Brachytherapy ?

My husband opted for the brachytherapy route, he had a choice, if you click on my avatar you will be able to see his history, I also have posted a thread "start of radiotherapy" , updated earlier today, which gives a summary of his radiotheraphy treatment prior to his planned brachytherapy (not everyone has both) you may find these useful.

If you haven't already done so phone PCUK for a copy of the "toolkit", the specialist nurses are brilliant.

All the best

Maureen

Hi Dave

Thank you for your message, its given me a lot to think about.

I remember watching a few minutes of the Horizen programme you mention but because I had no problems then, and I'm very squeamish didn't watch, unfortunately it not on iplayer.

Best wishes

Richard

Hi Richard,

I had a gleason 3+4 and was told l could not have brachytherapy because the MRI scan indicated that the cancer was aggressive on the left side and looked as though it was breaking out of the capsule. As already discussed the tool kit is a valuable source of information. I had meetings with a surgeon and an oncologist who both explained the treatment, the side effects and the expected outcomes. I opted for a laparoscopic RP. 

You need to gain a much information as you can, ask many questions, agonise over a decision and then decide the way forward that suits you.

Paul

Hi Paul

Thank you for your message, I have asked for the toolkit; really need to get as much information as possible.

Were you offered Da Vinci surgery, my cousin had this and recommended it - however his Gleason and PSA were much higher than mine, I feel the alternatives are probably better I would appreciate your views on this.

Its really uplifting to hear the successful outcomes on this site.

Best wishes

Richard

My 54 year old husband had Brachytherapy 8 weeks ago, 72 seeds were planted and although the 8 weeks hasn't been easy for him, it hasn't been anywhere near as bad as what we expected. Hasn't needed time off work, except a few days after the treatment and has still been able to play squash & golf. Main issues, constant need to urinate & stinging day & night, fatigue, pain on ejaculation a few times & ED all of which have been manageable with Tamsulosin & ibroprofen.

At six weeks his PSA level was down from 10.5 to 5 so heading in the right direction. Was also prescribed viagra to help with the ED, which has been rather interesting! So far only one out of the three tablets has worked with one to go....but it is early days so not giving up hope.

He was also offered the Da Vinci surgery and had made his mind up that was what he was going to have, however consultant felt that Bracytherapy would be the better option for him as he already had 50% ED and felt that surgery could potentially make this worse, so we went with the consultant and have been extremely pleased with how things have gone and seem to be heading.

Hope it all works out well with you.

Andrea xx

Hi Richard

The problem you will find it that there is plenty of information available and plenty of advice from others but in the end you have to make the decision.

I was in a very similar situation as you. Gleason 3+4 , T2, 35cc , PSA6.3 etc.

After researching I decided brachytherapy low dose seeds wsa best for me as every report I read indicated that the long term side effects were less than other options.

I had the op at the Guilford specialist brachytherapy unit at Guildford hosptal on 14th August 2015. ( 11 weeks ago )

I went in in the morning and came out the following morning . I have had no really bad effects other than difficult to pee. I was back down the gym and playing tennis 2 weeks after the op. My PSA 1 week ago was 2.3.

There are many others on this site with far more knowledge than me but for me it seemed a clear cut choice. Please do not forget that brachy is only suitable for those with earl;y stage local cancer and not long ago was mainly for private patients. The NHS has now approved the procedure and the cost to the NHS is approx £20,000.

Kind regards

Ray

I haven't been on the site for a while but reading as much as possible which has been helpful.

Also at my meeting with the second Oncologist to discuss possible treatment she said I would be suitable for Brachytherapy but said she would review my MDT and discuss with the first Oncologist - my hope was less seeds may be used and less side effects.

The results of the review are still not with my first Oncologist after 4 weeks She said she would do this within days, I have asked the nurse to chase this a twice and have just phoned the second Oncologist.

I've just received a copy of a letter the second Oncologist wrote after our appointment, before any review, She said the clinical stage was possible stage T3a, this came as a shock as the first Oncologist put it at T1/T2 !!! also Brachytherapy may be a suboptimal treatment.

Hi Banjoman

Thank you for your message.

I had a meeting with the second Oncologist last week, she said after discussing with the first Oncologist she has revised me to T2 - she said I would need hormone treatment 3 month before brachytherapy and 3 month after which I didn't expect.

She said she could give me a prescription that day, I said I would give it some thought first, I've had a difficult few years with a new business and don't like the reported side effects of hormone treatment - Also I've lost confidence in this doctor.

Later in the week I had a meeting with the first Oncologist who is pushing for a decision from me, he was surprised the other Oncologist thought I would need hormone treatment and said he would write to her.

I have arranged to have a second opinion but think perhaps I should go ahead with Da Vinci surgery.

Best wishes

Richard

I am always surprised to hear of men that HAVEN'T been given hormones with their brachytherapy!

I visited Cancer Research web site that says Hormone treatment may be used before brachytherapy if the prostate is large, I know my prostate is considered small so I guess this is why the first oncologist questioned it.

Richard

Hi Richard,

I wonder whether your problem might actually be too much information, too many choices and too much help from well meaning guys like me chipping in with our own thoughts? 

You say you feel '...fortunate that the Rotary Club offered a mass screening for PC...?'

Presumablly if that hadn't offerred mass screening you would be getting on with enjoying your life none the wiser?

Most men in there 60's have prostate cancer and most don't even know it.

Some of us do get symptoms, and are considered 'lucky' because we can get early treatment, that treatment may include the bonuses of impotence and incontinence!  However as we are often reminded other less lucky guys never get any symptoms, or at least not untill it is way too late for any currative treatment.  

Hormone Therapy is routinely given with radiotherapy for guys with higher Gleason grades, (look up neo-adjuvant and adjuvant hormone therapy).

If your doctors are telling you that it isn't really necessary, then you might wonder why not?  If you don't need adjuvant HT then it might be worth asking whether the brachytherapy is really necessary?

At Gleason 7, you might think it is worth giving the watchful waiting option a go, for after all that will guarantee you no side effects at all in the short term.

I know a guy like you, who was considered 'lucky' to have his cancer detected at a mass screening event.  He had treatment which was considered successful and 'saved his life'.  But as time has gone by, and he has learned more about PCa, he realises that he paid a high price in terms of his potency and continence, to save him from what was statistically a rather low risk of premature death.

So take your time and don't be rushed.

:)

Dave 

Decisions decisions - Unfortunately I didn't have much confidence with the second oncologist, that's made it harder - up until meeting her I had been very impressed with all the professionals I met.

I had a second opinion that was really worthwhile, he said Active Surveillance was an option, this hadn't been offered before, he was surprised with the possible T3a, but most worrying said that the hormone treatment would have reduced the size of my small prostate and it would have been difficult to get the necessary number of seeds in - to be fair he did say perhaps the oncologist had her reason.

Most people say get the prostate removed - I'm almost sure this is the option I will go with.

Many times I've thought perhaps the early diagnosis wasn't such a blessing!

Thank you for all the feedback its really helpful.

Richard

Banjoman, Watchful Waiting and Active Surveillance are slightly different as per the following from this sites Information

___________________________________________________________________________________________________________

"What's the difference between active surveillance and watchful waiting?"

Active surveillance is often confused with watchful waiting – this is another way of monitoring prostate cancer. The aim of both is to avoid having unnecessary treatment. But there are key differences between them.

Active surveillance

If you do need treatment, it will aim to cure the cancer.
It is suitable for some men with cancer that is contained in the prostate (localised cancer).
It usually involves more regular hospital tests, such as prostate biopsies and MRI scans.

Watchful waiting

If you do need treatment, it will aim to control the cancer rather than cure it.
It’s generally suitable for men with other health problems who may be less able to cope with treatments such as surgery or radiotherapy, or whose cancer may never cause problems during their lifetime.
It usually involves fewer tests, and these usually take place at the GP surgery rather than at the hospital.

________________________________________________________________________________________________________________

Watchful waiting is usually for the man who has other health problems and for whom treatment would cause an increase in those  problems

That's as I understood it anyway

Regular needle biospy isn't likely to be more than once a year unless there is a drastic rise in PSA

Edited by member 02 Dec 2015 at 07:05  | Reason: Not specified

Hello All

Thought I would give an update.

 I had robotic radical prostatectomy on the 15 January, went well the surgeon managed to keep all the nerves one side and most the other side so ED and continence shouldn't be a problem !!!

 At this time continence is a problem - Hope the pelvic floor exercises help soon as I see no improvement to date, I will go to the continence clinic in the hope they can offer help.

 I'm an optimist and thought IF I had a continence problem it would only last a couple of weeks - the level 2 protectors I had bought were useless, I'm getting through 5 level 4 protective underwear most days from Boots which makes life difficult.