Surgery

Surgery nothing like knowing they get it all out most of the time. I had my op on 2nd of July this year first follow up with consultant was good news ,still a bit of a problem with incontinence  but future looks bright good luck with everything  

Hi,

I suggest you and your husband look at all the options and inform. yourselves about the pros and cons of each.

None of the options is without its consequences and whatever option you choose it's good to know what these are so you can prepare for them. reduce them 

It is good to get the opinion of members of this online community who've had the various treatments.  However, I suggest you do more than that.  This partly because it seems to me that men who've had a particular treatment tend to be biased towards it.  You hardly ever hear anyone actually saying they made the wrong choice.

Also, mens experiences can be very different and you can hear both positive stories and horror stories about the same treatment.

It's better therefore to research the statistics, i.e. the chances or likelihoods.

I can only give you an overview. of surgery versus brachytherapy or external beam radiation.

All treatments are more or less equal in effectiveness for early localised cancer.  I have read claims that brachytherapy is better, but I do not believe it's the most popular choice, for some reason.

With surgery the actual treatment is quickly completed.  These days it's key hole surgery and doesn't require long in hospital.  The gland is totally removed and consequently not only the cancer is removed but all prostate cells.    This possibly reduces chances of recurrence.  PSA after surgery should be zero.  If the surgery fails to get all cancer cells, it can be followed up with salvage radiation.

There are some small wounds, a risk.of urinary infection and some pain or discomfort.  A urinary tube has to remain on for up to two weeks.

There is quite a high risk of urinary incontinence immediately following surgery.  It can last a few weeks, months or become permanent. It varies in severity and there are ways of preventing it of dealing with it.

There is also a high risk of immediate Erectile Dysfunction (ED)  following surgery.  There are many factors affecting this.  One is whether the actual surgery is "nerve sparing" or not. With both nerves spared, I believe the risk of ED is about 70%, with one nerve only spared about 85%.and with no sparing about 95%.  I'd have to check that.  Again there are lots of things that can be done to reduce the risk and treat the ED.  ED has psychological conequences!

With radiation, treatment takes longer.  With brachytherapy, radioactive seeds are implanted in the gland and  they continue to act for some time, although there is only treatment procedure to.insert them.

External radiation entails many visits to the treatment centre over many weeks..  Radiation treatment can cause severe fatigue.  The radiation treats the cancer cells but can also irradiate nearby structures.  This is not so much with brachytherapy because the radiation source is IN the gland.  With external beam radiation the beam goes through other structures so can cause collateral damage. e.g. to the urethra, bladder, bowel and rectum.  This damage varies in degree and can heal or may become permanent.  

Radiation kills cancer cells, but the gland is still there and there may still be PSA after radiation therapy.  Whether it's due to benign prostate cells or cancer cells isn't so obvious.  

If the treatment doesn't get all cancer cells it can be repeated once.  No surgeon will attempt to remove a prostate gland once it has be iirradiated.  There are other treatments that can be used, but they're not widely available.

There is less risk of urinary incontinence following radiation, but there is a risk.  ED does not generallly occur as an immediate consequence of radiation but it can be a later effect occurring about 2 years after treatment in about 50% of cases.  Again, I'd have to check that.

Any prostate cancervtreatment, like other cancer treatments is life changing both physically and psychologically and it helps to find out as much as you can and seek out and use any help that's available.

No matter your husbands treatment his PSA will be monitored for many years to come.

I hope this helps a little.

 a good site to find out more is the Prostate Cancer UK site.

We’ve studied all the 3 options in great detail, we’ve read so much from various sources and studied the fors and against all treatments but he is still leaning towards surgery we go back to the consultant on the 28th of this month to discuss what the next step is . 

That’s how my husband is looking at it , good luck with your recovery 

It is your husbands choice and once he's made the choice it should be supported.

I am biased, I had surgery nearly eight years ago, I have no incontinencr, no ED and no bowel problems. Due to chronic prostatitis for years prior to diagnosis, I had less choice than your husband, but it turned out well, it can do.

I will support anything he decides it’s still a shock even though we did expect it, his brother was diagnosed 3 years ago but sadly the cancer had spread to his bladder and bones by then . This is why my hubby has had a yearly check up . I’m glad things worked for you 

You should ask your urologist to refer you for a consultation with the surgeon.  It is always good to do this.  I had an appointment ready before all the results were in - as it seemed that my cancer was contained at the time but also had an appointment with a consultant radiologist.  As it turned out the tumour was pressing on the back of the prostate and it could not be ascertained if the cancer cells had spread so radiotherapy was deemed to be the best treatment and so it has.  nearly 3 years on and my PSA is "undetectable" and few side effects from the HT and radiotherapy.  I did get hot flushes and did get some low level bowel problems but this also caused by having to have a colonoscopy to determine if I had any internal bleeding from polyps - which were also removed which caused low blood count about 5 months post radiotherapy - the polyps and possible internal bleeding didn't have anything to do with the radiotherapy - just wish I hadn't had to have this done so close to the radiotherapy - there wasn't any bleeding and all pllyps removed were benign.  Did not get any bowel problems during the radiotherapy - just one night when I was weeing for GB - up about 30 times.  Some men had constipation and diarrhoea and were urinating frequently during the night seems it affects different people differently but once they made the oncolgists team aware of this they had medication which helped.  I am convinced that continuing to exercise - gym 3 or 4 times a week all through my treatment helped with the side effects of fatigue and mood swings - which if I had them I didn't notice at all.  Hot Flushes were not all that bad and really only noticed them when the HT finished - ie I noticed I wasn't getting any.  All in all I had a good experience and most of the men I shared the radiotherapy waiting room with had the same as any side effects were dealt with quickly and efficiently - mind set makes a difference too.  My brother has just had brachytherapy for a gleason score of 6 - to be honest if it wasn't for the fact that I had had prostate cancer he probably would have accepted active surveillance but opted to get treatment with brachytherapy and he has had no problems just urinating more frequently and finding it difficult to start flow a few times but medication dealt well with this and he is fine now - had the treatment on 21 Aug. 

We actually have an appointment with the consultant who does the surgery on the 28th of this month, my husbands score is 6 on one side but 7 on the other he’s probably going for surgery though not totally made his mind up . Glad you’re doing well 

That's good.  All the best to you both.

Of course, if your husband is offered surgery he will be seen by the surgeon before the operstion.  I don't know how it works where you live but "urologists" are the medics who diagnose and arrange treatment for prostate cancer and they are surgeons.  

However not all urologists can carry out radical.prostatectomy, this is a highly skilled procedure and there aren't that many surgeons that can do it.  There are none where I.  I had to go to another city.

If your husband is offered and chooses surgery he will see THE surgeon before, but the one you're seeing on the 28th could be, but may not be the one.

The other thing is that although you mention diagnosis, you don't mention any scans.  Treatment options are decided by a multidisciplinary team, (MDT),  not by an individual.  The options will only be decided after at least an MRI and a bone scan.  Hopefully these will show that surgery is an appropriate option, amongst other options, but that's not certain.  It may be that it's not.  It might be a bit premature to see THE surgeon before the MDT determination  following the scans.  In my case the MDT decided that surgery was the best option, external radiation not so good and brachytherapy not appropriate at all.

You don't really need to have to "ask" to be referred to THE surgeon, if appropriate, that will be done automatically.  For other options it will be the oncologist.

As I write, it's the MDT that looks at treatment options based on the information gathered from all the investigations.