Combined therapy

User

Posted 14 May 2022 at 13:14

Hi. I'm fairly new to all this so please bear with me.

Had PSA levels checked in March - 19.9 - so usual MRI, Biopsy, bone scan.

MRI and biopsy show of 6 sections of prostate

4 are (3+3) 6 with T2c staging

1 is (3+4)7 with T3 --- inside capsule but pressing on edge

1 is 'suspicious'

Bone scan is clear

I already have M.E. and fibromyalgia and we are carers for our son so there are all sorts of calls on my energy and time. I was really hoping that I might just squeeze into the option for brachytherapy. I knew this was a long shot but hoping as I have no idea how I'll manage HT + trips for 4 weeks of RT which seems to be my other option.

Letter from Oncologist at Addenbrookes this morning says brachytherapy is not appropriate for me (or not on its own) but I would be a candidate for 'combined androgen deprivation therapy, external beam radiotherapy and brachytherapy'. Presumably this is medical speak for Hormone therapy and radiotherapy but with brachytherapy as well /after the RT.

Nobody has mentioned this to me. I cant seem to find much info on 'Dr Google' and. as it's the weekend, I cant talk to any of the Specialist Nurses.

Anybody else had this Combination therapy, know anything about is, pros and cons ?

I'd be really grateful if anyone could share their experience of this. I always feel less anxious once I know a bit more about the situation and possibilties.

Thanks for any any advice you might be able to offer

User

Posted 14 May 2022 at 13:47

Yes I've had that. BTW I assume the brachy will be HDR rather than seeds. If so a likely time scale is 24 months HT at the 6 month mark a one night stay in hospital to have Brachy done Then a week later three weeks of EBRT and then continue on HT for remaining 18 months.

HT is not great for fatigue, you could possibly stop after a year with only a slight extra risk of recurrence.

There are a few people on here who have had that treatment. I would say it was reasonably easy to tolerate.

Dave

User

Posted 14 May 2022 at 15:53

My OH (PSA 8, T2b, Gleason 4+3 (1 lesion), N0M0) was offered RP by the surgeon RT (20 sessions) with HT (Tablets) of 6 month by the oncologist at our hospital or HDR Brachy (not suitable for LDR Brachy according to that oncologist ), with 15 sessions of RT and 9 month of HT in form of injections by Lincoln Hospital.

User

Posted 14 May 2022 at 16:56

Thank you both for that. I'm not sure exactly what else I'm being offered yet. I know that I've been told RP is not for me so it was then down to Brachy (if possible --- but we were talking LDR, not HDR at that point) or RT plus HT.

In conversation with Specialist Nurse when I got biopsy results, she mentioned HT for 3 months, 20 sessions of RT and then HT for another 6 months but we were waiting to have a meeting with the Oncologist to discuss further (the Oncologist who sent letter today). I'll have to phone Nurse on Monday to see where we go from here. No idea what HT (or RT) might do to my fatigue levels -- with M.E. I'm fatigued all the time so used to it but with RT on top, no idea. Have to try and work out best way forward like everyone else

User

Posted 17 May 2022 at 01:07

Call the PCUK nurses; they will be able to talk you through the implications. I think that brachy combined with external RT may be the best option anyway as it means fewer hospital trips - standard RT can be seven weeks! Also, depending on your hospital you may be able to choose a time slit for RT which is convenient for your caring responsibilities (my husband had almost all his RT sessions at 8.30am although I know at some hospitals the times are random). Also, you may be entitled to a carer's assessment from the local authority?

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

User

Posted 18 May 2022 at 01:45

Brachytherapy boost, as this is called, can be done with LDR or HDR, but is probably more often done in centres that offer HDR. LDR is limited to max Gleason 3+4, and prostate no bigger than around 50cc, and no seminal vesicle involvement (which you don't have if T2c). HDR doesn't have these 3 constraints.

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