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Lorraine is a nurse specialist and sex therapist and here to answer your questions...
Good Morning everyone.
I am just looking for a little bit of advice please.
My Dad is 57 and has recently been diagnosed with prostrate cancer. His Gleason is 7 3 + 4. On side if his prostrate is clear and the otherwise 15%. PSA 5.6. His cancer is contained and all scans show everything else to be normal.
He has been given 4 options
He is thinking either Brachytherapy or removal.
On his last scan the report suggest his prostrate is 67cc but my understanding is this is too large? So if he has to go on a course of hormone treatment does this limit his future treatment options? Is the hormone forced to work and what are the side effects.
If anyone has any experience s I would be grateful for your help.
Hi Claire, (same name as my daughter!!!),
I am 55 now, I was diagnosed in Oct last year, I was 54 then.
I have looked at all the options the same as u have listed, you have not mentioned H.I.F.U. that is high intensive focused ultrasound!
It's a 'delicate' subject to talk to a daughter about, but there can be 'male' side effects which can be less than pleasant for a man who has removal or hormone treatment????
I have decided to have hifu, the problem with it is there is not a lot of data on it, it is fairly new. From what I understand it can be repeated and if it still hasn't worked the other options are still available. I have spoken to 2 men who have had it and they have had no side effects from it and their psa levels have reduced greatly!
I'm no expert and getting my head around it has been one of my biggest problems, I think the 'word' is scarier than what your dad and me have? I don't know if this has been any help, feel free to contact me and good luck with whatever is decided!
Sorry to hear about your Dad. Firstly welcome to the site no-one wishes to become a member to. The saving grace your dad has is that it has been diagnosed early. Mine was a little late but they managed to cure me or should I say put me in full remission.
I had Brachytherapy, and had the same choices as your dad, I did not want radical removal, as that has many long term side effects and at your dad,s age I'm sure he does not want any of them.
Brachytherapy, is done either under a local or a full general, I opted for a local, and had no real problems after, only looked like "John wayne" who had lost his horse for a few days. The water works were affected for a few weeks but they righted themselves after a while.
The hormone treatment pre Brachytherapy, not only reduced the size of the prostate, it starves the cance; as it feeds and grows with Testosterone, the treatment stops the production of testosterone. The side effects are minimal, some hot flushes, mood swings, tiredness etc. You women laugh at us men complaining about it, but you go through the change of life without problems, I've been told it is a lot like that. Any way Google "Brachytherapy" and you will get a wealth of info come up. Also look up "St Lukes Cancer Center Guilford" they are one of the country's leading centres for the procedure, or look up a Professor S. Langley, who is also one of the leaders in the field. One thing I should say is get the best man for the job, as success depends on the accurate "mapping & application" as well as the surgeon who carries out the procedure. I can only recommend the process and must be classed as bias.
Your dad must weigh up the odds for each of the options, he must do the research in detail and then decide. I wish him all the best in his and your journey through the coming months and years ahead in beating this awful disease. If you need any more info send me a friendship request and we can chat off the public forum if you want to. All the best to you both.
Thank you for your reply.
They have never mentioned HIFU but I believe my Dads prostrate would be too large for his, last reading 67 cc.
Thank you David.
Yes you are correct and my Dad was looking at RP as a last resort.
Our concerns were if he has the hormone treatment for three months does it limit future treatments (if his prostrate doesn't reduce in size)?
We are on the Leeds boarder so will be treated at Jimmy's, has anyone any experience of Jimmy's?
With regards to Hormones affecting any other later treatments for prostate cancer, it will in no way effect any other procedures your dad may need, However saying that, if your dad has Brachytherapy which incidentally has a 97% success rate ,he should never need any other procedures in the future.
You do also realise, that he may need a few sessions of Radio therapy alongside the Brachytherapy as a boost. I had 26 sessions, but I also had Bladder Cancer and that was treated alongside the Brachytherapy treatment.
The horemones are stopped as soon as the Brachytherapy implants are installed into the prostate, and you get back to normal after a few weeks, although I will say the Sexual function takes a little longer if that is what your dad is worried about.
I am now back to normal. I was told 2 years ago that I had 2 years to live if I had no treatment. But now I am back to normal leading a healthy normal married life ,and all is well, although I am still having treatment for bladder cancer, and will have for some time to come.
Well Claire I hope once again that I have been of some help and should you need any more just shout.
Thank you David you have been very helpful.
We were under the understanding that should he have to have hormone treatment and it failed to reduce his prostrate size then it would limit future treatments such as the RP. He would only be able to go forward with radiotherapy.
My PSA at diagnosis was 19.1 with Gleason 7. I had 5 months of HT followed by 20 sessions of RT. I was very well looked after at Velindre in Cardiff.
Prostate Cancer Charity issue a "Toolkit" which gives full details of treatments and possible side effects. You can obtain a copy from their free telephone service on 0800 074 8383 which is open during office hours. My daughter got a copy for me and I found it very helpful.
I was promised a cure, and two years on my PSA is 0.028!
HIFU ((High Intensity Focused Ultrasound) isn't available everywhere and although a new treatment it sounds very promising since side effects are minimal.
Good luck to you and your Dad and please let us know how you get on,
Lots of good advise here - its difficult to offer advise as we all tend to be biased in some way - and viewed through our own experienced with this disease.
If I was in your dad's shoes I would definately opt for brachytherapy for the reasons David2 has stated. Far less intrusive that surgery - which is no guarantee of removing all the cancer.
One reason to start with hormone therapy is to reduce the size of the prostate and so start the process of quickly and maybe making it easier for further treatments.
But I would always say research as much as you possibly can and then write down along list of questions for thenext meeting of the urologist/oncologist. Don't rush as your dads case is fairly low grade.
I have no direct experience of HIFU but have visited a research centre that had a MRI/HIFU machine and if that is available close to your dad I would definately look into that.
You ask about Jimmies in Leeds - in the 3 years since my diagnosis - I've heard some good stories about the place. Or just over the Pennines you have probably one of the best cancer hospitals in the UK if not Europe - at Christies near Manchester.
As Colin says - I too would recommend that you phone the Prostate Cancer UK helpline - and talk to the specialist urology nurses there. call
0800 074 8383 (free from not be too conerUK landlines - Mon-Fri 9am-5pm Wed
Some good links to good advice for you:
Like your dad I was about 57 when I was diagnosed with Prostate Cancer Gleason 7, (4+3). I opted for surgery though my consultant told me afterwards that this was the only real option I had. I had Surgery and the Prostate was removed. There are several unpleasant side effects of surgery, incontinence and sexual issues (sorry I know in terms of dads we don't like to discuss such things) anyway all was well and I recovered better than expected. However this year I had to go back for 6 weeks of daily radiation as unfortunately the little blighters had escaped before surgery. This isn't to alarm you but to say that I think that if your dad opts for surgery, in my opinion sooner rather than later is the best course of action. Incidentally, I am soon to be 65 so it has been nearly eight years since my surgery so perhaps time is often an ally with this particular cancer. You will see lots of positive stuff on this forum relating to treatments and prognosis for Prostate cancer so I hope you can see that it is not as bleak as it first seems.
My husband went for full removal, like your dad there was not any spread it was contained in the prostrate. I have to say he has been brilliant, he only had his op two weeks ago.
He was home in three days, after a week he was walking our dog with no discomfort at all and now he his driving. He isn`t on any medication whatsoever, he is really well, he says he would recomend it to anyone.
The only thing I have to say is he still has a catheter in which he is now waiting to go and have it taken out, I cannot say anything about that until he has it out . He might be able to be without it or he may not we will have to wait and see.
Hope this helps in some way.
Good luck to your dad.
Well a call went yo the nurses about the treatment options offered too my Dad.
Basically the nurse said Dads prostrate is too large at present and he would need to go onto hormone treatment. They would still do the volume scan for the Bractherapy to check it is still be a viable option. He must then commence hormone therapy for possibly 12 months, they originally said three months. They mention the side effects of the treatment are not nice.
They then suggested removal again but Dad really does want to deal with the after effects of this treatment.
We are just waiting for Dads actual nurse to call back.
Thanks for the update Claire. looks like they want to monitor the reduction in size of prostate when on HT - it should reduce in size fairly quickly - but as per usual, we all respond to treatments in different ways - hence the 3 to 12 month window before Bractherapy.
The side effects of HT vary a lot again - some lucky men seem little affected - others really badly - with the rest of us somewhere in between. I take it you have looked them up either here on Mac or on Prostate cancer UK. The later user forum has apart from very many men with PCa - lots of wifes and daughters who can offer you lots of support and help - on how you can support your dad.
His nurses have said if he goes onto long term hormones and the prostrate doesn't reduce as expected then they would be reluctant to operate and perform a RP.
He is just now waiting for an appointment for the volume scan. They have said it is more than likely the prostrate will be resized then and that they then will be able to say if brachytherapy and hormone treatment is the best option. There thinking is if he shouldn't be able to have this he is going to go for radiotherapy.
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