What to do? I am only a newbie once

Hi Folks

This is all very new to me. I must confess to feeling calm and almost detached, which is weird but I guess not uncommon. I am semi retired 68 in very good health, wife and myself walk miles with our doggies each day. I have worked in the clinical trials field for over 30 years so I know a little about a lot. I am not a doctor.

My history see below. It has all moved rather fast since beginning of September. I cannot fault the system so far but I suspect my allocated cancer support nurse may be extremely busy.

GP appointment 13 August following months or years of mild urinary symptoms and yearly prostate examinations, this rectal prostate examination resulted in a referral to urology small hard nodule felt(?), PSA has always hovered around normal at 2.2

Urology consultation 27 August and consultant rectal examination referral for MRI

MRI 30 August (Sunday, Bank Holiday)

Urology Prostate biopsy 16 September for histology

Urology consultation 13 October cancer diagnosis (see below) options for surgery or hormone/radiotherapy

Notified of admission 16 October, Admission planned for radical prostatectomy 02 November. Assuming COVID doesn’t cause mayhem, which I suspect it might.

Biopsy results confirmed Gl 3+4 =7 (grade group 2) in five out of 20 cores taken, with the longest focus of cancer measured as 5.5mm. MRI confirms organ confined disease, T2 stage.

The MDT recommendations are active treatment. They can offer removal of the prostate or hormone therapy and radical radiotherapy.

Do I follow through with the planned surgery or look for focussed beam/ultrasound treatment, or will this be a hugely expensive route?

Best Wishes to All

  • Hi and welcome!

    Speaking from personal experience I would go for the least invasive option - radiotherapy (RT)  The hormone/ RT route whilst it has its side effects I feel its the way to go. My history was similar to yours but my Gleason was higher as was my PSA ( 9 and 18 respectively).

    Good luck in whatever you decide is best for you.

    Trying to get fit again!
  • Thanks for your message, much appreciated

    I was told by consultant that surgery and hormone radiotherapy had similar outcomes (85% survival at 10 years) but I know several who took the H/RAdio route and had awful SEs

    I am still undecided

    There are no other options? Surgery is so FINAL!

    Best Wishes

  • Hi

    I agree 're the finality of surgery, and thankful that they pushed me towards the RT route. In fact , when I asked what the other options were, they said RT was the best one for me.  I didn't question why surgery wasn't offered as, like you I feel, I didn t want it!

    There are well documented details of the side effects for both, and if the effectiveness is the same then I would go down the RT route. ( Others may disagree of course!)

    As an aside, and all please excuse my ignorance if I am staying something which is not possible, but if the RT /hormone therapy doesn't work can you still have the surgery? 

    Keep safe

    Regards

    Stuart

    Trying to get fit again!
  • You should be fine with Radiotherapy, with or without hormone therapy.

    I had RT with no lasting side effects, u will be ok so long as u don't have existing bowel/urinary problems.

    Just to pick up on Stuart's last point, surgery can be very difficult if not impossible sometimes after Radiotherapy.

    Steve

  • Hi

    Just 're read your post.

    The RT side effects are not that bad providing , as Steve mentions, you don't have any other bowel or bladder problems.

    The RT team will talk you through them ,and give recommendations on how to get round them. The main one for me was diet. If you go down the RT route make sure you ask for the dietary sheet and follow it religiously!

    The side effects don't kick in for a couple of weeks so don't get lulled into a false sense of security and ease off if you seem not to be having any - most likely you will!

    Some of the guys who were having RT, at the same time of me, were taking no notice of the sheet ( drinking alcohol) and I'm guessing that , maybe, this could be one reason why your friends side effects were bad.

    As Steve suggested, they don't last long after the RT finished so I wouldn't discount RT/HT on the basis of the side effects only.

    Regards

    Stuart

    Trying to get fit again!
  • You have a T2 tumour (T2N0M0).

    This would always be defined as a 'curable' cancer; therefore, at this stage, you need to look at curative options.

    PCa is a long-term disease (50% of us will die of something else before the PCa gets us). But as the years pass, it becomes less treatable; it won't always be curable if it survives your first treatment. So pick a treatment that is likely to deliver that cure, not one that sounds gentle, but will allow the cancer to return later. You've seen the movie trailers "It's back, and this time it's angry..."

    With cancer, it's vital to aim for winning in the first round. Because otherwise it will always go the distance, even if you win on points.

    Both surgery and radiotherapy are proven to be pretty effective (though a cure is never guaranteed with either). No other option comes close.

    - - -

    Heinous

    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.