Prostate treatment options

Hello Bui and welcome.

Can't help with your query but bumping your post as it was disappearing down the list. Hopefully somebody with the knowledge need will be along to advise you

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Some other people told me to look into Proton beam radiation and radiation seed implatation( brachytherapy). I guess if you have choices it brings some confusion.

Hope to make up my mind soon

Wishing you the best on the 1st

PCa history in my family I know is my dad. Died aged 86+ and his PCa was left untreated until it was too late.

I am therefore trying to ensure I get rid of everything relating to PCa in my body . Like you wrote a few weeks of inconveniences should not let you do what you have to do.

Weighing my best options for treatment and pray it will be the right one for eventual total cure - very open to all possibilities now

All the best

I went down the RP 12 months ago thinking that's the end of it, low and behold I start RT soon for 30 weeks, not out of the woods yet.

Good Luck

James

There is the feeling of urgency to do something after the diagnosis but if it is not a critical case I guess one should give some time to research/ talk about all options. I was diagnosed late October and I am already feeling now I should start my chosen treatment within the next couple of weeks. Tough to make a decision on treatment options that you hope is the lasting cure!

I have only been using this type of forum for travel / vacation advice but now see the importance especially for this "tough" process of making a decision. The travel / vacation advice is child's play.

Appreciate the replies more than I can pen down here ! Helping with my decision process and questions to ask my physicians / specialists as I meet them again next week.

It seemed the NHS fully accepted the research that pelvic radiotherapy in all its forms increases the risk of bowel and bladder cancer - I think the statistic was an increased risk x4 but since the risk for someone that hasn't had RT is something like .5% the chance of a man with prostate cancer getting later bowel/bladder cancer is 2% and the optimum time is 10-15 years after treatment. So the risk is still very very small ... the risk of dying from PCa is much greater than the risk of having successful treatment, recovering and then dying of bowel cancer. However, our hospital will not do brachytherapy on young men because they believe there is more chance of them living long enough to develop a second primary cancer (John was 50 when he was refused)

It also has to be said that all reliable research in this field is looking at 10 year data or longer but the fact is that RT now is much safer than it was 10 or 15 or 20 years ago. Most men now have IMRT rather than plain EBRT so the scattergun approach of years gone by is less common. Just my view but my guess would be that the data on second primary cancers 10 years from now will be very different to the data published 5 years ago.

Edited by member 30 Nov 2016 at 18:52  | Reason: Not specified

Bicalutimide does not affect the production of testosterone and should therefore not make a huge difference to the prostate gland's 'solidness' in the space of 3 months. Generally, the problem is where treatment has made the gland mushy so they cannot remove it cleanly because it falls apart and bits get left behind. Give your nurse specialist a ring and ask the question?

Thanks for the comments

I am presently out of the U.K. returning this Monday.

I guess why the specialists have not been responding fully to my questions is that the last two weeks I have been out of the country and asking them questions by mail.

They obviously do not want to write the comments down for reasons I can understand.

I am seeing them again this coming week with a lot more questions - quiet a bit got from this forum and the research I have been doing.

The objective in the end is to make an informed decision that I will be comfortable with and will cure my ailment .

I have repeatedly been told now that when you have choices it can cause some confusion but I need to stay focused .

Has anybody used it and can comment on it?

Is it worth insisting that it is used if you go the radiation way to minimize the risk of secondary radiation side effects?

Have meetings with my urologist and oncologist ( radiation) this week- different days

Will probably also see the surgeon another day

Summarising questions to ask as I meet them- have much better picture now than when I started

Have gathered quiet a bit from this forum

Thanks

As in the the UK some surgeons will be more highly regarded than others. Just because there are more men affected in total in the USA does not make surgeons more experienced, only that there will be more surgeons in the USA. The experience is limited to how many men a surgeon is able to operate on in a day which is likely to be two in either country. The techniques would be basically the same, although fewer hospitals have robotic surgery in the UK.

As far as radiation goes, there would be more choice in the USA because they additionally treat with Proton Beam for those that are suitable. Theoretically, Proton treatment should be superior to Photon because the energy is mainly released on the tumour and a much lower amount on it's way to and after the target as with Photon RT,(the so called Bragg Peak), so less collateral damage and the tumour is hit harder. This has proved to be very much the case with head tumours and indeed people are sometimes sent from the UK to the USA for this reason, the USA having the most Proton Beam facilities and the longest experience of this type of treatment. There are many patients and doctors in the USA who advocate this treatment for PCa also but there is a surprising lack of comparative data between this and other forms of RT. The advantage of using Proton beam to treat PCa over other forms of RT is less well defined. I did consider this back in 2008 when I was looking into other treatments but ruled it out on the grounds of cost, about three months overall in the States and check ups over there. I believe the number of fractions has now been reduced, so this would have an effect on time and cost.

The other forms of Photon RT available in the States are also available in the UK but not necessarily all at any one hospital.

Edited by member 08 Dec 2016 at 11:45  | Reason: Not specified

Lyn is right about this and it is certainly an aspect that should be established in advance. I was fortunate in that having decided to have my RT within a study in Germany, with EBRT supplemented by Carbon ions (which have an even higher RBE than Protons), the Royal Marsden agreed to monitor me and in due course referred me to UCLH for further treatment. So in my case I was able to get back into the NHS system and just as well!

The point is that there is no private equivalent to your NHS ED nurse / andrology clinic which means you would be dependent on either your private urologist or the relevant private hospital to be knowledgeable and up to date with current research etc and to write all prescriptions for pumps, pads, caverject (if needed) as the GP is unlikely to prescribe on a private consultant's say-so when it is going to come out of the GP's budget.

For my case she does not encourage Proton beam radiation -still trial and experimental

Brachytherapy -botherline- be ready for some immediate side effects

CyberKnife - first choice -tested and proven -will use SpaceOAR to minimize radiation to other organs-urine flow result excellent-will use bicalutamide to lower PSA for first three months -use markers-do MRI& CT scan and then 5days radiation. Side effects will be minimized e.g urinary urgency . Rectal and urinary side effects minimized.

She is confident if I want to go the radiation way this is the way to go.

Laser ablation - can be use as a salvage option if there are issues with radiation

Said no matter the treatment I choose -even surgery -ED will be worse

Always good to get an opinion on what treatment is considered best suited to you as an individual, as a standard approach may not be best for all patients. Also, regardless of how it all pans out, you can know you got advice from consultants familiar with your case and considered this as part of your decision, so in a sense some satisfaction in knowing you did all you could to get a good result in a situation where there are no certainties.

For John the pain started almost immediately and the moobs were obvious by 3 months. Unfortunately it is often a permanent side effect and it has taken him almost 5 years to get rid of them.

Noticed mild tiredness. Breast tenderness / enlargement also very mild. No other noticeable side effect .

Discussed this last week at visit to doctor - no need for extra medication since it is very mild and not bothering me.

Expecting advice / information from dietician team and physiotherapist to help with treatment.

PSA 5.9 two months ago now 3.45 last week.

Placement of fiducial markers / spacer OAR this coming Monday and CyberKnife radiation about 1/2 weeks after.

tiredness, Breast tenderness / enlargement mild. No other noticeable side effect.

PSA 5.9 three months ago ,3.45 a month ago now 3.06.

Postrate volume - 53 ml after biopsy last November now 30 ml this week.