I received my diagnosis less than a month ago

Hello Sardonnick 

A warm welcome to the Macmillan Online Community, although I am so sorry to find you here. For a 66 year old, you have done very well keeping fit and cycling as you do - and a BIG THANK YOU for raising the funds to keep Macmillan and The Community going.

Gleason 7 and a T3a, you say 

Sardonnick said:

I have met my surgeon

May I ask did you chat to an oncologist to consider the other options, Radiotherapy, Brachytherapy and Radiotherapy and what influenced you to pick surgery?

Great news that your GP is one who checks PSA  - I wish they all would!! Good luck with your surgery, do keep us updated with your progress - let us know if we can do anything to help.

Best wishes - Brian.

Hello Sardonnick , welcome to the club  no one wants to be a member of, sorry to find you here. 

Greetings from a fellow triathlete.

It is surreal and existential, but you get used to it. There is life and sports after diagnosis though expectations needs to be different. 

I'm also T3a and my treatment is radiotherapy and hormone therapy, it's worth checking your options before committing to a specific treatment path. 

Well done on your charity ride! 

Any questions you have please ask, we're a friendly bunch and we understand what you're going through. 

Btw, if you click on a person's name in the forum, you'll get to their biography. This is where we put a summary of our cancer journey. It's useful to see where people are at, you can start populating your journey in your biography section of your profile.

Regards 

G

Hi Brian, thank you for the welcome.  In answer to your question we had a long discussion with the Urologist who gave the diagnosis about the risks with other pathways.  The concern is that the worst and most aggressive cancer is near the edge of the prostrate and may break out and spread.  Urgency was recommended.  Radiotherapy with the preparatory hormone treatments would take months and given the nature of the risk and its location it could spread and complicate.  Brachytherapy is a long term treatment suitable for slow to moderate cancer which would not be appropriate for my diagnosis.  The recent bone scan shows that it hasn't spread to any degree.  If it had radio and possibly chemotherapy would be the new pathway.  Surgery is now booked for early June.

Thanks L1m I'll complete and update a profile.  It does feel a but isolating and whilst would wish this on any one it is also good to know that we're not alone.

But have you spoken to an oncologist about the options and carefully listened to their opinion? I had meetings with both a urologist surgeon and an oncologist. I then sought advice and counsel from many, especially on this forum. I also did my own research. After careful thought, I chose HT/BrachyBoost/RT. I was also 4+3, T3a. Good luck and best wishes to you.

Hello Sardonnick and welcome. I am not sure if you are aware but hormone therapy puts the cancer into hibernation rapidly which then shrinks the cancer making a smaller target for radiotherapy. Yes the radiotherapy does act longer term but the latest research shows that it is equally effective but with less potential side effects.

There is an informative video on the subject by Dr Mark Scholz.

https://youtu.be/ryR6ieRoVFg?si=ajmZ-Ik4Umukgz2f

I also think it is useful to point people in the direction of box 2 of the NHS guidelines on side effects from the different types of therapies so that they can discuss these with the experts before committing.

https://www.nice.org.uk/guidance/ng131/chapter/Recommendations#localised-and-locally-advanced-prostate-cancer

No matter what you choose pelvic floor exercises can help with recovery and there is an app which you can download called the SQUEEZY APP which explains how to do them properly.

Good morning Sardonnick 

Thank you for your reply. It would look to me that you haven't had a balanced view of the treatment available and haven't seen an oncologist - the surgeon has "bought" some business with his incorrect statements.

* If it's needing urgent treatment HT would have stopped any spread the day you started it - Bicalutamide starts working from day 1. (I see it's not that urgent it can wait until early June).

* Brachytherapy is done and dusted in two meetings  - a pre op and the day the seeds are sown - you are any ideal candidate for this treatment.

* Radiotherapy and Hormone Therapy do take months but as someone as fit as you and very active - this would be my choice of treatment - so I could keep up my activities - Surgery will put you out of action - for 6 months possibly for good.

I personally would consider ALL the options - fully check them out for their pros and cons as to how they affect you and speak to both an oncologist and people on here who have had the different treatments - you have time to reconsider.

Good luck.

Best wishes - Brian.

I hope you will find my husbands and my journey of help. I joined this wonderful forum when my husband had surgery on 2 February and how we had become so distant  just after a few weeks because surgery changes the dynamics in a relationship and the intimacy immediately. It’s 3 months now and we are making progress, he is continent but cannot get an erection without using intervention (a pump) which works well. He regrets surgery every day and I can see he is so troubled that we were never given any alternative, just a biased surgeon. Our most serious mistake was going private. My husband was a T2/soft T3a (not sure what that means) and close to the capsule. The surgeon has said he’s achieved bilateral nerve sparing but I’m not convinced, he’s been very vague. At follow up consultation we were told in some men erections may never return and we certainly wasn’t told that before surgery! We made the wrong decision and now how to live with that. We are together and have been for 33 years, this is a couples disease and WILL affect you both. Please explore all options with their side effects don’t make the mistake we did. If you want a sex life, surgery isn’t a good option. We are now in a waiting game, will his erections return which we’ve now been told if they do can take upto 2 years! That’s even if they return. If there another option that would give you the same positive treatment solution avoid surgery. Wishing you all the best x

I can see that a deciding factor for you was the 4 part of the Gleason score and it's potential for spread as it is close to the capsule edge. There is another interesting video on Gleason 4+4 which is the next stage up but it does give a good idea of how effective the different therapies are but also the risk of recurrence and long term side effects.

One thing to consider is that a urologist is very good at signposting and monitoring things but it is the oncologist who has the different tools at their disposal and they are the person to discuss other options with. 

https://youtu.be/Q-bOrWvmrz4?si=I809pFhsC-0y1TGt

Do not be rushed into making a decision through fear of the possibility of the cancer spreading out of the capsule. Get all your facts and options for treatment and potential side effects and then make a balanced decision which you and your wife can live with.

Hi Sardonnick , and as others have said, welcome to the club that no one wants to be a member of. 

I have much less knowledge than others that have already replied to you but I echo the opinion of all. For your own peace of mind and future do like I did and research all of the available treatment options, I was lucky in so much as I had a recently retired GP as a personal friend from whom to seek unbiased advice plus opinions from other friends who had trodden these roads before me.
At the time of my diagnosis we had been married for over fifty two yeas and were able to discuss all of the options and their related side / after effects very deeply which I found very reassuring.

My journey was long and slow but hopefully successful if you have the time and patience it's all in my profile. Admittedly I was T3 not T3a but am now nine months post RT and apart from the lingering effects of the HT, hot flushes and ED, I am now looking forward to a good future. 

Which ever way you decide to go I wish you a very successful outcome. Please keep us informed.

Rod