53 & considering Brachytherapy

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

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).

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

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. 

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