Brachytherapy an option

User

Posted 11 Nov 2019 at 21:27

My first post after diagnosis, don’t really do online stuff but active surveillance is an unbearable stress, even more so for my wife.

I am 56 yrs old, 3+3, 25% cores in right and 5% left, and 15% in targeted biopsy following MRI. Psa never been above 6 and now 3.25 having fallen for 6 months. Non aggressive and for the time being contained, but I am told I am too young to leave it.

Brachytherapy is an option i thinI I will have to take. has anyone good or bad experiences of the side effects? They seem to be mild compared to surgery, or is this just wishful thinking?

must say NHS have been outstanding in explaining and ordering all the options (although the choice is no easier). Thanks v much.

User

Posted 12 Nov 2019 at 19:35

I had brachytherapy over 12 months back. There are side effects, mainly bowel and bladder related and each person has a different experience it seems. At the time, the side effects are bearable and the memory soon fades as time passes. Erectile Disfunction is one side effect I still have ( but it is getting better) dry orgasms at first but now I have some seminal fluid.

PSA is well down but I await my next PSA test in December.

For me, brachytherapy was the right choice, I am though, a lot older at 75 so long term side effects are of little consequence.

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 12 Nov 2019 at 23:24

Originally Posted by: Online Community Member

I did read that someone had a spacer between Prostate and bowel for Brachytherapy but my consultant says this is for EBRT only

I am somewhat concerned that your consult is wrong. This may simply be that it's not offered at your centre and they simply don't know much about it. In the case of brachytherapy, the spacer has to be inserted during the brachytherapy operation, because it has to be done after the seeds are inserted (or after the catheters are inserted in the case of HDR brachytherapy) so that it doesn't get in the way of the ultrasound positioning.

User

Posted 01 Dec 2019 at 22:10

Hi, I had Brachytherapy back in January 2015, The treatment was done and dusted in a couple of hours and I was back home the same afternoon. Apart from bruising down below it was quite painless and manageable. However after the 1st week I contracted "radiation cystitis"...quite unpleasant but it only lasted a week or so. I was taking Tamsulosin for a while but stopped after around 6 months. Everything worked "as normal" after a while, although not quite 100% as before, but not too many problems. I was discharged by the hospital 2017 as cancer free, and my last PSA was 0.008 or something like that.

Hope this helps, and the very best of luck

Alan

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User

Posted 11 Nov 2019 at 23:42

Will it be brachytherapy with hormone treatment or on its own? If with hormones, how many months / years are they planning that to last?

Generally, for a low grade contained cancer, brachy is as successful as external beam radiotherapy or surgery but as you say, for most men the side effects are significantly more manageable. The side effects of HT, on the other hand, can have a significant (albeit mostly temporary) impact on quality of life. We do have one member who really struggled with pain after his brachy but I don't think the medics were ever able to come up with an explanation for that. Like EBRT, brachy brings a very small increased risk of additional cancers some 15 / 20 years later down the line - I think the risk increases from 2% to 4% or something like that. Brachy was our first choice but my husband was deemed too young - I am aware that many hospitals do offer it to younger men now.

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

User

Posted 12 Nov 2019 at 14:00

Hi Richard

How long since DX ? See my profile. . Nothing to do with brachy though.

Don't rush. Yes you are young and correct a decision may have to made sometime. . That sometimes could be years.

Pre 'treatment' PSA monitoring gets replaced with Post 'treatment'' PSA monitoring. I was fortunate to have had PSA bloods done for many years, providing a baseline etc.

Look at a few profiles. It would have been a far far harder decision for me and my wife if my biopsy had come back Gleason 6.

Hope this helps.

Gordon

User

Posted 12 Nov 2019 at 19:35

PSA is well down but I await my next PSA test in December.

For me, brachytherapy was the right choice, I am though, a lot older at 75 so long term side effects are of little consequence.

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 12 Nov 2019 at 21:40

Thanks all, really helpful.

no HT recommended although at 70cc vol this does seem to be large from what I have read. Glad to avoid HT if I can.

Robgrs, thanks for your post and profile. Time is not a healer in this case..interested in your comment on accuracy of psa. I have psa test done privately ie a company well man test, and NHS, for 4 years and the private are always consistently and significantly higher than nhs clinic albeit they are 3-6 months later. Seems very odd.

4.1 v 3.3

4.8v 3.6

5.2 v 3.5

5.2 v 3.2 in 2019

Thanks sparrow good luck for December. I did read that someone had a spacer between Prostate and bowel for Brachytherapy but my consultant says this is for EBRT only

All very helpful. Thanks

User

Posted 12 Nov 2019 at 23:15

Hi Richard

Interesting. Can I ask what triggered a biopsy ?

Also I assume T2C .

Do you have a detailed mpMRI ? Ie an idea where lesions are possibly positioned ?

Mine were multifocal and I wasn't told (I didn't have the knowledge in 2014 to ask..)

I have no idea if I was ever Gleason 6, I incorrectly assumed that the disease progresses thru. grades .

We were shocked post op that mine was transgressing the capsule.

Again. Don't rush . Explore all options. All treatments as you know have life changing side effects.

Gordon

User

Posted 12 Nov 2019 at 23:24

Originally Posted by: Online Community Member

I did read that someone had a spacer between Prostate and bowel for Brachytherapy but my consultant says this is for EBRT only

User

Posted 13 Nov 2019 at 00:13

I think you may be wrong Andy - the 15 centres of excellence have been invited to bid to roll out SpaceOar as part of the innovation project but not all have placed bids and those that have are only in the early stages of the project. The focus for the time being is for the CoEs to assist with embedding the use of gel in their local hospitals during IMRT or at the second appointment in HDR/IMRT combo but it is nowhere near universal yet. SpaceOar use in LDR brachy will be late to the party I think.

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

User

Posted 13 Nov 2019 at 07:22

Hi richard,

I had my Brachytherapy in September 2016 with PSA 2.19 Gleason 3+4=7 and 5 cores out of 20 positive.

My PSA is down to 0.22 as of January 2019 with blood tests at 12 monthly intervals the next in January 2020.

Looking back i had no real problems with bowls or water works, I still get up in the night at least twice but i used to years before brachytherapy. I took Tamulosen tablets for first few months to relax waterworks but stopped taking them in April 2017. I get 4 viagra on prescription each month and they help with ED but i am 73 so can't expect to much.If you click on my Avatar you can see my journey so far and if you need and more advice please let me know.

Regards John.

User

Posted 13 Nov 2019 at 19:07

Thanks Gordon

The low but rising psa suggested a problem, ( albeit my local nhs psa is consistently lower than Nuffield psa tests) I was recommended a biopsy but requested an MRI which should shadow pirad 3 lesson in one location left posterior. The targeted biopsy suggests not of great consequence as the tumour is otherwise quite widespread. T2.

I am told this is contained but of course delay brings the worry of escape at some stage hence I have been advised that action will be required at some stage.

A reference to perineural invasion was deemed “not significant”, so understand that it is contained and treatable by Brachytherapy.

I will enquire about the spacer it seems like a sensible extra precaution.

Really useful reading everyone stories, i wasn’t alerted to the website.

thanks again

Richard

User

Posted 29 Nov 2019 at 22:11

Hi Richard

I've just been diagnosed in September, similar age and I have opted for Permanent Seed Brachytherapy.

Happy to talk through stuff with you in private messages if you want.

Be strong, we are lucky it has been found now and not in ten years time when they might not be able to do anything but monitor it.

Kind regards

Stephen

User

Posted 30 Nov 2019 at 18:17

Thanks Stephen, you sound like you are focused which is positive.

Yes always good to talk. I have taken a few weeks off fact finding trying to take active surveillance seriously, but need to get back to it tomorrow and catch up with some helpful pointers, emails etc.

Happy to PM, otherwise my number (Privacy). Send me a text and an idea of good times to ring you if that’s easier.

Richard

Edited by moderator 30 Nov 2019 at 19:39 | Reason: Privacy

User

Posted 01 Dec 2019 at 22:10

Hope this helps, and the very best of luck

Alan

User

Posted 02 Dec 2019 at 08:35

Alan

Thanks for this, it's exactly what I have been told to expect, side effects and outcome but it helps a lot to hear from someone who's had the actual experience. Congratulations on the 0.008!

Stephen

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