Confused! Hormone + EBR Or RP?

Hi all, brand new to the forum. Just found out a few days ago that I have PCa. I am 57, married and now just retired. I had no symptoms but was detected during a routine blood test. I have had an MRI scan and three weeks ago had biopsies taken. I got my results on Wednesday 9th Sept which came as a big blow, totally unexpected. Although not a lot sunk in at the time I know my Gleeson score was 7 but unsure whether it was 3+4 or 4+3. Also, the Consultant said that the cancer is confined to my prostate at the present time and offered me the option of Hormone+EBR or RP. I initially thought the less invasive EBR was my best option, (not going through major surgery),but thought the Consultant was pushing the RP option during our conversation. It would have been a lot easier if I had been told which is the better option for me but that isn't the case. From what I have read I understand both options have very similar side effects and neither option has been proven to be better than the other. 

what I am keen to understand is the recovery time for both options, bearing in mind the EBR option can extend over many months before the radiotherapy begins. Also, what the likely pro’s and cons are for each option? Thanks in advance of any guidance and advice.

  • Hi Ian

    Welcome to the forum.

    There are many people on here who should be able to tell you their experiences of both treatments.

    If your Consultant is a surgeon, it is likely that he would think that RP is better.

    I believe there is a big difference between 3+4 or 4+3.

    Best wishes with your choice.

  • Hello Grsnda.

    My cancer has spread to local lymph nodes so I've been offered only radiation - starting in just over a week - plus I'm already on hormone therapy 

    However maybe I can help by saying I've done a stack of research on radiation and am increasingly hopeful. It seems it can be carefully focused on the cancerous tissues be they in the prostate or the nodes. The hormone therapy should have shrunk the tumours to make smaller targets anyway.

    Side effects can vary of course but I'm encouraged to be told the more hellish ones are unlikely. The more likely ones I am told are bowel and bladder problems but they can be relatively short lasting. I hope.

    Maybe someone else can help eith the removal option.

    • All the very best.
  • Hi GI

    Potentially there can be more side effects with surgery especially ED and urinary problems

    Unless u already have some bowel issues then RT should be fine with side effects mainly lasting during treatment and for a few weeks after. RT is very targeted these days especially if your centre uses the gold markers inserted into the prostate.

    If u have hormone therapy in addition to the RT then that can produce extra side effects which should disappear sometime after treatment finishes.

    I had RT and was very happy with the treatment and outcome, having said all that there r some people on here who were very happy with surgery.

    Only thing is you r young at 57 and don't really want to risk ED if that side of things is important to u

    Best wishes

    Steve

  • Hi, sorry you’re  a member of our club.  I had surgery and promising results after surgery, using tablets and pump.

    unfortunately subsequently discovered spread so now on hormone therapy which has messed any Ed recovery.  Surgery took 6/7 weeks to recover,  continence good, Ed promising.  For me radiotherapy after surgery possible, surgery after radiotherapy very difficult, that is why I chose surgery.

    Good luck with your journey each option has it’s difficulties , it’s a personal choice with ramifications that we deal with. That is why it must be your choice of treatment.  Perhaps ask how close to nerves the cancer is. If too close ask difference between two options I don’t believe much difference 

  • Ask your consultant if you can be referred to see a radiologist before making any decisions.  A radiologist will push Radiotherapy and a Urologist will push for surgery.  It is best to get a good view from both. 

    It is usual to have Hormone treatment  (HT) first - but not always.  This should be for 6 months and then have a month of radiotherapy.  After this you can either be asked to stay on the Hormone Treatment for up to 2 years or you can stop.  I had a gleeson score of 7 (3+4) but at MRI the tumour was seen to be pressing on the back of the prostate and it could not be confirmed whether or not any cancer cells had escaped so then it was decided that RP would not necessarily get all the cancer but  HT and Radiotherapy (RT) would get all the cancer if any cells had escaped. I had 3 x 3 month injections of HT.  Having the last one just 2 weeks before starting my 4 weeks of RT.  The effects of the HT lessened over the next year and by the annual check with my rad.onc my sex life was back to normal - to the extent that I asked him if this was OK as cancer seems to feed on testosterone.  The worst effects are from the HT which are fatigue, hot flashes and mood swings.  To help with these it is best to keep active throughout which I did going to the gym about four times a week all the way through the HT and RT.  That was nearly 4 years ago now and my PSA is still undetectable so as was said at the beginning of my journey it could be cured and that seems to be so - but you never feel totally free.

    Hopefully someone will come along soon and give you a similar story after RP.

    Take care of yourself and I suggest you look at the Prostate Cancer Toolkit selection of pamphlets on the Prostatecanceruk. website - they are brilliant, as are the specialist prostate cancer nurses on their helpline and they were fantastic with me as I only once in 2 years managed to get in touch with my key worker so those specialist nurses were asked all the weird and wonderful questions my wife and I had so well and made my journey so much easier.  If your hospital has a Maggies Centre I suggest you find out if they have a Prostate Cancer Group Meeting as it is such a good thing to share your experiences with others and have them share their experiences with you and your family too.  It would also be a good idea for you to find out whether your gleeson is either 3 +4 or 4+3 as 4+3 is slightly more aggressive than 3+4.  I would also ask if you are suitable for brachytherapy - where radioactive seeds are implanted into the prostate - my brother had this last year and again is doing well with few side effects. 

    Now tell all your male friends and relatives to get checked regularly.

    All the best,

    Des

  • Many thanks to all for your replies, I will be speaking to the Nurse today to make a decision. I am trying to think positive And not let it consume every waking hour but I am devastated. I have told my Sons and my Brother / Nephews to also get tested as it appears to be hereditary in my family. Hopefully, God willing, I will be able to post some positive news later in the year. Good luck and best wishes to all on this forum And thanks once again.

  • I was diagnosed in 2018 as T3A N0 M0 with a PSA of 15 and a Gleason score of 4+5=9. I have been on HT (Prostap 3) since October 2018 and will be on it for another year. I had 20 sessions of RT in February & March 2019. My PSA dropped to 0.4 within a month or so of starting HT and since completing the 20 sessions of RT has been <0.1. 

    I was 73 a few weeks ago and am back to full fitness attending a fitness class at Maggie's once a week and rowing as often as I can. I also do a lot of walking, at least 15 miles per week.

    Please ask your oncology specialist about joining the UK Genetic Prostate Cancer Study which is for patients who have a direct relative with PC. It is run by Cancer research UK and they are looking for a genetic link in families. My father died of PC at the age of 53 (a long time ago now) so they were very keen to get my DNA! Also encourage all your male relatives to get tested. The PSA test isn't foolproof but it's the best we have at the moment.

    Please see my profile for more.

    Seamus
    (See my profile for more)
  • Thanks for the advice seamus47, it is worth consideringThumbsup

  • Welcome unfortunately to the club. A year ago I knew very little about prostate cancer, and I am still no expert, so everything I write here is personal opinion from experience.

    If your cancer doesn't appear to have spread, and you are relatively young (which for this disease you are) and you are otherwise in good health, then I'm not surprised that your consultant has recommend surgery. The overall recovery time from surgery is much faster. I was told to take six weeks off work to recover from surgery, and that if all goes well I would be over most of the side effects within a year.(More on my story below.)

    In contrast hormone therapy plus radiation therapy instead of surgery is three years of treatment, and quite a long recovery period after that. So the difference is that you could be treatment and side-effect free in one year with surgery rather than perhaps four years with hormone and radiation.

    You're right in that long-term outcomes for both routes, in terms of slowing or even eradicating the cancer,  are more or less the same.

    However, both routes have risks and side effects. These are principally impotence, erectile dysfunction, and urinary incontinence. In my case the surgery removed both set of prostate nerves, so ED for me is likely to be long term, but i am in contact with an Andrology clinic. 10 months after surgery my urinary incontinence is almost completely gone, though I continue to use a pad during the day more for confidence than for need. (I have grown up children so I wasn't concerned about impotence. YMMV.)

    Some patients need follow up treatment after surgery. They found cancer in one of the lymph nodes they removed from me in surgery, so I have also had six months of hormone therapy plus six and a half weeks of radiotherapy. The side effects from these additional treatments have been weight gain, hot flushes, and quite severe fatigue. These should ease over the next few months.

    If hormone therapy plus radiotherapy don't achieve the desired effect they won't offer you surgery, but they may offer longer term hormone therapy.

    Wishing you all the best for your treatment whichever you choose.

  • Many thanks for replying. It really helps when you are offered someone else's experience Of this disease. I have decided that I will opt for surgery and will see a Urologist tomorrow. All the best and I hope you continue to get back to some sort of normality.