Gland removal preference

[pd63]

Every time I watch TV interviews of men with prostate cancer, they say my doctor said take it out this includes localised pc and this is how they are treated.Is there a bias towards RP in the UK or is it just that those on tv have had RP.

[ulfhbg]

I suppose that, like in Sweden, any signs of possible prostate cancer your are always having first meetings with Urologists and if you are diagnosed with localized prostate cancer they recommend you to do prostatectomy as this is what they do and they believe it’s best treatment of course. That’s also why you always should ask for a second opinion with oncologists because they are doing the other curative pathway; radiation in different modalities.

But, had a quick look at stats from UK Gov and it seems like approx 45 % choose prostatectomy depending on the diagnos of course and then approx 30 % choose radiation, give or take👍

[NanoMRI]

Ten years ago I consulted privately with several 'top' docs in London, including at Royal Marsden, on non-surgical procedures. All recommended I have surgery, based on multiparameteic MRI findings; foregoing the private revenues they would have received from me. How unbiased! I had RP back home in Texas, and remain grateful I did. All the best!

[Tall_Allen]

There is a bias toward RP everywhere -- the first doctor men see is a urologist and surgery is all they usually know.

[pd63 in reply to Tall_Allen]

Rabbit in the headlights maybe, but can be devastating to be diagnosed and we all react in our own wayMy diagnosis came about due to regular psa tests carried out because of family history so when diagnosed it wasn't a shock but still a bastard to deal with.

I had the advantage knowing my brother had EBRT following his diagnosis 13 yrs ago, no SEs, no recurrence so that I influenced my decision to have RT/SBRT.

Time will tell if it cures but if it doesn't I won't regret it, gotta live with it

[Tall_Allen in reply to pd63]

So often "just cut it out!" is a first emotional reaction. I think there ought to be at least a 1 month moratorium between receiving a prostate cancer diagnosis and scheduling a prostatectomy to let the initial "cancer panic" diminish.

[petabyte in reply to Tall_Allen]

Both my initial urologist and the specialist surgeon recommended radiation in my case. I had an initial preference for surgery but they "talked me out of it"!

I guess it depends a lot on staging and individual doctors.

[ulfhbg in reply to petabyte]

Hi !

My personal impression, from Sweden at least, is that the majority is consulted into prostatectomy and there is definetily no good overlaping between Urologists and Oncologists to help the patient have a good dialouge before deciding on the best choice for them. If that’s the case in UK I of course don’t know but hope it’s better.

With that, I have of course full respect for those who choose the prostatectomy path and the statistics show very good results from my point of view 👍

[MarkS]

I think it's a scandal that too often men in the UK NHS are recommended RP. I was one and as I walked in to see the urologist, he said he could see I was fit and a good candidate for RP. He said this to another friend who had RP and subsequently developed mets 3 years later. Fortunately I decided to look at the options and after a 1 hour consultation with an oncologist decided that RT + ADT was the way.

[conbio]

The "just cut it out" reaction seems to persist with some surgeons, though at least in the U.S. the more knowledgable ones are more nuanced. And from a patient perspective, with such news as "you have prostate cancer" the reaction is understandable.

TA, as usual, has good advice. You have some time. Take a deep breath. Do research. Depending on the specifics of your situation RP MAY be a good option. In my case (G 4+5, isolated to gland) it was pretty clear that the better long-term outcome was with ADT, EBRT, and Brachy. AND I would not have to worry about QOL long-term side effects.

Research. Talk to a surgeon, a radiation oncologist, and a medical oncologist. Best wishes.

[ParrotY]

After an MRI confirmed my cancer diagnosis, the first specialist I saw was a surgeon, gung ho on taking it out. But due to departmental policy, he had to refer me to a radiologist. This one said the best route would be the least invasive, ie radiology. I expressed my confusion and was invited to meet the HoD. He was also a surgeon, and told me that with my diagnosis, that I was Gleason 4+3 at stage T3b, he would recommend that, if I did opt for surgery, then he would recommend follow up radiology. So both treatments.

In the end I chose radiology, but this does go to prove I think that a specialist will normally choose his own specialism, and it's important to do your own research to see what's best for you.

[Teacherdude76]

Urologists are almost always surgeons so 109% will say surgery best option.Get a medical oncologist and a radiation oncologist opinions also then you will have a fully informed choice.

[Pepper2001]

I met with both an oncologist and a surgeon. Neither was touting for business and both said there was an equal chance of dealing adequately with the cancer. The decision was entirely mine with no attempt to influence either way. I decided on RP but unfortunately was not one of the guys who recover fully from the incontinence side effects. However, I have a friend who had hormone and radiotherapy and he has issues with the bowel. Another friend had brachytherapy and he has a stricture requiring self catheterization every morning . Everyone's experience is unique and personal and while it is helpful to read the experience of others there is no guarantee that your outcome will be the same

[fast_eddie in reply to Pepper2001]

Well there is another option besides surgery or radiation. I chose full gland HIFU more than 8 years ago. I have suffered no such quality of life impairments. Your mileage may vary.

[fast_eddie]

'Invasion of the Prostate Snatchers' by Dr Scholz should be required reading for anyone in a rush to 'just cut it out'.

[groundhogy]

In the beginning, there were only surgeons. They handled everything.

Then radiation guys appeared.

Then there were medical oncologists (MO cancer docs).

In most cancers nowadays, your first visit and usually your team leader, is an MO.

Not so in prostate cancer, the surgeons grasp their power preciously. Reluctant to give it up for some reason. Surgeons are still usually your team leader.

[addicted2cycling in reply to groundhogy]

groundhogy wrote -- " .... 2 years ago ...... My goal is to ride my bicycle wherever I can and not use the truck .... "

Sooooo - enquiring mind wants to know how the riding is going ???? 🤔+😀

[groundhogy in reply to addicted2cycling]

Not good unfortunately. My bike got stolen after a night ride. Think the theif saw my blinking back light and followed into the RV park where i live.

I found another similar bike at the good will, but my family keeps me running around so much i have difficulty taking care of myself

[groundhogy in reply to groundhogy]

I do very much enjoy when i do ride though. Takes me back to when i was 12. Lol

And i like a nice low speed life… or whats left of it! Lol