Radio Therapy or Surgery??

Gleason score 3+4, 4+3. I had prostatectomy 12 years ago. I am afraid at that time information I was given was very limited, in spite of the fact that I had private treatment. The most important thing my very friendly and kind consultant said to me was 'I am delighted to tell you that your cancer is well contained with ample margin. If you decide to choose prostatectomy I will be more than happy to treat you'. So he was happy and I was very happy and lucky! I am amazed how much information patients are given now. A good thing but I guess it can be confusing without detail discussion.

Hi Mark

I was diagnosed last week, and after a lengthy conversation with my Urologist I am opting (I think) for surgery. She said there is "quite a lot" of cancer in there, even though it is luckily still contained, so I want it gone. We did discuss RT or Brachy, but I was told that after one lot of treatment via either route, it wouldn't be possible/advisable to repeat if it comes back. At least with surgery, if there is a future issue it can be attacked with RT etc.

I am aware of the side effects that can go with surgery, but at 59 I am willing to tolerate them in order to be rid of this thing (hopefully).

Just waiting for a meeting with the surgeon to discuss, so nothing concrete yet, but I can't see me changing my mind.

Good luck with whatever option you choose. I am sure we will be updating each other via this forum!

Take care. 

Ian.

I remember my confusion at the onset. The only difference was that, I did not have the benefit of this wonderful site, when I got my diagnosis. I booked a meeting with all the various consultants - my main concern was ED. However, I soon got to understand that each path carried a risk of ED and/or incontinence. I even went left of field and requested a session with the HiFU team @UCLH. I made it to that treatment by the skin of my teeth. I had do another MRI scan and a second biopsy just to check if I was a good candidate for HiFU. The choice in the end boiled down to HIFU or surgery. I even took myself off the surgery list. What made my mind up was the opinion of the HIFU consultant when I asked him what he would do if he were me, he did not mince his words he said, giving my age late 50's he would go with surgery. That was that!

Yes, urologists will usually advocate surgery which is understandable as it is the area they know best and favour where the patient is suitable. But in my case the surgeon told me he would operate if I wanted but his view and that of the MDT was it was unlikely that he could remove all the cancer so recommended I have RT instead. Oncologists are more familiar with RT and apart from taking cases like mine that the surgeons don't want, feel that one of the forms of RT is just as good an option as surgery, particularly as major advances have taken place in RT over the last 10 or so years. There was a prominent member of this forum and great character and researcher user name 'Athalays' (You can see his profile here)- https://community.prostatecanceruk.org/default.aspx?g=profile&u=2673 He expressed great confidence in his Oncologist who claimed whatever a surgeon could do, he could do just as well with RT.
So it's good that specialists have confidence in their area of expertise where there are not contra aspects. Certainly, there was a time when surgery was largely considered the 'Gold Standard'. My second opinion who was a radiation specialist told me this was his view in 2007. However, with great RT refinement in the intervening years, this view is now contestable. Other individual considerations now may be given more weight by patients in coming to a treatment decision.

Edited by member 07 Sep 2023 at 14:36  | Reason: to highlight link

It’s a really difficult decision to make and everyone is different depending on their circumstances and medical situation. If I was recently married or in a new relationship with someone 20 years younger then that maybe a major consideration in any decision. As it is I am 30 years married. I was in that position in February and was presented with a whole menu of treatment options. I was encouraged (told!) to see at least the surgeon and oncologist before making any decision. What swayed it for me to surgery  was the oncologist when asked said in my circumstances they would choose surgery.  Good luck. 

It is, but my biopsy was G7 and I had the RARP and then the lab upgraded it to G9 T3bN0M0 - so it's a tricky one. Would my surgeon have proceeded with the RARP if they had know the state of the PCa beforehand?
Post RARP PSA was <0.01 so although it means I may still need RT later, initial results are promising.