Surgery or radiotherapy?

Hello Ethan (Ethan) 

So you have the choice between surgery and HT/RT. An important life changing choice which will impact on both you and your partner.

Grab yourself a pen and paper (I am old school!) and jot down a list of the pros and cons of each treatment as to how they would affect you and your partner.

I am 69 years old - I have had 3 years HT/RT - in answer to your specific questions I don't have bladder incontinence, I don't have erectile dysfunction and I don't have dry orgasms,  I DID have issues during treatment but these have now resumed "normal operation". You can read my journey by clicking on my user name or avatar - I did have other issues (like almost dying) but I am still here!!

Feel free to ask any specific questions.

Best wishes - Brian.

Hi Ethan - have a read of my bio (click on the snowy scene next to my name). Your diagnosis is similar to mine and I have had no ED or incontinence throughout my treatment.   AW

Thank you once again Brian. Can I ask are you seeing any improvement in a reduction of breast tissue and stomach fat? This was another of my concerns with the radiotherapy route.

Thank you Alpine Wanderer for your advice and for sharing your story, i truly appreciate it.

I too saw the Dr Sholtz videos about brachytherapy boost and hoped it might be the route forward. They mentioned a diagnostic tool called Prostox which can help determine whether a patient will be predisposed to suffer from long term aftereffects from one of the two brachytherapy treatments. Can I ask, was Prostox mentioned in your consultations, is it available on the NHS and also for your treatment was the spacer gel Spaceorg used?

My MDT reported that all options were active but surgery was preferred. When I spoke to the consultant who delivered the message he said the reason surgery was preferred and not radiotherapy was due to my age and health, they felt my body could handle the procedure, also due to my age they felt that I had many years ahead of me so the possible long term side effects of radiotherapy could play a factor down the line. He also said that this was the reason radiotherapy was often offered to older patients and not surgery. If further scans was not needed to determine whether there had been a metastasis, I probably would have said yes on the spot and not have had the opportunity to research further and consult with you wonderful people.

I have a consultation with a Clinical Oncologist soon, but sadly although his bio states he specialises in radiotherapy and brachytherapy, I do not believe he has as much experience in the later as your surgeon AW, which is a concern. I think the first question I will need to ask him is, considering my scans and overall profile, whether he feels brachytherapy will be suitable for me and to what extent he has practiced the discipline. Thanks again AW.

Hi Ethan - no, I didn’t have prostox or any diagnostic tool.  The prostatectomy surgeon said I was a prime candidate for surgery, but I felt uneasy about the chance urinary incontinence in particular. In addition, my surgeon consultant said he estimated a 30% chance of recurrence with the surgical route, so I didn’t fancy two sets of side effects compounding each other.  (as Dr. Sholtz says “one and done” is best).  I asked about SpaceOar, but the team said that the accuracy is far better in today’s radiotherapy than when SpaceOar was first introduced. They also didn’t want it to “mask” any potential escapees from the gland. I had brachytherapy at another hospital after I requested referral, as I really wanted to pursue brachytherapy boost - particularly after reading the ASCENDE Study report and the Canadian charts which seemed pretty persuasive. After brachytherapy, I was referred back to my local hospital for the hormone therapy (done at GP surgery) and 23 fractions of EBRT. So far, touch wood, my body has tolerated this aggressive approach.  AW

Hello Ethan (Ethan) 

When diagnosed I was aware of the possibility of growing a pair of "moobs". I was offered "tamoxifen". I was 66 at the time I have other issues so no - I am happy with where I am.

Yes I am overweight, yes I have a cracking pair of "moobs" but for me I am still om a "curative pathway", so it's been my choice to accept the changes to my body - the thing is I am still here and they are MY choices. I enjoy my family, holidays and life in general - once you have almost died some things change your attitude!!

Sometimes you need to consider treatment v quality of life!!

Best wishes - Brian.

Just to add to my previous post, here's a link to the NICE guidelines so this shows what you should have been told and offered:

NICE Guidelines Prostate Cancer.

Plenty to consider there!

We are all here for you - we have "been there done that" - anything you need to know - just ask.

Best wishes - Brian.

Thanks AW, I am leaning towards this route, and I’m realising that I may have to be insistent. Can I ask, did you have the low dose permanent seed implant or high dose? 

Thanks Brian, I read about Tamoxifen and may consider it when the time comes. I’ll read NICE Guidelines prior to my next consultation with my Oncologist in a couple of weeks. Thanks again.

Ethan

Hi Ethan - LDR permanent seeds.  All in my bio.  AW