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Act. Surveillance v Brachytherapy

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User
Posted 08 Feb 2018 at 16:23

Hi everyone

Following a Transperineal Biopsy in December last year, I have recently been diagnosed with Grade 1 Low Risk PC with a Gleason Score of 3+3=6. I count myself very lucky btw and realise it could have been a lot worse. I am a reasonably fit and healthy 60 year old and would like to maintain my quality of life that I currently enjoy. I've been offered various treatment options and I would like to hear from anyone who has experience of receiving Brachytherapy. Have you had any Urinary, E Dysfunction or Bowel problem side-effects since having the treatment? I am discounting Radical Surgery and External Beam Radiotherapy for the time being. I'm considering Active Surveillance at this early stage of diagnosis but would welcome any comments. Thanks PP

User
Posted 08 Feb 2018 at 22:41
Hi PP, I am in a similar situation to yourself with a Gleason of 3+3=6 and have been on AS for 2 years almost. I am monitored every 3 months with PSA test but these have been rising over the last 2 sets of results (latest results tomorrow!) I have never been offered any other treatments, but after researching myself and particularly on the PCUK site community forum it's interesting that others who are Gleason 6 localised PCa have opted for or have been guided down a more radical approach. If anyone can tell me what the Brachytherapy actually entails ,and is this an option for those who feel more comfortable with the PCa removed or at least tackled head on as such, rather than a waiting game to see what develops in the future. I am 54 years old and consider myself a fit person, but this choice is proving a difficult one to make a decision on.

Hope things work out for you PP.

Best wishes

Keithyboy

User
Posted 09 Feb 2018 at 15:52

Hi PP,

 

I am John the print and had a choice of Radical removal or Brachytherapy (click on my Avatar for full story ) and there were two reasons i took the brachytherapy route first I had a friend that had it done and was in remission after two years and 2, i felt  I may have less compilations  with bowl or water work problems and this out weighted the possibility of the  radioactive seeds failing in the near future and i also hoped that ED could be held at bay for a little longer.I was Gleason 3+4 and PSA 2.19 a bit higher than you so AS may be a good choice for you.I am 72 this year so had a good run so a little more risk in my life does not matter, and course we cannot guarantee any other non PC related illneseses that could creep up on us.I am 17 months on with PSA 0.44 and down to 6 months checkups so fingers crossed.

Good luck with your choice John.

 

Ps Thanks Sandra for the mention.

 

User
Posted 08 Feb 2018 at 16:54

Hello PP and welcome to the site

My husband was on AS for a year before he then had low dose permanent seed Brachytherapy. If you click on my avatar you will be able to read his journey as I keep it in the form of a diary.

There are also a couple of other members (Kennt and John the Print) who have had the same treatment and you might find all the profiles interesting.

If you are the sort of person who can live with the thought of PC cancer inside you, then AS will give you time to suss out all the other treatments available to you.

At 3+3=6 you have the possibility of just getting on with your life. AS and its monitoring should flag up any changes, like they did with my husband.

He was 73 at diagnosis and 74 when he underwent the Brachytherapy.

He had very few problems with it, the only major one now is some ED problems, which may well be age related rather than to do with the treatment as he is now 77.

Good luck with whatever path you choose. You could, in the meantime, go to Publications on this site and download the Toolkit, a set of information leaflets on the various treatments and possible side effects. Or you could ring one of the specialist nurses and ask for a hard copy to be sent to you.

Best Wishes

Sandra

We can't control the winds - but we can adjust our sails
User
Posted 08 Feb 2018 at 20:59

Hello, my results are much the same. I have the same choices regarding treatment, as do many on here. There is no easy answer, since all treatment options have similar results ( there are some differences) with varying side effects it has to be a personal choice. I have opted for A.S. for now, I am older at 74 so as it is likely that something else will kill me before the PCa gets bad enough to worry about A.S. is a reasonable choice.

Should my PCa change or PSA rise then I will consider Brachytherapy, it does seem to be a good choice for us "lucky ones" with low grade Gleason 6 diagnosis.

John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2

Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23  <0.01

User
Posted 09 Feb 2018 at 01:32

Hi PP,

If you are considering being on AS for quite some time you might be interested in this link by the widely regarded 'American medical Oncologist 'Snuffy' Myers. There are a couple of additional points that I would add. We know from when prostatectomies are done and in the lab afterwards the Gleason score is found to differ from the original assessment, more often the Gleason is upgraded than downgraded. Also, gleason may be changing over time whilst the patient still has his prostate and enlargement of the tumour regardless of Gleason score becomes more significant, particularly as it approaches the periphery of the gland. So over a longer period, imaging becomes important, especially if PSA doubling time, which should regularly and frequently monitored, happens at shorter intervals. https://www.youtube.com/watch?v=wtcQWhLC9YQ&app=desktop

Barry
User
Posted 21 Feb 2018 at 14:50

Hi Private Pike,

I had High Dose Rate Brachytherapy in 2010 ( Gleason 3+4) administered as monotherapy (ie without EB Radiotherapy) together with hormone treatment It was part of a clinical trial.

I have no problems at all with incontinence. I have ED, although this was as much to do with the hormone treatment as the brachy I think. The brachytherapy was quick, pretty painless and successful. Happy to tell you more if you need any more info.

User
Posted 21 Feb 2018 at 15:19

Hi

I am a 70 year old and was diagnosed with PCa in January 2016 with a Gleason score of 3+3, staging from MRI of T2c and a PSA of 8.4. All NHS treatment options were open to me.  I choose Active Surveillance as my view is 'intervention when only necessary'.  The plan at the time was to monitor with 3 monthly DRE and PSA tests.  All my DRE suggest swollen but benign feeling prostate presumably because the tumour is located ventrally and is not felt during examination.  My PSA continues to rise linearly by about 1 ng/ml per year.  I had a repeat transperineal biopsy in June 2017 the results of which were not significantly different from my first biopsy even though my PSA had risen to 9.7.  My last PSA (in Jan) was 11.3.  The care plan now is to measure PSA in May and if it continues to increase to do a mpMRI to check if the tumour has changed from the first MRI.   This is my experience of Active Surveillance.  It's been about doing the best we can to monitor any changes so we can react promptly if need be but avoiding over-treatent.  With a low-grade localised cancer AS gives you time to gather information to help you make the best decision for yourself.

All the best with whatever choice you make.

Peter

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User
Posted 08 Feb 2018 at 16:54

Hello PP and welcome to the site

My husband was on AS for a year before he then had low dose permanent seed Brachytherapy. If you click on my avatar you will be able to read his journey as I keep it in the form of a diary.

There are also a couple of other members (Kennt and John the Print) who have had the same treatment and you might find all the profiles interesting.

If you are the sort of person who can live with the thought of PC cancer inside you, then AS will give you time to suss out all the other treatments available to you.

At 3+3=6 you have the possibility of just getting on with your life. AS and its monitoring should flag up any changes, like they did with my husband.

He was 73 at diagnosis and 74 when he underwent the Brachytherapy.

He had very few problems with it, the only major one now is some ED problems, which may well be age related rather than to do with the treatment as he is now 77.

Good luck with whatever path you choose. You could, in the meantime, go to Publications on this site and download the Toolkit, a set of information leaflets on the various treatments and possible side effects. Or you could ring one of the specialist nurses and ask for a hard copy to be sent to you.

Best Wishes

Sandra

We can't control the winds - but we can adjust our sails
User
Posted 08 Feb 2018 at 20:59

Hello, my results are much the same. I have the same choices regarding treatment, as do many on here. There is no easy answer, since all treatment options have similar results ( there are some differences) with varying side effects it has to be a personal choice. I have opted for A.S. for now, I am older at 74 so as it is likely that something else will kill me before the PCa gets bad enough to worry about A.S. is a reasonable choice.

Should my PCa change or PSA rise then I will consider Brachytherapy, it does seem to be a good choice for us "lucky ones" with low grade Gleason 6 diagnosis.

John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2

Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23  <0.01

User
Posted 08 Feb 2018 at 22:41
Hi PP, I am in a similar situation to yourself with a Gleason of 3+3=6 and have been on AS for 2 years almost. I am monitored every 3 months with PSA test but these have been rising over the last 2 sets of results (latest results tomorrow!) I have never been offered any other treatments, but after researching myself and particularly on the PCUK site community forum it's interesting that others who are Gleason 6 localised PCa have opted for or have been guided down a more radical approach. If anyone can tell me what the Brachytherapy actually entails ,and is this an option for those who feel more comfortable with the PCa removed or at least tackled head on as such, rather than a waiting game to see what develops in the future. I am 54 years old and consider myself a fit person, but this choice is proving a difficult one to make a decision on.

Hope things work out for you PP.

Best wishes

Keithyboy

User
Posted 09 Feb 2018 at 01:32

Hi PP,

If you are considering being on AS for quite some time you might be interested in this link by the widely regarded 'American medical Oncologist 'Snuffy' Myers. There are a couple of additional points that I would add. We know from when prostatectomies are done and in the lab afterwards the Gleason score is found to differ from the original assessment, more often the Gleason is upgraded than downgraded. Also, gleason may be changing over time whilst the patient still has his prostate and enlargement of the tumour regardless of Gleason score becomes more significant, particularly as it approaches the periphery of the gland. So over a longer period, imaging becomes important, especially if PSA doubling time, which should regularly and frequently monitored, happens at shorter intervals. https://www.youtube.com/watch?v=wtcQWhLC9YQ&app=desktop

Barry
User
Posted 09 Feb 2018 at 15:52

Hi PP,

 

I am John the print and had a choice of Radical removal or Brachytherapy (click on my Avatar for full story ) and there were two reasons i took the brachytherapy route first I had a friend that had it done and was in remission after two years and 2, i felt  I may have less compilations  with bowl or water work problems and this out weighted the possibility of the  radioactive seeds failing in the near future and i also hoped that ED could be held at bay for a little longer.I was Gleason 3+4 and PSA 2.19 a bit higher than you so AS may be a good choice for you.I am 72 this year so had a good run so a little more risk in my life does not matter, and course we cannot guarantee any other non PC related illneseses that could creep up on us.I am 17 months on with PSA 0.44 and down to 6 months checkups so fingers crossed.

Good luck with your choice John.

 

Ps Thanks Sandra for the mention.

 

User
Posted 21 Feb 2018 at 14:50

Hi Private Pike,

I had High Dose Rate Brachytherapy in 2010 ( Gleason 3+4) administered as monotherapy (ie without EB Radiotherapy) together with hormone treatment It was part of a clinical trial.

I have no problems at all with incontinence. I have ED, although this was as much to do with the hormone treatment as the brachy I think. The brachytherapy was quick, pretty painless and successful. Happy to tell you more if you need any more info.

User
Posted 21 Feb 2018 at 15:19

Hi

I am a 70 year old and was diagnosed with PCa in January 2016 with a Gleason score of 3+3, staging from MRI of T2c and a PSA of 8.4. All NHS treatment options were open to me.  I choose Active Surveillance as my view is 'intervention when only necessary'.  The plan at the time was to monitor with 3 monthly DRE and PSA tests.  All my DRE suggest swollen but benign feeling prostate presumably because the tumour is located ventrally and is not felt during examination.  My PSA continues to rise linearly by about 1 ng/ml per year.  I had a repeat transperineal biopsy in June 2017 the results of which were not significantly different from my first biopsy even though my PSA had risen to 9.7.  My last PSA (in Jan) was 11.3.  The care plan now is to measure PSA in May and if it continues to increase to do a mpMRI to check if the tumour has changed from the first MRI.   This is my experience of Active Surveillance.  It's been about doing the best we can to monitor any changes so we can react promptly if need be but avoiding over-treatent.  With a low-grade localised cancer AS gives you time to gather information to help you make the best decision for yourself.

All the best with whatever choice you make.

Peter

User
Posted 01 Mar 2018 at 14:36

Thanks Peter. I saw a Consultant Oncologist last Monday to discuss possible Brachytherapy treatment. Following careful consideration of all the information available to me and the advice of two Consultants plus a Clinical Nurse Specialist, I have decided to opt for 'Active Surveillance' for the time being. I generally feel well in myself and want to continue with a 'normal' quality of life for as long as I can. Both Consultants have indicated that the 'AS' programme is well established and will closely monitor my health from now on. They have told me that I can opt for most of the treatments on offer in the future if required. However, I understand that Radical Surgery may be more complicated as we all get older. My last PSA reading was 6.77 in November 2017 and as my biopsy was carried out in December last year, they are deferring my next blood test until early April. When challenged, one of the Consultants said that they are looking for a trend in raised PSA levels, e.g. a multiplication (x2 or x3 etc) may indicate a change in the state of the tumour. A slight increase or decrease in values over several months may be misleading in terms of the status of the PC. Thanks again. PP

 
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