EBRT & Salvage HDR Brachytherapy?

Hi Dave,

Can't help that much. Only to add that I had straight forward HDR Brachy in July last. I have had no problems, and would recommend it to anyone suitable, and you are the only other person I know who has had it.

My last PSA was 0.43, and I had a blood test today, so still awaiting the results.

Will see the consultant again in early Feb.

Be interesting to see if anyone can give useful advice.

Dave.

Hi Guys,

Moving on from my previous post when I saw my Consultant in January, his opinion was that, despite my PSA being low, the fact that it has doubled twice should concern us.  Accordingly he set me a target of 0.6 for the next test in May. 

Anything above this, like 0.8, should trigger a resumption of HT.

Now I wasn't pleased with that news, but I trust my Consultant, he's kept me alive these last ten years, and I could see the sense in what he was saying.

However, I still bore a nagging doubt, if PSA levels in the 3 to 4 or even 5 range are perfectly normal for healthy men of my age, why aren't such levels perfectly normal for a man who has had part of his prostate irradiated?

Yesterday I had a follow up 'annual review' with the team of the specialist who gave me salvage HDR Brachytherapy.  Her line was that anything under the nadir+2 threshold was absolutely fine, and as my prostate settled down post treatment a PSA in low single figures was to be expected, indeed she told me not to consider HT until my PSA was in 'double figures'.

So clearly mixed messages, the consultant who I trust referred me to the specialist who I also trust, unless I have mistaken what they say, they can't both be right can they?

I would be interested to know what everyone's thoughts are about letting PSA rise post treatment.  Is letting the PSA rise untreated to double figures reckless, or is it merely ensuring that we do not over-treat a potentially benign, albeit battered and bruised, prostate?

:)

Dave

PS in an irradiated prostate, getting over 2 is not benign.

Hi Lynn & Ray,

Thanks for your responses, to some extent I think I am getting ahead of myself, after all when last tested my PSA was a mere 0.4, and if it had been 0.4 consistently since I came off HT, everyone would be congratulating me on a marvelous result.

Of course I am not foolish enough to expect it to have stabilised at that and anticipate something higher next test.

However I am in the mood for a white knuckle ride, and am prepared to stay off HT until we are absolutely sure that the rise in PSA can only be caused by PCa, I don't want to go back on HT merely to be on the safe side.

My own consultant is quite frank, saying that because there are so few patients who have had the same combination of treatment, he does not have an reliable statistics upon which to base his judgement.

From what I have seen on the internet, Nadir plus 2, or 3 consecutive rises reaching to over 1.5, seem to be the criteria, so I see no sense in going on HT until it is past that.

We also have to accept that a PCa tumour chucking out PSA at a level less than 2, is going to be hard to find let alone cure.

I don't think I will be a candidate for cyberknife or any other curative treatment, I have now had two blasts of RT, Lynn has previously pointed out that surgeons aren't keen on RP of a previously radiated prostate, and I have probably reached if not exceeded the safe limit so far as RT is concerned.

One of the problems I found after my first relapse, is that the doctors can only justify the expense of scanning us, if there is a prospect of some treatment.  So I don't expect them to go looking for a residual tumour if they intend doing nothing other than HT.    

I mean who knows what is going on, I could have some regrowth of the original tumour within the prostate,  I could have a new tumour within the 'healthy' residue of prostate tissue, I could have some small secondary tumour, I mean all my clear bone scans meant that there was nothing big enough to see at the time the scan was done.

So all I can do is watch and wait, time will tell, but I must admit the idea of letting the PSA rise to double figures before going back on HT has its appeal.

:)

Dave

Dave

To me the most important factors in deciding when to fire the treatment bullet are: rate of increase, age, survival time to-date, estimate of survival times between options, what my gut/faith tells me at the time, the as yet unknown factors.. I've no idea which of those will have the greatest weight if the time comes to decide. Your own list could well be very different to mine which highlights our journey is unique and we tread our own path. Good luck on your successful path to-date.

Ray

Edited by member 03 Mar 2017 at 19:46  | Reason: Not specified

Hi Dave,

Some consultants have a more proactive attitude than others but an individual's histology, what treatment he has had and his response to this and for how long it worked are some of the factors that may influence a consultant in proposing the way he/she may to be appropriate and this may well need to be modified over time. I have been told that a PSA figure of 1.2 will mean HT as the next step but just before starting this I will have a high quality scan through NHS or in need privately and if anything is obvious investigate what other options are possible in the light of findings. HT is a sort of holding situation and if another treatment option can defer this so much the better. If/when I reach 90 I may feel differently and just settle for HT but at a mere 80 I find my motor cycle heavy already without debilitating HT.

Hi Guys,

Just to update you all, my latest PSA on 3rd May is 0.2.

So in the 18 months since coming off adjuvant HT after the HDR brachytherapy my PSA has wandered about 0.1, 0.2, 0.4 and now back to 0.2.

I hate to use the c-u-r-e word because I know it's bad kama and tempting fate, but by the same token I don't visit this site so often these days, I am getting on with my life and PCa is becoming a less relevant part of it.

When first diagnosed ten years ago, with Gleason 9, PCa sort of knocked me off my feet, changed my outlook on pretty much everything, and invaded every aspect of my life.  I didn't think then that I would be here today, let alone posting about good news.

I know I have been lucky, and my heart goes out to those of you less fortunate.

I guess I am still pencilled in St Peter's diary, but I am starting to think that it might be on a page in the 2020's? 

So all I can do is wish you all well, and recommend salvage HDR brachytherapy to anyone offered it, as it seems to have worked for me? 

:)

Dave

Great news Dave long may it continue you story is a great help to us all.

Regards John.

This is just brilliant news - dare I say I told you so?

Enjoy that drink x