Decision about treatment.

  1. I was diagnosed as Gleason (4+5),  stage T3a,  N0 and M0.  The nurse mentioned I would be offered either surgery or radiotherapy.  I'm currently taking hormone tablets.  I'm in my 50s with no other underlying health problems.  I'm advised that erectile dysfunction is a consequence of both treatments but not a showstopper for me given the circumstances.  I found the Macmillan pamphlet very useful but thought surgery would not be an option with T3a so the decision is now causing me a little angst although generally mentally ok.    Any advice greatly appreciated.
  • Hi Jewitt and welcome

    T3a normally means that the cancer has broken thru the prostate capsule so u would prob be better off with Radiotherapy.

    Unless u have existing probs in the pelvic area  then ED shouldn't be an issue long term, when the HT has finished.

    Best wishes


  • One of the risks in surgery to remove the prostate is that it may damage or remove one or both sets of nerves that control erections, so if ED is a major concern, you should bear that in mind. But please listen to your medical team before you listen to me.

  • Staging is not an exact science: the surgeon told me "A 3a often turns out to be a 2 on the operating table". It immediately occurred to me that my 3a could turn to to be a 3b, and I wouldn't want that on the operating table.

    That was one of the main deciders for me. I had radiotherapy, with three years hormone therapy. These days, you might get away with a shorter spell of HT, and so fewer side effects.

    There's no easy way to make the decision, but you're right to be considering the long-term effects.

    Good Luck, whatever you decide!

    - - -


    A healthy-looking decrepit, 69-year-old male, mentally alert but forgetful. I no longer have an urge to choke people who say "all you need to beat cancer is the right attitude" - better to smile and move on.

  • I agree deciding is difficult, equally it’s your choice with the side effects something for you to life with. There are physical and mental side effects, think how you might think after finishing treatment, or during, think if things go well what if’s. Ask the specialist nurse,  I’m glad you’re on here, each of us have chosen our preferred route.  For me it was surgery because 

    1. Radiotherapy after surgery is more feasible than surgery after radiotherapy,  

    2. There was a chance of cure

    3. Being younger there were questions over longer term impact of radiotherapy (very longer term)

  • Hello Jewitt  Yes it's a big decision to be faced with but there are pros and cons for both treatments in your situation .The main one being that Radio Therapy is an option as a chance of cure  if the prostectomy fails .Many times the staging is incorrect prior to the removal of the prostate in my case it looked as if the cancer was contained but when it was removed my PSA remained high and a PET scan revealed lymph node involvement .So I was put on hormone therapy for six months prior to salvage  Radio.therapy that was 66gys over 6 and a half weeks finished in February .Along with the injection  hormone therapy I was given the wonder drug  Enzalutimde normally given for castrate resistant PC but since COVID has been prescribed as an anti androgen first line treatment for salvage situations. .My PSA dropped like a stone to undetectable in 4 weeks and has remained there ever since .There is a lot of interest amongst consultants  in the viability of removing the prostate in advanced and locally advanced prostate cancer cases it's a bit like removing a 'mother ship' that sends out instructions to its circulating drones or in our case circulating cancer cells  if its removed the cells have no base to get their chemical instructions from well this is a theory being investigated  anyway ..I fit this bill having had my prostate already removed and so far touch wood things are looking good. My cancer was  diagnosed 5 years ago I went on active surveillance but in late 2019 my PSA was doubling at a frightening rate so removal was the only option .The pathology put me at T3B .Gleason 4 3 with some 5 so pretty nasty and my base psa before hormone treatment had risen to 28 .But it's now <0.01 hopefully the enzalutimide and RT are working to kill off any nasties remaining .No treatment is an easy undertaking everyone is different in how they react to it .In my case I was completely dry one week after the prostectomy, no nerve sparing so no erections but that's not a big concern for me or my wife .I'm here alive and kicking still and hope to be so for many years .Think long and hard read up about both treatments and ask a lot of questions good luck to you .

  • My psa is 1.1 strangely so I'm not sure what that signposts.  I've read a book by dr walsh so I was moving toward surgery or the gold standard as he defines it   I think he invented the operation.  On reading these helpful comments (much appreciated) I may need to think again.  I have a meeting tomorrow.  I note the comment about the fragile nature of staging.  I hadn't thought of that.  I have no issues with ED so again that is a key consideration.    I'm pleased to hear about your progress.

  • The pamphlet seemed to suggest surgery wouldnt be an option at stage 3 but I've been offered it   

  • Surgery for 3a is pretty much a routine offer, I think; for 3b I think it might depend on the details.

    - - -


    A healthy-looking decrepit, 69-year-old male, mentally alert but forgetful. I no longer have an urge to choke people who say "all you need to beat cancer is the right attitude" - better to smile and move on.

  • I was diagnosed as T3A N0 M0 at the age of 71 and offered surgery or HT/RT. I opted for the latter as I am very active with rowing, walking, swimming and aerobics and was warned that surgery could lead to stress incontinence. I have been on HT for nearly three years with my last Prostap injection due in June. I had 20 sessions of RT starting in February 2019 which passed remarkably quickly.

    There are side effects to both HT & RT but mine are well controlled and I have no trouble with them.

    (See my profile for more)