Which treatment to choose

Hi G 

I must admit , if it's breaking thru now why didn't they spot it getting near the capsule edge some time ago.  Gleeson 7 is not massively aggressive.

Once broken through there is an argument that u would be better off with HT and RT rather than surgery, check this out online perhaps.

Don't forget that a surgeon will often, but not always, push for the surgery option for obvious reasons.

See what others say.

Best wishes

Steve 

Thanks Steve, the surgeon didn't give me the impression that he favoured surgery in my case, in fact he said that in some ways the radiotherapy could be better as it would hit the cancer cells everywhere which surgery alone may miss/leave behind.

So far my thinking has been to target the cancer source (prostate), get it out along with lymph nodes and then deal with any future cancer flare ups with radiotherapy if and when needed.

What do others think?

Graham  

Good Afternoon Graham

I have read your profile and - this is a personal opinion - at 74 I would be going for the HT/RT option (I didn't get the choice by the way) but my thoughts are the surgery is both invasive and can (not always) cause issues. It also depends on any other health issues you may have.

I have had issues - has it broken out of the prostrate or not - and tomorrow I start my RT - they are to target the lymph nodes as well.

I think if I had have been offered surgery for the removal I would have still gone down the line of HT/RT.

I know it's personal choice and I hope the above helps, and wish you all the very best which ever avenue you chose to take.

Kind Regards - Brian.

Is it in the lymph nodes Graham, if so another reason to poss go with RT.

Steve 

My husband was just 75 when he got his scan results - 2 tumours one each side with one pushing against the wall and perhaps just through it. His eventual diagnosis was T3 a, N0, Mo Gleason 4+3. He had said all the way along that he did not fancy surgery. Prostatectomy was mentioned as a second option but that would probably have to be followed by RT anyway. He opted for rt and ht. he is otherwise fit and healthy so could have discussed surgery further I guess. If it had been me, I would have looked at and into and discussed further the surgery option

my own thoughts were that I should support whatever decision he made. I looked up the stats for ht and rt. at his age and so long as no other illness occurs, he has a 98% chance of surviving 10 years following rt and ht. there is a 30% chance of recurrence. So, even if there is recurrence, with treatment if needed, men are still surviving 10 years - possibly more? Given the average life expectancy of men in England is something like 81 years , I think the odds look pretty good without the surgery. Also, there is a potential always for new drugs to come to the fore to deal with recurrence.

where I have not agreed with him is the use of a spacer to protect the bowel from the radiation. You can’t get this on the NHS and this costs about £6 k to be done privately. He did not want to do it. If the decision had been mine to make, I would have paid for it to be done.

But, the important thing here is that all of you men have choices to make and us women can only support you in the treatment choices you make.

that said, when push came to shove in our household the other night I could not and would not support the ‘no treatment’ option at this stage when complete cure is a possibility.

just my thinking and it’s perhaps biased? I won’t ever have to deal with prostate cancer. I want the best outcome for my husband - both psychologically and physically. Selfishly, and for my own sake as much as for his, I don’t want to lose him.

hth and I hope you can work your way through the minefield and reach the decision which feels right for you.

WW

As I have said many times before - without the support - we mere mortals (men) would be struggling to deal with the whole concept of PC. It's so complex and everyone is different. That's so important to remember we are all different.

We all want the best outcome and this is the place for opinions and advice - and I will say it again - we are all different.

I am pleased in your circumstances though that things are now looking up - long may it continue.

Kind Regards - Brian.

Hi Graham.

My understanding throughout my journey is that there is a preference amongst many urologists to favour surgery primarily in younger men, especially if they are otherwise reasonably fit and healthy and the tumour appears confined to the prostate. 

It took me a while to get my head around having a condition where surgery is very often the first resort rather than the last, but once the logic was explained to me I understood it. It gave me the best chance of ridding myself of the cancer and leading an otherwise normal life. But the side effects can be more extreme than if other options are pursued.

I don’t really know the ins and outs of the other treatments as I had surgery, but to paraphrase my understanding, because prostate cancer can be managed for many, many years without having surgery, non-surgical options seem to be preferred when the patient is that much older. I am perhaps not articulating this desperately well, but what I’m trying to say is that I can understand why your urologist appears to be shying away from surgery in your case.

What I will say is that you really need to make an informed choice, so ask questions of the experts. They will be expecting you to, believe me! This is a massive decision and cannot be made on the toss of a coin.

Best of luck.

HH

Hi Graham,

I'm really pleased you are having the HT, It will hold back any aggressive action while you wait to see about surgery.  My partner was taking/is taking Bicalutamide, he has had no noticeable side effects from it. He also has Zoladex  this is and implant that slow releases HT for a month and will have again tomorrow. As yet he seems fine with this.  He is a bit more advanced than you so he will also be having Abiraterone and steroids along side it. This is available in Scotland NHS and will be released all over the UK soon?. It was available in Covid times but for some reason not now (expense?) . It is linked with the "Stampede trail" There is a similar drug that is available on the NHS but I think it has more side effects. I wonder as it's obviously out there if it could be pushed for with a consultant? I would certainly have a go. Though you are no where near this and it is used for more advanced cancer anyway, I'm just talking generally and churning out information in a weird self soothing way. 

As far as being offered HT early I agree with you, My partners PSA was 115 and he also wasn't offered it until we asked. I think maybe it has something to do with how quickly it shrinks the cancer back making it less visible on scans?

I'm also really interested in the calculation your consultant did, I've not heard of it before. I guess there's some things that are used according to the situation. I do sometimes wonder if there has been a bit of a (hidden) area of information that my partners consultant has glazed over. 

Anyway, at the moment he is willing to go down a hit it hard route. With HT and RT.

Again great information "Grampy" Graham. It's so informative and helpful to know other peoples treatment.

            L

Hi, W W

I have read your other post where you said your husband suddenly decided he didn't want to go through with the treatment and I really felt for you. Obviously its upsetting for him to have this terrible worry and decision making, and understandable that the fight or flight impulse would kick in, but I totally understood your feelings at that point. I have to say I admire your control for not completely flipping out, I know I would have gone into a raging wife from hell mode, I don't think I could have coped with that decision at all. I absolutely agree with you about the spacer option. If you have the money spend it. You've done so much research and you've worried so much that you deserve to get that spacer for peace of mind. 

L

Thank you, L. To be quite honest, I was very angry and hurt.  it seems you and I are very much of a ‘like mind’!  I haven’t coped with it, to be quite honest, and all I can say is that it has been a tough few days.

x