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Is surgery the better option?

User
Posted 05 Jul 2018 at 14:55

Hi everyone, haven't been on line for a while , but latest PSA test was on 25th May 2018 and was down to 2.53 from 3.0.Went to visit Cambridge with the possibility of surgery... just having a think about what I should do. Good thing is I have not been as concerned as I was a few months ago.. don't know whether its the great summer weather and I am feeling better, holidays ahead and getting more exercise, I suppose all this helps. My father is suffering quite badly at the moment with his PCa , he took the option not to have surgery , but to go with Radiotherapy 11 years ago, but he is in the throws of dealing with all the symptoms of the cancer and treatment at this stage now.... brings me to think would I be better going down the route of surgery ?  I am 20 years younger than him and do not relish the chances of me going the same way , if i opt to stay on AS and then treatment when, if ever this tumour decides to move.  Anyway the sun is shining and at the moment and I intend to enjoy the summer.

 Keithyboy

User
Posted 04 Oct 2018 at 03:10

No Iain, that's been around for quite some time. I think what Keithyboy is referring to is more the integration of the MRI scanner and the RT, something nearer this :- https://www.itnonline.com/article/mri-treatment-planning


Turkish Hospital Begins MR-Guided Radiation Therapy With Viewray MRIdian Linac

Technology enables high-definition soft tissue visualization and real-time image guidance during beam delivery
Turkish Hospital Begins MR-Guided Radiation Therapy With Viewray MRIdian Linac

September 21, 2018 — ViewRay Inc. announced that Acibadem Maslak Hospital in Istanbul, Turkey has begun treating patients with ViewRay's MRIdian Linac. The MRIdian Linac is the first system to combine magnetic resonance imaging (MRI) guidance and linear accelerator radiation delivery. These treatments mark the first in Turkey using MRI-guided radiation therapy.

MRIdian MRI-guided radiotherapy represents the latest advance in the field of radiation oncology. The anatomical detail only available with MR soft tissue imaging enables on-table treatment plan adaptation to reshape radiation doses based on the anatomical changes that occur from one day of treatment to the next. Using a novel streaming video perspective, the technology also allows oncologists to visualize and automatically control beam delivery based on the real-time position of the tumor and surrounding organs.

"We are pleased to have commenced Turkey's first MRI-guided radiation therapy program and believe it offers cancer patients in our country a number of distinct benefits over traditional radiation therapy," said Enis Ozyar, M.D., professor, chairman of Acibadem University Department of Radiation Oncology. "MRIdian allows for clinical improvements in visualization and precision daily plan adaptation, and it provides us with the tools to deliver higher and potentially more effective radiation doses."

Acibadem Maslak Hospital is part of the Acibadem Healthcare Group, one of the leading institutions in Turkey in the field of private healthcare services. Comprised of 21 hospitals and 16 medical centers, Acibadem signed a joint partnership with IHH Healthcare in 2012 that enabled them to be a part of world's second largest healthcare chain. Turkey is currently one of the leading countries in health tourism due to the country's advanced diagnostic and treatment services offered.

In addition to treating a full spectrum of cancerous tumors, Acibadem Maslak Hospital intends to explore the benefit of local control, toxicity and survival with MRIdian Linac compared to standard radiotherapy technologies.

For more information: www.viewray.com

 

 

Whilst more precisely focused beams on the target will further reduce damage to nearby organs these cannot 'eliminate' damage caused because with Photon beams however directed collateral damage is caused on the path to and after the target.

 

Edited by member 04 Oct 2018 at 03:22  | Reason: Not specified

Barry
User
Posted 06 Jul 2018 at 09:15

There's a lot of info from sensible sources which suggests surgery is often not the best option... and that it's often performed either because 'that's how we've always done it', or for profit.

 

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User
Posted 05 Jul 2018 at 19:53
Hi,

Good your PSA dropped but still need to be wary. At least you have some time to decide the option you will go with. I don't know how good the RT was that your father had 11 years ago but is almost certain that improvements have been made since then both in terms of effectiveness and minimising radiation to vital organs. MRI scans today also provide a clearer picture of where to direct the RT. Also, it is highly likely that your father's cancer was more developed than yours. All things considered ,you do not have to think it follows that you will suffer long term as your father has should you opt for a form of RT.

Barry
User
Posted 05 Jul 2018 at 20:41

Hi it is a really a very difficult decision  towards  which road to go down with treatment. For myself  I decided to have robotic surgery  just in case the surgery did not get all the rogue cells leaving me the future option to have Salvage  EBRT.. Which in fact proved to be the case. I understand that it is much more difficult to have Surgery  following radiotherapy.

User
Posted 06 Jul 2018 at 09:15

There's a lot of info from sensible sources which suggests surgery is often not the best option... and that it's often performed either because 'that's how we've always done it', or for profit.

 

User
Posted 06 Jul 2018 at 10:16

Hi Andrew11, thanks for your response. Yes I have been told  that having surgery first means that if all cancer cells are not removed during surgery then treatment can happen, but not the other way around. That in many cases is the deciding factor. Having visited Cambridge  for an assesment the Robotic surgery seems very precise and has come on leaps and bounds to what use to happen when you had this type of surgery. Having been on AS now for over 2 years and the PSA fluctuating between 5 and 2.5 and the issue with my father struggling at 76 years old  with effects of treatment some years ago... the surgery looks like  a better option. 

 Keithyboy

User
Posted 06 Jul 2018 at 10:24

Hi Old Barry, 

thats very true that i may not follow the same path as my father , and indeed he was treated over 11 years ago , and things have moved on a lot since then. I had enquired about seeing if there was a way of genetically profiling through a blood test to see if i would indeed be likely to follow the same way as my father in terms of how aggressive the PCa was .. and was there a distinct possibility I was going to end up the same way. I have however no idea where I would start with this , was it available in N Ireland for a start and would this be available on NHS or would this need to be done privately.  All things to think about. 

 thanks again for your comments. 

 Keithyboy

User
Posted 06 Jul 2018 at 10:57

Hi Gulliver,

 yes there is something in what you say.... however my symptoms of frequent visits to the loo,mean  I have been told RT may not be the best option, and this form of treatment would only exaggerate the problem. 

 thanks 

 Keithyboy

User
Posted 06 Jul 2018 at 11:18
Depends on the stage as to whether surgery is the better option. Long term outcomes in terms of PC survival are pretty much identical for stage 1 and 2. Where it gets murky and RT is probably more effective is at stage 3.

Is your dad suffering after effects of RT, PCA or both? ?

User
Posted 06 Jul 2018 at 11:31

Hi francij1, he is suffering with both at the moment. The effects of RT and the PC seems to be active again. His also on Zoladex HT injections which are taking their toll. Makes me wonder if he had chosen the surgery route would that have been a better option, however his diagnosis was over 11 years ago and things have moved on so much since then. 

 keithyboy

User
Posted 06 Jul 2018 at 13:04
Well he wouldn't have had the radiation issues or they would have been delayed (because any salvage RT could be years later).

Make sure any systemic treatment he is receiving is optimum, (this site is as good a place as any to work that out!). If it isn't ask why? if you are not happy with the answers - complain or seek a second opinion.

I watched my dad due if it, I am determined not to do the same , I opted for surgery as it gives you an accurate pathology and a second chance at RT. Irony is that choice nearly killed me but I'm still here 3 years later and no RT yet so it was the right choice for me I believe..

User
Posted 06 Jul 2018 at 14:23

Thanks for for your reply, yes its all about making the right choice, but I suppose its very personal and you never know what is the right choice ? I think you make one and stick to it. Anyway the sun is shining and its Friday !

 best wishes 

 Keithyboy

User
Posted 06 Jul 2018 at 20:48

Originally Posted by: Online Community Member

Hi francij1, he is suffering with both at the moment. The effects of RT and the PC seems to be active again. His also on Zoladex HT injections which are taking their toll. Makes me wonder if he had chosen the surgery route would that have been a better option, however his diagnosis was over 11 years ago and things have moved on so much since then. 

 keithyboy

 

that can happen whichever treatment is chosen, my dad was clear for 13 years after RP and even had the official letter from the NHS telling him he was in remission but it still came back eventually. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 03 Oct 2018 at 17:37

Hi everyone, just updating my position since my last post.  Option given to me was surgery , but since my assessment at Cambridge .. there has been some interesting advances in what appears to be focussed radiotherapy and has reached the news very recently . This is radiotherapy administered while /during MRI scan and is targeted at the exact part of the prostate that has the cancer, thus eliminating the chances of damage to the surrounding healthy tissue.. does anyone else have any info on this ? There seems to be some research carried out at Queens University Belfast were a form of targeted radiotherapy has been looked at and is proving very successful in trials apparently. I have not had surgery as I held off during the summer , but need to move this on. I am seeing my Urologist next week and hope to mention these new developments to see if these options are first of all available to me, and are they viable options instead of surgery . I am 2.5 years diagnosed remaining on active surveillance. Any help appreciated. 

 Thanks 

 Keithyboy

User
Posted 04 Oct 2018 at 03:10

No Iain, that's been around for quite some time. I think what Keithyboy is referring to is more the integration of the MRI scanner and the RT, something nearer this :- https://www.itnonline.com/article/mri-treatment-planning


Turkish Hospital Begins MR-Guided Radiation Therapy With Viewray MRIdian Linac

Technology enables high-definition soft tissue visualization and real-time image guidance during beam delivery
Turkish Hospital Begins MR-Guided Radiation Therapy With Viewray MRIdian Linac

September 21, 2018 — ViewRay Inc. announced that Acibadem Maslak Hospital in Istanbul, Turkey has begun treating patients with ViewRay's MRIdian Linac. The MRIdian Linac is the first system to combine magnetic resonance imaging (MRI) guidance and linear accelerator radiation delivery. These treatments mark the first in Turkey using MRI-guided radiation therapy.

MRIdian MRI-guided radiotherapy represents the latest advance in the field of radiation oncology. The anatomical detail only available with MR soft tissue imaging enables on-table treatment plan adaptation to reshape radiation doses based on the anatomical changes that occur from one day of treatment to the next. Using a novel streaming video perspective, the technology also allows oncologists to visualize and automatically control beam delivery based on the real-time position of the tumor and surrounding organs.

"We are pleased to have commenced Turkey's first MRI-guided radiation therapy program and believe it offers cancer patients in our country a number of distinct benefits over traditional radiation therapy," said Enis Ozyar, M.D., professor, chairman of Acibadem University Department of Radiation Oncology. "MRIdian allows for clinical improvements in visualization and precision daily plan adaptation, and it provides us with the tools to deliver higher and potentially more effective radiation doses."

Acibadem Maslak Hospital is part of the Acibadem Healthcare Group, one of the leading institutions in Turkey in the field of private healthcare services. Comprised of 21 hospitals and 16 medical centers, Acibadem signed a joint partnership with IHH Healthcare in 2012 that enabled them to be a part of world's second largest healthcare chain. Turkey is currently one of the leading countries in health tourism due to the country's advanced diagnostic and treatment services offered.

In addition to treating a full spectrum of cancerous tumors, Acibadem Maslak Hospital intends to explore the benefit of local control, toxicity and survival with MRIdian Linac compared to standard radiotherapy technologies.

For more information: www.viewray.com

 

 

Whilst more precisely focused beams on the target will further reduce damage to nearby organs these cannot 'eliminate' damage caused because with Photon beams however directed collateral damage is caused on the path to and after the target.

 

Edited by member 04 Oct 2018 at 03:22  | Reason: Not specified

Barry
User
Posted 04 Oct 2018 at 07:41
Is Keithyboy not just talking about IGRT which is available in many hospitals in England but might perhaps be new to Belfast?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Oct 2018 at 00:04

I don't think so Lyn, Not in it's usual way. IGRT has been available in a limited but increasing number of hospitals for over 10 years. It is explained in this link https://www.radiologyinfo.org/en/info.cfm?pg=igrt.

When Keithyboy mentioned advances and trials, I think he is more likely to be referring to the new hybrid MRI/linac such as Viewray MRIdian, linac, the first system to combine magnetic imaging guidance and linear accelerator radiation delivery in real time. Watch Viewray's video to see this advance. https://viewray.com/discover-mridian/


Keithyboy could ask his consultant if this is what was being refereed to and whether it is likely to become adopted for the UK. I see that it is being put into a major French hospital.

Edited by member 05 Oct 2018 at 02:13  | Reason: Not specified

Barry
User
Posted 07 Oct 2018 at 14:20

Just seen this when catching up on some Daily Mail papers. It records the new MR scanner at the Royal Marsden and the first patient to be treated in this integrated machine in the trial they are doing. Here is the on line link :- https://www.dailymail.co.uk/health/article-6228849/ME-OPERATION-New-prostate-scanner-hits-cancer-bang-target.html

 

Edited by member 07 Oct 2018 at 14:34  | Reason: Not specified

Barry
User
Posted 07 Oct 2018 at 19:54

Wow .. great thread and exciting times.

having travelled to the USA for a ‘real time, in MRI FLA’ to avoid the side effects of a radical treatment this is a fabous development that makes so much sense. I love the quote:

 

“For decades the radiation oncology community has dreamed of the day when we could see what we treat in real time just as our surgical colleagues do, and we are excited that this day has arrived.

 

It sounds like a game changer indeed so fingers crossed the trial is successful and the investment approved. Looking at the selection criteria they are considering G7 ( 4+3) so it’s not just low risk diagnosis but intermediate risk too.

 

Thanks for the link Barry - you have made my evening. If this is succesful and reduces QOL bad side effects it will change the whole debate about screening too.

 

User
Posted 28 Nov 2018 at 17:09
Hi folks , its been a bit of a rollercoaster ride for me over the last few weeks , and I haven't been on the site for a while so only catching up now on recent posts. Can I thank all of you for your help and information I have just read in the recent thread of emails. I had to make a huge decision back at the beginning of October and decided to go down the Radical Prostatectomy route with robotic surgery and I am now out on the other side. I am now 2.5 weeks post op and doing well and was looked after superbly by all those at Addenbrookes in Cambridge I can't thank them enough for their help in getting me through this. I am coping well with the old water works and get all the results of the surgery in a few weeks time , but taking things easy and have got myself into a routine in the morning with a walk for 30 mins and then a sleep mid afternoon. Great news recently that Belfast now has a DaVinci Robot installed at Belfast City Hospital so this will save some men having to travel across to England for surgery. Early days yet I know but just glad to have this over with , I know I have still a long journey to go in the recovery process and although the decision was a daunting one , I think once the decision is made you stick with it and it is the right one for you.

Thanks to all for the help and guidance over the last year through the site and wish everyone good luck going forward dealing with this awful disease.

Keithyboy

User
Posted 28 Nov 2018 at 19:27

Keithboy,

 With your rising PSA i think you made the correct decision, and in good time. I wish you all the best for the future.

How is your father, i know he wasn't well when you last posted.

Neil

Edited by member 28 Nov 2018 at 19:28  | Reason: Not specified

User
Posted 29 Nov 2018 at 14:08
Hi Neil thanks for your kind wishes. Dad is coping well , but still having trouble with bladder and bowel , but dealing with it. Just means he finds it difficult making plans ahead as going on holiday etc. is now becoming more of a hassle than its worth. At 78 years old he is trying physio and exercises to try and help the situation.

Keithyboy.

 
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