Hi everyone I desperately need your help and advice. I was diagnosed with prostate cancer two months ago My PSA was 18, initial MRI scan showed that the cancer was contained within the prostate and biopsy showed I had a Gleason 3+4. Since then I have had an isotope bone and CT scan which I have just been informed confirmed the cancer for now had not metastasised. The recommendation was that I have surgery, via robotic radical prostatectomy but the side effects of abdominal scarring (five insistions), bladder incontinence (possibly temporary), erectile dysfunction (again possibly temporary) reduction in penile length and dry orgasms really concerns me. I was told (and read online) that although radiotherapy (both the external and internal treatment) will naturally circumvent the scarring and reduction in penile length, there would still be dry orgasms and the long term (3 months to 2 years) bladder incontinence and erectile dysfunction could be more severe or permanent. I am 57 with no children. I was told (or it was suggested) that just surviving this disease should be my priority but the reason I’m struggling to make a decision is I am beginning to feel the quality of that survival is if not just as important…perhaps more.
I guess my question is, does anyone have any advice as to how to choose between the two options. Have you had radiotherapy and have any advice as to what to insist upon to minimise the late effects of bladder incontinence and erectile dysfunction.
I am wary that every moment I delay making a decision gives the disease opportunity to spread. Please help if you can and thank you for reading this far.
Hello Angus (Angus JG)
The latest figures for Brachytherapy are to be found here:
NICE - Low-dose-rate-brachytherapy-for-localised-prostate-cancer-pdf-304199677
The figures for Surgery v Radiotherapy are here:
NICE Prostate Cancer. (section 1.3.7 shows reoccurrence rates).
I hope this helps.
Best wishes - Brian.
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Morning. Turning up a bit late here, but my view from the surgery side is quite positive as a balance. I’ve not used pads since 12th May, so my incontinence only lasted about 8 weeks after catheter removal. And it improved daily during that time (have a peek at my bio).
Tummy scarring is minimal. Hardly noticeable now, with 2 of the seven incisions now completely invisible. Even early on, apart from feeling a bit sore, I didn’t have any surgery issues.
ED IS an issue. The surgeon managed nerve sparing on one side and I have a small amount of spontaneous reaction, so am feeling positive about that, but nothing even close to anything “useable”. Vacuum pumps are, however a godsend and very effective 
Not sure about the threatened reduction in length, as TBH I’m having to use the largest tube and am nearly touching the end, so maybe the surgeon was very clever with his sewing… It is obviously a faff compared to natural erections, but hey, you take what you can get! Dry orgasms take some getting used to and are a little weird, but again still a joy.
But. Everyone is obviously unique in their recovery and side effects. I know acquaintances and friend on both sides of the RT/RP fence and have both positive and negative stories from each side. A friend who had massive problems with bleeds and pain which put him out of action for ages (I was back to work after 6 days) and another who felt weak and miserable and in pain through his whole HT/RT journey. Then again my brother in law who sailed through his HT/RT and another friend who also was back at work after a week after surgery and is as happy as anything with his choice (like me).
Hope you manage to get the treatment that best fits you. Keep digging and asking questions until you feel confident the journey is right for you. Being “only” 60 and fit, this really felt the right thing for me and I’m happy with my progress.
