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Brachy or Surgery?

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User
Posted 05 Feb 2021 at 18:45

Hi,


My first post. In December I was diagnosed with PC. It has been assessed as local medium risk. PSA 8.4 T stage 2A Grade 2 Gleason (3+4) = 7


I have been offered 3 treatments - external radiotherapy, Brachytherapy or a radical prostectomy. I am trying to make the decision of what option to take. I've discounted the external option and am leaning towards Brachytherapy but my wife thinks a prostectomy would be the better route to take as once the there is no risk of a relapse. We know this cannot be 100% guaranteed.  


I have to admit the side effects of a prosectomy do not appeal.


Can you give your thoughts on the treatment options? BTW I will need a mini-TURP before any Brachytherapy.


Thanks in advance


Paul


 

User
Posted 05 Feb 2021 at 19:15

Hi Paul, sorry you are here. This conversation had some good arguments, and is worth reading. 


https://community.prostatecanceruk.org/posts/t26986-Can-t-understand-why-anyone-would-choose-surgery-over-Brachytherapy--I-must-be-missing-something


It's very hard to make the choice, but keep posting here and asking questions, hopefully you will then be able to make an informed choice. 

Dave

User
Posted 05 Feb 2021 at 19:43

If only your wife was right that a Prostatectomy ends PCa. It does for some but many need additional treatment some time later. The biggest of a number of factors here is how well PCa is contained and this cannot always be determined until a Prostate is examined in the lab. Do your research and make an informed decision bearing in mind there are pros and cons for all treatments and even for those where initial treatment is not successful subsequent treatments can extend life.


Like your Avatar and expect there is a connection.  I flew in the beautiful VC 10 in the sixties and was lucky enough to be taken through the controls of the static display one at Brooklands some years ago on the occasion of the final closing of the runway there.  What a shame some ended up as in flight fuel refill tankers in a similar way to one of Brunel's passenger ships ending up as a coal carrier.


 

Edited by member 06 Feb 2021 at 14:22  | Reason: Not specified

Barry
User
Posted 06 Feb 2021 at 12:49

Hi Paul,


I was diagnosed in 2016 at 70 with PSA 2.19 Gleason 3+4=7 and 5 cores out of 20 positive.I had the choice of robotic surgery but asked at the meeting to speak to a Brachytherapy specialist that was in the hospital the same day.


I think you need to look at all the options and also possible side affects.I checked out this site and found a friendly bunch with a lot of experiences some good and some not so good but all willing to help out but you must also remember that there are no Guarantees with any of the procedures.


I took the Brachytherapy route as it seemed the best option for me with maybe less side affects and four years on i am still happy with the results.If you click on my Avatar you can see my journey so far.My PSA is down to 0.08 in December 2020 and my Specialist signed me off in January 2021 with yearly blood tests


Good luck John.

User
Posted 09 Feb 2021 at 19:08
NHS published data is that 90% of men are continent 12 months post op. Make sure you understand the definition of continence for each source you look at though - the NHS definition of being continent is using one pad per day or less whereas many men who have to use a pad every day would perhaps not describe themselves as continent.

It is the same for impotence data - the NHS data indicates that 90% of men can get an erection 12 months post-RP but this includes erections induced through chemical and mechanical assistance. Nor does the data make clear that of the 90% who can get an erection of some sort, only a proportion of those get an erection firm enough for penetration.

It is also acknowledged in urology circles that a significant proportion of men lie to their surgeon and claim to be more recovered that they actually are - only when surveys are undertaken with partners does a different (and possibly more reliable) picture emerge.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 05 Feb 2021 at 19:15

Hi Paul, sorry you are here. This conversation had some good arguments, and is worth reading. 


https://community.prostatecanceruk.org/posts/t26986-Can-t-understand-why-anyone-would-choose-surgery-over-Brachytherapy--I-must-be-missing-something


It's very hard to make the choice, but keep posting here and asking questions, hopefully you will then be able to make an informed choice. 

Dave

User
Posted 05 Feb 2021 at 19:43

If only your wife was right that a Prostatectomy ends PCa. It does for some but many need additional treatment some time later. The biggest of a number of factors here is how well PCa is contained and this cannot always be determined until a Prostate is examined in the lab. Do your research and make an informed decision bearing in mind there are pros and cons for all treatments and even for those where initial treatment is not successful subsequent treatments can extend life.


Like your Avatar and expect there is a connection.  I flew in the beautiful VC 10 in the sixties and was lucky enough to be taken through the controls of the static display one at Brooklands some years ago on the occasion of the final closing of the runway there.  What a shame some ended up as in flight fuel refill tankers in a similar way to one of Brunel's passenger ships ending up as a coal carrier.


 

Edited by member 06 Feb 2021 at 14:22  | Reason: Not specified

Barry
User
Posted 05 Feb 2021 at 20:35
Any particular reason you ruled out RT, Paul? RT and RP have almost identical long-term success rates.

Best wishes,

Chris
User
Posted 06 Feb 2021 at 08:15

Hi Chris. I'm just not keen on EBRT and the possible side-effects of that treatment. It strikes me that the radiation goes through too many other bits of you as compared to Brachy.

Edited by member 06 Feb 2021 at 08:22  | Reason: Spelling

User
Posted 06 Feb 2021 at 09:04
I actually found it a pretty trouble-free treatment, Paul. If you do have any questions about what it's actually like, I, and I'm sure others too, will be happy to answer them. The radiation dose is "shaped" by lead baffles (you hear them shuffling around as the machine's head moves) so the area to which radiation is delivered is highly targeted.

Best wishes,

Chris
User
Posted 06 Feb 2021 at 09:45

Hi Paul,


Are there not temp and perm bracky? There's more than 2 options available to you.. 


Depends why the mini TURP ? Any RT will obviously have long term positive and negative effects.  As Chris and others allude to in many ways, nothing is certain. External RT is far more sophisticated nowadays.


See my profile, which includes my brother, he had spaceoar fitted.


All the very best


Gordon


 


 

User
Posted 06 Feb 2021 at 09:47

Hi Paul is it LDR or HDR Brachy you are thinking of? I am somewhat in agreement with you about EBRT going through too many other bits. I was T3 and had HDR and EBRT, the EBRT hopefully will have got any cancer which had escaped. As you are T2 that is less of a worry, so brachy alone may suffice. 

Dave

User
Posted 06 Feb 2021 at 12:49

Hi Paul,


I was diagnosed in 2016 at 70 with PSA 2.19 Gleason 3+4=7 and 5 cores out of 20 positive.I had the choice of robotic surgery but asked at the meeting to speak to a Brachytherapy specialist that was in the hospital the same day.


I think you need to look at all the options and also possible side affects.I checked out this site and found a friendly bunch with a lot of experiences some good and some not so good but all willing to help out but you must also remember that there are no Guarantees with any of the procedures.


I took the Brachytherapy route as it seemed the best option for me with maybe less side affects and four years on i am still happy with the results.If you click on my Avatar you can see my journey so far.My PSA is down to 0.08 in December 2020 and my Specialist signed me off in January 2021 with yearly blood tests


Good luck John.

User
Posted 06 Feb 2021 at 18:47
Radiotherapy doesn't really go through many other bits unless the diagnosis indicates that other bits need it - that's the point of modern IMRT or IGRT.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 06 Feb 2021 at 20:31

As I posted elsewhere on this site. When I was diagnosed at the age of 70 in 2015 I chose surgery and was operated on by the Da Vinci Robot. I have not regretted it.  Its now 2021 and I'm fine, no medication ever and I carry on with my 2020 hobby, off-road running. I'm hoping soon that I can go hiking/camping again, its either going to be the Pennine Way (again!) or if I'm allowed the GR5 hiking route in France.

User
Posted 07 Feb 2021 at 13:27

Many thanks for you support and replies. I think I am going down the low dose (the seeds) Brachy route.


To answer the mini TURP question - I have had flow problems for a number of years and last week I had an ultrasound with the Brachy team last week that has confirmed the prostate has bulged it my bladder which more often than not affects my flow. Speaking to the brachy team they say they will carry out a mini TURP 6 - 10 weeks before the 'seeding' assuming my flow issue is resolved.


My treatment will take place at Stokes Centre for Urology at the Royal Surrey Hospital, Guildford. 


 


 


 

User
Posted 07 Feb 2021 at 15:54

Hi,   Have you any knowledge of the size of the lesion or exactly where it's located. 


It might be academic to some degree but one of the things that comforted me in my choice was it was close to the outer edge at the apex, and 13mm diameter or at least said to be 13mm.   


Close to the edge put some urgency on it and the size seemed fairly large for radiation.  Although they say they shrink it with hormones before radiation my simple mind didn't like the idea it was close to the edge and 13mm seemed pretty large for one side of the prostate.  For those reasons I was keen to get surgery done.


At the time I was Gleason 4+3 but in the lab after the op they said it was 4+4 which put it in high risk.  So I was glad it was out.  I was told the good news is negative margins.   None of that information is available to radiation patients but most people don't regret their choice.  It will also be a year before you know if it worked whereas you know within 6 weeks if the op worked and from then you're hoping it doesn't come back.


Brachytherapy wasn't offered to me and they gave me strange looks when I mentioned it.  Not done here I think.  I've never felt regrets anyway.  So all the best.  Peter

User
Posted 08 Feb 2021 at 00:48

Hi Peter


I don't know where the lesion is. At my last couple of consultations they did say I have a few months to make a decision on which treatment. Apparently there was no tumour to be seen on the MRI but there were some PI-RADS 3 lesions which is why I had a transperineal biopsy which took 22 samples 8 of which came back positive.


I am reassured about the low dose brachy treatment because the Stokes Centre is the largest centre for Brachy in Europe and in the global top 3.


 


 


 

User
Posted 09 Feb 2021 at 15:42

Hi mate, sorry you find yourself here, but you’re in good company 😀. I had low dose brachytherapy last Thursday in Royal Berks Reading and I am really glad I chose it.  I can’t believe how well I feel after the treatment. Had a couple of days of discomfort and blood in my urine, but I really feel well now after less than a week.  I cannot tell you what to do, but I am glad I chose brachytherapy.

User
Posted 09 Feb 2021 at 18:10

 I suppose my main worry about prosectomy is long term incontinence. From what I have read on-line Havard Medical School say 2 - 15% of patients suffer long term incontinence and Urology News UK are quoting 14%. Does anybody here have numbers that confirm numbers that I have found?

User
Posted 09 Feb 2021 at 19:08
NHS published data is that 90% of men are continent 12 months post op. Make sure you understand the definition of continence for each source you look at though - the NHS definition of being continent is using one pad per day or less whereas many men who have to use a pad every day would perhaps not describe themselves as continent.

It is the same for impotence data - the NHS data indicates that 90% of men can get an erection 12 months post-RP but this includes erections induced through chemical and mechanical assistance. Nor does the data make clear that of the 90% who can get an erection of some sort, only a proportion of those get an erection firm enough for penetration.

It is also acknowledged in urology circles that a significant proportion of men lie to their surgeon and claim to be more recovered that they actually are - only when surveys are undertaken with partners does a different (and possibly more reliable) picture emerge.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Feb 2021 at 11:35

Thank you all for your support and advice. I have finally made my decision and opted for brachy treatment based on less than a 1% reoccurrence rate and few risks of long term side effects.

User
Posted 11 Feb 2021 at 09:30

Hi,


I see that you are electing to go for the LDR BRACHYTHERAPY treatment, I had my diagnosis on the 12th of Feb last year PSA 6.2 Gleason 3+4 and elected for this treatment, I had 72 seeds implanted in my prostate on 22 July 20 and I to date I feel that it was the Best choice for me, This is a link to a thread i have compiled on my journey.https://community.prostatecanceruk.org/posts/t24531-My-LDR-Permanent-Seed-Brachytherapy-Journ


One year on I have made a full recovery from the procedure with minimal side effects and my most recent PSA was 1.29, so all is going the right way so far if you have any questions send me a message.


Regards


David

Edited by member 11 Feb 2021 at 19:32  | Reason: more information re post op

User
Posted 12 Feb 2021 at 10:20

Hi VC,


I had LD brachy last Dec and was very pleased with the procedure. Details are posted in the following link. Note that since end Jan I've only been getting up once a night to urinate.


I'm having my first 3 month review with the consultant next month so then I'll get a better idea of how things went. Will post if anything of merit.


https://community.prostatecanceruk.org/posts/t26895-My-HT-EBRT-LDR-Brachy-Experiences


Best of luck!...I'm sure that you'll be fine as it's a well established procedure.


Vince


 


 

User
Posted 14 Feb 2021 at 23:54

thanks for the feedback & links David & Vince

 
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