New to Forum, advice welcomed

Hi Andy b,

Click on my profile picture and then view profile to see my diagnosis and treatment. Was the drop from 111 to 87 caused by HT or did it just drop on its own accord?

A six month wait is very common between starting HT and Radiotherapy.

I had HDR brachy and a little EBRT. Maybe for you they want more dose outside the prostate in case it has spread, so plenty of EBRT and no brachy may be the better option for you.

A spacer will move your rectum away from the prostate so it won't get as much radiation, but that may not be a good idea, you may have prostate cancer cells on the rectum and you will want them to get blasted. Somethings are not as obvious as they first seem.

I was treated at the Christie, I can see some value in you getting a second opinion on HDR brachy from them. If you have to go there daily for EBRT it would be a problem for you.

I too come under Shrewsbury, and was recently diagnosed as T2 N0 M0 in July after a Transperineal.

Still waiting for the 1st face-to-face appointment, which finally came through today as end of September.
I dont know if the waiting time has been down to a T2 or other factors such as the strikes. Appreciate there will be many others with far more urgency.
But nothing like keeping you on a cliff edge of worry.

I still have pain down there somewhere after the biopsy, although cant quite pinpoint it. Like a dull ache inside and sitting down for long periods makes it worse.

Edited by member 16 Aug 2023 at 22:46  | Reason: Not specified

I also had external beam plus HDR brachy - this combination is called HDR Boost. It's suitable for high risk patients up to T3bN0M0 (I was T3aN0M0). It's a good combination of hitting the prostate hard with a higher effective treatment dose than can be delivered using external beam alone, providing a lower prophylactic dose outside the prostate to mop up micro-mets (mets too small to show on scans), and not too bad side effects (almost nothing for me 4 years later, but there are no guarantees, as with all treatments). What's covered by the external beam can be varied a bit. It will always be prostate and I suspect seminal vesicles too. It can also include pelvic lymph nodes, i.e. the locations where the cancer is likely to spread next, just in case it has already started. I chose to have my pelvic lymph nodes included (sometimes called Whole Pelvis by prostate oncologists, although that means something completely different to radiographers). So far, I'm very pleased with the treatment.

The period on hormone therapy before treatment (called Neoadjuvant Hormone Therapy) is usually 3-6 months. My hospital usually does 3 months, but I wanted to get my PSA lower before starting the radiotherapy, and pushed it out to 5 months. My onco was fine with delaying up to 6 months, providing my PSA was still dropping significantly - he didn't want me to delay if PSA decline was bottoming out, or worse still, starting to rise again. There are various papers suggesting getting the PSA down to 1 or 0.1 (different papers) before starting RT can give better outcomes, or less time needed on HT afterwards. However, not everyone's PSA will drop that low. In the UK, PSA often isn't measured while on Neoadjuvant Hormone Therapy, so if you want to play these games, you would need to ask for extra PSA tests.

There are some problems with PSMA PET scan.
There's currently something like a 7 week waiting list in many areas. This would delay your treatment, which might not be wise with a Grade Group 5.
You already started HT which makes the test less sensitive.
What if it finds something away from the prostate? They might not offer RT, because the RT might be pointless if there are lots of mets. If you did have one or two mets away from the prostate and they are only found after your primary treatment, they might offer to treat them at that point, but if found before your primary treatment, that's not normally offered. So you might want to consider just how hard you really want them to look look away from the prostate at this stage - it's a double edged sword.

Edited by member 17 Aug 2023 at 06:47  | Reason: Not specified

Many thanks for your perspective, much appreciated.

Best wishes 

Andy

Thanks Andy, much appreciated. We have a mutual interest in seeing how treatment progresses in Shrewsbury. I hadn't realised about Manchester until you mentioned it, and then did some further research.

Have to say, past few days my rear has felt like its burning in addition to groin pain, that's 4 weeks on from biopsy.
Kind of concerning so might have to contact the Urology dept and see what they think. Its near on impossible getting a GP appointment where I live and I'm not one to add to the A&E chaos for no real emergency.

Update: finally got a GP slot. Urine test clear, but advised likely Prostatitis. Had a chat with CNS at Shrewsbury, she advised give it some time as only 4 weeks since biopsy.

Edited by member 19 Aug 2023 at 00:01  | Reason: Not specified