What to do and where to do it

User

Posted 27 Sep 2017 at 10:43

Recently diagnosed with Stage T2 NOMO prostate cancer PSA 5.1. I've seen the oncologist and been given general information about the three treatments available to me viz surgery, radiothereapy and brachytherapy.

Prior to this I had read all I could about success rates of all three treatments and importantly the possible after effects. Must admit that Prior to seeing oncologist I thought I would be given advice and guidance on a basis personal to my case but came away thinking info was good but could have been talking about anyone.

I am seeing a surgeon in a few days regarding the option of surgery. My centre of excellence is the Christie Hospital and although my local hospital operate the Di Vinci Roboticic Option wondering has anybody had experience of treatment of any sort at The Christie. Also i do know that brachytherapy is available there as an alternative treatment.

User

Posted 27 Sep 2017 at 14:06

Hello Breth and welcome to the site.

I can't answer questions on your three options but would ask for clarification of the Brachytherapy that was offered.

Was this high dose (one off) or low dose (permanent seeds inserted and left).

As for advice from consultants, it would be rare for them to say do this or that. The choice has to be yours. They may offer advice based on their personal preference of they were in your shoes but unlikely otherwise.

The same on this site. There are many and varied treatments on here and many and varied are the reactions and results for the same treatments. My husband, for instance, had permanent seed Brachytherapy with very little in the way of problems. A few others undergoing the same treatment didn't have the same "luck".

If you go to Publications on this website you will be able to download the Toolkit. A range of useful publications and there may be something there that you haven't already seen.

There are also nurses on this site who will answer questions if you need them.

I'm sure you'll get somebody more useful along to advise you but none on here will say take this or that particular route as you are the one who will be living with the result so the final decision has to be yours.

Best Wishes

Sandra

We can't control the winds - but we can adjust our sails

User

Posted 27 Sep 2017 at 18:00

There is not a lot of difference between the success rates between the two forms of RT although brachytherapy of both types is increasingly being adopted. Longer term results are showing slightly better results where this is augmented with EBRT (IMRT or IGRT using various linacs). A similar situation applies to surgery where again overall there is little difference between outcomes of open surgery, robotic or laparoscopic surgery.

However, there are other considerations that include side effects which overall can vary more between surgery and different forms of RT. Surgery tends to result in fairly short ED assuming at least a good amount of nerve bundles at least on one side can be preserved and sometimes with help by mechanical and or tablets. This can improve over time which is also the case with a degree of incontinence, although in a very few cases this can be long term. Some surgeons prefer to do open prostatectomy as they consider it has certain advantages. It also means that it takes longer to heal and for the man to recover than with robotic surgery. Either way, this is an intricate and major operation. In the event, should there be a suspicion that all the cancer could not be surgically removed or indications are subsequently found that this was not the case EBRT can be added but with further potential side effects.

Both forms of Brachytherapy involve a surgical operation whereas EBRT does not. However, EBRT does require attending for usually 20 - 37 successive sessions called 'fractions', which some might find inconvenient, particularly if the treating hospital is a fair way away. RT can eventually lead to ED, particularly if accompanied by HT, which is often the case and in a small number of cases many years hence may initiate other cancer or any cancer in the prostate unaffected by RT may in a relatively short time again become a problem. Few surgeons will remove the charred prostate after RT whereas RT is often done after failed or doubtfully successful surgery.

Whether you opt for surgery or a form of RT, it is important that you get an experienced surgeon and that cutting edge RT of whatever kind is administered.

These are some of the considerations from which you may understand why consultants often do not push for one treatment over another. Different men may well view risks and other aspects differently and therefore opt for different treatment.

Barry

User

Posted 28 Sep 2017 at 14:10

You have had a couple of good answers but for what it is worth here are my two penny's worth!

Your cancer is localised so the chances of you surviving the cancer are very high, probably greater than 97% whichever of the three treatments you choose. So, as mentioned, I believe choice is about what you are happy with and what you aren't. There is no doubt that on the whole LD Brachytherapy has fewer side effects and side effects tend not to be as severe as with the other 2 treatments.

What is the size of your prostate and what is your Gleason score. What were the results of your biopsy and was it a TRUS or template biopsy? Finally what was your Gleason score?

User

Posted 28 Sep 2017 at 23:51

Hi Ian,

Welcome. I can't add much more than Barry (he distills all the critical points)

I don't know your PSA history (if any). Overall health etc . Any other symptoms ? Did you have mpMRI scan ? (ie have you any indication where lesion(s) is and size ?

Are you retired ? ie some folks make decision on basis of ease and frequency of access to treatment centre.

Please see my profile. - my brother is 70 now, choose RT, (with hormone pre RT) he lives only 20 mins from hosp. 45 sessions (he's in Australia)

The point I would also add :

Has AS been discussed or don't you consider this wise at all ? I do realise it's Grade 4 and if you see in my profile - I always remember my consultant saying - its not the volume that matters, its the grading. You could ask for 2nd opinion or more detail on what has been found. Yes, there's always a risk of breaching capsule.

My brother was unifocal and waited about 9 months. He even discussed 'ablation' with his consultant, finally decided on RT (with SpaceOAR protecting bowel) He has his first post RT PSA around Nov. this year, and to date he has had no side effects at all.

Post treatment, I had op, therefore PSA needs to be undetectable (to whatever decimal place the lab uses) for as long as possible. re. RT, you probably know. a nadir is reached and obviously values will change as prostate tissue is still present. This can be a differentiator in people I've spoken with in their decision process.

I do understand your point about 'advice and guidance', however the more I understand the disease, there is no preferred single, no risk solution that any expert can recommend. There is a wealth of information on this site.

- ie as explained to me by my consultant, what everyone is looking for (and probably in this order he said)

1. Cancer 'free' 2. 'Pad-free' continence 3. Erectile function

Hope this helps ...

Regards

Gordon

Edited by member 29 Sep 2017 at 00:11 | Reason: Not specified

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