Can't understand why anyone would choose surgery over Brachytherapy? I must be missing something?

diagnosed last week ! 

Anterior abnormal area, 10 out of 13 cores Gleason 3+4=7 (10% pattern 4).      

Perineural invasion present, maximum cancer length 13mms, maximum percentage core involvement 80%.

MR scan show possibility of T3a N0M0.

Benign feeling prostate.

PSA 8.

(Above cut and pasted directly from biopsy constants letter)

I’m 51 generally fit and healthy with absolutely no symptoms at all, and never had any problems with my water works or ED. 

Would still be none the wiser had it not been for a very efficient GP calling for a check up scan following a bad bout of prostatitis (told it’s not linked at all) 

Biopsy consultant has told me active surveillance isn’t an option and like many on here I now have the difficult decision surgery or brachytherapy - no mention of any HT

My initial thoughts with no “official “ information to hand other than from here and google was surgery, being an engineer my thoughts where why waste time treating it with a radioactive seed😳 when you can just cut it out and be done with it. 

Having now had consultations with the surgeon and oncologist I am now more confused than ever

If what the oncologist says and the info in the Brachytherapy booklet he gave me is all fact? 

Why on earth would anyone put themselves through the surgery???? Apart from the very obvious reason “it’s cancer😳 just cut it out and get rid of it in one go” I’m struggling to find another reason why people would choose surgery. Plus there seems to be quite alot of people on here that have had surgery then have needed to have RT and HT anyway as it wasn’t all removed first time round.

Or am I missing something vital? 

Success rates appear to be similar for both. 

Days off work and recovery appears much shorter with Brachytherapy - 2 separate days in hospital with a few days feeling rubbish and back to work the week after, with the surgery it’s a major operation(with its associated risks) much longer in hospital, catheter in for 10 days + and weeks of work. 

Both appear to have similar risk of ED and long term water works problems.

And going down one route seems to preclude the use of the other if it isn’t 100% successful with both ending up needing hormone or external radiotherapy. 

Surgery seems really popular for men in their 40’s and 50’s and less so above 70 

The above 70 bit I totally get (recovery) but can’t understand why it is so popular for the younger chaps , please help as I must be missing something 

Thankfully I’m covered by my wife’s work health insurance so either treatment hopefully shouldn’t  be affected by COVID.

Thanks

x

Edited by member 13 Jan 2021 at 23:05  | Reason: Spelling

Hi Phillip,

It's a difficult choice, but if you have been given options that's good some men don't have the diagnosis to choose.

There are no easy options which one you choose, there are no right or wrong decisions, the decision you make is right for you only time will tell.

I was on Active surveillance for 3years but in November 2020 I had a prostatectomy during the course of my active surveillance I studied all the different treatments in great depth and sought advice from others, my surgery went fantastic a full nerve sparing was possible, I am now fully continent had very little problems after catheter removal, ED will take a little longer spoke with my surgeon this morning and he has referred me to a ED Clinc even though I'm not that far off.

I had no problem with recovery I'm retired but after 2 weeks I could easily have returned to work I could drive no problem everything now healed.

I have no regrets whatsoever and I know if further treatment was ever required then I could have radiotherapy, but if that is the first choice then surgery becomes less of an option due to the changes after radiotherapy alters the tissues.

Good luck it's a personal choice go with what you think is best for you don't rush it.

You can make a case for or against any form of treatment. There are many factors that should be taken into account when deciding which of the treatment options a man is offered to plump for. In some cases the situation is make easier when you are told your individual situation means you are more suited to one form of treatment over another but this is not always the case. Sometimes both your urologist and oncologist (who tend to favour their own area of expertise) will say surgery or radiation would be suitable. You need to fully understand what is involved both in the treatment and potential side effects both short and long term although these can vary.

I suggest you download or obtain a copy of the 'Tool Kit' which is informative and gives an impartial view on Prostate Cancer (PCa) and effects of treatments. Consider this and then make your choice. https://prostatecanceruk.org/prostate-information/our-publications/publications/tool-kit?_ga=2.206109653.795867346.1564408880-1013787081.1564408880

Hi Philip. I can't advice you about your choice of treatment but I can say I've spent to good part of a year making my decision. You can see from my profile that I have a similar set of diagnostics as you and I waited for 15 months on active surveillance before biting the bullet. I'm 100% pleased I opted for Brachytherapy. It's only been just over a week since my op but I've had no side effects nor pain (a little burning when peeing for a couple of days). I'm 69 and my take is that even if I get 5 years PC free, hopefully by that time there will be many more salvage treatment choices available. But at the moment I'm holding on to the data which argues convincingly that long term success of BT is slightly better that RT.

When I was first diagnosed Jan 2018 (age 62) it was with a "low risk" Gleason 6, and I was put on AS.  When they found a new "high risk" Gleason 8 tumour in Oct 2019 (age 64) and clinical intervention became necessary my first thought was go for surgery.  I think it's a pretty classic response, get rid of prostate get rid of PCa!  Then the MDT advised me against it.  They wanted to remove lymph nodes too and they thought, given my physical state and lifestyle, that the potentially five hour op under GA would carry too high a morbidity risk.

So I settled for EBRT, which finished last August.  Had some pretty unpleasant side effects since, some of which have cleared up now but some such as,nocturia (average four times a night which leaves me wasted the next day), radiation cystitis and piles, are still giving me a lot of pain and grief.

Part of me still wishes I'd had the thing whipped out, especially as I have a non-secreting tumour so the regular follow up PSA tests are not a reliable indicator as to whether the cancer is still there and growing.  That said, I met a guy in the waiting room while having my EBRT.  He'd had his prostate surgically removed four years previous.  Told me he thought he was "cured".  Then four years on a routine blood test showed his PSA had rocketed.  So he was back in for EBRT.

Not sure what point I'm making here to be honest, other than no option offers a 100% certain outcome, and all options can and will have a knock-on effect on your life.

Edited by member 24 Jan 2021 at 20:38  | Reason: Not specified

Hi Philip,

Sending best wishes for your upcoming surgery, I mentioned in an early post that I had surgery on the 25th November 2020.

I have made great progress no problems with the continence, but still do the kegel exercises which I started as soon has I made the decision to have surgery and like you had no problems prior but realised you need to strengthen the muscles there pre and post op for life.

I can honestly say it was not a bigger deal as I thought it would be, a bit of advice stop the pain medication ASAP it causes constipation along with the anathesectic, the only discomfort I had and I stopped them after 2 days paracetamol are fine, take the laxatives they prescribe whatever you do. 

The only other bugbear is the Foley catheter, but it is a necessary nuisance, just keep everything clean sleeping is awkward but you get use to it, change to a night bag surprising how much you pass.

Regards

Daily

T2c is sometimes on the intermediate risk side, and sometimes on the high risk side, depending which paper you read. The "risk" is that of there being micromets outside the prostate which don't show up on a scan, and later cause recurrence.

I might guess that if you've had it long enough to be on both sides, it's also more likely to be outside. However, prostate cancer is often multi-focal (starting in several places separately), so this may not always be the reason it's on both sides.