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User
Posted 20 Mar 2023 at 14:15

Good afternoon all. Finally had a meeting with Oncologist last week. Sent me home with a few things to think about. To summarise. Diagnosed last November. Gleason 3-4, T-2 and PSA at diagnosis 9. 1 core from 25 less than 5%. Met with surgeon in December who explained his side of things. Put on A/S with the provisio of seeing Oncologist. Had two further PSA readings of 11.1 then 6.1. As I said, met Oncologist last week who's offered 20 sessions of Radiotherapy and either 3 or 4 months of HT ( can't remember) He also said Brachytherapy may be an option subject to certain tests. He also said that my prostate was 54cc and that they usually do patients with 50cc max. Is this correct? And what other tests would they have to do to qualify me for this particular treatment if I chose to go through with it? Many thanks. 

User
Posted 20 Mar 2023 at 19:33

Mount Vernon do LDR brachy on prostates up to 55cc, but larger prostates can be shrunk with 3-6 months hormone therapy first (Bicalutamide).

HDR brchytherapy can be done on larger prostates, but fewer places are able to do that.

User
Posted 20 Mar 2023 at 20:46

Fifefella, you are in the situation many of us here have faced of making a decision among various options. It is hard because there aren't clear differences in outcome and side effects tend to be quite variable between different patients getting the same treatment.

I was also told that brachytherapy was likely to be difficult due to prostate volume - but even to be assessed I would have to be referred to another hospital fifty miles away which could delay any alternative treatment. I went for surgery, but having subsequently had biochemical recurrence resulting in salvage radiotherapy I have no way of telling whether radiotherapy might have turned out better.

Good luck!

Edited by member 20 Mar 2023 at 20:47  | Reason: Not specified

User
Posted 21 Mar 2023 at 11:00
Hi Fifefella I had brachytherapy at the Beatson ( Glasgow ) at the end of last year. I was under the impression that the prostate should be 50cc or less and you need a PSA of less than 10.0. I have read on the internet ( so it must be true 🤔) that some doctors will accept 60cc or less and a PSA of less than 20, however I don’t think this was in the U.K.

Another test you have to get a “good” score in is the IPSS test. This is the questionnaire which you may have already filled in relating to strength of flow, continuity of flow and how many times you go during the night.

I initially was going to have three months of HT before my procedure however as my prostate was only 30cc the HT was not required.

Apparently the problem with a large prostrate and brachytherapy is that the pelvic bone can block some areas of the prostate where the radioactive seed need to be placed.

Rgds

Dave

User
Posted 21 Mar 2023 at 16:05

Hi and welcome,

I had PSA 2.19 Gleason 3+4=7 in April 2016 at the age of 70 with 5 cores out of 20 positive but was not told how big my prostate was at the time and was offered Robotic surgery by first surgeon and it would be done at my local Hospital the Lister in Stevenage Hertfordshire. But i asked to speak to a Brachytherapy Specialist and he said i was ok for Brachytherapy but would have to go to Mount Vernon.The actual operation was very quick I went in on a Sunday had operation on the Monday at 2pm and was back in the ward by about 4.30 and was given a couple of pain killers but was in very little pain at all.As soon as i could pass water i was ok to go home at 3pm the next day after a long wait for prescription that took longer than the operation,

I had the brachytherapy  in September 2016 at Mount Vernon with six monthly PSA tests that reduced slowly over the next 6 years and i was signed off in January 2022.Psa is 0.04 with yearly tests in September.

I can't say what procedure is best for you as it a bit of a lottery for all of us.ED will be a problem in all procedures as will be the side affects, and I believe i have been very lucky so far.I get 4 viagra a month and nocturnal erections returned after 5 years. Good luck with your choice.

John.

 

User
Posted 22 Mar 2023 at 05:22

So there can be guide figures for different treatments but Consultants can be flexible using their experience and what an individual presents. A classic case of this is HT where there can be appreciable differences in the length of time a man is asked to be on it. 

Many find that having made a treatment decision considerably reduces the weight on a your shoulders and then again post treatment.

Edited by member 22 Mar 2023 at 05:27  | Reason: Not specified

Barry
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User
Posted 20 Mar 2023 at 19:33

Mount Vernon do LDR brachy on prostates up to 55cc, but larger prostates can be shrunk with 3-6 months hormone therapy first (Bicalutamide).

HDR brchytherapy can be done on larger prostates, but fewer places are able to do that.

User
Posted 20 Mar 2023 at 20:46

Fifefella, you are in the situation many of us here have faced of making a decision among various options. It is hard because there aren't clear differences in outcome and side effects tend to be quite variable between different patients getting the same treatment.

I was also told that brachytherapy was likely to be difficult due to prostate volume - but even to be assessed I would have to be referred to another hospital fifty miles away which could delay any alternative treatment. I went for surgery, but having subsequently had biochemical recurrence resulting in salvage radiotherapy I have no way of telling whether radiotherapy might have turned out better.

Good luck!

Edited by member 20 Mar 2023 at 20:47  | Reason: Not specified

User
Posted 21 Mar 2023 at 11:00
Hi Fifefella I had brachytherapy at the Beatson ( Glasgow ) at the end of last year. I was under the impression that the prostate should be 50cc or less and you need a PSA of less than 10.0. I have read on the internet ( so it must be true 🤔) that some doctors will accept 60cc or less and a PSA of less than 20, however I don’t think this was in the U.K.

Another test you have to get a “good” score in is the IPSS test. This is the questionnaire which you may have already filled in relating to strength of flow, continuity of flow and how many times you go during the night.

I initially was going to have three months of HT before my procedure however as my prostate was only 30cc the HT was not required.

Apparently the problem with a large prostrate and brachytherapy is that the pelvic bone can block some areas of the prostate where the radioactive seed need to be placed.

Rgds

Dave

User
Posted 21 Mar 2023 at 16:05

Hi and welcome,

I had PSA 2.19 Gleason 3+4=7 in April 2016 at the age of 70 with 5 cores out of 20 positive but was not told how big my prostate was at the time and was offered Robotic surgery by first surgeon and it would be done at my local Hospital the Lister in Stevenage Hertfordshire. But i asked to speak to a Brachytherapy Specialist and he said i was ok for Brachytherapy but would have to go to Mount Vernon.The actual operation was very quick I went in on a Sunday had operation on the Monday at 2pm and was back in the ward by about 4.30 and was given a couple of pain killers but was in very little pain at all.As soon as i could pass water i was ok to go home at 3pm the next day after a long wait for prescription that took longer than the operation,

I had the brachytherapy  in September 2016 at Mount Vernon with six monthly PSA tests that reduced slowly over the next 6 years and i was signed off in January 2022.Psa is 0.04 with yearly tests in September.

I can't say what procedure is best for you as it a bit of a lottery for all of us.ED will be a problem in all procedures as will be the side affects, and I believe i have been very lucky so far.I get 4 viagra a month and nocturnal erections returned after 5 years. Good luck with your choice.

John.

 

User
Posted 22 Mar 2023 at 05:22

So there can be guide figures for different treatments but Consultants can be flexible using their experience and what an individual presents. A classic case of this is HT where there can be appreciable differences in the length of time a man is asked to be on it. 

Many find that having made a treatment decision considerably reduces the weight on a your shoulders and then again post treatment.

Edited by member 22 Mar 2023 at 05:27  | Reason: Not specified

Barry
 
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