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User
Posted 14 Jan 2021 at 14:54

My husband had rectal cancer and had 25 sessions of radiotherapy and then further radiotherapy via Papillon treatment. This means he cannot have any further radiation. He then had surgery to remove his rectum and unfortunately has now been diagnosed with prostate cancer. Gleason score 3+4 and now on active surveillance. The consultant said that no treatment is needed right now but since the appointment we have reflected and feel he has said because previous treatment and surgery makes treating my husband too difficult. I am at my wits end with worry, my husband is really low and defeated. He fought the rectal cancer very bravely and copes well with the stoma but it’s like he’s just waiting for the inevitable after this latest diagnosis. It doesn’t help matters that we are living through this dreadful pandemic. Any comments will be greatly appreciated. Thank you

User
Posted 14 Jan 2021 at 19:10
I think the issue here is going to be more about his mental health than anything else. Being diagnosed with, treated for and recovering from cancer is traumatic - to then be diagnosed with a completely separate cancer must be devastating.

As I think some of us probably said on your previous thread, it is good that he has been considered suitable for active surveillance and the specialist would have been unlikely to recommend AS just because of the previous treatment. If they thought he needed treatment now, they would have banged him onto hormone therapy before you could blink. As long as AS is done properly, it should be fine - regular PSA tests, regular DRE, regular mpMRI scan and repeat of the biopsy if there are concerns that the cancer is becoming more active. The skill of the oncologist will be identifying when to start HT.

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

User
Posted 16 Jan 2021 at 09:08

Prostate is accessed via rectum during brachytherapy, not for the seed implant, but for the ultrasonic imaging probe to get the seeds into the right place (or brachytherapy catheters for HDR brachytherapy).

There may be other ways of doing this imaging, and because HDR has additional ways to do more precise seed positioning than LDR, there may be one of the main cancer centres which could manage to do this.

User
Posted 16 Jan 2021 at 11:12
The man has already had EBRT (I assume IMRT) and Papillon, which is brachytherapy. I think if he has been told that RT to the prostate isn't possible because he has had maximum dose to that area, that will apply to brachy as well.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 14 Jan 2021 at 15:05

If both surgery and RT have been ruled out, other treatments are available. Have you investigated brachytherapy? This implants radioactive "seeds" into the prostate which deliver an extremely localised dose of radiation.

Best wishes,

Chris

Edited by member 14 Jan 2021 at 15:06  | Reason: Not specified

User
Posted 14 Jan 2021 at 19:10
I think the issue here is going to be more about his mental health than anything else. Being diagnosed with, treated for and recovering from cancer is traumatic - to then be diagnosed with a completely separate cancer must be devastating.

As I think some of us probably said on your previous thread, it is good that he has been considered suitable for active surveillance and the specialist would have been unlikely to recommend AS just because of the previous treatment. If they thought he needed treatment now, they would have banged him onto hormone therapy before you could blink. As long as AS is done properly, it should be fine - regular PSA tests, regular DRE, regular mpMRI scan and repeat of the biopsy if there are concerns that the cancer is becoming more active. The skill of the oncologist will be identifying when to start HT.

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

User
Posted 15 Jan 2021 at 07:00

My OH has FAP so had a colectomy 25 years ago, when he was diagnosed with pca in September he was told he wasn’t suitable for conventional radiotherapy and surgery would be tricky due to old scar tissue, he opted for brachytherapy and is due to have the seed implantation 15 Feb. There is a risk to his remaining bowel but not as much as other treatments. Brachytherapy might be worth considering when he needs treatment but not all health authorities offer it, we have to travel 70 miles. Hope all goes well.

User
Posted 15 Jan 2021 at 13:47

Thanks for your response. Excuse my ignorance but what does FAP stand for and does your OH have a permanent Stoma and is his rectum intact?  As this is the usual route to the prostate this is no longer possible for my husband post surgery. 
Thanks again

User
Posted 15 Jan 2021 at 13:54
Ellie, for a prostatectomy they go in from the front. The only time (to the best of my knowledge) that the prostate is accessed through the rectal wall is during a DRE examination by a doctor, or for a TRUS biopsy. I'm slightly puzzled by why it would have an impact on surgery, unless it's due to old scar tissue or something like that?

Best wishes,

Chris

User
Posted 15 Jan 2021 at 19:53
The prostate is removed through the stomach, Ellie so I suspect that the stoma is in the way.

There is a version of prostatectomy that goes through the perineum but again, the previous surgery may make that too risky.

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

User
Posted 15 Jan 2021 at 21:46

Thank you all for your replies - we are making notes of everything we are learning through this community and our research online. We have learned so much about rectal cancer through my husband’s experience and would do things differently with hindsight. We now feel that we will arm ourselves with as much knowledge as possible this time around, so thank you for your help.

User
Posted 16 Jan 2021 at 09:08

Prostate is accessed via rectum during brachytherapy, not for the seed implant, but for the ultrasonic imaging probe to get the seeds into the right place (or brachytherapy catheters for HDR brachytherapy).

There may be other ways of doing this imaging, and because HDR has additional ways to do more precise seed positioning than LDR, there may be one of the main cancer centres which could manage to do this.

User
Posted 16 Jan 2021 at 11:12
The man has already had EBRT (I assume IMRT) and Papillon, which is brachytherapy. I think if he has been told that RT to the prostate isn't possible because he has had maximum dose to that area, that will apply to brachy as well.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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