Hi David
I sympathise with your dilemma, I went through the same 7 years ago. This time round there are very few options for me, so it's (sort of) easier!
I did a lot of research when I was first diagnosed and opted for Brachytherapy for the following reasons:
- less chance of incontinence
- less chance of erectile problems (although as time goes by this can become a problem with brachy)
- I have a stomach operation when I was 17 and have a large scar. I was told that because of this a prostatectomy was trickier and they may have to revert to open surgery during the Da Vinci procedure
- I worked for myself and recovery from Brachy was quicker
It has to be remembered though that this judgement was made 7 years ago - technology, experience etc has come on a lot even in that time. Certainly now the cancer has returned removing the prostate is much more tricky due to radiation 'damage' from the brachy.
Re. Prostatectomy: Unless they have told you otherwise, with nerve sparing treatment I would have thought that you have an excellent chance of erectile function returning reasonably quickly. Also, because of your age I would also expect incontinence not to be an issue from a month or so after the procedure. Your surgeon should have spoken to you about the prospects re. both ED and incontinence. Did he say how much nerve sparing they think they are able to do (e.g. 50%, 100%)? I would also imagine that if you have strong erections now you it is much more likely erections will come back after surgery if you have nerve sparing. The same can be said for urinary symptoms - if all is good at the moment things should recover well.
Re. Brachy: It's a perfectly good procedure and success rates etc are about the same as prostatectomy. However, follow up treatment if the cancer returns is trickier to treat and almost certain to cause worse side effects. Brachy in itself is not without it's side effects and I had some urinary problems afterwards and over time my erections have become less strong.
Just a quick note here - you don't need to have an erection to orgasm. That might not help but it's important folk are aware of that.
It is difficult with both procedures to say what side effects you would have, how long they would last and how severe they would be. Some folk sail through both procedures, some have a rough time but I would imagine with both procedures most folk get back to near normal in time. Certainly with prostatectomy outcomes have improved a lot since I first had to make a decision and it's possible I may have chosen this route should I be making the original decision now. With prostatectomy you also have age on your side.
I think it's just as important to have an experienced person to perform the procedure whichever you choose - and it's worth asking about this.
I know very little about MR-Linac. It's a 'new' procedure and therefore likely that medium to long term side effects are unknown.
Alas, it's only you that can decide which route you go down. As I've said before I think both brachy and prostatectomy are viable options for you.
To be apprehensive before any treatment is normal - esp. when you are not suffering any pain etc ATM. The mind often focuses on the worst case scenario but let's face it that never happens!
Good luck - and let us know what you decide.
Originally Posted by: Online Community MemberHi Zumerest,
Firstly, thank you for sharing your experience. It is really helpful as I am looking to seek additional information regarding Brachytherapy this week before my proposed operation on Thursday.
I have also been made aware of MR-Linac, and am wanting to see if this is something that I could be viable for.
I am left with the option of deciding on whether to defer the operation planned for this Thursday and look into Brachytherapy or to carry on as planned and have the operation.
I agree a difficult decision to make.
Edited by member 13 Dec 2021 at 17:20
| Reason: Not specified