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Different nhs trusts

User
Posted 09 Aug 2022 at 18:24

I was treated by Southampton general hospital and must thank them for their expertise and now  I am on 6 monthly psa test , my question is do different trusts treat pc options differently ? A friend of mine as been diagnosed 63 , psa 5.4 , Gleason 7 he lives in Northampton ( he doesn’t use the internet ) he’s been offered active surveillance or RP , no mention of rt/ht or brachytherapy , he’s got another psa test in nov and as been told to make his decision then ? I find it strange he’s not been offered rt /ht route? 
Thank you for reading 

User
Posted 09 Aug 2022 at 19:16

It does seem to vary between trusts. I think that if a trust doesn't have the equipment to offer a treatment they don't mention it, but if you ask for that treatment you can be referred to another trust which does offer it.


I hope someone with more experience will post with more precise details. Of course another possibility is that for some reason these really are the only sensible options.

Dave

User
Posted 10 Aug 2022 at 06:27

Our trust only offered RP and RT with HT.

User
Posted 11 Aug 2022 at 11:07

What treatments are offered depend on a few things...


Your diagnosis:
You won't be offered focal treatments if you don't have organ confined focal disease.
You won't be offered prostatectomy if you have spread to lymph nodes, and often not for T3 disease.
You won't usually be offered curative treatments if you are Stage 4.


Your age or expected longevity or state of health:
You won't be offered prostatectomy if you're over an age limit (typically 70-75) or have a life expectancy of < 10 years, or a BMI exceeding a limit (typically 30-35).
You might not be offered radiotherapy if you are a young patient and other options are viable.
You might not be offered external beam radiotherapy if you have serious bowl issues.
You might not be offered treatment if you have other conditions which mean your life expectancy is shorter than the period before you might get problems from prostate cancer if left untreated.


Previous treatments:
You might not be offered prostatectomy if you've had previous pelvic surgery or radiotherapy.
You might not be offered radiotherapy if you've had previous pelvic radiotherapy.


Treatments available:
You probably won't be offered treatments the hospital doesn't do, because they won't have anyone on the MDT to say you would be suitable for that treatment. All hospitals will offer prostatectomy or radiotherapy though, if necessary through another hospital and having their consultants on the MDT. Focal therapies are less likely to be offered, because few MDTs will have anyone with any focal therapy expertise. To a lesser extent, the same goes for brachytherapy.
It you are interested in a treatment not offered because they don't do it, ask about being referred elsewhere, and be careful about accepting advice from those not expert in it.


In spite of this, sometimes people aren't offered treatments which are not obviously unsuitable, so it's always worth checking why you haven't been offered a treatment if you're interested in it.

User
Posted 11 Aug 2022 at 19:31
My urologist could only offer HT, RP, or EBRT. He did, however point me in the direction of LDR Brachytherapy at another trust. I eventually got approval for this and was sucessfully treated. It pays to be aware of treatment options, pros and cons, and to be prepared to ask for what you want. John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2


Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23  <0.01

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User
Posted 09 Aug 2022 at 19:16

It does seem to vary between trusts. I think that if a trust doesn't have the equipment to offer a treatment they don't mention it, but if you ask for that treatment you can be referred to another trust which does offer it.


I hope someone with more experience will post with more precise details. Of course another possibility is that for some reason these really are the only sensible options.

Dave

User
Posted 09 Aug 2022 at 20:29
Ask the question of your Consultant as to why the various forms of RT are not being offered to you or may be but is it in your particular case RP is the most appropriate radical option.
Barry
User
Posted 09 Aug 2022 at 20:46

The consultants at my trust offered a full range of options RP, HT RT, Brachy, HIFU. Then proceeded to tell me why each of the options other than RP were not best path to follow. As OldBarry said, ask.

User
Posted 09 Aug 2022 at 20:51
Thax for replies I told my friend to ask why only 2 options given .
User
Posted 10 Aug 2022 at 06:27

Our trust only offered RP and RT with HT.

User
Posted 11 Aug 2022 at 07:17

Originally Posted by: Online Community Member


Our trust only offered RP and RT with HT.



Where this is that case, I think it unlikely the hospital would discuss other forms of treatment with the patient

Barry
User
Posted 11 Aug 2022 at 11:07

What treatments are offered depend on a few things...


Your diagnosis:
You won't be offered focal treatments if you don't have organ confined focal disease.
You won't be offered prostatectomy if you have spread to lymph nodes, and often not for T3 disease.
You won't usually be offered curative treatments if you are Stage 4.


Your age or expected longevity or state of health:
You won't be offered prostatectomy if you're over an age limit (typically 70-75) or have a life expectancy of < 10 years, or a BMI exceeding a limit (typically 30-35).
You might not be offered radiotherapy if you are a young patient and other options are viable.
You might not be offered external beam radiotherapy if you have serious bowl issues.
You might not be offered treatment if you have other conditions which mean your life expectancy is shorter than the period before you might get problems from prostate cancer if left untreated.


Previous treatments:
You might not be offered prostatectomy if you've had previous pelvic surgery or radiotherapy.
You might not be offered radiotherapy if you've had previous pelvic radiotherapy.


Treatments available:
You probably won't be offered treatments the hospital doesn't do, because they won't have anyone on the MDT to say you would be suitable for that treatment. All hospitals will offer prostatectomy or radiotherapy though, if necessary through another hospital and having their consultants on the MDT. Focal therapies are less likely to be offered, because few MDTs will have anyone with any focal therapy expertise. To a lesser extent, the same goes for brachytherapy.
It you are interested in a treatment not offered because they don't do it, ask about being referred elsewhere, and be careful about accepting advice from those not expert in it.


In spite of this, sometimes people aren't offered treatments which are not obviously unsuitable, so it's always worth checking why you haven't been offered a treatment if you're interested in it.

User
Posted 11 Aug 2022 at 19:31
My urologist could only offer HT, RP, or EBRT. He did, however point me in the direction of LDR Brachytherapy at another trust. I eventually got approval for this and was sucessfully treated. It pays to be aware of treatment options, pros and cons, and to be prepared to ask for what you want. John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2


Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23  <0.01

 
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