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What drove your treatment decision?

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User

Posted 04 Feb 2025 at 14:33

Hi Mark46, how did the consultation go, has it helped you make a decision?

I found myself in a similar situation to yourself, and many others I’m sure, trying to decide which treatment to opt for. Whilst my diagnosis was such that it allowed me the choice it does place a bit of a burden on yourself having to make that decision.

I found reading this post, and others, very helpful particularly the link posted by OHWOW which relates to a study by Oxford and Bristol Universities. Another poster, OLD BARRY gave a link on another thread to prostatecancerfree.org which compares the success rates of the various treatments which are generally available on the NHS.

In conclusion to my consultations with both the surgical team and radiologist I’ve decided to opt for BRACHYTHERAPY so hope that I’ll pass my “flow test” otherwise I’m back to being a bit undecided.

Whichever way you go they all seem to have similar success rates and rates of reoccurrence, about 25-30% I believe, so wishing you well on your up coming journey.

Thanks for the original post, all the best John

User

Posted 04 Feb 2025 at 15:47

This is partly based on anecdotal evidence. However, when looking at UK prostate forum websites when men are suitable for surgery or radiotherapy approach their individual specialists it seems they are often, when guidance offered, steered towards surgery. A number of men say their surgeon recommended surgery, no surprise there but the oncologist when asked also recommended surgery. Why is this? I appreciate often little guidance is offered but it has surprised me how often oncologists say surgery. This may not be true in other countries. What is not in doubt that younger men when they have options are recommended surgery.

Edited by member 04 Feb 2025 at 15:49 | Reason: Not specified

User

Posted 04 Feb 2025 at 19:14

Originally Posted by: Online Community Member

A number of men say their surgeon recommended surgery, no surprise there but the oncologist when asked also recommended surgery. Why is this? I appreciate often little guidance is offered but it has surprised me how often oncologists say surgery. This may not be true in other countries. What is not in doubt that younger men when they have options are recommended surgery.

I was 48 at diagnosis and my Urologist said he probably just about favoured RARP but thought Brachytherapy would be a fine choice. My oncologist definitively recommended Brachy as he believed quality of life would be better and the hope was that I would have a lot of it left to live! 🤞😂

Maybe the advice, I received isn't normal but I think it's possible/probable that oncologists recommend surgery when they appreciate a patient wouldn't be a good candidate for RT treatments (size of prostate, urinary function and IPSS score etc).

I also think some (how many?) men who are diagnosed, never even speak to an oncologist - they're under the care of a urologist, who as you say will clearly favour their own surgical speciality, and the patient accepts their advice because they're the expert.

I wonder whether those men ever then really take the time or are presented with the opportunity to explore RT in detail. Of course RT will be mentioned in the conversation but that's different to having a proper conversation about it with the actual person who would perform the radiotherapeutic treatment.

I say this because a friend who was diagnosed spoke to me about BT but never actually spoke to an onco - he just accepted the advice of his urologist and went for a RARP. I couldn't understand why he didn't at least speak to an onco to hear from them about RT options but ultimately, that was his decision to make!

🤷‍♂️

User

Posted 04 Feb 2025 at 19:26

Does any one know where to find statistics for the impact of Robot Assisted Radical Prostatectomy on erectile dysfunction? I think the figures that are quoted probably include a large number of men who had a prostatectomy before robots. Thanks

User

Posted 04 Feb 2025 at 19:52

I think the age, disease classification / location and physical fitness conditions are primary factors that influence treatment recommendations. It’s possible that if your PC is contained, relatively low GS and you’re young with possibility to have more children in the future then they most certainly wouldn’t recommend RARP. I believe the urologist have to offer/discuss all treatment options will patients, even if they offer preference for a treatment. My research and discussion with the urologist at my diagnosis consultation and others suggested to me that if you’re in the lucky 70-80% then surgery offers complete cure. Unlike others where the prostate remains in situ and could rear its ugly head again. Another “advantage “ of surgery I was told is that it’s easier if you need to have further treatment like RT (as in my case) should the pc return. Good luck all.

User

Posted 04 Feb 2025 at 19:55

An article in the Times a world famous professor says Robot is;

“It’s fantastic technology in that it’s led to less pain, less bleeding, quicker recovery. But, compared to open surgery, where you make a big cut, studies show it hasn’t reduced the risk of erectile dysfunction or urine leakage.”

User

Posted 05 Feb 2025 at 11:15

Provided the Onco gives you a choice, that is 50-50 between removal & HT - I would say, go for the latter.
Not Invasive, less infection risk. The only downside of RT+HT, is, it all takes longer.

The new idea of a stronger dose of RT, less visits & no HT would be I would be worth looking at - but I've already had the 20 episode + HT over 2 years, done & dusted!
I wonder with this new HT treatment, if there is even more risk of Bowel/Rectum damage?

Edited by member 05 Feb 2025 at 11:16 | Reason: Not specified

User

Posted 09 Feb 2025 at 17:56

Hi Mark

First time post. I'm 65, I was diagnosed a 3+4 localised about a year ago. I'm fit and active, cycling, gym, swimming etc. Also, I've done Pilates classes for about 10 years, so I'm pretty used to seeing, if not wearing, glamorous Lyrcra outfits. I have just had robotic assisted surgery (RARP) on 15th Jan this year.

The treatment decision totally overwhelmed me, and despite reading every piece of literature given by the NHS nurses, consultants and Prostate Cancer UK, there was no clear favourite that faired better than doing 'nothing' (or active maintenance, depending what your definition of what nothing is). By the way, I assume you have used the Prostate Predict website for comparison purposes. I found it very unhelpful for a 3+4, because at 10 years after diagnosis, it appears everything is virtually the same in that percentage-wise, you're still alive.

Slightly off-topic for you, unfortunately, I have Parkinson's Disease at a relatively early stage which is only kept from progressing by doing exercise. Fortunately though, I like exercise, even in Lycra. But watching my PSA level rise over the months got to me a bit, and I decided it was time to call time on a treatment option. The only modicum of 'proper' help came from the radiologist who said in her experience radiotherapy generally resulted in fatigue for longer than the recovery to full fitness under the robotic surgery. Exercise, therefore was my biggest deciding factor.

I don't know if my recovery is relevant as apparently I'm fairly unique: there aren't any posts involving Parkinson's disease in this forum. Also, I since found out from a nurse after surgery that people with neurodegenerative disorders tend to find recovery from incontinence more difficult, and sometimes never recovery continence at all. This information, if imparted prior to surgery, may have influenced my decision. I've now got an open tap, as it were, and it's actually getting worse since catheter removal nearly 2 weeks ago.

Early days, but I've seen a few posts from people regretting their decision, and I'm tending to think the same for me.

I don't know if this helps, if not sorry!

Best of luck.

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