Surgery or Radiotherapy? Decision made!

Morning AW,

Jacob diagnosed with HP 2 years before the PC. He had endoscopy and HP was found plus stomach ulcer. He prescribed double antibiotics and PPI as Alwayshope said. However, still had reflux and stomach aches. PPI is not wonderful for a long term so we both gone on free acid nutrition to try solve it without medicine. And here is why I am writing this post: The cancer treatment eliminate completely his stomach problems. So Millibob for a change this PC gifting him something. We do not know how it is possible and what the connection maybe AH can have an assumption but here we go.

Lots of love

Dafna

Good morning Dafna. Off the top of my head I think that a lot of us look more closely at our diets once given a cancer diagnosis and possibly modify it so that the gut flora changes. This might have helped reduce the acid production but also the cells in the gut lining will have been replaced and repaired over time. At least one good thing has come out of having prostate cancer as you say.

Sending big hugs your way.

Often gut/digestion issues can be because there's too little acid in the stomach.

Eddie xx

Hi Alwayshope and co.,  interesting discussion as always.  The body produces white cells including lymphocytes (killer T cells - great name, eh?).  My lymphocyte army is still somewhat depleted after full pelvic radiotherapy (but still recovering well).  It may be that this little army has been overrun by the bacterial infection and they need a helping hand via antibiotics.   AW

I’ve been thinking.  I know, always a dangerous activity.  

Anyway, a lot of men have recently, as always, been offered the eternal choice of prostatectomy or radiotherapy.  Of course, both choices may be best for a man’s individual case and prostatectomy may be the best way forward for a fit, younger man.  Or radiotherapy may not be possible due to other medical conditions.  This missive is merely to inform and is NOT because I chose radiotherapy over prostatectomy: BOTH are effective at curing cancer in most cases where a curative pathway is offered.   But during the decision process many men are not told two important differences between the two, that can result in side effects. Of course, radiotherapy can damage erectile and urinary function as well, but the mechanics of removal are described below:

1. Prostatectomy removes the internal urethral sphincter valve.  The external urethral sphincter valve ( in your pelvic floor) is left intact.  When you urinate, the internal and external sphincters open to allow urine to pass. During a prostatectomy, the prostate is removed, which also removes the internal sphincter.   The loss of the internal sphincter can lead to urinary incontinence, or accidental urine leakage. However, most men experience gradual return of normal urinary function over time. This is especially true of younger, fitter men. 

2.  During a prostatectomy, the nerves that run alongside the gland may be damaged or removed, depending upon whether the cancer is interwoven in them.  A surgeon may be able to preserve these nerves (they control erections and continence). This is called nerve-sparing surgery.  If cancer is growing near the nerves, the surgeon may need to remove them. This can cause erectile dysfunction.  Even if the nerves are preserved, it can take time for erections to recover.  Also, continence recovery may be more difficult if nerves are damaged. 

So, why write this?  Well, the thinking I was doing was at 04:00, so I need to get it off my chest as I do not want a repeat tonight!    AW

Oh, I should add the obvious rider to my explanation above: I’m not medically trained, so these observations are merely to help you men who are in the decision phase and help you frame questions to ask your consultant surgeons and urologists.   AW

… and finally (yes, I really don’t want a repeat thinking session at 04:00)…. I see a lot of comments about “well, if surgery fails, I have radiotherapy to fall back on”.   This is usually true, but if you’re going into such remedial salvage radiotherapy this means another potential set of dangers to add to your side effects. You go into remedial radiotherapy with only one sphincter valve (in your pelvic floor) and a set of nerves that may be damaged (or completely removed) by surgery.  As I already mentioned, radiotherapy also damages structures around the cancer cells that it is going in to kill. So urinary and erectile function can be made worse.

My advice is to put these simple to understand factors to your consultants (the surgeons/ urologists will be probably be saying “we can cure you” and - guess what - the oncologists/ radio therapists will be saying the same thing).  So ask for percentages of success regarding no side effects and percentages of success regarding the need for salvage radiotherapy. 
My surgeon (highly regarded- good profile on the internet) said I had 30% chance of salvage radiotherapy. I felt that this was too high so I chose radiotherapy. 

So, there we are. I’ve got it off my chest and I hope it gives you food for thought.  Ask questions - don’t let fear control you.  And please don’t say things like “if in doubt, have it out”.  Consider the consequences. Ask, check and ask again if necessary.    AW

Adding my pennies worth to an already excellent overview by AW, when I had my meetings with the surgeon he said, and I quote, “don’t worry, I’ll keep cutting and cutting until I’m sure I’ve got it all”. Yeah, horror story. Best thing he ever did saying that. Needless to say from that moment on I pretty much knew a prostatectomy wasn’t for me!

You’re probably thinking “ah, but why is AW not sleeping and is awake at 04:00?”  Well, I’m at my mother In laws house and we have two single beds.  My mattress is really soft and uncomfortable!  I am going to bring a mattress topper next time!!      AW

Hi AW like you, I’m not a surgical or medical expert but, from what I have heard while on this journey , your 4 am ruminations are spot on physiologically.
  
From our own experiences and from what I have read on here, I think that there must also be consideration of the psychological side of things.

Some men seem to decide on surgery because their immediate and longer term outlook is to ‘just get it ( the cancer) out’. Being an arachnophobe and, arguably, from a woman’s perspective, I think, this wanting to ‘get it out’ must be as strong as my feeling if I found a large spider on me! I would literally be screaming for someone to get it off me!

Some men choose the RT /HT route because they fear the surgeon’s knife. But, this route also has its well documented physiological and psychological drawbacks to consider.

i think there are some very powerful messages that are probably not being adequately addressed by the men/ women in white coat but which we all know! 

1. 1. There are no guarantees of complete cure and there are side effects whichever route is chosen

2. Both routes to potential cure can be a major struggle for a lot of men

3 research must continue 

4. there is little consideration or support in the NHS for wives, partners and family members caught up in all of this

5. we must always remember those people who are being treated long term without the hope of cure as their cancer is advanced

Although it’s still morning, I add that, at the end of the day, there is no perfect solution right now and we need to understand that the route to take is very much a personal decision. Like yourself, my husband chose the RT/HT route.

HTH and just my own thoughts and conclusions and thank you for yours! I hope you got back to sleep!!!!