Treatment choice at 48 and starting my LDR Brachytherapy Journey

Hello!

I'll start by saying thank you to everyone on these forums for their contributions which I’ve referred to since 2015 - it's been an incredibly useful source of information during difficult times! 👍

Now it's my turn to hopefully give something back to anyone else who might be starting their own journey or deliberating about choices.

With a history of PCa in the family, I was advised to start PSA testing from the age of 40. I did and my first PSA test in 2015 came back at 4.1 (and 3.7 on a retest).

I had an MRI scan locally but didn’t really feel comfortable with the Urologist in my local hospital, so I sought a second opinion and landed on a Urologist (and team) who I’ve trusted implicitly ever since.

My first TP biopsy under GA was in Feb 2016 - all 34 cores came back negative. Since then, I've been having 6 monthly PSA tests and annual multiparametric MRI's.

Over the last 7 years, the MRI’s showed no changes and no visible lesions but although my PSA went up and down a bit, overall it did show an upward trend.

My consultant told me that despite the reassuring looking MRI’s, based on my prostate size of 40cc, when the PSA level breached 6, the PSA density would be high enough to really warrant/trigger another biopsy (I think I’d been resisting a 2nd biopsy for some time at this point!)

By the end of Feb 2023, with a PSA of 6.55, I had my 2nd TP biopsy, this time under local anaesthetic.

Of the 24 cores taken, 2 came back positive – one in the right anterior sector (5mm) and 1 in the right posterior sector (4mm). Both were graded Gleason 3+4 (10% pattern 4)

In addition to there being no visible lesions on the MRI, there was also no evidence of perineural invasion nor any presence of cancer cells in the fat tissue surrounding the prostate surface

I was offered Active Surveillance, Robotic Surgery or LDR Brachytherapy.

Unusually, my consultant is one of those rarer breeds that has done high volumes of both prostatectomy and brachytherapy procedures. As such, I felt he was much less biased than others might have been when discussing the options.

We agreed almost immediately to rule out taking the AS route. Given my age (48 now) he and I felt this would only be delaying inevitable treatment and the chances of curative treatment were going to be best if done as early as possible. When I asked him what he would do, he said that if he were my age, his choice would probably be to go down the robotic surgery route because he felt there would be more certainty in the long term. He was careful to explain though that given the early diagnosis and grading, I should be a good candidate for either option.

Because my Dad had Brachytherapy 17 years ago (he's still PCa free by the way 💪) and because I’d had 7 years of monitoring myself, I was already fairly up to speed with the pros and cons of both options but nevertheless, I spent the next couple of months drilling down into every detail I could find.

I seemed to be researching endlessly and discussing tiny details I’d read about in research papers with my poor wife who has probably suffered more than that I have! Because my consultant isn’t local to me, I also met with a couple of other surgeons and oncologists to discuss the options available locally. It was interesting to hear about different BT techniques and surgical outcomes from different centres. I also talked to other friends/friends of friends who have had treatment for PCa and their experiences. As with my wife, I must have bored many of my friends to death with my deliberations as I bounced back and forth between treatment choices on a weekly/daily/hourly basis 🤣

Finally though, I decided that with nothing to choose between the outcomes, I was going to go down the Brachytherapy route. Truth be told, the thing that really made the decision difficult was the statement that ‘salvage therapy after BT is much harder/has worse outcomes than salvage after surgery’.

That sweeping statement may be true and I hope I don’t have to find out first hand but as much as I heard about the limitations and effects of salvage options after BT, I also heard about how unappealing the effects of salvage can be after surgery.

So, I’ve decided not to think about failure, recurrence or salvage and focus on the here and now. Brachy seems to offer the same chance of a positive outcome with less trauma and fewer side effects. Hopefully, that all turns out to be the case!

5 days ago, I had 76 seeds implanted in a single stage procedure. Thus far, I’ve had an uneventful few days. I was discharged the same afternoon, and other than intermittently passing blood in my urine and feeling a bit tender round the perineum, everything up to now has been fine. There’s already a little bit of a feeling of urgency but that could just be part of the initial recovery.

I’m aware that the side effects will ramp up over the coming weeks as the radiation starts to do it’s job but hopefully the Alfuzosin which I started a couple of days before the procedure will help.

Although I’m being careful not to overdo things, I’ve been getting on with life as normal without any problem.

My first follow up is scheduled for two weeks time, CT and MRI scans at 4 weeks post procedure and a further follow up at 6 weeks to review the scans.

So that’s my story so far, I plan to check-in here regularly and will update as I know more!

Cheers! 🥂

P.S. If you’ve made it through this entire wall of text, you deserve a medal! 🏅

Hi Tom,

I seriously wouldn't worry. I was just the same, very anxious but unnecessarily so.

My oncologist suggested the the immediate side effects of the procedure would be less than that of the biopsy because it was less invasive (they weren't 'cutting' anything out, but just putting the seeds 'in').

Actually though, I found the immediate recovery a tiny bit worse but I'm seriously talking small margins - I experienced no pain at all, just a little discomfort around the perineum for about a week but in reality, I was probably overly sensitised to it because I knew what they'd just done (and my wife says I'm not very brave 😂!)

I was also a little disconcerted by the immediate feeling of urgency and reduced flow which I didn't expect initially but that's now almost completely disappeared. I'm aware those side effects could increase again though in the next few weeks as the radiation builds up but I hope it will be OK - so far so good!

As far as wine is concerned - no adverse reaction last night and none tonight! I'm absolutely sure it would have been fine earlier too but my better half can be something of a taskmaster when she wants (so I relied on a stiff single malt instead!!!🤪🥃)

Also just back from another 9 holes of golf this afternoon and feel I could easily manage 18 even in this mini-heatwave we're experiencing and as I'm booked off work, I have 18 booked in with a friend on Monday! 🏌

Best of luck but seriously, you won't need it, don't worry, it's all very easy!

Cheers

Paul

Thought I would update here after my first 4 monthly post procedure PSA test and consultant follow up.

In the 4 months post procedure, PSA has dropped from 6.55 pre procedure to 2.12 .

Yesterday I was more than a bit disappointed with the fall. I had hoped/expected it to be more dramatic especially as I’d seen quite a few members on here who had dropped from higher initial readings than mine to readings of under 1.0 within the first three months.

However, I’ve been reassured today by my consultant that he sees the decrease of 68% as actually very good. He said it was as good as he hoped for and that the drop in younger men is not usually as rapid as it is in older patients.

He also warned me that it would go up and down over the next few years and not to panic! I was already aware there would almost certainly be a PSA bounce at some stage but he reiterated that the fluctuations are greater in younger men. It looks like I might be in for some nervy times ahead!

My consultant said his hope was that the PSA would ultimately drop to below 0.5 after 3 years. Again, I would have thought/expected/hoped it would be lower – under 0.2 in my mind but I’m not the one that has done more than 1,500 Brachy procedures and spent my life dedicated to all things prostate so I suppose I should go with his read and not mine!! 😆

So all in all, feeling pretty satisfied at this stage with my initial concerns reassured. Time to forget about it for another 4 months now!

From the physical side of things, everything continues to be pretty close to perfect. Initial minor urinary urgency and frequency has now become unnoticeable although I am still taking Alfusozin daily (but advised today to ‘trial’ taking it every other day from 6months).

I now take half a 10mg tadalafil tablet 3 times a week as well which I’m not sure is absolutely necessary but it has made me feel like a teenager again so I’ll stick with it for the time being! 💪😂😂 The dry orgasms are becoming less dry by the week which has helped to make the feeling of orgasm much more ‘normal’ again.

I literally have to pinch myself sometimes at how smooth this whole process has been up to now. In and out of hospital within hours on the day of the procedure. Only very minor urinary side effects for a few weeks post procedure and back to normal life without compromise within days.

Let’s just hope all that stays the same for another 30+ years! 🤞

Edited by member 14 Sep 2023 at 17:26  | Reason: Grammatical corrections!