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Any future new treatments?

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User
Posted 04 Jul 2018 at 16:59

Hi - like many on here I have a decision to make regarding treatment ... basically surgery or brachytherapy.  I am Gleason 7 (3+4) T2 localised, early 50's.  A main concern is whether the cancer would return and so I am edging towards surgery, however, I am basing that decision upon what treatments are available now, for example,  I would prefer to have brachytherapy (without radiotherapy or HT) but leaving the prostate in place creates a risk of the cancer returning BUT I am wondering if there are any new promising treatments currently being trialled that may be options to treat my prostate in the future if I went for brachytherapy instead of surgery? Or are there any links regarding such "treatments"?  Thank you. 

User
Posted 04 Jul 2018 at 20:04
Hi,

You ask whether there are any new types of treatment that could be used to treat your prostate if brachytherapy proved ineffective (and apparently disregarding EBRT). There are focal treatments such as HIFU, Cryotherapy, Nanoknife(IRE) and FLA but unless given within a trial might need to be paid for privately. Cyberknife is another possibility some men have at a few hospitals within the NHS but this is another form of radiation which you don't seem to want to consider. If none of these salvage treatments work you are down to the systemic ones like Chemo, special drugs and radium 223 and wildly expensive immunotherapy.

Where cancer is caught quite early and is not extensive, sometimes focal treatments are given as an alternative to RT or Surgery. But this is normally done within a trial or privately and in only a few places.
Barry
User
Posted 05 Jul 2018 at 00:24

Professor M E (we are not supposed to name consultants directly on this forum even if named in an article or video) is regarded as the foremost focal specialist in the UK and probably a lot further abroad. He tends to have run a trial for many if not all of the focal therapies. I did ask him how he rated VTP whist at my last appointment at UCLH and as I anticipated he said it was too early to draw conclusions.


I believe this is similar if not the same as FLA (Focused Laser Ablation) which is said to have Israeli origins but a doctor referred to in this article seems to have become well known for. I believe it was this treatment, but can't remember where that our member Claret's husband had a while back but this was done privately and possibly in the USA. https://sperlingprostatecenter.com/focal-laser-ablation-new-york-city/ Watch the video.


I had RT (but not the Brachytherapy form in 2008 and it was found that cancer was reestablishing itself in my prostate so I had HIFU as salvage therapy (within a study) in 2015. Unfortunately, Since then my PSA as slowly risen and a PSMA scan has shown a small cancer within my Prostate. I am hoping that UCLH will repeat the HIFU to the affected area but if proves too awkward due to place the HIFU probe, I will accept cryotherapy or another form of focal therapy.  I do not want to be treated with HT or any other form of systemic treatment unless this proves really necessary .

Edited by member 05 Jul 2018 at 00:44  | Reason: Not specified

Barry
User
Posted 05 Jul 2018 at 09:10

Hi


i know this is tenuous thought but my sister -in -law who is an executive in a drugs company  working as an auditor on drugs trials world wide told me that there are many many promising results for combating prostate cancer.


 Unfortunately it’s a bit too late for my husband but promising for other newly diagnosed men


good luck

User
Posted 05 Jul 2018 at 11:23

Hi bluetrew - sorry its too late for your husband (and many others). At the moment I am basing my decision upon what treatments are available now but as you mention there are many new things happening at the moment - whether they will be available on the NHS is another thing though. I believe there is a good chance that if my prostate cancer was successfully treated by brachytherapy then it could return but by the time it returns then such new treatments might be available? One big question I now have is how long on average does prostate cancer take to return after brachytherapy or radiotherapy?

Edited by member 05 Jul 2018 at 11:24  | Reason: typo

User
Posted 05 Jul 2018 at 12:42

Have you been shown your Nomogram probablity forecasts for what they call “bio-chemical recurrence”, i.e. cancer returning within five years following prostatectomy or other therapy?


They can calculate it using Gleason and PSA and staging results pre-treatment, and then revise the forecast post-treatment.


I only found mine when I obtained my full medical records to take to a private consultation - no-one thought to have mentioned it to me.......


It was optimistically put at a 63% chance of no recurrence within five years following prostatectomy, which I immediately read as a 37% chance of recurrence within five years, despite being an optimist!


Anyway, it’s all gone now, so I will become a statistic myself in due course!


Cheers, John

Edited by member 05 Jul 2018 at 13:05  | Reason: Not specified

User
Posted 05 Jul 2018 at 13:01

As you asked I will summarise although you can read my histology by clicking on my Avatar profile and bio, or by doing this for anybody else you want to check on as most people detail their histology in this way because what they say in threads tends to be lost over time.


My PSA was stable for about 2 years after RT treatment but then began to increase slowly but persistently thereafter. This is not greatly surprising as there remains some good cells within the Prostate. However, towards the end of 2014 my PSA had climbed to 1.44 and my consultant felt that the way it had progressed indicated there was some new or residual cancer in the Prostate which was confirmed by MRI. I was then referred to Prof M E at UCLH and after more tests and scans was accepted into a trial providing salvage treatment (HIFU or Cryotherapy as appropriate - the former in my case) , for failed RT. Please note that biochemical failure is normally considered to be the case if PSA reaches 2.0 plus the patient's nadir. I had the HIFU in July 2015 by which time my PSA had reached 1.99 so before the usual threshold. After the procedure it went down to 0.39 but has again slowly risen and as PSMA scan (done privately) showed small amount of cancer, I hope will be eradicated with some further focal therapy to the prostate. Also note that it is not usual to give focal treatment if the cancer is outside the Prostate.


However, initial RT can work for a shorter or very much longer time or forever, it depends on many factors, so my case is not necessarily very typical. Be aware that it often takes many newer forms of treatment years before being generally adopted by the NHS, although some of them become available earlier privately or abroad where patient's PCa may be treated more aggressively.

Edited by member 05 Jul 2018 at 19:29  | Reason: Not specified

Barry
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User
Posted 04 Jul 2018 at 20:04
Hi,

You ask whether there are any new types of treatment that could be used to treat your prostate if brachytherapy proved ineffective (and apparently disregarding EBRT). There are focal treatments such as HIFU, Cryotherapy, Nanoknife(IRE) and FLA but unless given within a trial might need to be paid for privately. Cyberknife is another possibility some men have at a few hospitals within the NHS but this is another form of radiation which you don't seem to want to consider. If none of these salvage treatments work you are down to the systemic ones like Chemo, special drugs and radium 223 and wildly expensive immunotherapy.

Where cancer is caught quite early and is not extensive, sometimes focal treatments are given as an alternative to RT or Surgery. But this is normally done within a trial or privately and in only a few places.
Barry
User
Posted 04 Jul 2018 at 22:13
Hi Barry - the treatment options I have been given are all recommended on the basis of "cure", however, due to family history of prostate cancer I am concerned that it would return a few years later to my prostate (hence my leaning towards surgery as at least it resolves that issue) but in a way I am thinking of possibly "gambling" (as most of the treatments seem to have an element of this anyway) and maybe going for brachytherapy with the knowledge that the cancer may return to my prostate but in the hope that in a few years time there will be better alternatives or combinations of treatments (or something new) that could possibly offer better treatments than what I am looking at now. In a way I am looking at "todays" decision being based upon what tomorrow "may" bring.
User
Posted 04 Jul 2018 at 22:23

This is an example from this site about "VTP" this quote from the article sums up my thoughts about having brachytherapy to treat the cancer rather than having the prostate removed - in the hope that treatmentss like VTP become more established so that if the cancer does return to my prostate then there would be more options:


"In 1975 almost everyone with breast cancer was given a radical mastectomy," says Professor [removed name], who led the study. "But since then, treatments have steadily improved and we now rarely need to remove the whole breast. In prostate cancer we are still commonly removing or irradiating the whole prostate, so the success of this new tissue-preserving treatment is welcome news indeed."


The link is here:


https://prostatecanceruk.org/about-us/news-and-views/2016/12/new-laser-activated-drug-shining-a-light-on-focal-therapy


This is just a general example of what I would be hoping for over the coming years if my prostate was not removed and not specifically this example.


 

Edited by member 05 Jul 2018 at 08:55  | Reason: Not specified

User
Posted 05 Jul 2018 at 00:24

Professor M E (we are not supposed to name consultants directly on this forum even if named in an article or video) is regarded as the foremost focal specialist in the UK and probably a lot further abroad. He tends to have run a trial for many if not all of the focal therapies. I did ask him how he rated VTP whist at my last appointment at UCLH and as I anticipated he said it was too early to draw conclusions.


I believe this is similar if not the same as FLA (Focused Laser Ablation) which is said to have Israeli origins but a doctor referred to in this article seems to have become well known for. I believe it was this treatment, but can't remember where that our member Claret's husband had a while back but this was done privately and possibly in the USA. https://sperlingprostatecenter.com/focal-laser-ablation-new-york-city/ Watch the video.


I had RT (but not the Brachytherapy form in 2008 and it was found that cancer was reestablishing itself in my prostate so I had HIFU as salvage therapy (within a study) in 2015. Unfortunately, Since then my PSA as slowly risen and a PSMA scan has shown a small cancer within my Prostate. I am hoping that UCLH will repeat the HIFU to the affected area but if proves too awkward due to place the HIFU probe, I will accept cryotherapy or another form of focal therapy.  I do not want to be treated with HT or any other form of systemic treatment unless this proves really necessary .

Edited by member 05 Jul 2018 at 00:44  | Reason: Not specified

Barry
User
Posted 05 Jul 2018 at 08:56
Thank you for the info I will look into it - I also edited the previous quote to remove the name. How long was it before cancer re-appeared in your prostate after treatment?
User
Posted 05 Jul 2018 at 09:10

Hi


i know this is tenuous thought but my sister -in -law who is an executive in a drugs company  working as an auditor on drugs trials world wide told me that there are many many promising results for combating prostate cancer.


 Unfortunately it’s a bit too late for my husband but promising for other newly diagnosed men


good luck

User
Posted 05 Jul 2018 at 11:23

Hi bluetrew - sorry its too late for your husband (and many others). At the moment I am basing my decision upon what treatments are available now but as you mention there are many new things happening at the moment - whether they will be available on the NHS is another thing though. I believe there is a good chance that if my prostate cancer was successfully treated by brachytherapy then it could return but by the time it returns then such new treatments might be available? One big question I now have is how long on average does prostate cancer take to return after brachytherapy or radiotherapy?

Edited by member 05 Jul 2018 at 11:24  | Reason: typo

User
Posted 05 Jul 2018 at 12:42

Have you been shown your Nomogram probablity forecasts for what they call “bio-chemical recurrence”, i.e. cancer returning within five years following prostatectomy or other therapy?


They can calculate it using Gleason and PSA and staging results pre-treatment, and then revise the forecast post-treatment.


I only found mine when I obtained my full medical records to take to a private consultation - no-one thought to have mentioned it to me.......


It was optimistically put at a 63% chance of no recurrence within five years following prostatectomy, which I immediately read as a 37% chance of recurrence within five years, despite being an optimist!


Anyway, it’s all gone now, so I will become a statistic myself in due course!


Cheers, John

Edited by member 05 Jul 2018 at 13:05  | Reason: Not specified

User
Posted 05 Jul 2018 at 13:01

As you asked I will summarise although you can read my histology by clicking on my Avatar profile and bio, or by doing this for anybody else you want to check on as most people detail their histology in this way because what they say in threads tends to be lost over time.


My PSA was stable for about 2 years after RT treatment but then began to increase slowly but persistently thereafter. This is not greatly surprising as there remains some good cells within the Prostate. However, towards the end of 2014 my PSA had climbed to 1.44 and my consultant felt that the way it had progressed indicated there was some new or residual cancer in the Prostate which was confirmed by MRI. I was then referred to Prof M E at UCLH and after more tests and scans was accepted into a trial providing salvage treatment (HIFU or Cryotherapy as appropriate - the former in my case) , for failed RT. Please note that biochemical failure is normally considered to be the case if PSA reaches 2.0 plus the patient's nadir. I had the HIFU in July 2015 by which time my PSA had reached 1.99 so before the usual threshold. After the procedure it went down to 0.39 but has again slowly risen and as PSMA scan (done privately) showed small amount of cancer, I hope will be eradicated with some further focal therapy to the prostate. Also note that it is not usual to give focal treatment if the cancer is outside the Prostate.


However, initial RT can work for a shorter or very much longer time or forever, it depends on many factors, so my case is not necessarily very typical. Be aware that it often takes many newer forms of treatment years before being generally adopted by the NHS, although some of them become available earlier privately or abroad where patient's PCa may be treated more aggressively.

Edited by member 05 Jul 2018 at 19:29  | Reason: Not specified

Barry
User
Posted 05 Jul 2018 at 16:08
@Barry - thank you for the update' my PSA at the moment is 1.3; 12 months ago it was 1.2.

@Bollinge - thank you; I have just added that to my list of questions for the consultant next week.
 
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