Hi
I have been looking at discussions on the forum for a couple of weeks now and it seems a really kind and generous forum and so I am posting to see if anyone might please share their wisdom and experience around treatment options.
My husband, 54, has recently been diagnosed with localised prostate cancer. He had no symptoms, but had a PSA test, which showed it raised at 4.85 and then another PSA around the same level so had an MRI. The MRI showed a diffuse area so they offered a biopsy, which showed cancer - Gleason score 7 (3+4). It is localised and no node or other involvement beyond prostate.
We feel very fortunate that it has been found early and that we have options, but with options come decisions, which is where it feels more challenging.
My husband has, in theory, been offered a variety of treatment options, including active surveillance, radiation, brachytherapy, HIFU, cryotherapy and a radical prostatectomy.
Given his age (relatively young), he's been advised against radiation therapy given the chance of it causing secondary cancers. We have also been led to believe that if he has the treatments that aren't surgery now, he will likely not be able to have surgery later or it will present greater risks.
It seems that the choice we are being steered towards is between active surveillance and a radical prostatectomy.
To provide some context, there is a history of cancer within my husband's family - both his parents died of cancer relatively young (very early 60s and 70) - his father of oesophageal (having had mouth cancer previously) and his mother of pancreatic. Given this experience of cancer, my husband is keen to have the cancer removed. Whilst the surgeon has advised there is no genetic connection between prostate cancer and the cancers my husband's parents had, I have read that there can be connections genetically between prostate cancer and pancreatic cancer meaning that prostate cancer can be more aggressive where there is the genetic connection - additionally, his parents are from a part of Spain where a particular BRCA1 founder originates, which seems to be linked with this. I appreciate I may be worrying unnecessarily (and it may be a case of a little bit of knowledge is a dangerous thing!) and my husband has never undergone any genetic testing re cancer, but I guess we both feel that with the outcomes his close family members have had with cancers and given we have been advised he will need treatment at some stage even if he undergoes active surveillance at this point, we are veering towards surgery. My husband has private medical care through his work and so has seen a surgeon who specialises in radical prostatectomies with CUP and who thinks, based on the information he currently has, that he can spare the nerves (I am not sure if this is the man commonly referred to as the professorwhocannotbenamed?). Given all of this and thinking it would be better to have surgery at a younger age and whilst the cancer is as small and contained as possible, my husband is leaning towards a prostatectomy rather than active surveillance.
I am sorry for the long post, but I would really welcome people's thoughts and advice around the choice between active surveillance and a radical prostatectomy – both in terms of personal experience and in terms of anything we may be failing to consider / unaware of.
Thank you very much in advance.