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Post brachytherapy

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User
Posted 10 Jun 2020 at 22:09

Hi Guys 

Im new to the community but have been on this journey for a while.

My question is Post Brachytherapy what would my long term treatments options be ? 

 

thanks 

User
Posted 11 Jun 2020 at 10:11

Hi Jimmy,

You really need to get your PSMA scan results, because that will decide if there are curative options available. These might include focal therapies to the prostate, and maybe cyberknife if you have a only a small number of mets in certain other places. Prostatectomy might be an option too, although rarely performed after radiotherapy.

You may need to be pushy here. Many hospitals don't think to suggest treatments they can't offer themselves (one of my pet peeves), and for salvage treatments, you may benefit from treatments only available at the main cancer centres of excellence, which may mean referral for second opinion.

If there aren't curative treatments available, then you are on to long term management of the prostate cancer with hormone therapy.

User
Posted 11 Jun 2020 at 10:19

Hi Jimmy,

Not to sure what you mean by treatments.I had Brachytherapy in September 2016 and had no further treatment since then apart from tamsulosin tablets and 6 monthly PSA tests, then on to yearly  tests.I started with PSA 2.19 Gleason 3+4 =7 and 5 cores out of 20 samples positive.

Psa 0.18 in December 2019

If you click on my Avatar you can see my progress but i can still answer any other questions if that helps.

 

John.

Edited by member 11 Jun 2020 at 10:23  | Reason: Not specified

User
Posted 12 Jun 2020 at 01:05
Once you have your scan results, you could ask to see a surgeon at your current hospital and, if they cannot offer removal, seek a referral to someone who does undertake removal post-brachy. You need to be aware though that the risk of side effects such as incontinence & ED is much higher as a fried prostate is rather gloopy & therefore not so easy to remove in a complete piece.

You could also explore whether HIFU or cyberknife might be possible.

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

User
Posted 16 Jun 2020 at 20:29

Got my PSMA appointment today for mid July , not sure yet how I am going to get to London and possible overnight unless the hotels are opened shortly and flights increase, I'm an NI resident. 

My consultant has discounted HIFU because the redundant seeds block the sound waves and I suspect the cyberknife may also be a non runner.

NI has broken the tie with Addenbrooks for difficult surgery and are now linked with Dublin, I know Addenbrooks were exemplary , has anyone any experience or reports on the Dublin clinics? 

 

Jimmy

User
Posted 18 Aug 2020 at 20:13

Hi Guys 

A quick update , I have the report from the PSMA and have activity in both lobes, previous assessment was only in one side, good news is no abnormal uptake anywhere else 😄.

I have a date next week for pre-op assessment in the Mater Hospital Dublin with possible salvage robotic prostatectomy within 14 days after.

My research hasent turned up much on the Dublin Treatment so I will make my final decision after the meeting with the surgeon.

Regards 

Jimmy

User
Posted 19 Aug 2020 at 08:40

Hi Jimmy, sorry your having to consider a salvage prostatectomy. Hope all goes to plan.

I presume you are aware of the difficulties/complications with this ?

Ido4

User
Posted 19 Aug 2020 at 21:04

Yes I am aware of the difficulties and the possible consequences.  

I would appreciate any information from anyone in the team who has been through salvage surgery and their experience post op ?

I am still debating with myself on weather or not to do it, and change my mind almost daily.

 

Appreciate any advice 

Jimmy

User
Posted 20 Aug 2020 at 00:35
I note the reason why HIFU was ruled out but wonder whether this would also apply to Cryotherapy or Nanoknife. With the former, while other organs are protected, cancer cells are killed by an ice ball that forms. This is a procedure that is used more in the USA but there are a few specialists in the UK. With Nanoknife or Irreversable Electroporation (IRE) to be more precise, electrodes are placed inside the tumour and electrical impulses blow holes in the tumour crippling it. I don't know whether this is being done now in the UK and if so within the NHS. It is certainly done in Germany. If you are interested as a possible alternative to salvage surgery, you could get an opinion from the top Focal Specialist at UCLH in London who I know has knowledge of these therapies and did run a trial on Nanoknife which ended a few years ago. However, he should know where it might be available even if only privately in the UK.

So, if interested you need to act quickly or defer surgery for a time. If you contact Professor M E at UCLH don't forget to mention the 'Gold Seeds' at the outset as it's possible that these might rule out these other two forms of Focal Therapy.

Barry
User
Posted 20 Aug 2020 at 13:13

Hi Jimmy 

As Barry said Prof M E at UCLH would be a great place to start for focal. I think they still offer nano knife as I looked at this as an option before I found out my cancer was multi-focal. I went the surgical route with Prof Whocannotbenamedhere who is a high volume ninja at surgery. I was lucky to find him via recommendation on here and IRL. Had surgery back in a November 2019 and good thus far. The Prof always said he enjoys a surgical challenge so if you decide not hat route might be worth running you situation past him.

TG

User
Posted 20 Aug 2020 at 13:36

Might also be worth chatting with andyprostate on here as he went through Several HIFU procedures at UCLH and earlier this year had a RARP at UCLH.

TG

 
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