I will shortly need to make the decision about which treatment option to take for my prostate cancer. The choice is surgery to remove the prostate or one of various forms of radiology. Having been on active surveillance for a couple of years, my PSA and biopsy results are getting slightly worse and I think the time has come to get it sorted before it starts metastasizing.

One of the issues I have found a bit frustrating is that there is no single medical professional saying either the surgery or the radiology is the best course of treatment – the surgeon is extolling the benefits of surgery, and the consultant radiologist supporting the radiology option.

It would be useful to get some real world experiences from those who have had treatment for prostate cancer or those who are facing a similar dilemma to me.

Best of luck with your decision. Sorry can’t help with direct experience.
If you don’t get any replies with experience then it might also be worth checking out the Macmillan forums, there’s usually someone who’s been through it and posted.
Best of luck.

Personally I’d get it cut out and I assume you still get radiotherapy to kill any bits they missed. You really don’t want it spreading. I have a friend with terminal prostrate cancer (caught after it had spread), it’s pretty unpleasant – he’s on hormone treatment, which is buying years of life, but the side affects sound pretty unpleasant.

My wife is a urology cancer nurse specialist.

She has said before if you are younger then removal is better because if you go for radiology and the cancer comes back at some point in the future, it can be very difficult/impossible to remove the prostate because of the scarring.

The conversation came about because my dad had prostate cancer and had a removal and that would be what she would advise me if I had it at my age (48).

There are also some possible side effects of removal as well which you will be aware of. My dad had his op 10 years ago and is now fine, some initial incontinence but excercises resolved that.

I am surprised you cannot get better advice from the hospital/cancer team.

Good luck

Friend had an op and is working on sorting incontinence with kegeal (is that the right word?) exercises with limited effect TBH. But he does have the radiology option as a fall back option.

It’s certainly changed his and his partner’s life considerably. Sorry I cant help further but MacMillian are a good call.

I’m in the very same situation, no large prostate but MRI scan showing at two places and classed as a grade 1
I’ve spoken to both the surgeon and the oncologist both wanting the work both saying good chance of full recovery due to age 59, never smoked or drink much alcohol,no weight issue but so many side affects and self employed. I read lots about it but sounds selfish don’t really want radical treatment
Just can’t make my mind up

No personal experience yet (given genetics I might be back asking the same)… though my uncle died of complications of prostate cancer (left too late) and my father had pretty much everything else wrong (had spent the last 40 years with a <10yr life expectancy) but had radio therapy and died of other causes 10-15 years on.

Either way good luck and maybe ask both specialist why not the other as opposed to why theirs?

Get as much advice as you can. I researched and considered all options before taking the one that had been most strongly recommended to me as appropriate for my symptoms/stage of cancer. I had the surgery. I’d be lying if I said that everything in the garden is rosy but I now lead a pretty much normal life.

On the MTBR forum there is an over 50’s thread where this sort of thing is covered in some detail.
Wishing you well.

From talking to other chaps with this cancer the radioactive implants are a once only treatment with no alternatives if it recurs.

If your prostate is not too big the operation is not too bad and is carried out by robot (surgeon guided) and the organ comes out through a small hole in your stomach. If it’s big beast like mine it’s a more involved experience.

Mine is very low risk as the thinking is that the second biopsy removed what few malignant cells that were present. I’ve had my lottery win it would seem.

Start work on your pelvic floor exercises now, there’s an NHS app called Squeezy that reminds you to do them and show what should be done for the various exercises.

Good luck with your choice.

I have been through this. My understanding was that if the cancer has not spread outside the prostate, surgery should stand a good chance of not resulting in long-term difficulties (eg erectile and urinary issues). But there is a risk. Radiotherapy is not risk free either – what type is being proposed? So there is an aspect of it which is quality vs length of life all on a probabilistic basis, if you want to look at it in such stark terms.

I had the surgeon and the radiologist selling their treatment as well, but the consultant who subsequently handled the case said that in my case surgery had been the right choice. (I had follow-up radiotherapy as well, which overall was more unpleasant.)

I get the impression your cancer is less advanced than mine was, so possibly more of a balanced judgment to make. Feel free to pm me if you want.

Had mine removed 6 years ago, age 48, it was quite advanced based on the post removal pathology, but thankfully was contained and I remain cancer free. Mine was keyhole and there have been a lot of advances since, on robotic surgeries, which are likely to have less long term impacts. Happy to have a chat on PM.

the surgeon is extolling the benefits of surgery, and the consultant radiologist supporting the radiology option.

This isn’t overly helpful, even though the benefits/risks of each intervention do need to be weighed up carefully – the correct approach could vary widely based on the wishes of the patient. Ideally the clinicians should be considering your case in a multidisciplinary way and keeping you in the loop to make sure you can make an informed choice.

Is there another contact you could speak to on the team? Explain that both are recommending different strategies, and it is confusing for you as a patient.

Mine was keyhole and there have been a lot of advances since, on robotic surgeries, which are likely to have less long term impacts

My wife has also told me that if I was to ever be diagnosed, she would prefer me to go to the local ‘super hospital’ instead of where she works because they use robotics and the potential for the less desirable side effects of removal are substantially reduced with that type of surgery.

Following on from @greyspoke has said your Gleeson score is important for making the choice. 6 is the lowest and should lead to a good prognosis. 6 is contained in the prostate, the higher scores denote spread to the surrounding tissue and skeleton.

If there is a nurse practitioner in Urology they are a good source of information. Macmillan fund our hospital trust’s one and he is a great help. More approachable and available than a consultant, they issue his work mobile phone number too.

A chap I know is awaiting an op for prostate cancer, his daughter is a doctor so I assume well advised. Anyway, he eats a load of dried cranberries every day, i just googled it and seems genuine. He does eat a lot, not just a handful.

Another mate who has early symptoms was told by his doctor to eat pumpkin seeds, roasted are far nicer.

No idea if it works but can’t do any harm, hope all goes ok.

Not a lot to add to all the above, but I’m coming up to 15 years post surgery and radiotherapy and am still cancer free.

Pre robotic/keyhole surgery which couldn’t remove all the tumour as despite the imaging indications it had spread beyond the capsule. Radiotherapy was to mop up whatever was left. Hormone treatment for 5 years after that.

Deciding to go for surgery was an instant choice at 49 for me, I wanted rid of it, and I think that decision saved my life.

As I understand it the Gleason score is more a measure of the aggressiveness of the tumour rather than it’s spread, Staging is used to describe spread.

Good luck with your treatment!

My dear old Dad had his removed, using robotic assistance, last week. Op on Thursday, out of hospital Friday afternoon. He’s never had any real illness nor a general before, so, TBH, the effects seem more psychological than physical at this point. He just needs to realise that, if all the scans he has had are correct, this is a step forward and normality will hopefully be back soon.

Couple of lads at work – ranging from just turned 50 to early 60’s have had theirs done too. Both are back to normality and thanking that it was done.

Thanks for all the replies and some useful suggestions such as the app for pelvic floor exercises.

In my first biopsy in 2018 the Gleeson score was 7 with only 10% of tissue affected; the second biopsy in January this year (prompted by big increase in PSA levels) resulted in a Gleeson score of 6 but on one side 25% of the tissue was affected including one large area, so the second biopsy missed the small area of higher grade cancer. Since my biopsy in January, I have had another PSA test a couple of weeks ago and it has risen again since the previous raised result which prompted an MRI scan and the biopsy in January, hence coming to the conclusion that its probably better to act now rather than leave it.

Initially I was preferring the radiology route, but am now veering towards the surgery option, and your responses above have helped affirm my changing thoughts.

Once again a big thanks for your supportive replies!