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What to do - aged 52? Watch, HOLEP (and watch) or Prostatectomy

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User
Posted 30 May 2024 at 13:11

Thanks TechGuy,

That's actually one the questions I've asked the consultant (is it better to have the surgery sooner?). Based on the research I've done, I am more or less sure that I'll go with the HoLEP for now. I see that as a sort of half-way house - it will sort out my enlarged prostate symptoms and the bits they remove can be analysed.

I am currently on the search for a new consultant as my current one is proving very difficult to get any answers from - and a second opinion won't hurt anyway.

User
Posted 31 May 2024 at 07:38

Second opinion very good indeed. I did the same when I felt a loss of synergy with my initial team.

Are you going private or NHS? UCLH guys are very good I hear. I used an amazing surgeon at Santis Health….top of his game and they use the new Da Vinci single port system at Guys Cancer Centre. Initially saw him for second opinion but he was so well regarded and I got a great vibe and all the right answer when we met I went with him for surgery….would use him all over again without hesitation. 

Edited by member 31 May 2024 at 07:41  | Reason: Not specified

User
Posted 31 May 2024 at 10:12
I'm with Techguy on this one - to me, the diagnosis can never be 100% definitive and the only way they really know is when the prostate is on the lab bench being examined. If RP is on the table, as it was for me, then I'd seriously consider it. I was under-diagnosed at the time and am now on salvage RT - so definitely something to bear in mind.
User
Posted 31 May 2024 at 11:13

Originally Posted by: Online Community Member
I'm with Techguy on this one - to me, the diagnosis can never be 100% definitive and the only way they really know is when the prostate is on the lab bench being examined..

But having your prostate removed to be sure of diagnosis is a bit drastic. This disease is all about risk. As you unfortunately know even surgery doesn't eliminate recurrence. They'll always be different options and experiences of AS. I was told that about 30% of those on AS would later require radical treatment. They seemed good odds to me. 

User
Posted 31 May 2024 at 11:46

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
I'm with Techguy on this one - to me, the diagnosis can never be 100% definitive and the only way they really know is when the prostate is on the lab bench being examined..

But having your prostate removed to be sure of diagnosis is a bit drastic. This disease is all about risk. As you unfortunately know even surgery doesn't eliminate recurrence. They'll always be different options and experiences of AS. I was told that about 30% of those on AS would later require radical treatment. They seemed good odds to me. 

Surgery can be curative if actioned early enough. Assuming spread hasn’t occurred either via mets or extra cellular debris which occur during biopsy.  

Type 3 cells (Gleason 6) are not strictly in situ (although less likely to migrate) or a pre-cancerous neoplasm…they are cancer and encompass all the pathological traits of a cancer cell and as such have the mechanics to metastasise. 

 

Edited by member 31 May 2024 at 11:49  | Reason: Not specified

User
Posted 31 May 2024 at 12:01

Another study appeared yesterday generally supporting active surveillance for low risk cancer.

https://jamanetwork.com/journals/jama/article-abstract/2819352?resultClick=1

Obviously this an individual decision, and there will be a lot of factors to take into account. It's all about balancing various risks.

For what little it is worth my own personal view is that the possibility of avoiding prostatectomy/radiation for a long time, and maybe even indefinitely is a prize not to be sneezed at.

Even in those cases where treatment is eventualy required, there are competing factors to consider:

On the one hand, as some have said, there is the possibility that the final outcome might be worse if treatment is done later.

On the other hand, however, that is only a possibility and will not necessarily be the case by any means. And in the meantime:

a. those extra years of life to be enjoyed without treatment could be very valuable

b. techniques of treatments may improve and there may even be better treatments coming along that aren't available now.

 

User
Posted 31 May 2024 at 12:08

Thanks for these comments. They're all questions I was going to ask my consultant. I am in the process of changing consultants at the moment as my original one seems too busy to respond (after telling me to put my questions in an email to him).

Thanks.

Edited by member 31 May 2024 at 14:25  | Reason: Not specified

User
Posted 31 May 2024 at 12:11

Best of luck. We are all here if you need a sounding board

User
Posted 31 May 2024 at 12:37

Generally, this site, through no fault of its own, is hugely biased towards AS failure. Those who've found it a successful option, have no need to visit the forum.  In fact, the same applies to all treatment options.  I adore this forum, but it should carry a warning, 'We tend to focus on poor outcomes' 😉

Edited by member 31 May 2024 at 13:07  | Reason: Typo

 
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