Ok, so I'm now on the HT/RT pathway ...

Proton beam therapy was not available here at the time (remember the case of the little boy kidnapped out of  a Southampton hospital by his parents and taken abroad so that he could have proton beam therapy around the same time?   I am not sure that there are many places - if any offering it for prostate cancer here even now as it is mainly used for other cancers.  At the time it was not available privately here either.  I think it was being trialed here for some cancers mainly head and facial, and eventually the little boy who had been kidnapped out of the Southampton Hospital by his parents did receive proton beam therapy here I seem to remember.  I also looked in to Cyber Knife with Dr Nicholas Van Ass at the Royal Marsden  (you will have seen him interviewed on TV about the 1 week of RT) - again Cyber Knife uses just 1 week of treatment but he said it would be no better for me than the normal RT and he had actually trained the consultant I was with.  So rather than pay for cyber Knife I went back with NHS.  The Fiducial markers cost at least £1000 plus the cost of staff needed and scans for insertion - and that's 2015 prices - most scans are around £800 to £1500 each if paid for privately - probably more now.  Again as I said I believed spaceoar was still available on the NHS - though maybe not at every cancer centre so if you can find it being used you may have to ask to go to be treated at a different cancer centre.  I have no idea about the cost of spaceoar or whether or not it is actually still used as all I could find on NICE at the time the person posting was told it was not available was that it had been passed for use but nothing about it being withdrawn for any reason.  

I would not see the need to use both spaceoar and fiducial markers and am sure the NHS would not contenance using both together due to the high cost.  Gold has gone up a lot recently!

Sorry if there are mistakes in my posts.  Even though I click on more and edit and then edit my post not all the edits go through so I am leaving them sort of half edited!

I looked into the Space Oar situation in the UK at the end of 2022/beginning 2023. As it was then, ( I think it was Feb 2023) NICE had decided not to approve it for NHS use as there was insufficient evidence for using it for men with bowel disorders such as Crohns Disease etc. My concern with this is that I could not find anything about trials for these men with space oar. That does not mean, of course, that they were or are not happening! I did turn up one paper which, if I interpreted the data correctly ( I am no statistician!) suggests that space oar does protect the bowel but there is an increased risk of urinary problems. I also enquired about the cost of having it done privately - then it was about £5000 locally. The only places where NHS space oar was available at that time were in those hospitals still trialling it. I think Derby was one of them. This info is , I’m afraid, now somewhat dated and somewhat vague as my husband decided not to have the Space Oar. He went through the RT in Feb/ March 2023 and the only side effects were some bloating and tiredness. He has since recovered and doing very well with no problems ( fingers crossed)

I did want my husband to have the space oar but it was his decision to make about his own body! I supported him in that decision because in the midst of this he suddenly announced one day that  he was fed up of all ‘the messing about’ and was not going to have any treatment at all!

we also asked about fiduciary markers. We were told that these were fine if they stayed in the right place! We didnt go any further!

hope this helps

Glad to find out what happened with space oar.   I have to say at my last scan after RT which I had to ask for, my fiducial markers had not moved at all - even though my prostate was smaller and had changed texture since the recent RT  I now imagine that 6months + after RT ( I am now nearly 8 years post RT) it is pretty much non existent.   A friend of mine did ask if I would leave one to her in my will.  Unfortunately she pre -deceased me.  I am being cremated anyway so leave it to whoever survives me to go through the ashes to find any gold that is left!  I did ask about the fact that as the prostate changed during the process of RT what would happen to the markers but was told for the short time they use them - they were inserted about 10 days prior to starting RT they were very unlikely to move at all but would stay with the prostate where the RT was needed as shown in the initial mapping scan prior to the start of RT.  Again this is why they generally like to give you your RT session at about the same time every day and one of the reasons why you have an empty bowel and full bladder  (or not what ever that particular team and/or hospital chooses as its system) at the time of the RT sessions so that everything is in pretty much the same place and the radiologists and the machines pretty much sees the same picture every time.

You will find that many consultants. cancer teams. hospitals or health boards have different ways of doing some things so the experience of some parts of our journeys will be different as can be seen from whether or not you have a full bladder or not.  After 10 out f 20 RT sessions my hospital no longer used the mini enema's but still insisted on the full bladder.  They only had one problem with me on my very last RT session when I had trapped wind and had to go and wait in the waiting room when another gent had his RT and practice downward dog until things were put right - luckily no one in the waiting room then! :)

Well gents, let me stick my oar in here.

My RT treatment was with Christies - they are a cancer hospital and nothing else. The main hospital is in South Manchester but we have an "outstation" in Oldham with full CT facilities, beds for in patients and 2 RT machines and my treatment was at Oldham.

As I was reading about everyone else prior to my RT they were "full bladder - empty bowel" - at Oldham we appear to be the only place doing "empty bowel - empty bladder" so at the planning scan because like Able I like to know these things, I asked "why".

The radiographer said * once you have your 3 tattoo's (thanks NHS!) we line you up on the machine and with an empty bowel and an empty bladder - the bladder collapses and gives us a clearer view of the prostate. As you are aware when you lie on the "sunbed" the RT machine rotates once - this is a type of CT scan where we ensure you are in the correct position on the "sunbed" and after this rotation sometimes you will feel a little correcting movement to adjust your position. Once we are happy that you are lined up correctly we then have two further rotations where we zap the bugger with ionizing radiation - and bingo - we kill the cancer cells - along with a few healthy ones too!".

As a layman that sounded good to me and I am happy with her explanation.

Well for me after 20 fractions, I think it's worked. I had the fatigue - not too bad and a couple of days during RT my weeing and stools were shall we say - more frequent - but I put that down to the RT combined with a "micro-enema" everyday.

9 months later I feel amazing - my PSA is still on it's way down and life is good.

Thanks NHS and the fantastic staff at The Christie at Oldham - Brian.

Yes, empty bowel and bladder, makes sense, wonder why some have to drink water before a session of RT

Steve 

Just had my CT paperwork today for Cheltenham in January. Full bladder,empty bowel. Enema for first 10 sessions.

10Up  Great news and I hope it all goes well. You will come to have a "love hate" relationship with the micro-enemas!!

Just different ways of doing things and continuing to do it the way they are used to doing it I suppose - it makes sense that if the radiologists are used to doing it that way at one cancer centre then they will continue to do it that way.  I trust them to know what they are seeing and how they like to see it and that is the way they do their job as well as they do.  I believe I am testament to their brilliance at doing their jobs.  As my hospital also is just a cancer hospital too I wonder if they have changed their practices since my treatment.  I have a friend who will be going there shortly to have RT treatment for prostate cancer so am looking forward to hearing his experiences.  Thankfully even though he had to have an aortic aneurism sorted first he is still low gleason  7 (3+4) and similar to me with PSA and even better staging still at T2 rather than a question mark on T3.  the only thing is that although he knew his two consultants were talking to each other during the treatment he now has to find out if he can still have the RT as first discussed as his radiologist needs to ascertain how the aortic aneurism treatment may affect this - and they were apparently talking to each other during all that - you'd think they already knew!  Id hate to be in a situation where they hadn't been talking to each other.