Seeking advice here from all of you experienced experts.
Brief history
Current age 63
Jan 09 PSA 6 12 needle biopsy One core shows HGPIN No follow up beyond gaffing medical file to PSA all blood tests. Not aware of this
Dec 13 PSA 6.71 12 needle biopsy Adenocarcinoma 8/12 cores 15% involvement 51ml gland Gleason 3+3=6 T2 N0
MRI shows organ confined disease.
Following discussions with the Addenbrooks MDT, upgraded to Gleason 3+4=7 T3a
Options available; AS not applicable, Brachytherapy N/A, RP possible but not recommended as extra capsular extension means no Nerve sparing and no guarantee of full removal.
Decision then Neo Adjuvant HT + RT
6 months Zoladex 3.6mg Subcutaneous monthly injections
Continuing HT whilst undertaking 37 treatments of IGRT to 74 Gy
Mar 14 Full body scan No Mets
Feb 14 Started HT
02 Aug 14 Gold seed implants
09 Aug 14 CT Planning scan
29 Aug Start RT
17 Sep Last scheduled RT treatment
Side effects. Usual hot flushes, irritating, especially at night. Nocturia, 2-5 times a night. Fatigue, sometimes slept for 18 -20 hrs, wake up exhausted.
SE from RT, 2 days in had irritation of Bladder resulting in cessation of flow. Extremely painful. lasted 4 days, avoided Catheter, just. Cleared up of its own accord, few urine problems since. Tolerable.
Beginning to get tired from RT now, could also be from early starts every day & public transport!
In July, started to become aware of change in personality & attitude. More aggressive, less inclined to tolerate other viewpoints. Loss of concentration and memory. Will stop partway in a conversation, brain just stops working.
Excessive overconfidence, started to become risk averse, felt like superman, can do anything, without consequences, feeling quite invulnerable. Not true of course. Led to some appalling errors of judgement and risk taking when driving ( which I do for a living ), and out walking, Walked in front of a train! Saw it coming, and just crossed the tracks, it was close, but it didn’t bother me at all.
Culminating in a stupid traffic incident, which made me think that if I carry on like this, I’ll have a serious incident.
In conjunction with the OH, GP & work, voluntarily stopped driving and am currently on 6 weeks sick leave. Return to work to be discussed later with GP, Oncologist & Occupational health.
Reason for request. Onco suggest stopping ALL treatment at end of RT. Watch PSA & see where it goes.
Never been high, even with T3a, so not convinced I’m my case that it’s a good indicator.
From the site, David Kirkham suggests good reason to continue HT after RT, ‘to control dying cells’, recommended for total 3 yrs HT
‘Chilled’ suggests, if PSA at start was < 50 then 3 years, if > 50 then Indefinitely
‘Alathays’ suggests a Testosterone test to provide a baseline & other drugs to eliminate Adrenal T to < 1.0 nMol/L for added benefit
NICE suggest ADT for up to 3 years for men with High Risk Localised PCa. Not sure if mine falls into this category, but at my staging with my PSA, I’m not inclined to take the risk.
The only other relevant factor I can find, is a report from e.cancer.org of Feb 2013, which states that statistically, an HT treatment time of 18 months shows no benefit over a traditional treatment of 3 years.
If true, it also has the added benefit of getting off these side effects sooner. I’m all for that, but not at the expense of reoccurrence!
So question time. What do I say to my Onco when I go for my end of treatment meeting?
I’d obviously like to carry on HT. What experiences have you had when on a similar treatment path?
All advice gratefully received.
Chris.