T3b Left-Side Invasion: Can't decide: Surgery vs. Brachytherapy Boost UCSF

Good morning marco1ca .

This is a group that no one really wants to join, but now you are here you will find it a great place for help and comfort, from people who have been there.

My own diagnosis was one small step more advanced than yours, and I wasn’t offered surgery.

I am being treated with what my doctors call “curative intent”, by a combination of radiotherapy (EBRT) and hormone therapy. There are significant side effects BUT none that have make a significant kink in my life. Even the sexual problems were not a disadvantage to me because of problems my wife had, which we had already adapted to.

So, I have been doing better than ok in terms of keeping going and the treatment is on the projected pathway.

I have not had surgery but do know 4 men who have had, and from this extremely small and unrepresentative sample, only one has not subsequently received salvaged radiotherapy.

It seems to me that trying to find the success rate of the surgery only side at the hospital you are considering, and achieved by the surgeon you have in mind, is vital to this decision.

The interesting thing is that the overall success rate of both the treatments at the stage you report is both similar and successful.

Good luck with discussions on this, and on making the choice.

Hi marco1ca I’m bound to be biased, but I would definitely go BBoost.  With your diagnosis, I think there would be a high chance of recurrence so you would have two sets of side effects.  Ask your doctor surgeon - what are my chances of recurrence?  Also, read my bio.  No long term side effects, but I may have been lucky insofar as I’m very fit.  Or just lucky.  Read my bio before you decide.  AW

Hi Marco1ca

I agree with AW, EB with brachy boost.

I always reckon that once pushed through the gland edge T3,  then probably better off forgetting about surgery.

All the best 

Steve 

Hello marco1ca 

A warm welcome to the group from me too - although I am so sorry to find you joining us.

I never had the choice of surgery and am a T3a but my team were aware the cancer MAY have left the gland so surgery was out!

I have been on this group for almost 5 years and the number of men I see who have surgery and come back 12/18 months later having to have salvage RT/HT looks to be rising. It's the wording of the surgery I don't like

marco1ca said:

planning a partial nerve-sparing approach on the affected left side while completely sparing the healthy right side? 

he may be PLANNING that approach but when he gets in there and finds issues, he's not going to stop, wake you up and say "hey mate we have a problem" - you wake up and it's been done, problems or not!

For me it would be Brachytherapy Boost all day - but that's just a personal opinion from messages on the group, but I hope it helps.

Best wishes - Brian.

Hello marco1ca,

And a warm welcome from me, but I'm sorry you have the need to join us here. 

My preference would also be Brachytherapy Boost based on your detailed information.

All the best, Derek.

Hi marco1ca,

I had surgery and was forced down that route as I had Ulcerative Colitis and radiotherapy would trigger my condition and potentially make my life unpleasant for the duration of the treatment and possibly beyond.  My op was non-nerve-sparing, so I can't talk to that.  I have adapted to life knowing there will never be a natural erection and frankly it kind of became a good thing as I never had the will-it or won’t-it-come-back struggle.

Urinary control returned within 5 months and remains very good.  I do have a small weakness when I have a bad cold or over-exercise.  I play bowls and table tennis most weeks and am in full control.  The odd leak I have had has never been enough that I needed a pad after that initial 5-month period.

I won't advocate for which route you should go as it as a personal choice that comes down to your circumstances.  I was glad I had my operation as the outcome was the cancer was slightly more advanced and I wouldn't have known had I not had the prostate removed.  I am happy that the cancer has been removed.  

On the point about salvage treatment - I may end up having this done as my PSA is still rising (now at 0.24). However, the two years plus since the operation are so wonderful and hopefully I will get another year or two before I have to have the radiotherapy and hormones.  If I am lucky any new tumour location might be found and the treatment might be directed away from my bowel and as such I will escape the worst of having it done instead of the operation.

Whatever path you go down - I hope and pray it is a massive success and that you have a rapid and complete recovery.

Thank you for your reply;  did they remove both nerve bundles or just one side during our surgery?

Millibob said:

he may be PLANNING that approach but when he gets in there and finds issues, he's not going to stop, wake you up and say "hey mate we have a problem"

Thank you i will look into this more

It was both sides so I have no chance of recovering erections.  Tough to handle mentally initially but now I am okay with it.

I'll start by saying I'm probably biased because I had HDR Boost (HDR brachytherapy and external beam radiotherapy) which I think is a good treatment. I was T3a, so not quite the same diagnosis.

Surgery isn't often offered for T3b - the success rate isn't good, often requiring salvage radiotherapy afterwards. (it is sometimes found only during the surgery that it's T3b, when it was believed to be a lower staging prior to surgery.) I was told that I wouldn't have nerve sparing for my T3a, and that was a significant factor in me choosing the radiotherapy path.

For the HDR Boost, I was told at the outset I would be on 18-36 months ADT. As I approached 18 months, I asked again and was told that as my PSA had been undetectable ever since the radiotherapy, I could stop. The ADT wasn't causing me any problems I couldn't put up with for a bit longer, so I continued to 22 months, in case it gave me an extra 1 or 2% chance of a cure. There was an option with the HDR Boost to include my pelvic lymph nodes in the external beam at a prophylactic dose - no spread had been found but I was considered high risk and there could be micro-mets (too small to show on any scans) so I asked for that to be covered too.

I'm now 7 years after the radiotherapy, and everything works just as it did before treatment. A couple of years after treatment, I remember telling my oncologist I almost wouldn't know anything had been done, which was certainly not what I was expecting at the outset. Radiotherapy does have a risk of ED happening slowly afterwards. If it does, it starts within 2 years of the radiotherapy. The incidence is less than half that of ED from surgery, and I managed to swerve that one. My oncologist thought the risk with HDR Boost was lower than with full dose external beam alone, although there was no data on that.

Wishing you all the best with your treatment. Happy to answer any questions.