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Robotic prostatectomy or Radiation Trearment?

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User
Posted 12 Nov 2014 at 15:19

Hi Roy - not really considered HIFU as understand it is still under trail. What hospitals currently are involved with this treatment? If cancer returns after HIFU can they then use radiation treatment or conduct surgery?

I'll look through this site at some time and see if I can find details of somebody who has had this treatment.

dl

Edited by member 12 Nov 2014 at 15:24  | Reason: Not specified

User
Posted 12 Nov 2014 at 15:23

Hi Luther - I have had it explained to me that once they look at the prostate after the op they could find that the cancer is of a higher grade than suggested by the original biopsy. It is reasons such as this that are pushing towards the surgery route. ATM they can't detect any cancer on the MRI scans, even the cancer detected by the biopsy.

dl

User
Posted 12 Nov 2014 at 17:11

When I had my biopsy, I was told my scan looked fine. if only.....

Stay Calm And Carry On.
User
Posted 12 Nov 2014 at 22:00

Originally Posted by: Online Community Member

You are correct BarrieM I currently live in Devon and my RALP surgery is booked in at the RD&E.

Only just worked out that on this site you can view each others profiles which is really useful (I'll say it again - what a great site').

What is the significance of your PSA rising slightly 2 years on from surgery?

Would love to hear about your experience ...., especially if it's a good one!

 

Not sure that having an op is a good experience,but never the less I had it,all in all it was as much as I had expected,a bit uncomfortable and bloated because of the gas afterwards but nothing untoward.

The care up to and after the op at the RDE I couldn't fault,well looked after and monitored.

Reading about others I've said before I'm lucky in so much as not requiring any drugs for erections they managed to do nerve sparing on both sides,continence is good no pads required after Dec 13.

But be prepared for disappointments on this score we are all different there have been some who have breezed through here with being dry almost immediately after having the catheter out,there are others who are struggling with continence issues 2 or 3 yrs down the line.

One thing you must be sure of and stick with is the choice of treatment,myself I chose RALP at the time because I would rather get to 70 sure of having made the right choice than get to 60 wishing I had taken  that option.

As regards the PSA rise they were unable to give a solid reason for its rise and another blood test saw it back to undetectable so who knows,they were happy for me to have a longer time until the next test which will be early in the new year.

All in all I'm fit and well and I no longer have cancer which is what it was all about.

Good luck and ask away on anything else.

 

 

User
Posted 12 Nov 2014 at 22:03

Originally Posted by: Online Community Member

Hi Luther - I have had it explained to me that once they look at the prostate after the op they could find that the cancer is of a higher grade than suggested by the original biopsy. It is reasons such as this that are pushing towards the surgery route. ATM they can't detect any cancer on the MRI scans, even the cancer detected by the biopsy.

dl

 

I had two template biops following two MRI scans neither scan showed any cancer,so for some a biop is the only detection.

User
Posted 18 Nov 2014 at 15:16

Have decided to look into Brachytherapy after discovering this useful site http://www.prostatespecialist.co.uk/home/ - not NHS but found it useful. Called the hospital I’m due to be treated at this morning and asked for someone to see me regarding the possibility of Brachytherapy. They told me I was ‘pencilled’ in for Robotic Surgery on 7th Jan but said I wanted to explore Brachytherapy further. Someone is going to phone me back I am told.

I note on this site that I may not be suitable for Brachytherapy as PSA >10 and Gleason 7 also IPSS is probably >15.

I’ll let you know what happens.

dl

 

Edited by member 18 Nov 2014 at 15:16  | Reason: Not specified

User
Posted 19 Nov 2014 at 02:17

Many of us found our primary treatment choice very difficult to make, in some cases agonisingly so, made even more difficult with increased options. But it does make sense to consider all possibilities, discuss your preferences with a consultant(s). There is no reason why you should cancel your appointment for surgery on 7th Jan at this stage, you might still decide ultimately that this is your preferred primary choice. Sometimes, a patient may be suitable for a treatment but it is not mentioned because the diagnosing hospital is not able to offer that treatment. In such circumstances, the patient should ask to be referred for an alternative informed opinion.

Barry
User
Posted 19 Nov 2014 at 12:47

My consultant, a surgeon, recommended surgery. He also recommended that I see an Oncologist before making up my mind. I saw the Oncologist who suggested I have surgery and quickly.....my decision was an easy one to make thank goodness.

User
Posted 19 Nov 2014 at 13:52

I too was fortunate to be offered a choice of treatments....... Radiotherapy with associated hormone therapy or surgery. 

Surgery was the recommended route suggested  by my consultant who then referred me to a hospital and surgeon who is very experienced in robotic procedures.

Brachytherapy was not an option for me as it was felt that the size and volume of the disease was too great in my case.

I was happy to accept the risks involved  with surgery ( eg potential side effects etc ) and am pleased I took this treatment option.

The histology report following surgery gave me a much clearer picture of the extent of my disease as opposed to the RT route.

Whatever decision you make I wish you well

Best Wishes 
Luther

User
Posted 21 Nov 2014 at 14:45

Well it seems my hope of exploring low dose brachytherapy further a are non-starter. Had a letter from my consultant which says:

"We wouldn't normally recommend low dose rate brachytherapy for the sort of prostate cancer that you have been diagnosed with. It tends to be used for patients with the slower growing type of tumour and lower PSA on the whole (my addition: I am Gleason 3+4 and PSA 11.8).

The Majority of men diagnosed with the sort of cancer that you have will end with robotically-assisted prostate removal as the treatment of choice".

A little surprise from what I have found on the net but he's the expert I suppose and I'm not going to argue with a man who will be wielding a knife over me in early in the New Year!

dl

“Whatever you are, be a good one.”  
―     Abraham Lincoln

User
Posted 21 Nov 2014 at 14:55

I'm sure you won't regret it. Have a great Christmas and New Year in the meantime..

User
Posted 21 Nov 2014 at 15:19

Thank you Martin - you too.

dl

User
Posted 21 Nov 2014 at 15:49

Originally Posted by: Online Community Member

Well it seems my hope of exploring low dose brachytherapy further a are non-starter. Had a letter from my consultant which says:

"We wouldn't normally recommend low dose rate brachytherapy for the sort of prostate cancer that you have been diagnosed with. It tends to be used for patients with the slower growing type of tumour and lower PSA on the whole (my addition: I am Gleason 3+4 and PSA 11.8).

The Majority of men diagnosed with the sort of cancer that you have will end with robotically-assisted prostate removal as the treatment of choice".

 

“Whatever you are, be a good one.”  
―     Abraham Lincoln

That was pretty much the response I had when I inquired about Brachy....

At the time I was clinically assessed as  T2b Gleason 6 (3+3) with PSA of 9.86

I'm pleased I chose surgery and my subsequent histology afterwards confirmed in my view that I made the right choice for me..

Best Wishes for your forthcoming treatment
Luther

User
Posted 21 Nov 2014 at 15:56

Good luck Devon Lad.  I'm sure you will have many questions on the op itself, before and after the event.  I and many others who have been down this route will be able to answer those questions.

User
Posted 21 Nov 2014 at 19:24

Thanks Guys - it's good to know you're there.

dl

“Don't be afraid of your fears. They're not there to scare you. They're there to let you know that something is worth it.”
― C. JoyBell C.

User
Posted 21 Nov 2014 at 22:31

Best of luck Brian,you'll be well cared for down at the R&D.

User
Posted 11 Dec 2014 at 21:07

After further research decided not to give up on the brachytherapy option as still can't see at this stage why I am not suitable for this treatment. At last managed to get an appointment with a clinical oncologist tomorrow morning.

Fingers crossed.

dl

 

User
Posted 12 Dec 2014 at 16:48
Looking good ....... oncologist agrees that I'm suitable for Brachytherapy and has referred me back to doc who can re-refer me. Fingers and toes crossed!

dl

User
Posted 12 Dec 2014 at 17:53

There are two kinds of Brachytherapy, high dose where highly radioactive probes are inserted for a relatively brief period during an operation and low dose where radioactive seeds are placed in preselected parts of the Prostate. Either method can if considered appropriate be augmented by External Beam radiation as part of the therapy. My question would be that because either treatment is designed to kill existing tumours, what are the chances of new tumours growing elsewhere in the Prostate in due course? Although it wasn't Brachytherapy, (which is just a different form of radiation), the combined External Beam plus Particle therapy I had eradicated the tumours found on diagnosis but a new tumour has since grown in another part of my Prostate. This can't be treated with more radiation because I have had as much of it as is deemed reasonably safe. Surgery, if I found a surgeon who was prepared to do it, would now be more difficult with increased risk of side effects. So I am hoping that I will be considered a suitable candidate for salvage HIFU. However, had I opted for surgery in the first place, backed up by radiation to cover beyond where the knife could cut, now I wouldn't have a prostate where a new tumour is growing. So as well as there being the possibility of radiation initiating cancer in the long term it may not prevent new tumours growing within the Prostate in the short to medium term as in my case.   Something to take into account.

Edited by member 12 Dec 2014 at 18:18  | Reason: Not specified

Barry
User
Posted 14 Dec 2014 at 17:40

Originally Posted by: Online Community Member

There are two kinds of Brachytherapy, high dose where highly radioactive probes are inserted for a relatively brief period during an operation and low dose where radioactive seeds are placed in preselected parts of the Prostate. Either method can if considered appropriate be augmented by External Beam radiation as part of the therapy. My question would be that because either treatment is designed to kill existing tumours, what are the chances of new tumours growing elsewhere in the Prostate in due course? Although it wasn't Brachytherapy, (which is just a different form of radiation), the combined External Beam plus Particle therapy I had eradicated the tumours found on diagnosis but a new tumour has since grown in another part of my Prostate. This can't be treated with more radiation because I have had as much of it as is deemed reasonably safe. Surgery, if I found a surgeon who was prepared to do it, would now be more difficult with increased risk of side effects. So I am hoping that I will be considered a suitable candidate for salvage HIFU. However, had I opted for surgery in the first place, backed up by radiation to cover beyond where the knife could cut, now I wouldn't have a prostate where a new tumour is growing. So as well as there being the possibility of radiation initiating cancer in the long term it may not prevent new tumours growing within the Prostate in the short to medium term as in my case.   Something to take into account.

Hi Barry

 

It is LD Brachytherapy that I have been 'battling' to explore. Not sure anyone knows the % chances of any particular individual having a recurrence of the cancer but whether you have radiation treatment (inc. Brachytherapy) or a radical prostatectomy there is a risk that the cancer can return, usually I told this is 10 - 15 years after treatment. I am aware that radiation isn't an option after already having radiation and that a radical prostatectomy after radiation is much trickier as it's difficult to 'prize' the prostrate away from it's surroundings once it has had radiation treatment. However, there are some hospitals that will do this. I have had it explained that usually 'younger' folk with PCa (and I haven't been called young so many times as I have recently for donkey's years!) have radical prostatectomy either because they just want the cancer removed as quickly as possible or because they have been advised to have this treatment, partly for reasons you have given above. Many centres won't perform brachytherapy on folk with my Gleason score of 7, only on 6. However I have now had it confirmed that I am eligible for brachytherapy and that it is as likely to be just as effective as radical prostatectomy would be despite the lack of 'longer term' information on 'young' guys like me (I'm 59). I know there is a risk with it returning at a later date - but this is the same with any treatment. I would like brachytherapy for several reasons, mainly that I have a large scar on my lower stomach due to an operation in my teens that may lead to them having to switch from robotic prostatectomy to open surgery at the time of the op and the fact that I am self employed and will need to get back to work ASAP after any treatment.

I would like to explore one of the new treatments that only targets the cancer rather than the whole prostate but after 'fighting' to get this far I think I would pushing my luck if I requested one of them! However in your situation I think that I would definitely press for something like salvage HIFU. I have learnt a lot of things about the NHS since I have been diagnosed with PCa and whilst I won't go as far to say that we 'are only a number' as someone said to me and I also believe that everyone that has advised me has had my best interests at heart I have also found that it is worth doing your research and pressing, where necessary, for other opinions from both surgical and clinical oncologists. I have also found this site both helpful and comforting as I expect you have.

Good luck Barry and please keep in touch.

dl

 
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