Which Prostate cancer treatment ?

Hi Rowie.

I'd be reluctant to offer advice, as all these decisions are so personal and everyone's situation is different. The situation regarding side effects is also unclear, as all we have are numbers and averages to go on. Nothing seems to be entirely foreseeable or guaranteeable. I myself have a high Gleason score of 9 with no visible signs of spread. My own oncologist advised against surgery and suggested radiotherapy. His reasoning in my case was that the cancer was present in all my biopsies throughout my prostate and he felt that there might be some non-detectable penetration of the capsule, meaning that I could go through surgery and still be left with the problem, PLUS the foreseeable side effects of the surgery. 

The main issue with surgery appears to be whether nerve sparing is possible or not, as it is damage to the nerves which seems to generate most post surgical incontinence and ED problems. Friend of mine had surgery in December and he still suffers from both of these, though I am not at all sure if the situation is likely to improve for him or not.

The main issue with radiotherapy appears to be the risk of bowel damage. There is now a product, not suitable for everyone but a possible boon to many, called Spaceoar. This is a gel barrier that is surgically placed between the prostate and the bowel to protect the bowel during radiotherapy. It was not felt to be helpful in my case, but many people do speak highly of it, it is an approved NHS procedure (though, being new, it is not available everywhere), and seems to be well worth looking into if one is considering radiotherapy.

I was also told by my oncologist that long term outcomes are extremely similar on average for surgery and radiotherapy. My own oncologist was of the opinion that the risks of life-changing side effects were less with radiotherapy and told me that he therefore has has personal preference for that avenue of treatment, even though he himself is a surgeon. 

I hope that those few thoughts help.

Very best wishes,

Jonathan.

Many thanks Jonathan very good information, take care.

Rowie

My pleasure

Hi Rowie

Strange why a surgeon would ask u too consider RT when he is doing himself out of a job, particularly when u have requested surgery.

The main drawback with surgery , when I was considering which way to go , was the potential for ED. Not everyone is bothered by this and obviously not everyone who has surgery has ED but it is something to consider. Yes, surgery removes the prostate and potentially all the cancer with it but not always. It could be worth finding out how large the tumour is within the prostate and where it is within the prostate.

all the best

Steve

Hi Rowie

I will be 72 in August and was finally diagnosed in September 2018 after first being referred to the urology clinic in March 2018. I had a Gleason score of 4+5=9 and a PSA of 14. I was offered the choice of surgery or hormone treatment & radiotherapy. Being a very active person who does a lot of walking and rowing I went down the route of HT/RT as there is a possibility of "stress incontinence" after surgery during strenuous activities.

The outcomes are roughly the same for the two treatment paths and HT/RT was right for me. I am now 15 weeks post RT and will be on HT until October 2021. My PSA is undetectable and I have some problems with sweating profusely in this hot weather but hot flushes aren't much bother and the hot weather probably won't last too long! I do have fairly frequent mood swings and my "dangly bits" have shrunk to about half their size compared to before HT started. Unfortunately both those side effects go along with the hormone treatment.

It might help you to make a decision if you write down all the big cons and little cons for each treatment path (there are no pros!) on a large sheet of paper and look at the bottom line.