Brachytherapy Gleason 3+4. T2cNo

Good afternoon, Bluecloud1 ,

Welcome to our group. It is good to see you, despite the fact that none of us really want to be hear, we do swap information and, occasionally, jokes. Or even recipes.

If memory serves me correctly, our friend  Alpine Wanderer went through this process. You can look up his profile to get a really good idea.

You can see his profile on by clicking on his name.

Best wishes,

Steve

Hello Bluecloud1 

Another warm welcome to the Macmillan online Prostate Community from me although I am so sorry to find you here.

Further to the post above from my friend Steve (mstev2) I am sure now that we have tagged Alpine Wanderer to this post he will get back to you - he has completed brachytherapy - and I have an idea he may be away working this week.

Here's a link to his entire journey and thought process behind the brachytherapy:

https://community.macmillan.org.uk/cancer_types/prostate-cancer-forum/f/diagnosis-and-treatment/265758/surgery-or-radiotherapy-decision-made?pifragment-13906=1

Feel free to ask any questions, however trivial, you will get answers.

Best wishes - Brian.

Hello Bluecloud1 and welcome.

PCUK offer a guide to recommended treatment pathways dependent on TNM, Gleason, initial PSA. If you go down to section 2 there is a flowchart you can click onto which indicates that T2c puts you into a higher risk group which suggests that additional therapy should be added to the Brachytherapy to give you a reduced chance of recurrence further down the line.

https://prostatecanceruk.org/about-us/projects/best-practice-pathway

Just keep asking questions and we will try and help if we can.

Hi !!

I think most evidence I’ve seen regarding the use of Brachytherapy only for a T2C is:

- Gleason 3+4 with low grade of 4

- A lower volume of prostate (I’ve seen somewhere of example of max 50 - 60 CC)

- Both mpMRI and PSMA Pet Scan should be done to really secure that prostate cancer is confined (e.g. no EPE or spread)

- PSA of 10 or lower

I think most references for T2C show:

- EBRT (maybe with a boost)

- ADT short term

Best wishes - Ulf

Thank you, to be honest I just can’t figure out why it T2cNO when the left hand side is described as benign in the biopsy report, so this is what I need to question the team about

Thank you, I just can’t figure out why it’s been graded at T2cNO when the biopsy states benign left hand side. 

Hi Bluecloud1 - in your case, being a T2, brachytherapy as a mono therapy would, in my opinion, be a suitable choice. I see that your consultant has already suggested this.  Check out some of the links in my bio: however, note that I had boost (the addition of normal external radiotherapy to kill any escaping cancer in the pelvic area, plus hormone therapy (a systemic treatment to starve & kill and tiny cell structures that had escaped elsewhere and to weaken those cancers about to be killed by radiotherapy). You might want to ask your consultant about a short course of hormone therapy (6 months) alongside brachytherapy mono therapy to weaken your own cancer and starve any tiny bits that might - just might - be just outside the prostate.  The reason I say this is that T2c is one step away from T3a (I don’t mean to frighten you), but sometimes I have seen a T2c upgraded by pathology further down the line (in the case where a patient has had the gland removed. Just a question for your consultant who will probably say no not required.  Your consultant will base this answer on the MRI scan (location of the cancer) and histology from your biopsy (cancer attributes and if their are any aggressive traits).   AW

Fabulous, thanks. I am seeing the mdt team on Wednesday and I want to fully understand why they have graded me at T2c when the cancer is only on the right even though it’s shows parades 4 on the left.  I think they missed that one on the biopsy and perhaps have graded it just to be on the safe side…. When I have had this meeting I will meet my consultant again.. what I was wondering though is if he can do brachytherapy on both sides then the issue goes away.  I will of course take your information and use it to help me when I ask questions as I think the brachytherapy is the answer, but he did say I don’t need anything else so I will think how to word my question when I see my consultant who is separate to the mdt team.  I do wander though because it been nearly 2 months since my biopsy whether it’s moved out of the gland as it was 30% then.     Anyway, thank you…