Prostate Cancer treatment options

I think it could be useful if you could provide details of your diagnosis and more specifically what is being proposed over and above that provided by EBRT to the Prostate. Is it for example that the RT will include some of the lymph nodes which is done with some patients? Care is taken to minimise dose to other organs, particularly the Rectum by shaping beams. Are you being offered the rather new 5 fraction regime or the generally offered 20 fraction one or what precisely is this unproven procedure you have been offered? I don't think from the information you have provided so far that men who have had RT can readily identify with what is on offer. In any event, with all PCa treatments men suffer varying side effects. I would have thought that your Oncologist would be in the best position to provide general information on likely short term side effects in a case such as yours, if not the long term. You could ask to have an appointment with a different Oncologist as a second opinion to help you make your decision.

Thank you Barry and Jules for your comments. I am happy enough (as far as my knowledge goes) with my Consultant and the Western General in Edinburgh has a good reputation but you have put forward some ideas that I will take up.

I understand that they propose a 20 fraction external radiation beam therapy and my decision is whether this will be for the prostate alone (standard) or for the prostate and the immediate area surrounding the prostate (aggressive). Although the cancer tests showed the cancer had not spread beyond the prostate the Consultant was concerned that could be happening but not identifiable. It was put to me that at my age (75) the standard might be preferable as the recovery would be easier and if not clearing the cancer or preventing its return should take me into my early 80s or perhaps beyond. The alternative might provide an advance that timeline but that was not a definite / proven and the side effects were likely to be worse and detrimental to my ongoing health recovery.

Surgery was not an option given the aggressive nature of the cancer but I did not follow that up and will do so at my next consultation. brachytherapy was not mentioned and I will ask about that as well. Things to think about. Many thanks.  Stuart

It's very difficult to comment without the exact diagnosis (Gleason, staging, presenting PSA).

The fact that your PSA hasn't come down to a lower level on hormone therapy for a year is a bit of a concern. I would ask about adding 2 year's Abiraterone to your hormone therapy, which I believe is available in this case in Scotland. It does add more side effects to the hormone therapy though.

Why have you been on hormone therapy for a year and not started curative treatment yet? You don't want to go castrate resistant before finishing curative treatment.

I had a treatment with the option of treating pelvic lymph nodes too, even though no disease was in them. I took that option. It was done at a lower dose than would have been used if there was known disease in them, 46Gy over 23 sessions. I do have some minor painless rectal bleeding which has no impact on my quality of life, but I suspect the HDR brachytherapy was much more likely to have caused that. No side effects other than that, and continence and sexual function are just as good as they were before treatment (which will include an element of luck).

Locating cancer is done by scans of varying types and biopsies. The psa blood test tells us nothing about location. Some of the lower level scans, right up to MRI, will not give a very detailed image and can miss picking out problems. Once you've been on HT for a while, tumours will shrink and be even harder to pick up. So your consultant may not have the tools to pick up any spread to the seminal vesicle, or elsewhere, at this stage and it comes down to an educated guess.

Have you had a biopsy at some stage and do you know the results of that?

Going through RT is not easy and can cause some fatigue, but it's painless and over in a relatively short period of time. I was given the full works at age 75, 81Gy in 45 fractions to the prostate and PET scan detected cancerous lymph nodes, along with 60Gy in 45 fractions to lymph nodes that were deemed possibles. Recovery from the RT took a couple of months but hormone therapy was both tougher to live with [varies from one person to the next] and amounted to 3+ years of reduced quality of life that were pretty hard to take.

Key question for your consultant now could be, if they go for prostate alone, what action would they propose if you happen to get recurrence in the seminal vesicles or elsewhere if they're not treated with RT now? If you get past the point where EBRT is possible, there are other possibilities but sometimes the proposed path will be to stay on HT for the rest of your life and as Andy says, the fact that your psa is 1.8 while you're on HT is not a great sign for the effectiveness of that drug in your case.

It also sounds like a chat to Derek might be fruitful if you've got the same specialist!

Jules

Edited by member 21 Apr 2025 at 01:26  | Reason: Not specified

Thanks Derek. Perfect description of "our" Consultant 😄, but agree he seems to know what he is doing. I am quite confused by my options after reading about everyone's treatment but hopefully some ideas forming and a few questions to ask at my next consultations. My age (75) seems to be a concern for some of the more aggressive treatment options. Regards  Stuart

I hope I wasn't alarmist Clyde. I  blame your taciturn Scottish consultant [I have Scottish ancestry so no cultural slur intended] for not exactly giving you a full and frank description of what's going on, but given what you've figured out and his experience, he's probably on the ball. The choice of treatment comes down to his confidence that there's no spread. If you're otherwise in good health you shouldn't need to consider the difference between the two RT options in terms of how hard they are to deal with.

There's a parallel between the treatment given to Derek, where the consultant pulled back on the broader cover radiation to localized and a similar localized treatment for you, though the reasons seem to be different.

I hope the decision isn't too stressful for you and maybe your extra questions will bring out the best in your consultant.

Jules