Dilemma on treatment choice

Good morning Darksal and welcome to the group. Yours is a dilemma faced by many in that you are being asked to make decisions without being given the tools or knowledge to do so so I hope that we can start to fill some of the gaps. In order for us to help you with more targeted information it would help if you could update your profile if you are comfortable doing this with a little background information like initial PSA, TNM, Gleason, age and how you came to have a PSA test in the first instance. These all play into helping you choose the best treatment route for you with a good long term outcome.

There is a book you can download for free which gives you a good starter to explain the different treatment options within surgery or radiotherapy plus hormone therapy and will start answering some questions but might also open up more which we will try and answer for you.

https://issuu.com/magazineproduction/docs/js_prostate_cancer_guide_for_patients_ezine

The first thing we will all recommend is to try and get as fit as possible as this will help you recover more quickly from whatever treatment you choose.

It can be a difficult time, especially at the start of the journey, and there is plenty of help available so just ask away and I am sure plenty will be along to give you a helping hand.

Good morning Darksal , AH has given you a great start but if you have any questions, please ask away, but let us know your staging etc.  David

Hi Darksal , if you’re into statistics on recurrence rates, check out my bio .      AW

Hi all.

Many thanks for your replies.

So my background in more detail. I had none of the classic urinary symptoms - perhaps a bit more in the day but I was not waking in the night. I went to GP in July 24 after recovering from Covid. I had a particularly bad UTI which he left untreated The GP performed a DRE and said my prostate was just smoothly enlarged but boked me in for a PSA test.. I had recurrent UTs and at the time of my PSA test I was till having the effects. My initial result was 36 but we booked in another for 3 weeks later and again I had a UTI and next result was 34. Dr believes that this could be effecting my result. I then had an MRI - result Likert 4- though it  showed there was no spread beyond the prostate and no involvement in lymph nodes or surrounding area. Similarly my bone scan showed no spread to the bones

I then was booked for a biopsy . My first had to be abandoned for another UTI. I returned a week later after treatment. The biopsy showed result of 7 [ Gleason 3+4] but with suspicion of ECE.

Then I had pet scan in December and the result in January was a bulge in capsule and microscopic presence in one seminal vesicle so stage T3a.

That s my journey so far and I have been offered both options of treatment...and hence my dilemma. My mind is whirling like mad and I am not sleeping … Both surgeon and oncologist say a curative path is possible...but which one would be best for me?

I would appreciate further advice to help me.

Hi Darksal - best thing to do is look at a lot of bio’s on here and see how people got on (we’re all different).  The main points to will see cropping up time and time again, so all I can say is do your research. If you’re T3a and it’s bulging in the capsule, you need to crack on.   AW

I should add that I see an awful lot of T3a’s who go for removal, who then have to come back for radiotherapy to mop up escaping cancer cells in the prostate area, thus having two sets of side effects.

Alternatively , I see radiotherapy patients who suffer from the associated hormone therapy etc. But most are mild irritants rather than serious issues.

As I said, we’re all different and you may be one of the fortunate ones.  AW

Many thanks Darksal for the update.  You didn’t mention if you have been put on HT.   Do you have a follow up meeting organised? David 

Hello Darksal 

I have been watching this thread - so I thought it's time to stick my oar in.

Alpine Wanderer said:

If you’re T3a and it’s bulging in the capsule, you need to crack on.   AW

 Alpine Wanderer has made a very important point there so I am a fellow T3a. I have been down the HT/RT route, I had a few issues on the way (you won't encounter most of my issues) but 3 years on the pathway. Would I do it again for a "curative pathway", yes I would. You can read my journey by clicking on my name or avatar.

I am happy to answer any questions on HT/RT.

Best wishes - Brian.

This has just happened to a good friend of mine.

He had a prostatectomy, and the subsequent histology was very good.

However, six months on and his PSA is beginning to rise, so now he faces HT  and RT

This was exactly what he was trying to avoid.

I spent sometimes talking to him yesterday and, hopefully, cheered him up somewhat.

Hi, a Gleason 3+4 normally allows you lots of options, I am going down the brachytherapy route with no other treatment at all, and others have had it with HRT treatment, and other beam radiation and others have it removed. You may even be offered active surveillance, however I didn’t fancy that as I still haven’t figured out what a moderator slow growth means and exactly how far on that journey I am, ie is it just about to go to 4+3 and the more I ask and read the less I still understand.. it’s quite a learning curve and making the decision is not easy, but what’s really fortunate is you have the decision, many other the decision is basically made for them as they are not so fortunate.  This is a good forum to help you but in my view you don’t have an exact answer.  Has brachytherapy or SABR been offered to you ?  It might be they can’t do it at T3a, as I think it has to be wholly inside the prostate.  Anyway, good luck with your research try to stay away from google, it drove me nuts