What drove your treatment decision?

Hi Mark

I am also from Chester but now living in Cornwall. To keep it short and sweet, diagnosed in March 23 with a T2 active surveillance for six months. I then had a face to face to look at my histology and it was multi focal (T2c) close to breaking out but contained. I opted for surgery as radiotherapy can still cause ED and incontinence but with additional side effects. Had surgery 6th of December and since I had the catheter out have been dry. Since day one at night and five weeks later I have very minimal drips/ leaks during the day. Had my post op appt today and the post operative histology showed seminal vehicle involvement and my final staging is T3b. As far as it goes I am cancer free with clear margins.

My experience of the surgery and follow up was all good and I am close to being back to normal. I believe RT and HT is a bit more drawn out and rat runs the risk of further cancers down the road. At the end of the day the choice is yours and yours only, all I will say is do the research and make an informed decision and don’t focus too much on the worst case scenarios, the doctors all seem to want to emphasise the worst case for some reason. Good luck.

Keith,

Each case does of course have to be treated on it's merits and any contraindictions taken into acoount but one important factor the clinitions consider is a patient's age and physical condition. So mostly where men are suitable, they tend to advocate surgery for younger patient and RT for older men. The reasoning here is twofold, namely because younger men have a longer expectation of life and surgery means there is less chance for cancer to develop over the long term. Secondly, robotic surgery is now more common and a younger man is in most cases more likely to cope more easily with the stress on the body due to the way he is suspended during the operation. Conversely, the older man is rather recommended RT which he can more easily cope with and because his life expectation is shorter he is less likely to be affected by another form of cancer being triggered over fewer remaining years. There are cases regardless of this where some younger men have RT and older men have surgery but the surgeons become less inclined to want to operate, particularly if a patient is not considered really suitable. So there is some cross over between what is considered young and old. Also, some men tend to become physically older than their age whilst others remain much fitter and stronger, so even considering just the age factor it can be a variable.

I believe what you say is nearly right in terms of the side effects in so much as surgery does sadly increase incontinence in a few men permanently and for many for a period of time as it improves. I don't think RT does this much at all, although it can produce other side effects as a result of the radiation but also because of the HT that usually accompanies it. As regards ED this often affects men. immediately after surgery but in many cases improves over time, sometimes by pumps and pills. On the other hand ED does not happen immediately after RT but gradually develops over months/years. The accompanying HT does play a principal part in this - a loss of libido you could say for most men.

What adds to uncertainty is that neither the clinician nor the patient know beforehand the degree and extent of side effects and even more importantly how successful teatment will be for an individual. There have been many cases on this forum over the years when a member has been given an expectation of so many years but has exceeed it very considerably. Men can respond so differently. We also have to remember that new techniques, equipment and new ways of treating have been introduced over recent years, so results should improve as the long term analysis will undoubtedly show. One thing is definite and that is that early diagnosis gives a man the best chance of successful treatment, although even so a man nearing the end of his natural life span may reason he would rather avoid side effects of treatment at that time and take his chances of dying of something else.

Edited by member 24 Jan 2025 at 04:38  | Reason: Not specified

I was 58 on diagnosis, pretty fir, good weight etc.

I suffered plenty of side effects from the HT (Zoladex), probably most of those expected. Some bladder/bowel issues from the RT.

My RT was in 2016, my HT finished summer 2018.

Took a while of course for side effects to go but they dir and the treatment has done what it was supposed to, accepting tne PCa may come back.

Knowing what I know now I'd be 'happy' with same treatment (although times change/progress etc).

I was gleason 8 (upped to 9 after TURP) with PSA 21.

Peter

- would an inserted Gel Bowel Shield be used

- who would give support on side-effects (e.g. ED) - hospital or via GP (might vary by area?)