Surgery or radiotherapy?

Thanks Richard’s Dad, I feel that I may follow your route but if possible without the additional radiotherapy. Please let me know how you continue to fair with the ED, this was something I wanted to avoid by leaning away from the surgery path.

Thanks again RD for sharing your story.

Unfortunately my ED started very soon after I started on this journey and wouldn’t say the Brachytherapy or Radiotherapy effected it but the Hormone Therapy certainly added to it so I am really hoping for an improvement now this is coming to an end.

Thank you so much Fzh2p0 for your story. This may sound crazy but I am slightly relieved to hear you had a positive experience with surgery. I was frightened that since the recommendation for my case was “preferably” surgery (it did state that all options were live), my Oncologist may feel that brachytherapy was not suitable for my situation and that I would have little option but to agree to surgery.

From your story I believe whichever route I take, there may be light at the end of the tunnel.

I have to say at one point after first being diagnosed and prior to coming across this forum, after days of research, my head pounding and emotionally drained…I just felt like flipping a coin and going with whatever fate decides. I still have those moments but thankfully not as much.

Thank you once again Fzh2p0.

Hi Ethan

Another one from the surgery side. Diagnosed April 2023. T2c Gleason 4+3. Tumors on both sides. Contained but close to the edge on one side, so only partial nerve sparing. Surgery in September 2023. Urinary incontinence lasted a matter of weeks after catheter removed. 20 months on and have made a complete recovery. Scars difficult to see. Initial ED issues improved over the first year and now have no problems in that regard. Maybe a little reduction in penis length but nothing that bothers me. 

My recollection of the stats is that most people who have surgery recover from urinary incontinence within 12 months. However, about 50% have some level of ED. There are tablets that can help with this, but don't work for everyone. 

My experience of surgery has been a very good one, but whichever route one takes, each of us is different and there is a level of uncertainty. A close friend of mine decided on the HT/RT and has had problems with bowels, extreme tiredness as well as the impact of testosterone reduction on sex life that others have mentioned. Fortunately things are gradually improving for him.

Good luck with whichever treatment path you choose.

Feel free to ask me anything.

Cliff

Hi, yes, i am confused over the HT bit if the cancer is inside on a 3+4 gleason, thats going to take some explaining as ldr brachytherapy is targetted radioactive seeds which should kill the cancer and by default stop any further spread, so why have HT as well, it just doesnt make sense and mine was done at christies …. I would love to hear the logic.   

Thanks for sharing that Richards Dad, I’ve read the hormone therapy reduces testosterone which in turn reduces libido and the rest is history. Once you come off the HT perhaps things will improve. I myself would like to avoid the HT but I suspect that won’t be an option. Best of luck and thanks again.

Thanks Cliff, yours and Fzh2p0‘s stories gives me hope that should I have no option but to take the route of surgery things may work out better than I’m fearing. I guess all we can do is try to stack as many cards in our favour by the choice we make. Thanks again Cliff for that perspective.

Hi Ethan, I had a very similar diagnosis and a little over 4 weeks had the surgery I am fine with hardly any leakage  and hints that erectile function will return.  My surgeon responded to my wishes and avoided nerve damage believing everything was left undamaged.  I had similar doubts and spoke with the urology nurses about it and they explained: 

The advantage is that you can still have radiotherapy after surgery if there is still PSA present but you cannot have surgery after radiotherapy.  I also had a diagnosis of Fibriform indicating a potentially aggressive form of prostrate cancer so the surgery was urgent after a bone scan confirmed there were no other signs of cancer. 

I still have no symptoms which makes the whole situation somewhat surreal and more existential than physical!  My only frustration is the 'No Exercise' instruction which applies up to 6 weeks after surgery. 

I am 67 years old already, a keen cyclist now and an ex-rugby player/coach, runner and triathlete.  I hope this is reassuring for you.

Hello Sardonnick 

Just a correction - Radiotherapy IS possible after surgery although it's difficult.

Confirmation from the NHS here:

N H S Prostate Cancer Treatments.

Best wishes - Brian.