cases has been seed brachytherapy, although in the last couple of years, these diagnoses have also been eligible for the new 5 SABR radiotherapy sessions without hormone therapy (from the PACE-B trial). At one of the centres I run a support group for which specialises in all the types of radiotherapy, since the new 5 SABR radiotherapy sessions has been available, everyone I've come across has chosen the 5 SABR radiotherapy sessions rather than seed brachytherapy.

User

Posted 19 Apr 2026 at 22:22

Bagsyboy, there isn't a definite recommendation because the published clinical trials suggest all treatments have roughly the same success rate. The main difference is the profile of side effect risk, which in turn depends to some extent on the patient.

And you need to remember that a 10-year success rate is reporting on the treatment regime from 10+ years ago, there have been improvements in both surgical and radiotherapy technology in that time.

Andy62 highlights a particular example. For many people undergoing radiotherapy their issues with short to medium term side effects really result from the hormone therapy which is taken in parallel. The new "hypofractionnated" approach (fewer sessions each of higher dose) seems to give a good success rate without hormone therapy or its side effects, but we won't know for certain until another 10 years.

Basically the younger you are (say under 60) the better your chance of good recovery of functions after surgery, while radiotherapy (which tends to have lesser short term side effects but a longer term - 20+ year - risk of cancer) is often recommended for those who are older, say over 70. You are in the middle!

In the end it comes down to your decision given there isn't a "best" treatment. You need to talk to your doctors about the specific chances of success and risks of side effects in your case, and take into account the treatments offered and how up to date they are. (In particular, does the hospital have the latest generation of radiotherapy machines, or surgeons using the lates techniques). Members of this forum are all experts on their own experience, and that is valuable background for you in working out what to do, but none of us can say how it will turn out for you. Have a good delve around the forum to lean from all our experiences, and I am sure currently active members will be very happy to answer any questions you have.

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