Heart disease and prostate cancer

Hi Frank,

There are not many men or their representatives on this forum with heart disease but this additional problem is a major complication as you will be aware both as regards to full diagnosis and treatment.

You mentioned HIFU, which although still regarded as experimental due to unknown long term experience, in the short to medium term is now comparing quite well with others treatments. HIFU is usually preceded by a template biopsy and MRI scan and the needles for this are placed with the aid of a real time scan. In the HIFU operation usually done under general anaesthetic but occasionally epidural, In the the HIFU operation the probe is carefully focussed on the tumour which is ablated. However, I am not sure if suitable alternative scans could be given as appropriate in your case, to ascertain that the procedure could be done. You would need to discuss your particular situation with a 'HIFU specialist'. Should you investigate this possibility please let us know what you are told and of course let us know whatever treatment you have.

Active surveillance is not necessarily a forever decision ... if used correctly, it simply delays radical treatment until the benefit (extended life) outweighs the risk (early death). To be done properly, AS must include frequent PSA test with at least annual DRE and annual MRI. In your case that is problematic so I would want to know what alternative scans they can/will offer you. AS without any scan is not AS, it is waiting and hoping.

Re expected morbidity - it depends on how close to the edge the tumour is, which is information not known for you at the moment. I suspect that is why they can't give you an answer. However, you could go to the Memorial Sloane Kettering nomograms and enter your stats so far - that will give you a predicted outcome - do bear in mind though that the tool is American and outcomes in the uK are slightly worse. Your consultant may have access to a similar tool for the UK or your area (our urologist has one that has been adjusted specifically for Leeds statistics)

There are many different MSK nomograms but this one seems most reelvant to your current question: https://webcore.mskcc.org/survey/surveyform.aspx?&preview=true&excelsurveylistid=4

Research has been published very recently that indicated that for men diagnosed early (T1 cancer) there was no difference in outcomes at 10 years post-diagnosis i.e. they had the same chance of still being alive 10 years later whether or not they had treatment. The crucial thing there of course is that some men will be thought to be T1 but it subsequently turns out to be higher.

Thank you Lyn, I did read the report from 10th Oct and was of the opinion that AS was the way for me, however when I was told that I wasn't suitable for it I started to look for alternatives to surgery and radiotherapy as I know my cardio condition, however it seems the surgeon and the radiotherapy people didn't. It was only when I insisted they contact my cardiologists to ascertain the suitability of their recommendations regarding my heart and my suitability for these options that they changed their minds and offered AS.

The question I asked both was " what will kill me first, my heart or PC?"

I'm not bothered about AS as I have been living with the sword of Damocles (heart state) over my head for 20 years so another sword  dangling there for a few years more isn't a problem, but I do need the answer to both before I can make a decision.

I'm also aware that treatments and techniques are advancing at a pace and that may be by the time I need to act something else is available.

At this moment in time I'm concentrating on life, holidays, riding my bike, good food and the love of a good woman.

I have an appointment with the cardiologist tomorrow then I will have another PSA test in a couple of weeks and get the result when I come back from Lanzarote (the day before I see the surgeon for the second time) so that will be an interesting consultation, I will keep the community informed of the outcomes and my decisions.

You guys are incredible thank you from the bottom of my heart (the bit that works) and pay no heed to my "gallows humour " its just the way I deal with life.

Best Regards

Hi Frank,

I have only just revisited this site after several months. It may assist your decision if I just outline my own experiences as we have several things in common. 

I am 71, have ischaemic heart disease, a heart attack in 1992 and a pacemaker since 2007. I was diagnosed with prostate cancer in 2013: Gleason 6 (3+3), PSA 7, T2b. MRI scan was inappropriate. In view of my age and concerns about my heart and surgery, (I felt that if the latter, the sooner the better), I decided to investigate this as a preference. I had a private consultation with a urologist at UCLH who warned of the usual issues, especially erectile dysfunctiion, continence etc. At my request my local urologist kindly referred me to UCLH for robotic prostatectomy.

The hospital team was marvellous but from an early stage, and possibly because I was concerned to raise the question of my suitability for surgery, the tendency was to advise AS notwithstanding that during the period of a few months my PSA increased to 8 then 9. One team consultant considered me low-risk of progression so tried to refer me back to my local hospital. I was not convinced this was a good idea as unlike others with similar stats there was no clear picture of the extent of tumour. After objecting to AS I was offered template biopsy. As a result, the disease was regraded Gleason 7 and I was now considered for treatment: surgery, radiotherapy or HIFU. Having considered the side effects I once again opted for surgery. HIFU was very attractive except that monitoring involved MRI scans. My cardiologist considered me fit for surgery and did not offer to change my pacemaker, so I settled on the surgery. My pre-op bone scan was T2N0 and PSA 11.2.

The prostatectomy was carried out in September 2014. Recovery was uneventful. Histology: pT2C, positive circumferential margin. I was advised that I had been operated on "just in time" and that my post-op PSA should be carefully monitored. the first two tests were a satisfactory 0.1 by June 2015 it had increased to 0.2 and in November 0.24, so I was offered radiotherapy of the prostate bed to deal with any ca cells that may have been left behind. The RT course was completed in April 2016 with few side effects. So far, my tests in July and October have been a satisfactory 0.1 which is where I hope it will stay.

So, in conclusion, I applaud your desire to get all the facts, and if you manage to become "MRI friendly" the resulting scan will, I hope make your treatment decision that much easier.

I hope your session with the cardiologist went well and that whether you opt for treatment or AS, it all turns out fine in the end.

I have had a busy few days so have only just seen your post yes having heart issues does rule out certain treatments and options but I just wanted to reassure you that there are always ways around everything.

Trevor had his first heart attack at 58 this was quite a major one and he had to be resuscitated once he was stable he had 2 stents fitted . He never does things by halves and since had another 3 heart attacks he now has 8 stents fitted and had his defibrillator put in around 5 years ago. His pca was diagnosed in 2013 with ext bone mets , we were initially told that it would hinder quite a few treatments and I am sure it will in the future but in the here and know we have managed to get by.

I suppose I am trying to say yes certain treatments will be of limits for you but there are always alternatives .

BFN

Julie X

Hi Frank

I`m glad that the cardiology appointment went well. I assume that the MRI compliant pacemaker was fitted as outpatient surgery or is it even more simple than I imagine? 

As you say, having the extra diagnostic tool does help the decision making, so good luck with the MRI scan. My PCa was found to have invaded both sides of the organ and I forgot to mention that the main tumour was found to be very large, so I am content that I and my advisers made the right call following the template biopsy. It`s great that you will now be able to avoid that procedure.

Regards,

Dave