Worried about impact of treatment on heart

Gleason 6 T3a is a little bit of a unusual combination, which might call the Gleason 6 into question a bit.

Being T3a, they will probably still want to hit it quite hard.

The higher power radiotherapy treatments delivered over shorter periods benefit less from hormone therapy, so you might ask about something like HDR Brachytherapy where a shorter or even no dose of HT might be required. This can be combined with a reduced dose of external beam which can help to mop up any undetected micro-mets around the prostate, and this combination is called HDR Boost although the external beam would benefit from some HT. Stereotactic radiotherapy (SABR/SBRT) might be another option with less need for HT. Some places might also consider LDR Brachytherapy depending if they think they can catch the T3a (locally advanced) part with it. With a Gleason 6, they wouldn't normally do HT, but being T3a, I would question if he's really Gleason 6.

If he does have HT, there are a few types. The tablets (Bicalutamide) have fewer side effects with the exception of higher risk of breast gland growth. The GnRH Agonist injections (Prostap, Zoladex, Decapeptyl) are more powerful and effective, but do have risks of coronary issues. The GnRH Antagonist injection (Firmagon/Degarelix) is similar to the other injections in effectiveness, slightly less risk of coronary issues, but is a less pleasant injection and given more frequently (and much more expensive). I don't know how the tablets compare with the injections for coronary issues, but unlike the injections, they don't tend to raise blood pressure, cholesterol, and blood glucose, so they may be better.

Obviously something to discuss with your oncologist. Brachytherapy and Stereotactic radiotherapy are only available at some centres. If your centre doesn't do them, they will probably not be experts in their suitability and you would have to ask for a referral elsewhere if you wanted to ask more about those treatments.

Edited by member 31 Oct 2022 at 09:29  | Reason: Not specified

Thanks Andy and Chris, we too were a bit unsure why you would receive a Gleason score of 6 with T3a. The urologist said it was T2/T3a as the cancer is pressing on the edge of the capsule so they couldn’t be sure if it had broken through so I’m assuming they rounded it up to T3a.  Has anyone else had that happen, I was just wondering if it’s quite common? We’ve tried to take comfort that it means it slow growing but at the moment it’s just a worry as we read and hear a lot of contradicting information.

That’s really helpful advice about all the treatment options, we are going to take a load of notes with us so we can ask all the relevant questions and make sure we have some background knowledge of the different treatments available. The urologist did say the oncologist may decide to just start RT straightaway or use HT for two to three weeks either side of the RT which she might have suggested as an option due to my husbands heart condition.

Lots to think (and worry) about before the appointment but I’m sure there are sadly many men diagnosed with PCa who have existing heart problems so we will have to put our trust in the professionals as I’m sure they will know what they are doing 

Thanks for explaining, it was all a bit of a shock as my husband has had no symptoms at all and it got picked up through routine blood tests so we do consider him to be lucky as it may have become far more advanced by the time any symptoms started to develop.  Sorry to ask another question but do you know if that meeting would take place prior to us meeting with the oncologist ? It’s the waiting that’s frustrating my husband more than anything and we were both hoping that appointment would confirm the treatment plan and get it started. Many thanks 

In answer to one of your questions. I was diagnosed T2b prior to my prostatectomy. After post op pathology, I was graded T3a, even though I had clear margins and the tumour, whilst pressing against the capsule, had not broken through. Without removing the prostate, I imagine that all diagnoses are liable to a margin of error. 

Thanks Barry, my husband isn’t under a cardiologist anymore, he just has a scan every 2 years which again we see as a positive and hopefully he will be fit enough to respond to the treatment. We are hoping he will be back under the care of a cardiologist during his treatment though to make sure his heart health is all ok.  We have a lot of questions to ask when we see the oncologist and the responses in this thread are really helpful, I appreciate you all taking the time to answer our questions.

Thanks J-B, we’ll make sure we have all the right questions we need to ask the oncologist. We’re really concerned about the impact on his heart so we’re hoping the oncologist will be able to advise…I’m sure there are many others in the same position.

It’s good to hear you and Chris found it a supporting environment…I can imagine it does feel very lonely once it’s completed. 

My husband has been assigned a couple of support nurses which the urologist said would make contact which was 2 weeks ago now and he’s not heard anything from them yet. Is that normal or are they just there if you want to pick up the phone and ask for advice?

I’m sorry for all the questions, this is all very new to us!! 

Thanks Andy, my husband is on various medications for his heart, including statins but I’m hoping all this will be monitored.  He has regular blood tests at the doctors so we will make sure his blood glucose is checked as part of that.

Is it normal to experience back, neck and shoulder pain? My husband has always had back pain, probably for the last 10 years but it’s got a lot worse and has recently started to radiate into his neck and shoulder. It could be stress related (he’s complained about it more over the last month) but I was wondering if anyone else has experienced this? He’s not had any bone scans but the MRI didn’t show any signs of it spreading to his pelvic bone so we’ve taken that as a positive. 

As he has been diagnosed as T3, I would hope that they will offer him a bone scan before he starts on HT properly. They don't usually do bone scans for a Gleason 6 but as you are realising, your husband's G6 is a little more extensive than would usually be the case so worth asking for a bone scan if it is not offered. 

The main problem with key-hole surgical removal and heart problems is that the patient is tipped head down / feet up for the duration of the operation and this puts huge pressure on the heart. It is also a long time to be under a general anaesthetic. He might be suitable for open surgery - the operation is a bit quicker than with keyhole (so less time under GA) and he wouldn't be tipped head down - but it is still significantly more risky than if he didn't have heart problems.

Hi everyone, I just thought I would post an update following my husbands oncology appointment last week. It was all relatively  positive and they have advised the HT/RT route is the best option as there would be too much stress on my husbands heart with the operation. Although they don’t believe the cancer has spread, they have offered a bone scan which will be in a few weeks time. The only other issue which showed up on the scan is with his colon. They have assured us it’s not cancer but they are sending him for a colonoscopy to check the inflammation as this may mean RT they might not be an option. They couldn’t say what an alternative would be but advised us not to worry about it at this stage.  

My husband has been prescribed 50mg of Bicalutamide for 28 days then monthly injections of HT for 4 months prior to starting the RT.  

He has only had 3 tablets so far but this morning has woken up feeling like he’s been hit by a bus!! All his joints and muscles are aching, particularly his knees which he said are incredibly painful, he does have arthritis in them but he said the pain feels different to normal.  

Are aching joints a common side effect? I was just wondering how long the effects last for? Is it just a few days whilst his body gets used to the tablets or will he feel like this indefinitely?

Edited by member 22 Nov 2022 at 18:49  | Reason: Not specified