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53 & considering Brachytherapy

User
Posted 31 May 2020 at 16:08

All

53 and diagnosed with Prostate Cancer T2 and a Gleason score of 7 (4+3).  I have been a looking at a number the treatment options and looking for thoughts of those in my age that have progressed on the radiology route.

Initial consultant has recommended surgery given that the cancer is localised. The biopsy identified majority of the cancer (7 cores from 15) on the right side and small element on the left (1 core from 12). Surgeon has indicated I am likely to lose the nerve endings on the right side and therefore strong possibility of ED moving forward. He has indicated circa 25% chance of recovery for ED.

Now considering Radiology options with a combination treatment off Brachytherapy and radiology (4 weeks of treatment) which they believe will give me a strong chance of a curative treatment and much lower post op impacts in terms of incontinence and ED.  As an active runner and tennis player, these are strong considerations for me post op.

Really keen to hear from other men in my age bracket that may have gone down the Brachytherapy route and to hear your insights and views on this.

Many thanks (in advance)

G

User
Posted 31 May 2020 at 21:50

I was 56 at diagnosis, T3a, Gleason 3+4, PSA 57 (see my profile).
You're 53 at diagnosis, T2c, Gleason 4+3, PSA ?

For brachytherapy, there's a choice of HDR (temporary) brachytherapy, or LDR (seed) brachytherapy.

Also, ask about having SpaceOAR to temporarily space your rectum away from prostate during treatment, s oit gets a lower radiation dose, reducing risk of side effects (something I do have, but not serious).

I went for HDR brachytherapy + EBRT + HT, because I'm well in the high risk category.
You might not be quite so high risk (if your PSA < 20), so I'm wondering if the EBRT is needed, and just do the Brachytherapy? Not sure - a question for your oncologist. It's a trade off between more side effects versus more likelihood of recurrence.

With regards to HT and libido, yes it is an issue, and it effects different people to different degrees. My libido is low after 15 or 21 months on HT (depending how you count it), but erections do still work fine providing you keep your concentration and don't get distracted (and there's plenty you can do to help with that). For some people, erections don't work on HT though. (HT doesn't directly prevent erections - any effect is indirect via loss of libido.)

I do run periodic group sessions (at least before COVID-19) and presentations (even during COVID-19) on how to keep sexual function working (amongst other things) while on HT, but that doesn't mean everyone will be able to do so to the extent they would like to.

Edited by member 31 May 2020 at 21:58  | Reason: Not specified

User
Posted 31 May 2020 at 22:33

Hi, I was 53 at diagnosis T3, g4+5 psa 25. 95% of my prostate showed cancer. For me the MDT had little interest in surgery, they said I'll need radiotherapy as well as surgery so may as well avoid the side effects of surgery and just go down radiotherapy route. So I was started on HT April 2018 for two years. HDR brachy in August 2018, Ebrt 37.5 greys over 15 days, September 2018.

I have had zero libido for the last two years it may return now I'm off HT. As far as ED is concerned I seem to be able to function, just can't be bothered due to low libido. 

I have no idea what the future holds for me. I may be cured, I may get no further side effects, or the cancer may return and I may get side effects in the coming years. It is impossible to know. 

I have no real complaints about the side effects of the treatment I have had. I think the side effects of surgery are far more immediate and I would say more troublesome.

I believe the 5,10,15 year survival rates are equivalent for the two treatment options we are discussing.

Monitoring psa post surgery is more informative than monitoring psa post RT. That could have an impact on which treatment you choose. 

Dave

User
Posted 31 May 2020 at 23:39

My dose was:
15Gy (1x15Gy) HDR to prostate,
46Gy (23x2Gy) EBRT to prostate, and prophylactically to seminal vesicles and pelvic lymph nodes.
18-36 month HT (duration up to me in discussion with onco, but not decided yet - I don't have bad side effects).

This combo is called HDR Boost, pioneered by Mount Vernon with 2 hospitals in other countries, but it's now offered by all the main cancer centres which have HDR capability for high risk patients.

No SpaceOAR (was discussed and I could have had it on NHS, but not advised due to diagnosed high risk).

Only side effect ongoing is slight occasional rectal bleeding, no pain, no inconvenience. I was offered a 2 week referral to colorectal in the middle of the COVID-19 peak. Given I had a clean bowl screening colonoscopy a year before PCa treatment, and you don't get RT-induced bowl cancer 6 months after RT, and the bleeding is a common RT side effect, I said I was happy to wait until COVID-19 died down a bit - most unlikely to be bowl cancer.

HDR is different from LDR in that the treatment takes 10 mins, rather than 3-6 months. This changes the profile of the side effects. For HDR, they kick in pretty instantly, but also go very quickly. Urgency, urge incontinence, tiny bladder capacity (100ml when I came out of hospital, but had doubled in 2 days, and again in 2 weeks), and small continuous leak (I wore small incontinence pads). It was all resolved (and no more incontinence pads) after a month. My urine peak flow rate dropped from 25ml/sec before treatment to 10ml/sec. This didn't change for months and I assumed it would stay like that, but then it started increasing, and it's back to about 20ml/sec now.

Erections worked throughout whole procedure, but were painful just after the HDR because urethra didn't stretch long enough. This gradually fixed itself over next 3 months. I don't think this is a common side effect. Penile shortening is common, but is usually temporary, and mine recovered over those same 3 months. There is a risk of late onset shortening too, usually about 1cm if it happens. (Don't know how that compares with LDR.) There's also a risk of shortening due to HT if you don't regularly have erections or undertake penile rehabilitation, but this should be avoidable if you know you have to actively do something to avoid it (and most people are not told that).

I suspect the symptoms for LDR will last for some months, but might be less severe.

I'm a cyclist, and I cycled throughout the EBRT. I waited some days after the HDR, but was back on the bike very quickly. I did buy a noseless saddle so there's nothing under the prostate/perineum.

I extended my neoadjuvant hormone therapy (the part before radical treatment) out to 5 months, aiming to get my PSA down to 0.1 before RT (it was 0.12, which I was happy with). Since the treatment, it has been <0.01. At the moment, I've very happy with it, but I'm well aware many different things can still go wrong, ranging from late onset side effects (including ED) through to recurrence. I am a little surprised you are not being offered HT - it generally improves outcomes for the low dose rate RT treatments (EBRT and LDR brachy), but isn't of benefit for high dose rate treatments (HDR, Cyberknife and other highly hypofractionated RT).

User
Posted 01 Jun 2020 at 07:05

Hi. Just for you to have to compere experiences.....

I decide to go down the surgery route. I was given three treatment options We chose robotic surgery. As the cancer was contained in the prostate the surgeon could remove the prostate while saving the nerves. In my case i was quickly continent (a little stress incontinence persists) and no issues with ED

So I am a supporter of surgery over radio or hormone.   BUT the advice of an experienced medical professional should carry much more weight than my personal experience.

It's not all sunshine and roses post surgery. I've had on going issues with bladder neck scarring blocking the flow which has resulted in weeks being catheterised and one urgent visit to the A&E dept for retention.

The upside of surgery even with these issues it's done quickly (Admitted on a Friday, driving home the next afternoon) and recovery commences the day after the operation. Only 5% of robotic removal operations result in scarring so i am unfortunate to have issues.

I've put this in for comparison I hope it help you. 

User
Posted 01 Jun 2020 at 22:35
Thanks for people’s comments so far, they have been really helpful. Had s further consultation eh the oncologist today to understand the treatment in more detail. Proposal is for 3 months hormone therapy followed by low dose permanent seed brachytherapy and 4 weeks of external beam therapy at a lower dose.

They are confident this will give a good outcome and with surgical options. Lots to think about before I make a decision.

Dave - thanks for your mail, I can’t reply to personal messages at the moment but appreciate your views and best of luck with your treatment, be keen to great how it all goes.

G

User
Posted 02 Jun 2020 at 15:58

Dear G... I'm now 76 and not in your age bracket but you might find the story of my experiences with HT and LDR Brachytherapy usefull. Just click on my Avator

Regard Tom  

User
Posted 02 Jun 2020 at 18:47

I had similar thoughts regarding which path to take. This is my storey and hopefully positive. I elected for surgery.

Going into surgery I was seen as a simple T2, surgeon advised me post RP surgery for whatever reason the cancer was more extensive then initial data presented and I was a T3B with the cancer busting out of capsule and spread to seminal vescile - Cancer did not get into lymph nodes (18 were tested). No nerve sparing on my left side, right side relatively untouched.

That was almost 2 years ago. All tests subsequently have shown PSA is ‘undetectable’.

My Gleason was 4+3+5, the 5 referring to a high grade cancer with a higher risk of reoccurrence.

 

Suggestions: Select your surgeon with care. A High volume surgeon is a must. My surgeon (NHS) is based at the Marsden. They were fantastic. I took surgery over other treatments as I wanted backstops if the cancer came back. I didn’t fancy 2 years of HT.

I have had no incontinence Issues at all (I had a suprapubic catheter) and now seeing very promising signs of getting an erection capable of penetrative sex. My ED issues are greatly improving. I am on 5mg Ciallis.  I will be 63 this year and in good health and feel fantastic.

 

I found all the medical staff excellent, and keen to offer advice - don’t be afraid to ask any question no matter how trivial you think it is. 

User
Posted 29 Jul 2020 at 08:19

Hi was just going through some posts and came across yours, I am 1 week post LDR Brachytherapy, if I can be of any assistance ? Oh yes and just off to the Golf Course!

User
Posted 29 Jul 2020 at 14:09

Hi Help83,

Glad you have a date for your Brachytherapy, is that date for the Volume test or for the actual procedure itself? I have started an new conversation on this forum about my Brachytherapy, there was some good input from other users already about the treatment and I just wanted to add to it, I will be updating it every few days.

I had my seeds ( 72 implanted ) last Wednesday and to be honest at the minute I feel fine, the site where the needles went in is still a bit tender and I am going to the toilet more frequently than usual but that is partly down to drinking a lot more water than usual, I had a 5 day course of antibiotics which finished on Monday and the only other medication that I am taking is Tamsulosin which helps you maintain a good flow and keeps the water works running. My main problem at present is tiredness but I think that is partly down to the fact that I am up 2/3/4 times a night going to the toilet but I have cut back a bit on the water and I was only up once last night and I feel a lot less tired today.

i know it’s early days and I don’t know what lies ahead but all is going well, I didn’t have HT just straight forward Brachytherapy.

 

The Big thing for me was the mental stress of waiting and the impact of COVID 19 on cancer treatment, I should have had mine back in May but it was delayed, I woke up on Thursday morning and for the first time in months was not worrying about having the treatment but now I just have to let the seeds to their business, by the the treatment received from the NHS was brilliant.

anything else just ask.

 

regards

David

User
Posted 30 Sep 2020 at 14:53

Hi was just going through some of my posts on the forum, are you still going ahead tomorrow ? and if so good luck, I have found the experience mostly positive, some minor side effects, fatigue etc but nothing that won’t get better over time  

User
Posted 30 Sep 2020 at 15:53

Hi.. thanks for following up, I’ve been meaning to update this thread for over a week. I had my Brachytherapy 2 weeks ago this coming Thursday. Had 70 seeds implanted and a Space OAR for the external radiotherapy which starts on the 26th October.

overall I am feeling well, pretty uncomfortable for a few days and then things settled down. I am starting to see some side effects starting to come through now with some slight burning discomfort pee-ing and some reduced flow rate but all are pretty manageable. They have me taking Tamsulosin to try and help with the flow.  Overall, pretty pleased and trying to live my life as actively as possible.

I have my CT and MRI scan for radiotherapy planned for 16th October. Looking forward to 25th Nov when the EBRT is complete and I can then fully focus on life...

will update again when I start the EBRT...

stay safe and I hope things continue to be positive for you

Graham

Edited by member 30 Sep 2020 at 15:54  | Reason: Not specified

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User
Posted 31 May 2020 at 20:39
For how long are they proposing you will have HT alongside the RT / brachy? You may avoid ED for a number of years but your libido is likely to be zero.

If you are not suitable for complete nerve sparing I would be a little bit cautious about any suggestion that you don't need HT.

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

User
Posted 31 May 2020 at 21:50

I was 56 at diagnosis, T3a, Gleason 3+4, PSA 57 (see my profile).
You're 53 at diagnosis, T2c, Gleason 4+3, PSA ?

For brachytherapy, there's a choice of HDR (temporary) brachytherapy, or LDR (seed) brachytherapy.

Also, ask about having SpaceOAR to temporarily space your rectum away from prostate during treatment, s oit gets a lower radiation dose, reducing risk of side effects (something I do have, but not serious).

I went for HDR brachytherapy + EBRT + HT, because I'm well in the high risk category.
You might not be quite so high risk (if your PSA < 20), so I'm wondering if the EBRT is needed, and just do the Brachytherapy? Not sure - a question for your oncologist. It's a trade off between more side effects versus more likelihood of recurrence.

With regards to HT and libido, yes it is an issue, and it effects different people to different degrees. My libido is low after 15 or 21 months on HT (depending how you count it), but erections do still work fine providing you keep your concentration and don't get distracted (and there's plenty you can do to help with that). For some people, erections don't work on HT though. (HT doesn't directly prevent erections - any effect is indirect via loss of libido.)

I do run periodic group sessions (at least before COVID-19) and presentations (even during COVID-19) on how to keep sexual function working (amongst other things) while on HT, but that doesn't mean everyone will be able to do so to the extent they would like to.

Edited by member 31 May 2020 at 21:58  | Reason: Not specified

User
Posted 31 May 2020 at 22:29

Thanks for the reply Andy62.. my PSA level was 11.9.  Consultant isn’t suggesting I do hormone therapy so the proposed combo would be permanent seed Brachytherapy plus a course of radiology. They have also said they would put a space AOR to limit the impact on the rectum

This clearly isn’t an easy decision but for me its the quality of my day to day life that is as important to consider and I feel that surgery, whilst finite in terms of curing the cancer (mine is localised) the thought of long term ED based on the surgical prognosis and an impact on my normal weekly running and tennis routine I think would have a greater impact on mental health. I am comforted by the consultant being reasonably happy that the proposed combo treatment would be curative..

Really helpful to hear your views and although I would agree we are at different risk levels I appreciate your insight. How were you in terms post brachytherapy symptoms? I have heard feelings of urgency and cystitis type burning can be expected 

User
Posted 31 May 2020 at 22:33

Hi, I was 53 at diagnosis T3, g4+5 psa 25. 95% of my prostate showed cancer. For me the MDT had little interest in surgery, they said I'll need radiotherapy as well as surgery so may as well avoid the side effects of surgery and just go down radiotherapy route. So I was started on HT April 2018 for two years. HDR brachy in August 2018, Ebrt 37.5 greys over 15 days, September 2018.

I have had zero libido for the last two years it may return now I'm off HT. As far as ED is concerned I seem to be able to function, just can't be bothered due to low libido. 

I have no idea what the future holds for me. I may be cured, I may get no further side effects, or the cancer may return and I may get side effects in the coming years. It is impossible to know. 

I have no real complaints about the side effects of the treatment I have had. I think the side effects of surgery are far more immediate and I would say more troublesome.

I believe the 5,10,15 year survival rates are equivalent for the two treatment options we are discussing.

Monitoring psa post surgery is more informative than monitoring psa post RT. That could have an impact on which treatment you choose. 

Dave

User
Posted 31 May 2020 at 23:39

My dose was:
15Gy (1x15Gy) HDR to prostate,
46Gy (23x2Gy) EBRT to prostate, and prophylactically to seminal vesicles and pelvic lymph nodes.
18-36 month HT (duration up to me in discussion with onco, but not decided yet - I don't have bad side effects).

This combo is called HDR Boost, pioneered by Mount Vernon with 2 hospitals in other countries, but it's now offered by all the main cancer centres which have HDR capability for high risk patients.

No SpaceOAR (was discussed and I could have had it on NHS, but not advised due to diagnosed high risk).

Only side effect ongoing is slight occasional rectal bleeding, no pain, no inconvenience. I was offered a 2 week referral to colorectal in the middle of the COVID-19 peak. Given I had a clean bowl screening colonoscopy a year before PCa treatment, and you don't get RT-induced bowl cancer 6 months after RT, and the bleeding is a common RT side effect, I said I was happy to wait until COVID-19 died down a bit - most unlikely to be bowl cancer.

HDR is different from LDR in that the treatment takes 10 mins, rather than 3-6 months. This changes the profile of the side effects. For HDR, they kick in pretty instantly, but also go very quickly. Urgency, urge incontinence, tiny bladder capacity (100ml when I came out of hospital, but had doubled in 2 days, and again in 2 weeks), and small continuous leak (I wore small incontinence pads). It was all resolved (and no more incontinence pads) after a month. My urine peak flow rate dropped from 25ml/sec before treatment to 10ml/sec. This didn't change for months and I assumed it would stay like that, but then it started increasing, and it's back to about 20ml/sec now.

Erections worked throughout whole procedure, but were painful just after the HDR because urethra didn't stretch long enough. This gradually fixed itself over next 3 months. I don't think this is a common side effect. Penile shortening is common, but is usually temporary, and mine recovered over those same 3 months. There is a risk of late onset shortening too, usually about 1cm if it happens. (Don't know how that compares with LDR.) There's also a risk of shortening due to HT if you don't regularly have erections or undertake penile rehabilitation, but this should be avoidable if you know you have to actively do something to avoid it (and most people are not told that).

I suspect the symptoms for LDR will last for some months, but might be less severe.

I'm a cyclist, and I cycled throughout the EBRT. I waited some days after the HDR, but was back on the bike very quickly. I did buy a noseless saddle so there's nothing under the prostate/perineum.

I extended my neoadjuvant hormone therapy (the part before radical treatment) out to 5 months, aiming to get my PSA down to 0.1 before RT (it was 0.12, which I was happy with). Since the treatment, it has been <0.01. At the moment, I've very happy with it, but I'm well aware many different things can still go wrong, ranging from late onset side effects (including ED) through to recurrence. I am a little surprised you are not being offered HT - it generally improves outcomes for the low dose rate RT treatments (EBRT and LDR brachy), but isn't of benefit for high dose rate treatments (HDR, Cyberknife and other highly hypofractionated RT).

User
Posted 01 Jun 2020 at 07:05

Hi. Just for you to have to compere experiences.....

I decide to go down the surgery route. I was given three treatment options We chose robotic surgery. As the cancer was contained in the prostate the surgeon could remove the prostate while saving the nerves. In my case i was quickly continent (a little stress incontinence persists) and no issues with ED

So I am a supporter of surgery over radio or hormone.   BUT the advice of an experienced medical professional should carry much more weight than my personal experience.

It's not all sunshine and roses post surgery. I've had on going issues with bladder neck scarring blocking the flow which has resulted in weeks being catheterised and one urgent visit to the A&E dept for retention.

The upside of surgery even with these issues it's done quickly (Admitted on a Friday, driving home the next afternoon) and recovery commences the day after the operation. Only 5% of robotic removal operations result in scarring so i am unfortunate to have issues.

I've put this in for comparison I hope it help you. 

User
Posted 01 Jun 2020 at 22:35
Thanks for people’s comments so far, they have been really helpful. Had s further consultation eh the oncologist today to understand the treatment in more detail. Proposal is for 3 months hormone therapy followed by low dose permanent seed brachytherapy and 4 weeks of external beam therapy at a lower dose.

They are confident this will give a good outcome and with surgical options. Lots to think about before I make a decision.

Dave - thanks for your mail, I can’t reply to personal messages at the moment but appreciate your views and best of luck with your treatment, be keen to great how it all goes.

G

User
Posted 02 Jun 2020 at 15:58

Dear G... I'm now 76 and not in your age bracket but you might find the story of my experiences with HT and LDR Brachytherapy usefull. Just click on my Avator

Regard Tom  

User
Posted 02 Jun 2020 at 16:17

Thanks Tom.. really detailed and insightful details. I have decided to go down the radiotherapy route as of now and will look to start HT in the coming weeks. Who knows what the future holds but this feels the best course or action for me and all the evidence from multiple consultants I have spoken to suggest a curable treatment for where I am. 
I will keep you updated on progress.

G

User
Posted 02 Jun 2020 at 16:25

Long term incontinence would be a problem with running but there are other solutions like having a tap inserted.  I think there is another intervention as well.   I'm not sure of how that would effect running though.

My incontinence took around 6 months to go completely although there are other effects that a few have mentioned.  One is that you can leak a very small amount if you get sexually aroused and that still happens to me, although not every time, after 3.5yrs.  On ED, it never responds automatically and is temperamental.  None of this bothers me much but we're all different.

 

 

User
Posted 02 Jun 2020 at 16:26
Thanks G and good luck. Will follow your progress with interest

Regards Tom

User
Posted 02 Jun 2020 at 18:47

I had similar thoughts regarding which path to take. This is my storey and hopefully positive. I elected for surgery.

Going into surgery I was seen as a simple T2, surgeon advised me post RP surgery for whatever reason the cancer was more extensive then initial data presented and I was a T3B with the cancer busting out of capsule and spread to seminal vescile - Cancer did not get into lymph nodes (18 were tested). No nerve sparing on my left side, right side relatively untouched.

That was almost 2 years ago. All tests subsequently have shown PSA is ‘undetectable’.

My Gleason was 4+3+5, the 5 referring to a high grade cancer with a higher risk of reoccurrence.

 

Suggestions: Select your surgeon with care. A High volume surgeon is a must. My surgeon (NHS) is based at the Marsden. They were fantastic. I took surgery over other treatments as I wanted backstops if the cancer came back. I didn’t fancy 2 years of HT.

I have had no incontinence Issues at all (I had a suprapubic catheter) and now seeing very promising signs of getting an erection capable of penetrative sex. My ED issues are greatly improving. I am on 5mg Ciallis.  I will be 63 this year and in good health and feel fantastic.

 

I found all the medical staff excellent, and keen to offer advice - don’t be afraid to ask any question no matter how trivial you think it is. 

User
Posted 29 Jul 2020 at 08:19

Hi was just going through some posts and came across yours, I am 1 week post LDR Brachytherapy, if I can be of any assistance ? Oh yes and just off to the Golf Course!

User
Posted 29 Jul 2020 at 10:30

Hi DRAMF. Thanks for the message and pleased to hear you are back on the golf course already.. that’s sounds really positive.

Have been on HT for 6 weeks now and feeling fine in myself.. LDR Brachytherapy is planned for 1st October

Had a blood test after 3 weeks of HT and PSA is down from 11.9 to 3.4 which is positive news..

Are you also having EBRT or just brachytherapy? Would be interested to how things progress in terms of ongoing side effects of the brachytherapy But hope it’s positive for you

User
Posted 29 Jul 2020 at 14:09

Hi Help83,

Glad you have a date for your Brachytherapy, is that date for the Volume test or for the actual procedure itself? I have started an new conversation on this forum about my Brachytherapy, there was some good input from other users already about the treatment and I just wanted to add to it, I will be updating it every few days.

I had my seeds ( 72 implanted ) last Wednesday and to be honest at the minute I feel fine, the site where the needles went in is still a bit tender and I am going to the toilet more frequently than usual but that is partly down to drinking a lot more water than usual, I had a 5 day course of antibiotics which finished on Monday and the only other medication that I am taking is Tamsulosin which helps you maintain a good flow and keeps the water works running. My main problem at present is tiredness but I think that is partly down to the fact that I am up 2/3/4 times a night going to the toilet but I have cut back a bit on the water and I was only up once last night and I feel a lot less tired today.

i know it’s early days and I don’t know what lies ahead but all is going well, I didn’t have HT just straight forward Brachytherapy.

 

The Big thing for me was the mental stress of waiting and the impact of COVID 19 on cancer treatment, I should have had mine back in May but it was delayed, I woke up on Thursday morning and for the first time in months was not worrying about having the treatment but now I just have to let the seeds to their business, by the the treatment received from the NHS was brilliant.

anything else just ask.

 

regards

David

User
Posted 30 Sep 2020 at 14:53

Hi was just going through some of my posts on the forum, are you still going ahead tomorrow ? and if so good luck, I have found the experience mostly positive, some minor side effects, fatigue etc but nothing that won’t get better over time  

User
Posted 30 Sep 2020 at 15:53

Hi.. thanks for following up, I’ve been meaning to update this thread for over a week. I had my Brachytherapy 2 weeks ago this coming Thursday. Had 70 seeds implanted and a Space OAR for the external radiotherapy which starts on the 26th October.

overall I am feeling well, pretty uncomfortable for a few days and then things settled down. I am starting to see some side effects starting to come through now with some slight burning discomfort pee-ing and some reduced flow rate but all are pretty manageable. They have me taking Tamsulosin to try and help with the flow.  Overall, pretty pleased and trying to live my life as actively as possible.

I have my CT and MRI scan for radiotherapy planned for 16th October. Looking forward to 25th Nov when the EBRT is complete and I can then fully focus on life...

will update again when I start the EBRT...

stay safe and I hope things continue to be positive for you

Graham

Edited by member 30 Sep 2020 at 15:54  | Reason: Not specified

 
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