What option should my husband choose.

Hi. New on here. My husband recently diagnosed. Gleason 9. PSA 6.6. What to do? Based on your experience would you have robotic prostatectomy with radiotherapy follow up or go straight for the hormone therapy/radiotherapy. Would have the op in 6/7 weeks privately or start ht now. Told it’s T3 with histology showing perineural invasion. It’s aggressive. No symptoms at all. He’s a healthy 65 years old. No underlying.  Experts can’t agree what route to go down. Doctor says outcome is similar either way. It’s up to my husband now. Anyone similar? Thanks guys.

  • Hi and welcome to the forum. I was 71 when diagnosed with PSA of 11, Gleason 9 and T3A N0 M0. I was offered either surgery or HT/RT and opted for the latter. Sadly the experts will not tell you their preferred treatment path and will leave it to you and your husband to decide. I chose the HT/RT path as I am very active and was warned that I could suffer from stress incontinence following surgery.

    I had three years of HT which finished almost a year ago and 20 sessions of RT in Feb/Mar 2019. There are side effects of both treatment paths ut I found the side effects of HT/RT were manageable.

    Good luck with the treatment whichever way you go.

    Yesterday is history, tomorrow is a mystery and today is a gift.
    Seamus
    (See my profile for more)
  • Honey, exactly as mine. Diagnosed August 21,  Originally medium aggressive, specialist overruled that to highly aggressive, no PSA as it stayed at 1.3, thanks to all that say watching that will keep you safe!!! Had prostate removed as I'm 58 and no other issues, and the risks of radio t initiating other cancers later is real. So, watching PSA and periodic PET scans, getting some function back as surgeon could nerve spare on one side. Even catching it this early, it had invaded one lymph node which the scans didn't show and only showed during surgery. Happy to give my take on it all! 

  • Thanks for that Simon. So no rt for you then. We haven’t read anything in detail about initiating other cancers. Have you got any more info on that please. Husbands PSA has been a red herring for him too we now believe. Urologist said he could have had this cancer for up to 5 years. No symptoms at all. 2 yearly PSA tests because of family history which unfortunately due to covid was over 3 this time.

  • Thank you Seamus.

  • Honey hi. Yes the specialists  gave me the choice of RT or radical op, no pressure either way. I'm 58 so early in life to get it, and only a little younger than your man, so the arguement is the same. The advice was that at my age the possible risks of the RT causing bladder colon and even kidney issues including initiating cancer in them is higher the longer your  life expectancy post op, as we both have. The organs are all tightly packed and close to each other there, the prostate sitting right under the bladder. So the RT inevitably impinges on other organs, I guess. Having cancer of the prostate this early in life tends to be more aggressive, so I'm now told, so the earlier the intervention the better. Any help you need or further info, feel free to ask away!.

  • Food for thought. Thanks Simon.

  • At 51, I'm worried about the cancer that Brachytherapy might cause in the future so I'm leaning towards surgery if I have to choose between surgery and radiation treatment

  • I think surgery is preferable in younger men and HT/RT in the older ones. I was 71 at diagnosis so the  prospect of longer term damage from RT was less daunting.

    Yesterday is history, tomorrow is a mystery and today is a gift.
    Seamus
    (See my profile for more)
  • Your husbands numbers are nearly identical to my diagnosis last year. PSA, high grade, gleason.. i was 66 when diagnosed I decided on surgery which happened Jan this year. Its tough for a few weeks but Ive recovered well and returned to my old times exercise program. I dont suffer from stress incontinence even when pushing up hill on my bike.

    However sugery did not cure me and now Im starting a course of RT. I believe I still made the right decision. My tumour was 25 cm and I cant see how RT  would have killed it off first time out. All I have now are a few cancer cells left over which need blasting.

    I hope it goes well for you. This forum is the right place for information. I wish I hsd found it earlier

  • Just diagnosed and I have to decide HT/RT or radical op. Gleason 8 T2 no metastasis to bones. 3/6 biopsies on left side. I worry over catheter issues and nerve damage and incontinence but also that HT/RT isn’t as effective and may lead to other cancers. I’m 73 and active. The op involves a quicker time scale in June/July as HT/RT will take me to Sept/Oct to have RT then 2yrs HT. 

    I wonder which is most effective and will suit active life style.