Treatment Decision

Hi badger1234 ,

The Macmillan page on Brachytherapy is here:

https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/brachytherapy-for-prostate-cancer

Once you have seen the side effects, you can ask people here to tell you what they actually feel like.

I am on hormone therapy right now, and while I do suffer from hot flushes (quite a few each day), some fatigue, a small amount of brain fog, and occasional mood swings, erectile dysfunction and loss of libido; none of these are causing problems that have stopped me being content with life.

The drug I am on for hormone therapy is this one - https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/goserelin-for-prostate-cancer.

Hopefully that is some help for the moment.

Other friends will be along soon.

Best wishes, 

Steve 

Hello badger1234 

Yours is the $64,000 question. I was unable to have surgery (I would not have had it anyway if offered) so it was HT/RT for me - I had am aggressive cancer and other issues but you can read my journey by clicking on my avatar or name.

My good friend Alpine Wanderer has gone through Brachytherapy and has details his journey. I am sure he will be along to answer any questions but you can read his journey here:

 Surgery or Radiotherapy? Decision made! 

HIFU is not available in most parts of the Country and is High Intensity Focused Ultrasound - here's a link where a couple of Community members have had this treatment:

 HIFU treatment? 

I hope the above helps -feel free to ask any questions - nothing is silly or too trivial.

Best wishes - Brian.

Thanks Millibob - yes , badger1234 , once you have looked at the thread given to you by Millibob, or perhaps just read the concise version in my bio, please feel free to ask questions.   AW

I am just interested why you chose the Brachytherapy rather than the RT & Ht combined? Having an enema every day for RT sounds a real pain, how did you manage to avoid this please? 

Hi Badger1234

Like you I was a Gleason 7 (4 + 3) & knew I didn't want an op so it was a case of HT & RT.  It was originally planned that I would have SABR (5 sessions of RT every other day at a higher dosage) but the planning scan revealed that there was a risk with this so I ended up with 20 sessions over 4 weeks with the intention of a cure.  I did enquire about Brachytherapy but the nearest hospital where this was offered was over 50 miles away).  

Having to use a daily enema isn't anywhere near as bad as most people think - it's actually a micro enema & is very easy to self administer & I found the effects are a once only thing which help ensure that your bowels are empty before each RT session (full bladder).

Everyone has their own personal preferences as to which treatment option to choose, so my advice is to read up as much as you can on each one using reliable sources such as Macmillan, Prostate Cancer UK (not google) and make a list of what's important to you.  Any questions you may have then ask away on here as everyone is more than happy to share their own experiences. If it helps, you can read my journey by clicking on my name. 

Best Wishes

Brian

Hi

Thanks for the reply. How has the radiotherapy gone? Has it been successful?

Did you have hormone therapy or tablets or injections, and over what time period please?

Hi Badger. Making a decision on treatment as a layman is not at all easy. For what it is worth I will give you my story. I was first diagnosed in 2013 with what fortunately proved to be the less aggressive form.  I was Gleason 7 with a rising PSA never higher than 10 on a 6 monthly blood sample. I have had MRI scans every twelve months since and three template biopsies sessions- these latter look at approx. 50 core samples on each session.  The scans showed significant progression of the tumour and the biopsies showed a similar state of affairs . I  was reluctant to have the suggested radiotherapy as I was scared of permanently ending up with a suprapubic catheter as I was aware that it could cause further strictures in my urethra where I already had a major 30mm stricture present from a historic trauma. Hence I avoided active treatment and decided to take a chance that I could outlive the progression.

Then at the start of 2023 I was diagnosed with cancer of the oesophagus - completely unrelated to and not caused by the prostate cancer. Consequently I had no option but to undergo chemotherapy ( paclitaxel plus carboplatin) in conjunction with radiotherapy to the affected area of the oesophagus and finally a major operation. I am very lucky to be doing well after all this hospitalisation.

However the good news from all this chemotherapy is that my latest MRI scans for the last two years has shown my prostate tumour stopped in its tracks and my PSA down to 2.0- I now check it 3 monthly.  So as a layman I ask myself why I was not offered chemotherapy sessions without radiotherapy as an initial solution to my prostate problem.  Knowing what I know now I would have taken this route but it was never suggested. Nor have I seen on this site that anyone else has taken this route or been offered it - I may well of course be wrong and maybe my comments on this thread will provoke further information from others. As I said at the start of this I am a complete layman so I find the whole thing a bit of a mystery. 

I wish you all the best in your treatment and hope I have not muddied the waters too much.

Hello Anglars 

i agree choices are hard and as this is a peer to peer forum, none of us are medically qualified, however advice is given from personal experience.

Chemotherapy for Prostate Cancer is sometimes offered for locally advanced prostate cancer that may return but normally only for advanced prostate cancer and the reasons are two fold - cost and the side effects of chemotherapy can be "brutal" to say the least.

Most people with a diagnosis similar to that of badger1234 will be offered the treatments already being discussed as he will be on a "Curative Pathway" with any of these and Chemotherapy is not considered suitable.

I do hope this helps.

Best wishes - Brian.

Hi badger1234 - to answer your questions:  I chose the combination of brachytherapy plus RT and HT because of evidence that reoccurrence rates were lower (see videos links in my bio).  I have some aggressive features (although caught early) such as cribriform, which is more likely to spread if given the chance.

I only had enema for the pre planning scan. I was relatively loose anyway (nervous) so didn’t need any for the RT, except the last one of 23, when the LINAC showed some minor blockage in my bowel.  I had no issues taking enema, an easy process. 
AW

Hello Anglars . As Brian has said chemotherapy is occasionally offered to men with local and locally advanced prostate cancer but only if there is a good risk of it spreading or if the histology indicates one of the rarer prostate cancers such as small cell which don't normally respond well to traditional treatment. Also other therapies have been shown to be more effective for men with local or locally advanced prostate cancer. For men with advanced prostate cancer with multiple mets then chemotherapy as a first treatment alongside ADT and a second generation antiandrogen is showing good results with improved time before progression but this data has only recently become available. Over the last 10 years the treatment for different stages and types of prostate cancer have been refined and added to as hormone therapies have become available and the more precise radiotherapy as well as focal therapies and surgical techniques have been improved upon. The next 10 years should bring more knowledge and treatments into the armoury with targeted therapies which might be less broad acting than the chemotherapy and thus with less side effects.

You have not muddied the waters but have made a valid comment based on your own experience and I am glad that your chemotherapy has had an additional benefit in stopping your tumour and reducing the PSA in the meantime.