What to think for next stages.

User

Posted 27 Jul 2026 at 16:28

I have grade 8/9 localised (lesion near the wall) with no metastasis other complications. I am on Relugolix and have been for 5 weeks and PSA has gone from 5.8 to 0.45 which I believe is a good result. The MCT nurse was suggesting another PSA test in 3/4 months. Because I have a urinary stricture from a TURP in 2019 which I self-catheterise at 2/3 week intervals and I think it's not an aggressive one, I am pushing for a review of the stricture to decide whether radiation treatment is really ruled out (I think the MCT have come to that conclusion w/o really assessing the situation). I would have thought either of those treatments can be considered (remove the lesion and hence the primary aggressive source).

I was also thinking that HIFU or Cryo might work but no mention has been made. I am 79 yr male with no co-morbidities and very fit. Would be interested with any views. Thanks.

User

Posted 27 Jul 2026 at 19:23

Hi Allex

Just a quick reply to say that I have a post RARP stricture in the Bulbar region. I asked my urologist, if I get a recurrence would the stricture mean I can't have radio therapy. He said it will make no difference.

Cheers

Bill

User

Posted 27 Jul 2026 at 20:18

Thanks Bill, my stricture is within the prostate I believe. So a RARP or any removal will be challenging.

User

Posted 27 Jul 2026 at 21:21

Hi Alex,

Relugolix is an ADT Hormon treatment more normally given further down the line and it is expected to considerably reduce PSA relatively fast and appears to be doing this. The 8/9 is probably your Gleason score which may be between the two. What we don't know is your staging which goes up to 4 with any immediate letter denoting spread within the prostate or if it is contained. A further letter number denotes possible spread and to where. I suggest you ask about this and press for an answer on your treatment options.

Barry

User

Posted 28 Jul 2026 at 08:38

So far in my report from biopsy:

- Prostate cancer in 8 of 14 cores.

- Overall score 4+5

- Worst score 4+5

- Perineural and Extraprostatic Extension absent

- Not for Radiotherapy due to stricture!

It looks as if the lesion is contained at this time. I am to see an Oncologist because I have queried the last decision in that list and if still not a option asked when my prostectomy will be. They will do another PSA in 3/4 months. I am wondering what PSA value they wait for if I am to have a prostectomy?

User

Posted 29 Jul 2026 at 21:18

Ah, now see what you mean by 8/9. Never seen it expressed that way. Focal not only depends on cancer being contained but where it is in the Prostate and how much of it there is. Scar tissue from your turp could be a factor. Also, if Focal didn't work, it would make RT more difficult. You are right to ask what your options are and why. You might be suitable for CyberKnife, although this is not so widely available and is restricted on the NHS.

Barry

User

Posted 30 Jul 2026 at 14:07

It seems the only option then is prostatectomy or knife or Cryo (although they are not NHS I think) with a urethral resection and hope the stricture gets cut out too. Although I do wonder why that has not moved to that stage but have to wait for another PSA in 3/4 months to check on it being lower than the currant reduction from 5.8 to 0.45! What is the idea there I wonder.

User

Posted 30 Jul 2026 at 19:27

Cryotherapy is a form of Focal Therapy. At UCLH, they tend to use it where HIFU is not able to reach the cancerous area(s). However, they sometimes use Nanoknife (Irreversible electroporation), another Focal option. A further option is Focal Brachytherapy, where treatment is directed right into the tumour. Sometimes Focal treatment can be obtained on the NHS but a specialist needs to ascertain whether a form of Focal is right for an individual. Many doctors are not familar with Focal treatments and are unable to offer them, so tend to favour their own specialities.

Barry

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