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User
Posted 24 Sep 2026 at 14:46

Hi all. 


I've just been diagnosed with Gleason 4+3, in 14/16 cores and suspected early T3 with risk of Proximal Urethral sphincter involvement. Bone scan was clear and PET scan showed no lymph node or seminal vesicle involvement which was a relief. 


Probably like most on here I have been offered RT with Hormones or surgery. I have spoken to both the Oncologist and Surgeon and it seems the outcomes are similar albeit with different side effects.


The surgeon did say that in my case there is a 30-50% chance of needing further treatment down the line due to the urethral sphincter involvement. 


I would be interested to hear from others who have faced the difficult decision of RT vs Surgery (knowing likely follow up RT required)  and their experiences. 


Thanks 


Patrick


 

User
Posted 25 Sep 2026 at 09:40

Indeed it is, I do remember feeling terrified when told I had cancer, then the realisation of all the side effects involved in the various treatments knocks you again. We all go through that.


It does get better though! If they can save one side that can be enough. It still takes a while for recovery as although you come out with small scars it is still major surgery.  So don't be disheartened when initially things aren't working. Being relatively young you tend to bounce back better with respect to continence and ED. 


It's worth starting pelvic floor exercises, there a handy NHS app called Squeezy Men that you can down load for a couple of pounds

User
Posted 26 Sep 2026 at 10:54

Good morning Patrick


Welcome…..


I am afraid I cannot help in the choices issue - I was incurable before I was diagnosed with lymph node spread.


What I can say though with certainty is - get as fit as you possibly can !  Many treatment approaches will involve fatigue, and the best way to combat fatigue is to exercise, so the fitter you are the better you will be. Halfway through chemotherapy I signed up for Sir Chris Hoy’s Tour de 4 as a goal  - and six months later was in Glasgow smashing my target of riding 12km by reaching 15km and raising £1275.00 for Prostate Cancer UK.  


Once you have a treatment pathway set yourself some goals and focus on them, one step at a time.


My current goal is to recover from hernia surgery last week in good time to be fit for radiotherapy in November.


Don’t forget to click on our names/ roundels to get our own storied (where completed that is).


 

Best wishes - stay positive


CeePee

User
Posted 26 Sep 2026 at 11:38

Hi, Patrick.


I'm sorry, especially as you are much younger than most of us old codgers, that you've had to join 'Our Club', but welcome to the forum, mate.


I see from your bio that your PSA is 14.


After two years on active surveillance, aged 66 years, they discovered that my cancer had progressed. I was Gleason 8 (3+5), in 20 out of 24 cores, prostate capsule breached, T3a staging, my PSA was still only 7. I was given the option of radiotherapy and HT or surgery. I went for RARP as I wanted a quick fix.


The surgeon told me before the operation that I would have non nerve sparing surgery which would leave me impotent and that there was a 60% chance of recurrence.


After surgery, three and a half years ago, the cancer was upgraded to Gleason 9 (4+5) and the staging was confirmed as T3a. Since then I have lost the ability to have any natural erections, but can get them with penile injections. Up to now, I've been very lucky and have not had any recurrence.


Younger men are more likely to opt for surgery. If some of your nerves can be saved there's a pretty good chance that you'll recover natural erections. Your problem seems to be that that due to the location of your tumour the surgeon may have to leave a positive margin. This unfortunately, may increase the risk of recurrence.


I think the general recurrence rate after surgery is about 30% so your surgeon's prediction of your recurrence risk being 30-50% seems reasonable.


In your case, I think I'd risk the 50% chance of successful surgery. If there is recurrence you can always fall back to salvage radiation to the possible dodgy margin.


Whatever you decide, I hope that the primary treatment works. Best of luck, mate.  👍 

Edited by member 26 Sep 2026 at 13:41  | Reason: Typo

User
Posted 26 Sep 2026 at 12:57

Thanks, some really good advice.


Also, reading  through the posts and bios on this Community has been a great support to me. Its a rubbish disease but reading the stories here gives hope so thank you all for sharing

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User
Posted 24 Sep 2026 at 15:53

Hi Patrick,


Sorry you have joined our club and find yourself here, however there's lots of help and info available so ask lots of questions.


I was in a very similar position to you Gleason 3+4 T3b early seminal vesicle involvement. Bone scan and lymph nodes clear aged 48.


I was offered both surgery or RT/HT. MDT recommended surgery initially. However I changed surgeon due to the first being called away for a family emergency. Second surgeon recommended RT/HT. He said he could do the surgery but it would be none nerve sparing, and I would very likely need salvage RT, he didn't give a percentage chance.


The none nerve sparing really put me off, plus not wanting the side effects from both surgery and RT/HT, a double wammy, in my view. I also had HDR Brachytherapy thrown in as well at the last minute, radioactive material is briefly inserted directly into the prostate, then remove. Mine was done under general. There is a long term chance of Erectile issues with RT, especially when combined with Brachytherapy. So far so good, I finished HT in June this year.


I think generally men our age go for surgery, I'm guessing because its physically removed so re-occurrence is less likely in the future?? Though obviously it can return, hence salvage RT. I was never told or warned away from RT by anyone.


I'd be asking if your surgery would be nerve sparing if you haven't already,  I would have considered it more had that been the case for me.


 


All the best


John

User
Posted 24 Sep 2026 at 17:17

Thanks John.


Great to hear you’ve come out the other side and doing well. 


i was told the nerve bundle on right side could not be spared which like you does concern me. I hope that means the left is potentially be spared but unsure how much that would change the risk. 


lots to consider. It really is trying to pick the least worst option 🙂. 


 


 

User
Posted 25 Sep 2026 at 09:40

Indeed it is, I do remember feeling terrified when told I had cancer, then the realisation of all the side effects involved in the various treatments knocks you again. We all go through that.


It does get better though! If they can save one side that can be enough. It still takes a while for recovery as although you come out with small scars it is still major surgery.  So don't be disheartened when initially things aren't working. Being relatively young you tend to bounce back better with respect to continence and ED. 


It's worth starting pelvic floor exercises, there a handy NHS app called Squeezy Men that you can down load for a couple of pounds

User
Posted 26 Sep 2026 at 08:58

for sure. I find the thoughts swirling and second guessing  at 3am the worst. I do hope this will settle down once I get a plan in place.

Im leaning towards surgery at the moment. For me I’d like to have the damned thing removed and like the idea of having  RT as Salvage option. The surgeons comment that likely urethra sphincter involvement meaning may result in needing to leave some cancer cells behind and likely need for SRT makes me second guess this. 


Thanks for the tip. I’ll check out the Squeezy app. anything I can be doing in advance to help recovery is great and with the added bonus of providing a distraction 

User
Posted 26 Sep 2026 at 10:54

Good morning Patrick


Welcome…..


I am afraid I cannot help in the choices issue - I was incurable before I was diagnosed with lymph node spread.


What I can say though with certainty is - get as fit as you possibly can !  Many treatment approaches will involve fatigue, and the best way to combat fatigue is to exercise, so the fitter you are the better you will be. Halfway through chemotherapy I signed up for Sir Chris Hoy’s Tour de 4 as a goal  - and six months later was in Glasgow smashing my target of riding 12km by reaching 15km and raising £1275.00 for Prostate Cancer UK.  


Once you have a treatment pathway set yourself some goals and focus on them, one step at a time.


My current goal is to recover from hernia surgery last week in good time to be fit for radiotherapy in November.


Don’t forget to click on our names/ roundels to get our own storied (where completed that is).


 

Best wishes - stay positive


CeePee

User
Posted 26 Sep 2026 at 11:38

Hi, Patrick.


I'm sorry, especially as you are much younger than most of us old codgers, that you've had to join 'Our Club', but welcome to the forum, mate.


I see from your bio that your PSA is 14.


After two years on active surveillance, aged 66 years, they discovered that my cancer had progressed. I was Gleason 8 (3+5), in 20 out of 24 cores, prostate capsule breached, T3a staging, my PSA was still only 7. I was given the option of radiotherapy and HT or surgery. I went for RARP as I wanted a quick fix.


The surgeon told me before the operation that I would have non nerve sparing surgery which would leave me impotent and that there was a 60% chance of recurrence.


After surgery, three and a half years ago, the cancer was upgraded to Gleason 9 (4+5) and the staging was confirmed as T3a. Since then I have lost the ability to have any natural erections, but can get them with penile injections. Up to now, I've been very lucky and have not had any recurrence.


Younger men are more likely to opt for surgery. If some of your nerves can be saved there's a pretty good chance that you'll recover natural erections. Your problem seems to be that that due to the location of your tumour the surgeon may have to leave a positive margin. This unfortunately, may increase the risk of recurrence.


I think the general recurrence rate after surgery is about 30% so your surgeon's prediction of your recurrence risk being 30-50% seems reasonable.


In your case, I think I'd risk the 50% chance of successful surgery. If there is recurrence you can always fall back to salvage radiation to the possible dodgy margin.


Whatever you decide, I hope that the primary treatment works. Best of luck, mate.  👍 

Edited by member 26 Sep 2026 at 13:41  | Reason: Typo

User
Posted 26 Sep 2026 at 12:57

Thanks, some really good advice.


Also, reading  through the posts and bios on this Community has been a great support to me. Its a rubbish disease but reading the stories here gives hope so thank you all for sharing

 
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