Now Have My Biopsy Results

Many thanks Alwayshope for finding that reference.  I had been searching unsuccessfully for hours trying to find just such information.  It puts a different complexion on Brachytherapy for my particular situation.  Reading that, I am now inclined to re-focus on IMRT.   HOLEP may introduce too much complexity and potential recurrence risk.

It is so useful to get others' input in these situations.  Multiple brains are better than one.

Your second point is also very pertinent regarding the reduction in the 'size of the target area' in order to reduce collateral damage.  I was too focused on the 'size of my prostate' being only 36cc.  You have alerted me to that important distinction.

I am frankly quite scared about HT, its serious side effects, and how it can propel you into a lower and alternate negative health status.  It can be a bit of a Faustian bargain!

There is also the significant matter of my solitary kidney and CKD 3b.  There is a plethora of research papers on HT and associated AKI and that is in those with 2 kidneys and normal function.  I cannot but think it would be more detrimental in my situation.  Once again it is difficult to find specific research papers relevant to my situation.

I fed my stats into the Cambridge Predict Nomogram.  The gain between Conservative and Radical treatment is statistically small.  Perhaps the halfway house of RT and no HT could be an appropriate strategy given my circumstances and age.    My decision is not yet made, I am still gathering information.  I will also explore a possible shorter duration of HT with frequent kidney function testing (as suggested by Millibob) if that would be made available to me.

I also have some concerns with RT.  Over the past 6.5 years, I have had approximately 12 abdominal CT scans resulting in high radiation exposure in the area of my prostate.  I will have to discuss the RT risk with the oncologist, taking that exposure into account.

It is very difficult trying to find the best fit for your specific characteristics and limiting /avoiding treatment harms.

Thanks again.

Dedalus

Thanks for your comments Steve.  They are very pertinent.

AS is very appealing and tempting, but I have read so many anecdotes of issues further down the road.

You are so right over your concern with the 14mm MRI-identified tumour, this bothers me too.  IIRC I read that AS should not be considered for tumours over 5mm!

You also make an important point about the proximity of the tumour to the capsule.  Having a 36cc prostate with a 14mm tumour I did ask that question post MRI.  The nurse specialist who gave me my results said it was not mentioned so it must not have been an issue.  I'm not so sure!

The consultant said with AS you 'may' have 5 years to go and enjoy life, but I am not sure my stats are quite right in order to die 'with it rather than of it'.  I want to die healthy LOL.

The consultant spoke virtually en-passant about AS.  I am not sure he was convinced himself!

BW

Dedalus 

Well I would try and find out more about proximity, I asked if I could see the MRI to look at the tumour relative to the gland but they wouldn't, but there is another story 

14mm , possibly not AS , but then I'm no expert.

Do much investigating

Good luck

Steve 

Hi Dedalus.

My husband has been having 3 monthly MRI's since July 2020 with only annual CT scans to check that there is no additional spread so there is reduced radiation exposure. His CKF means that he doesn't have the tracer with either type of scan and this does not affect the results.

I have found an article which comments on radiation from CT scans which would indicate that even having had 12 so far the cumulative effect is still relatively low in comparison to the total exposure you would be given with RT.

https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct#:~:text=The%20effective%20doses%20from%20diagnostic,of%201%20to%2010%20mSv.

We asked the nephrologist about chemotherapy and radiotherapy treatments when it was assumed that hubby had lost a kidney and his comments was that they should not be discounted because of the CKF, in fact people on dialysis can still have these treatments.