Radiotherapy or Prostatectomy

With a recurrent cancer did the surgeon or radiotherapist made it clear that this time you can cure it? They really need to be clear about that point.

I agree with you about sides effects but we are all different and a second treatment will not have the same side effects than if it was your first treatment. With ED already you will certainly have trouble. But we all go down that line and the most important issue is to cure your cancer.

Personally I choose Surgery vs Radiotherapy (surgery mid September) on the basis that Surgery will cure my cancer and if not I can have radiotherapy. Doing surgery after radiotherapy is more complicated.

You had cryotherapy so did they say what are your options if they don't cure it this time?

Can you have:

Cryo + surgery + radiotherapy

Cryo + radiotherapy + surgery

That help you decide.

Hi Erick62

1. Thanjs for taking the time to answer my post. Yeah both the surgeon and Radiologist have said that my 2 new lesions either side of the PZ are curable with either treatment. The problem is that as I’ve had previous cryo the surgeon said the op is a bit more difficult as the cryo area is like working in concrete. Not been offered cryo again as the whole prostate needs to be treated. You say you had surgery mid September (I assume that was 2021 - what side effects short or long have you had so far?

Stavros,

My decision was easier, I wasn't suitable for surgery so I had the Hormones and VMAT Radiation.

No complaints, it done the job, been in Remission now for 6 months.

My main side effect of the Radiation treatment was fatigue, especially going into the 4th week.  Peeing was down to a trickle, as a result of the Radiation causing my Prostate to strangle my bladder.  

The Hormones made me a bit weird, crying for no apparent reason, and the Hot Flushes!!!  They're getting more and more and it could be another 8-10 months before they are out of my system.

The ED started about a year ago, will I return to normal once the testosterone kicks in again?  Who knows.  Will the Cancer reappear, again, who knows.

Seeing the Oncologist next week for my 6 monthly appointment. PSA levels 0.03

No regrets at all.

Best of luck with your decision, remember not everyone gets side effects!

Hi Steve

Thanks for sharing your experience - yeah I am leaning towards Hormone + Radiotherapy at the moment - nice to hear you are doing well and in remission so far 

Steve (Stavros)

Hi Stavros,

I've had PC since 2012 and on watchful waiting for nine years, then Lupron (Prostap) for the last year. Two years ago, I had the option of surgery with a great surgeon but having previously has peritonitis after botched gall bladder surgery, decided that IMRT was my best route. I looked at every other treatment available both in the UK and abroad. Now booked to do a Space Oar next week (bowel spacer to prevent damage from RT) and then in late August to September 37 doses of radiation.

HT is evil in its effects. It as made me feel like a much older man than I am, but there is no getting around it, it reduces both your PSA and your testosterone. The latter fuels tumour growth. PSA is currently under 2 from 16.5 and testosterone nearly non existent. Also on Tamoxifen to prevent gynaecomastia (breast enlargement) due to the lack of testosterone and the increase in oestrogen. Latest MRI show that my prostate had reduced substantially in volume and size on HT.

I should mention that I am a T3B and my oncologist is aiming for a cure since it has not metastasized.

The decision between RT and surgery is not an easy one. With either you will have Lupron HT or equivalent, perhaps for years afterwards. I am sure you will have a gut feeling about which way to go. Outcomes with both surgery and RT are approximately the same, but for me the idea of having a nine inch cut in my body was not appealing, so I went for RT. However, it is true that surgery after RT is not as easy as RT after surgery so that may influence your decision.

Hope that helps and the very best of luck with your choice! Personally, I am under instructions for my grandchildren to live to 95, so keep positive!

Jonno

Hi Jonno

Thanks for replying - yeah I’m leaning towards HT with RT now I’m under UCLH so good reputation. Surgery bit more difficult as had previously cryotherapy 5 years ago.  I’m T2a so lower grade than you.  Suppose I will start trying my wife’s bras on
I hope all goes well with you and you will live long to meet your grandchildren’s wish 

regards 

Steve(Stavros)

Steve,

You have to start worrying when they fit you better than your wife!

I was a T2, this time last year I just got my planning appointments through, made me cry a bit (thanks again Hormones).

Looking back now, I can laugh, not so much then.

 We have to laugh or otherwise we cry (ooops wait a minute we do that as well ! ) Good luck and let’s all keep in touch about our respective treatments

Stevr

Steve,

There seemed to be more bad days last year.  Luckily, and I mean luckily I am in Biochemical Remission, so as long as my PSA levels can stay between 0 and 2, everyone is happy, no more treatment including Hormones.

I do tend to repeat myself and waffle (I put it all down to the Hormones).  Same with the dreaded E.D.

The treatment worked, I just wish it would with all PC sufferers.  Not much to ask!!!

My surgery is planned for mid September 2022. 5 weeks to go. Anyway, the results will not help you much since you are in a different situation. 

The good point is that both treatments they offer you cure the cancer.

Concerning sides effects, with surgery it is important to make sure they can deliver nerve sparing operation. If the surgeon is confident on that point it may be because your tumor is located away from the nerves. With this option you (we) can expect less side effects in the long term.

My personnal choice for surgery is: you cure the cancer and they send the removed prostate to the lab for analysis. So you get back results that can really tell you if they didn't find anything hidden in the prostate. Peace of mind for the future. Incontinence side effects are lower for guys with a longer membranous urethral lengh. I don't know what is the magic figure but under 10 mm incontinence might last longer. ED, mostly about nerves sparing and current situation and general health. These 2 side effects improve gradually with the help of pelvic floor physiotherapy. Well this is my hope.

Hope it helps.