Surgery or radiation

Hi Kit and welcome 

I had similar readings when I started Radiotherapy.

Gleeson 6 , PSA about 13, active surveillance for 4 years before.

My tumour was getting near the gland edge so that is why I started treatment.

It's a shame they didn't pick up on the growing tumour with you but hopefully u can start treatment soon, HT should start soon to stop further growth before the radiotherapy starts.

So that's my suggestion HT and RT, in mind easier than surgery.

Remember though I am not a specialist.

All the best 

Steve 

By the way, how many MRI scans did u have during the 2.5 years to monitor 

Hi Kit , I’m with Steve (Grundo ) on this.  My logic is that a ‘bulge’ sounds near the edge, so RT to zap the prostate and edge would be preferable.

Hello (Kit ) 

A warm welcome to the group although I am so sorry to find you joining us. I assume the worry is causing you some anxiety posting at 5.35am or are you just an early riser?

The question Surgery or HT/RT is the $64,000 question and is ultimately down to personal choice. I am surprised that you haven't had a 2nd  biopsy to see if the cancer is still a Gleason 6 but hey-ho - something that you didn't wish for anyway.

So as long as the cancer is still within the prostate as the MRI shows both treatments should be on the cards - you may also be suitable for brachytherapy, although this isn't always offered as it's not available in every health authority but if you were suitable you could ask about it.

My honest answer to you is it's down to personal choice - you need to list each treatment as it would affect you and your partner - the pros and cons of each possible outcome and side effect both short and long term. Once you've done that and if you still are not sure - or you have any specific questions - come back to us - nothing is too trivial.

If anxiety is an issue please do give our Support Line a call on 0808 808 00 00 (8am to 8pm 7 days a week) - they will be able to help.

Best wishes - Brian.

Hi thank I’ve had MRI scans

I’m sorry the monitoring failed you. I think I am on a similar pathway. Would you share who was running the monitoring? I am with TrueNTH. The hospital refer to it as “My Medical Record”.

I never really felt that surgery was the best option for me. But surgery does keep radiotherapy as a treatment if it’s needed in the future. That is one consideration. 

RT will be my option when my PSA is around 16-17 or like you I’m close to the edge or the PNI has allowed the buggers out. If any of those occur at that point RT or RT/ADT. I would take two years of surveillance as a win.

The way I looked at it was. if there is bio chemical reaccurance then the later I start RT the older I will be before that happens. 

3 MRI scans

Hi Kit yes, I’m with the others on this : check out my bio.  To be honest, with your stats I think radiotherapy would be a sensible choice. Read as many bios as you can before you decide.  Yes, you can have radiotherapy if surgery fails.,, but that means two sets of side effects.  AW

With the radiotherapy option it might be worth asking if they intend to treat the seminal vesicles or other local tissue as well on a ‘just in case’ basis, given the bulge in the gland. Just before I had my treatment they mentioned treating the SVs,  I asked if cancer had been detected there, they said no but it was usually the first place cancerous cells settled once outside the prostate. That gave me a lot of confidence in their radiotherapy plan.

Having said that, PCa was already in the pelvic lymph nodes and surgery wasn’t an option, so it didn’t sway any decision.

I didn't have the choice due to my high risk - currently on HT 3 months so far with radiotherapy to follow.

However I would almost certainly chosen RT as long term side effects specially urinary are slightly better in some surveys.

However specially if you have a bulge, and with surgery the  issue then is when removed aside from side effects -  is the prostate clear of possible cancer at the boundary of the removed prostate ?  - ie positive margins (not good as cancer not fully removed) or not  - which can't be confirmed until after the op. That might require radiotherapy later which meant you may as well have had radiotherapy at the start (with some HT) .

The idea that " if I have the Op now I can always have radiotherapy later" is outdated as it means the operation failed and should not have been the primary radical treatment anyway.