Brachytherapy ?

Hi Banjoman

Thank you for your message.

I had a meeting with the second Oncologist last week, she said after discussing with the first Oncologist she has revised me to T2 - she said I would need hormone treatment 3 month before brachytherapy and 3 month after which I didn't expect.

She said she could give me a prescription that day, I said I would give it some thought first, I've had a difficult few years with a new business and don't like the reported side effects of hormone treatment - Also I've lost confidence in this doctor.

Later in the week I had a meeting with the first Oncologist who is pushing for a decision from me, he was surprised the other Oncologist thought I would need hormone treatment and said he would write to her.

I have arranged to have a second opinion but think perhaps I should go ahead with Da Vinci surgery.

Best wishes

Richard

I am always surprised to hear of men that HAVEN'T been given hormones with their brachytherapy!

I visited Cancer Research web site that says Hormone treatment may be used before brachytherapy if the prostate is large, I know my prostate is considered small so I guess this is why the first oncologist questioned it.

Richard

Hi Richard,

I wonder whether your problem might actually be too much information, too many choices and too much help from well meaning guys like me chipping in with our own thoughts? 

You say you feel '...fortunate that the Rotary Club offered a mass screening for PC...?'

Presumablly if that hadn't offerred mass screening you would be getting on with enjoying your life none the wiser?

Most men in there 60's have prostate cancer and most don't even know it.

Some of us do get symptoms, and are considered 'lucky' because we can get early treatment, that treatment may include the bonuses of impotence and incontinence!  However as we are often reminded other less lucky guys never get any symptoms, or at least not untill it is way too late for any currative treatment.  

Hormone Therapy is routinely given with radiotherapy for guys with higher Gleason grades, (look up neo-adjuvant and adjuvant hormone therapy).

If your doctors are telling you that it isn't really necessary, then you might wonder why not?  If you don't need adjuvant HT then it might be worth asking whether the brachytherapy is really necessary?

At Gleason 7, you might think it is worth giving the watchful waiting option a go, for after all that will guarantee you no side effects at all in the short term.

I know a guy like you, who was considered 'lucky' to have his cancer detected at a mass screening event.  He had treatment which was considered successful and 'saved his life'.  But as time has gone by, and he has learned more about PCa, he realises that he paid a high price in terms of his potency and continence, to save him from what was statistically a rather low risk of premature death.

So take your time and don't be rushed.

:)

Dave 

Decisions decisions - Unfortunately I didn't have much confidence with the second oncologist, that's made it harder - up until meeting her I had been very impressed with all the professionals I met.

I had a second opinion that was really worthwhile, he said Active Surveillance was an option, this hadn't been offered before, he was surprised with the possible T3a, but most worrying said that the hormone treatment would have reduced the size of my small prostate and it would have been difficult to get the necessary number of seeds in - to be fair he did say perhaps the oncologist had her reason.

Most people say get the prostate removed - I'm almost sure this is the option I will go with.

Many times I've thought perhaps the early diagnosis wasn't such a blessing!

Thank you for all the feedback its really helpful.

Richard

Banjoman, Watchful Waiting and Active Surveillance are slightly different as per the following from this sites Information

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"What's the difference between active surveillance and watchful waiting?"

Active surveillance is often confused with watchful waiting – this is another way of monitoring prostate cancer. The aim of both is to avoid having unnecessary treatment. But there are key differences between them.

Active surveillance

If you do need treatment, it will aim to cure the cancer.
It is suitable for some men with cancer that is contained in the prostate (localised cancer).
It usually involves more regular hospital tests, such as prostate biopsies and MRI scans.

Watchful waiting

If you do need treatment, it will aim to control the cancer rather than cure it.
It’s generally suitable for men with other health problems who may be less able to cope with treatments such as surgery or radiotherapy, or whose cancer may never cause problems during their lifetime.
It usually involves fewer tests, and these usually take place at the GP surgery rather than at the hospital.

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Watchful waiting is usually for the man who has other health problems and for whom treatment would cause an increase in those  problems

That's as I understood it anyway

Regular needle biospy isn't likely to be more than once a year unless there is a drastic rise in PSA

Edited by member 02 Dec 2015 at 07:05  | Reason: Not specified

Hello All

Thought I would give an update.

 I had robotic radical prostatectomy on the 15 January, went well the surgeon managed to keep all the nerves one side and most the other side so ED and continence shouldn't be a problem !!!

 At this time continence is a problem - Hope the pelvic floor exercises help soon as I see no improvement to date, I will go to the continence clinic in the hope they can offer help.

 I'm an optimist and thought IF I had a continence problem it would only last a couple of weeks - the level 2 protectors I had bought were useless, I'm getting through 5 level 4 protective underwear most days from Boots which makes life difficult.