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jamie2009

Prostate Removal v Radiotherapy for Prostate Cancer.

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I have been recommended to have treatment for my Prostate Cancer after 3 years of being on Active Surveillance in the UK, I am 65.

My last Biopsy indicated one of the samples was Gleason 7, (3+4) I have had 2 Consultations, one for removal and one for Radiotherapy.

Currently I have opted for Radiotherapy, a Clinical trial called PACE at my local hospital overseen by the Royal Marsden in London.

I asked the Surgical Consultant if he would recommend removal or radiotherapy, his reply was he didn't want recommend anything as I could come back to him (also he said he had no knowledge of Radiotherapy) and make a complaint if things went 'wrong'

I asked the Specilist Nurse, she said they won't recommend as both treatments have similar success rates.

Has anyone had Prostate treatment and what one ?

TBH I don't think anyone can recommend a specific treatment as people have different reactions to them but just experiences of some one who has had any form of treatment.

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Have you considered HDR brachytherapy ? Uncomfortable procedure, but very good outcome with lower side effects.

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That was my option but the Radiotherapist said my Cancer wasn't deemed aggressive enough for Brachytherapy.

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Moved to the Health Forum

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So I gather what you have been offered is external beam radiation therapy?

 

Seems a bit odd to me as brachy is usually preferred for low and intermediate risk cases, not the other way around. EBRT would usually be preferred only for aggressive cancers. It is more expensive than brachy. It also has a higher rate of side effects (though still just a minority of cases).

 

Plenty of TV members have had both surgery and radiation treatment  for prostate cancer. There is no one-size-fits-all best treatment.  The individual patient's overall health status has to be factored in, along with patient preferences and age.

 

Although it has generally been thought that cure rates were similiar for surgery and radiation, the most recent study I have seen suggests that surgery provides the best chance for cure  overall https://www.ncbi.nlm.nih.gov/pubmed/26700655

 

However, individual patient factors may sometimes make surgery more risky for that specific patient.

 

Brachytherapy generally has the lowest incidence side effects

 

 

From what I understand of the PACE trial,  it is designed to compare long term results from a special type of radiation therapy called stereotactic radiotherapy compared to conventional radiation therapy  and surgery. Also as I understand the study design, men who are surgical candidtaes (i.e. no contraindication to surgery) are randomly assigned to receive either laparoscopic surgery or stereotactic radiotherapy, while those who are not surgical candidates are randomly assigned to receive either conventional radiotherapy or stereotactic radiotherapy . In the latter group, the patients are not initially told which type of radiation therapy they are getting in order to minimize bias in self-reported side effects.  However if you have no contraindictaions to surgery then as I understand the trial design, the only radiation therapy group you could be assigned to would be the stereotactic radiotherapy.

 

So if you are in this trial and have been assigned to the radiation group you may be scheduled not for  EBRT  but rather stereotactic radiotherapy , which is a shorter course of treatment than other types of radiation therapy and seems to have lower incidence of side effects. As far as is known its outcomes are similiar to those of other approaches but as it is new there is a lack of clear long term evidence on that (hence the trial).

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3 hours ago, Sheryl said:

So I gather what you have been offered is external beam radiation therapy?

 

Seems a bit odd to me as brachy is usually preferred for low and intermediate risk cases, not the other way around. EBRT would usually be preferred only for aggressive cancers. It is more expensive than brachy. It also has a higher rate of side effects (though still just a minority of cases).

 

Plenty of TV members have had both surgery and radiation treatment  for prostate cancer. There is no one-size-fits-all best treatment.  The individual patient's overall health status has to be factored in, along with patient preferences and age.

 

Although it has generally been thought that cure rates were similiar for surgery and radiation, the most recent study I have seen suggests that surgery provides the best chance for cure  overall https://www.ncbi.nlm.nih.gov/pubmed/26700655

 

However, individual patient factors may sometimes make surgery more risky for that specific patient.

 

Brachytherapy generally has the lowest incidence side effects

 

 

From what I understand of the PACE trial,  it is designed to compare long term results from a special type of radiation therapy called stereotactic radiotherapy compared to conventional radiation therapy  and surgery. Also as I understand the study design, men who are surgical candidtaes (i.e. no contraindication to surgery) are randomly assigned to receive either laparoscopic surgery or stereotactic radiotherapy, while those who are not surgical candidates are randomly assigned to receive either conventional radiotherapy or stereotactic radiotherapy . In the latter group, the patients are not initially told which type of radiation therapy they are getting in order to minimize bias in self-reported side effects.  However if you have no contraindictaions to surgery then as I understand the trial design, the only radiation therapy group you could be assigned to would be the stereotactic radiotherapy.

 

So if you are in this trial and have been assigned to the radiation group you may be scheduled not for  EBRT  but rather stereotactic radiotherapy , which is a shorter course of treatment than other types of radiation therapy and seems to have lower incidence of side effects. As far as is known its outcomes are similiar to those of other approaches but as it is new there is a lack of clear long term evidence on that (hence the trial).

I had a long discussion with the surgical fella, he was in his sixties so had plenty of years experience, he said nothing positive about having the prostate removed.

I thought problem solved if you remove it nope he said there can be tumours not visible to the human eye or a scan still there.

The Pace trial is sterotactic/cyber knifing, 2 different types, 1 over a period of a week the other over 4 weeks, you are selected by randomisation. 

I was going for surgery now Radiotherapy but every day I wake up thinking am I doing the right thing.

i am fit and healthy, PSA level was just over 7 at diagnosis but has since dropped below 3. Only one of the 10 Biopsy samples was 7 but they said it could have been there before but it wasn't picked in a previous sample.

 

I would like a treatment which is not going to dehabilitate  me but unfortunately no can or is prepared to tell me which way to go, my choice, 

There are loads of Clinics on the net telling you all the success stories but obviously don't mention the ones which are not so successful.

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Well if you join the trial, the choice will be made for you.

 

There is unfortunately no guarantee whichever treatment you have.

 

In terms of adverse effects, brachytherapy and stereoactic RT have statstically less than EBRT and surgery.

 

But plenty of people have surgery or EBRT without serious long term adverse effects.

 

If you have a choice of consultants you might like to see a diffetent radiation oncologist to discuss brachytherapy as the reaon you were given does not make sense to me.

 

 

 

 

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33 minutes ago, Sheryl said:

Well if you join the trial, the choice will be made for you.

 

There is unfortunately no guarantee whichever treatment you have.

 

In terms of adverse effects, brachytherapy and stereoactic RT have statstically less than EBRT and surgery.

 

But plenty of people have surgery or EBRT without serious long term adverse effects.

 

If you have a choice of consultants you might like to see a diffetent radiation oncologist to discuss brachytherapy as the reaon you were given does not make sense to me.

 

 

 

 

TBH Brachytherapy wasn't siscusssed, Radioligist said it wasn't suitable for me, me being cynical I was 'diverted' towards the trial.

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Had radical prostatectomy at 57 in Harley St London by the no 1 Dr in Europe for prostate cancer. When I asked him what treatment he recommended he replied that if I were his father he would say have the prostate removed. But then of course he would say that  as he was a surgeon.

 

At 64 signs of the cancer returned and I required 30 zaps of radiotherapy. 

 

I am now 76, had 7 stents inserted last year, and still playing golf 2 times a week. One thing for sure if you are lucky enough to survive these problems when they come along, is that you certainly get in to perspective what is and isn't important in life. Somehow those  bad drives, missed putts and bad rounds of golf are not nearly as important as they used to be.

 

 

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21 hours ago, lelapin said:

Had radical prostatectomy at 57 in Harley St London by the no 1 Dr in Europe for prostate cancer. When I asked him what treatment he recommended he replied that if I were his father he would say have the prostate removed. But then of course he would say that  as he was a surgeon.

 

At 64 signs of the cancer returned and I required 30 zaps of radiotherapy. 

 

I am now 76, had 7 stents inserted last year, and still playing golf 2 times a week. One thing for sure if you are lucky enough to survive these problems when they come along, is that you certainly get in to perspective what is and isn't important in life. Somehow those  bad drives, missed putts and bad rounds of golf are not nearly as important as they used to be.

 

 

 

Thanks, good read, the reason for considering Radiotherapy was as I said in an earlier post there could still be cancer cells in the vicinity of the prostate after removal.

Whilst Radiotherapy does affect the surrounding organs it will hopefully eradicate any cancer cells outwith my prostate.

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Cure rate is not higher with radiotherapy than with surgery (in fact may be just slightly less).  So that should not be the basis for decision.

 

When surgery is done they will check for clear margins in the removed tissue. If the margins are not clear, or if post-op PSA levels indicate that prostate sells remain, radiation might then be advised.

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A year ago I had prostate holep surgery in india, cancer was found post operation in the biopsy, I had radiation and chemo in Bangkok

 

It seems to me you need opinions from top urologists/oncologists

 

I am sure my man in india would give you an opinion, he was trained in the USA, and is the right age around 40, if you want to try this PM me and I will give you his details

 

I also have excellent oncologist again USA trained at chulalongkorn in BKK, and can point you to a 40 yr old urologist there as well

 

Jamie the very upto date radiology is very targeted like a snipers rifle and is less likely to affect other organs

 

Good luck

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Have you looked into Protom therapy for prostrate cancer? At the moment this treatment is not offered in the UK or Thailand. You would need to travel to the Czeck Republic or elsewhere. Fairly expensive procedure, but painless and showing the best long term results. Well worth reading up on.

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