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Hi, I am 52 fit and have no symptoms of prostate problems. On 28/5/07 i had a routine health check and had a PSA of 12.2 so had a biop and they found anenocarcinoma but due to incoputant private surgen in Thailand it was inconclusive. so I went back to uk where after another biop they found no significant pathology in the right lobe but in the left... 5 cores 26mm, in 2 cores it showed an infiltrating adenocarcinoma, gleason 6 (3+3) occupying 5% or total core volume. no vascular or perineral invasion. I had to return to Thailand after biop and had an MRI and bone scan which were normal. My psa reading is now 13 and acording to the doc who gave me a digital exam the prostate was small, so the doc recomended a 6 month course of hormone then bracitheropy. I dont know if this is good advise so will be looking for a second opinion. Can anyone please advise. Many Thanks for you time.
to recap.....psa13 gleason 3+3 small prostate and fit with no symtems.
I was diagnosed in 2007 and have had hormone + external beam radiation and then brachytherapy. Hormone treatment brought my PSA down to under one and after the subsequent treatment at the last reading it was 0.05. I was 73 years of age when diagnosed, a little older than you.
Worse thing about Hormone treatment is the hot flushes, but I did not find them a real problem. There does seem to be some disagreement as to what constitutes brachytherapy. When our American friends speak of it they talk about irradiated seeds being implanted. In my case 17 needles were inserted into the prostate and I was subjected to three sessions of radiation via the needles, but nothing was implanted.
I suggest you determine what your doctors mean by brachytherapy and possibly make your mind up about having it after you see what hormone deprivation achieves
Peter:
No disagreement. You seem to have had High Dose Rate brachytherapy-HDR. The radiologist using a template in the perineal area introduces tiny hollow needles through the skin and into the prostate. Then radioactive liquid circulates and distributes its radioactivity to the prostate over some minutes and then are removed. Treatment is repeated on other days as is necessary from calculations. The location of the needles and time of circulation, as well as the type of radioactive substance all are calculated to provide the best opportunity of success with fewest side effects. Traditional brachytherapy uses implanted seeds which remain in the organ to decay over some time of days weeks or more. The HDR is a more recent development with the advance of technology. Most centers of HDR have experience of the traditional method, though the reverse may not be true.
Seems like your PSA score would bump you up a risk level from the 3+3 Gleason score. Questions I would ask: What is my staging (TNM)? What is my approximate prostate size (From Ultrasound and DRE)?
Staging sometimes correlates accurately to chance of out of prostate spread and prostate size relates to the facilitation of brachy. I would get these answers and a second opinion before I started any treatments. Once you have all three factors PSA, Staging, and Gleason, you can plug them into the Partin Tables or other nomograms to get statistical probabilities as to treatment decisions. You can read my posts in the mentor's section. Do your homework and good luck. - p (Alaska, USA)
I am sorry that it has taken so long to post your story on the site and to respond to this posting.
Dealing with the question of brachytherapy first. There are two main versions. The most common is known as SI (Seed Implant). In this one, an appropriate number or radioactive ‘seeds’ (the precise number will depend on a number of factors including size of gland) are inserted into the gland via the perineum (the flesh between the rectum and the testicles) using a set of needles and a pre-configured template. The seeds lodge in the gland and stay there permanently.
The alternative method is what is known as HDR (High Dosage Radiation) Brachytherapy. In this method, the needles and templates are used as in SI but the seeds are placed into the needles, left for an appropriate number of minutes and then removed. This procedure is repeated a number of times until the total calculated dose has been delivered. The seeds are not left permanently in the gland. This is also known as a hypofractionated procedure which essentially means that the dosage delivered with each entry of the seeds is greater than the dosage delivered by the SI method but the total dosage is less. The theory is that this causes more damage to the tumour cells and, because the seeds can be placed so precisely there is less chance of collateral damage to the rectum, bowel and bladder, all of which are kin close proximity to the prostate gland.
There are many sub-sets of these two basic modes, dealing with dosage and radioactive materials used in the seeds; the use of ADT (Androgen Deprivation Therapy) before or after the procedure (this is known as neo-adjuvant or adjuvant treatment) and the use of EBRT (External Beam Radiation Treatment) as neo-adjuvant or adjuvant treatment. There is no definitive evidence that any one of these methods is better than any other, BUT there is no doubt that the experience of the team providing the procedure is absolutely critical in the outcome. The choice and placement of seeds is crucial and as the gland moves when the needles enter (wouldn’t you!) the experienced operators are able to estimate where this reaction has moved the target.
The suggestion that you have six months ADT prior to the proposed procedure seems a little unusual. ADT is often prescribed to reduce the size of a large gland, but you say that your gland is small, so that cannot be the reason. I think it would be a good idea to discuss the concept with your doctor and ask him to explain, in terms that you can understand, why he feels this is the best option for you.
I don’t know if you are aware of the issue of Active Surveillance. This has clome about because it is clear that many of the men who have treatment for prostate cancer do not benefit from the treatment, mainly because they were never at risk from the disease, yet they are subject to unwanted side effects. This has led leading US pathologist Dr Jon Oppenheimer to say, on his Blog:
For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make.
