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Brachytherapy v's RP

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User
Posted 29 Jan 2017 at 17:29
Hi everyone - I hope you don't mind me posting as just recently diagnosed with PC and not sure where best to get some advice on what may just be a simple question.
I am 57 years old, very fit and active and without any medical history. My Father had PC but lived until the ripe old age of 89.
I have a PSA level of 4.4 and a Gleason score of 3+4 and a very small prostrate. I has a biopsy which gave a result of 11 out of 20 cores effected.
I am considering RT or RP but each Consultant I have seen remains totally convinced that their own field of expertise will provide the best route forward.
I have a believe found one of the best surgeons for the RP treatment but it is unclear to me as to how to identify the best hospital or Doctor for the Brachytherapy route - with this procedure looking a little easier than the RP (?) is this of less a concern?
Are there any links to the Brachytherapy route that compare this option to the RP option?
I am in a fortunate position at work that I will be allowed time to recover from whatever route I decide to take but the choice here is proving very difficult.
Sorry to trouble you with this request but any advice would be much appreciated.
User
Posted 30 Jan 2017 at 10:17

Hi Skiingbuffy,


I had an almost identical diagnosis to you, PSA 4.5, Gleason 3+4, and a small prostate. I initially saw a surgeon who recommended RP, but for reasons i won't go into here I didn't pursue this with him. I went to see another surgeon who also favoured RP, but he insisted I saw an oncologist to get a balanced view of all the options. The oncologist, who worked alongside doctors who covered all treatments, also came down in favour of RP. A common reason seemed to be that if the other treatments were unsuccessful, it was then more difficult to go for removal.


I had my RP end August last year; my first PSA test was 0.0, and I have my second tomorrow.


Good luck.


David.

User
Posted 30 Jan 2017 at 10:39

Research says that all else being equal, surgery and external beam RT have exactly the same success rate in terms of remission at 5 years / 10 years after treatment. The data suggests that brachytherapy also has the same success rate at 5 years but there isn't yet a lot of evidence about brachy at the 10 year point. Indicators are that
- surgery causes ED and incontinence immediately but for most men it gets better over time
- external RT has less side effects immediately but ED and bladder problems may develop later
- brachy has even less side effects immediately, ED and bladder problems may develop over time but we don't yet know what longer term side effects there might be

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Feb 2017 at 15:12

Just wondering re being too young for Active Surveillance point above.

My husband is 53 Gleason 6 (3+3) PSA 3.56 and was given Active surveillance as an option.

I have read the protecT report on low risk PCa and it doesn't mention an age restriction for AS.

Has anyone more knowledge on this?

Thanks

Clare

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User
Posted 29 Jan 2017 at 19:22

Welcome to the site - sorry you find yourself here. You don't have to apologise for asking, that is what this site is about and you will find it a very supportive community.


I'm 62, fit and active with no other health issue other than the occasional skin cancer - thankfully not melanoma. Also 3+4 with 5 from 14 cores. I struggled to choose the best way forward for me, but I have now decided on RP. I looked at all the potential side effects and the other members have openly shared their experiences with both procedures - the good, the bad and the ugly. There have been a couple of really good threads on brachy with regular updates from the members' original treatment. There are also threads from members who have recently undergone surgery.


I suggest you read the different threads and feel free to ask more questions. I didn't have conflicting opinions from the consultants, but that may have been influenced by having first met the surgeon before the oncologist. In any case we all have to make the decision, it's not easy.


Good luck.


Chris


 

User
Posted 29 Jan 2017 at 19:59

Hello Skiingbuffy and welcome to the site

You mention Brachytherapy but there is more than one.
There is permanent seed brachytherapy (LDR low dose rate) (which my husband had - click on my picture to read his profile) and (HDR high dose rate)

LDR are seeds left in situ and they do their job whilst active and gradually lose their strength having, hopefully, worked their magic. It's a one off treatment with follow up appointments

HDR is temporary brachytherapy, and it involves inserting a source of high dose-rate radiation into the prostate gland for a few minutes at a time to destroy cancer cells. It is not available at every treatment centre in the UK.

If you go to Publications on this site you can download The Toolkit and it will give you information regarding treatment

All the best

Sandra

We can't control the winds - but we can adjust our sails
User
Posted 30 Jan 2017 at 03:59

Hi Skiiningbuffy,


High and welcome to the site i had a similar diagnosis to you and was seen by two surgeons one who offered a full removal and he seemed to think I would take that route as they have the Robotic machine in the Hospital (LISTER Stevenage)and I think i may of accepted that route if I had not had the experience of a friend that had gone down the Brachytherapy treatment route so asked if i had that option with my Gleason score of 3+4 =7 and was seen the same day by the  the Surgeon that in the end performed my operation at Mount Vernon.


I must say i found this site very useful with a great group of people that had many experiences to share with me.


If you click my avatar you will see my progress ie just coming up to to four months and my first PSA test and of course a little concerned of the out come and I still think did i take the best option from the consultants only time will tell but a 70 (I think do you feel lucky PUNK)!!


YES i do.I wish you luck with your decision but there is always a friend on here to listen to you and help.


Regards John.

User
Posted 30 Jan 2017 at 10:17

Hi Skiingbuffy,


I had an almost identical diagnosis to you, PSA 4.5, Gleason 3+4, and a small prostate. I initially saw a surgeon who recommended RP, but for reasons i won't go into here I didn't pursue this with him. I went to see another surgeon who also favoured RP, but he insisted I saw an oncologist to get a balanced view of all the options. The oncologist, who worked alongside doctors who covered all treatments, also came down in favour of RP. A common reason seemed to be that if the other treatments were unsuccessful, it was then more difficult to go for removal.


I had my RP end August last year; my first PSA test was 0.0, and I have my second tomorrow.


Good luck.


David.

User
Posted 30 Jan 2017 at 10:39

Research says that all else being equal, surgery and external beam RT have exactly the same success rate in terms of remission at 5 years / 10 years after treatment. The data suggests that brachytherapy also has the same success rate at 5 years but there isn't yet a lot of evidence about brachy at the 10 year point. Indicators are that
- surgery causes ED and incontinence immediately but for most men it gets better over time
- external RT has less side effects immediately but ED and bladder problems may develop later
- brachy has even less side effects immediately, ED and bladder problems may develop over time but we don't yet know what longer term side effects there might be

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 30 Jan 2017 at 11:50

Hi Guys,


All I can add is that looking for 'evidence' about which sort of treatment is best, is often a futile exercise, because amongst other things medical science is progressing so fast, with new treatments and tweaks to existing treatments, that guys like me who have survived 10 years since diagnosis had treatment which has now been superseded.


I was a Gleason 9, and back in 2007, the thinking was that RP was too risky for high grade Gleasons as no matter how careful the surgeon, or robot, is with his scalpel, miniscule bits of cancerous tissue will escape into the blood stream to fetch up elsewhere and start a secondary tumour.


So for me it was easy EBRT was the only option, and if that failed that was it, I was given odds of 60%.


When PCa 'came back' in 2013 things had moved on, whereas in 2007 I had been told that you can only ever have one blast of RT below the diaphragm, suddenly I was being offered salvage HDR brachytherapy, apparently because they cook your tumour from the inside you can now have more than one blast of RT without damaging surrounding tissues!


Not only that, the Consultant asked if I had considered RP, that is RP for what was G9, and RP for a prostate previously irradiated!


Even something as straightforward as 'old fashioned' EBRT isn't the same now as it was ten or twenty years ago, they keep changing the total dose and factions, presumably to make it even more effective.


So when looking at 10 year survival rates, bear in mind that these are based on 'primitive' treatments, and whichever option you choose should give you even better odds.


:)


Dave

User
Posted 30 Jan 2017 at 22:29

Hi
I was diagnosed late last year after being fobbed off for three years and I finally got the option of a biopsy.
Gleeson 3+4 small prostrate and not spread according to MRI .
PSA 3.7
I'm 55
Active surveillance not an option... too young
Brachytherapy no
Being Zapped with radiation with hormone treatment.... not really an opinion,too young and if it failed being operated on very difficult
So the only option sold to me was The Da Vinci operated by a highly recommended surgeon who did 70 last year alone in Leicester.
I also took a chance and had nerve sparing.
It's very early days as I had it Jan 4 but so far so good and I do appreciate I've got a long way to go but I've been continent so far after the catheter was removed after two weeks.
It can be sore,scary and your emotions go everywhere but with help especially this charity and family all being well you'll be fine
All the best

User
Posted 30 Jan 2017 at 22:57

An important consideration is the staging which I can't see having been given. If the cancer is thought to be well contained within the Prostate, surgery is likely to offer the best chance of cure over the long term because cancer sometimes regrows in radiated prostates. Also, in need RT can follow RP but only a very few surgeons will do the much more difficult RP after RT. Where surgery is an option this is more often done in younger men who would normally expect a greater number of years still. Surgery is also likely to be the preferred choice of men who want a diseased Prostate removed regardless. Against this, it does mean for some men immediate ED issues some of which will only be helped by artificial means. Similarly, various levels of incontinence ranging from the short to long term can be experienced.

RT, (there are several ways of administering), can gradually lead to ED issues and for a short period during and after the RT and after it urinary frequency and urgency. Many years later, perhaps 20 or so, RT has in a few cases initiated other cancers in the general pelvic area. Although Brachytherapy involves an operation, EBRT does not but it does involve a commitment to have 20 or as much as 37 fractions depending on the dose. Hormone Therapy is generally, though not always, given with RT starting before and sometimes continuing for anything up to 3 years after RT ends. HT does have side effects which should also be considered. The 'Tool Kit' will detail what these could be. Side effects are experienced to a greater extent in different men.

This can be such an important decision that it is worth carefully listening to what your consultant's say and reading up in more detail about treatments before opting for one.

Barry
User
Posted 31 Jan 2017 at 11:10

I cant add much to what has already been said.  Main considerations for me was the side effects, and incontinence was my biggest fear, so went down the RT route. IGRT at Worcester and although it was seven and a half weeks, everything went smoothly.  Too early to tell yet if it was successful.


Dont forget, whichever treatment you choose, you can choose the hospital too, not limited to your local.


All the very best and good luck.

User
Posted 01 Feb 2017 at 12:52

Thank you everyone for your very kind and useful replies. I think the final decision is made much easier by your responses.


Just a quick question on location of hospitals - I appreciate that the closer you are to the hospital of choice will make it easier but is this a major factor? At the moment if I go for the RP route I am considering London whilst I live in the Wirral at the moment.


Thanks

User
Posted 01 Feb 2017 at 15:11

There are many good hospitals and surgeons in various hospitals but not all are yet able to offer robotic surgery should this be the preferred choice. It is also possible that a surgeon working in a major hospital will have done more ops than in a smaller one, an important consideration because often and regular experience by the surgeon is important in getting the best chance of a good result. It is not necessary to go to London - try contacting nearer major hospitals for information on success rates but the largest pool of top surgeons in the UK is there. However, it has to be understood that some surgeons take on cases that are more borderline and it follows that these may not compare favorably with surgeons who only 'cherry pick' cases that are more likely to give better results. This can making choosing a surgeon on results only more difficult.

Barry
User
Posted 01 Feb 2017 at 18:24

Skiingbuffy you have a centre of excellence on your doorstep I think?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Feb 2017 at 10:29
Hello. I thought I would add that my OH was diagnosed aged 57. He wasn't offered surgery. Not sure why it wasn't really mentioned. He was given a choice if EBRT or brachytherapy. Also they suggested active surveillance. He left it about 6 months then chose brachytherapy. The choice was mainly made as it was the least hospital visits. He's a farmer and can't take time off. So he chose January as it is a quiet time as far as the arable land goes. Paid someone to do the cattle and spent one night in hospital. That was 2 years ago. He did suffer quite bad immediate side effects. Apparently this is very unusual. 2 years on psa is 0.7 (taken 6 months ago, due for another) he does get days where his prostate aches all day and his bladder habits have changed a lot since treatment. But we have 2 friends that had brachytherapy a few years before my OH that had minor side effects and were back to normal by about 6 months. Several years later they both have low psa still.
It is very hard knowing which treatment to take. All the best.
User
Posted 02 Feb 2017 at 15:12

Just wondering re being too young for Active Surveillance point above.

My husband is 53 Gleason 6 (3+3) PSA 3.56 and was given Active surveillance as an option.

I have read the protecT report on low risk PCa and it doesn't mention an age restriction for AS.

Has anyone more knowledge on this?

Thanks

Clare

User
Posted 02 Feb 2017 at 15:46
Hi
On what data / basis have you decided on London ? And what type of surgery.

Incidentally I only meet my surgeon about 1 hr before he operated.

See my profile. I was dry completely after catheter removed. So he must have done the training course. Lol.

All the best
Gordon
User
Posted 02 Feb 2017 at 16:08
I didn't realise you said too young for active surveillance. My OH was 57 and encouraged to do it. They said he would need treatment eventually, they said maybe 2 years, maybe 10 years. But he opted to have treatment. Must admit he now wishes he'd followed their advice. But his Gleason was 6. So slightly lower.
User
Posted 02 Feb 2017 at 17:22

Originally Posted by: Online Community Member


Just wondering re being too young for Active Surveillance point above.


My husband is 53 Gleason 6 (3+3) PSA 3.56 and was given Active surveillance as an option.


I have read the protecT report on low risk PCa and it doesn't mention an age restriction for AS.


Has anyone more knowledge on this?


Thanks


Clare



 


I don't understand the "Too young for Active Surveillance" either.  Surely the longer you can leave treatment (especially Radical treatment) the better for the person and his lifestyle.


Active surveillance means you are carefully monitored and as soon as changes are see then the advice changes.  If you can live with the knowledge that you have a cancer inside you, the surely AS gives you time to research all your options, especially if you are told that it is a suitable option for you.


I do know that some low PSA results can still mean aggressive cancer but that is the exception rather than the rule (Isn't it?)

We can't control the winds - but we can adjust our sails
User
Posted 02 Feb 2017 at 18:58

There is no such thing as too young for AS - I assume that Tony was just setting out for us his own assessment of his options and how he made his decision.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Feb 2017 at 21:58
Originally Posted by: Online Community Member
I didn't realise you said too young for active surveillance. My OH was 57 and encouraged to do it. They said he would need treatment eventually, they said maybe 2 years, maybe 10 years. But he opted to have treatment. Must admit he now wishes he'd followed their advice. But his Gleason was 6. So slightly lower.


Apologies. I'm unclear. Do you mean he would have preferred to not have treatment?
Have you asked why surgery was not offered ?
I appreciate 6 weeks to fully recover. Heavy lifting etc. I had catheter for 7 days after that quite active and mobile.
I wasn't offered brachy and knew nothing about it. ..

Gordon
 
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