10 yrs ago my husband had brachytherapy at age 57, since when PSA gradually began to creep up again and last year jumped to 7.5. PET scan & biopsy confirmed aggressive cancer in prostate & SVs (Gleason 9), probably due to cancer cells being missed in brachytherapy.
Prostatectomy & further brachytherapy ruled out by oncologist, who said only option is containment for as long as poss by HT (Prostap). PSA first reduced to 0.4 but now risen to 2.6. In absence of pain and peeing problems, doctor seemed unconcerned, mentioned ‘PSA bounce’ & changed parameters in path lab (whatever they are!). Further review in 3 mths. Obviously not the result we were hoping for. With all the other treatments mentioned on this forum, we don’t know why he said HT was only option.
Maybe take a good look into High Intensity Focused Ultrasound (HIFU) as a way to ablate the re-emerge cancer. IMO, Memorial Sloan Kettering (MSKCC) or MD Anderson are the best centers to be evuated for, and explore other leading edge options. Also, you may want to look into clinical studies that involve various immune system enabling treatments. Both institutions have excellent websites with information on all of the above.
Best wishes, thoughts, and prayers.
Helen
I am so very sorry to hear the Gleason score of 9 . After things like radiation or in his case the bracytherapie it may not be possible to do a prostectomy or radiation. But treatments are all in how one person treats the cancer. I hope you have access to a medical oncologist . Also if you can seek a second opinion .There are stronger drugs like zitiga or Xtandi . I think the prostvac or other immune therapies work better at the start of prostate cancer but ask about them . 💙💙💙
I can only assume that HT means Hormone therapies, but you did not identify which product or for duration. Its common, ( In the US) that failed BT leads to many options, depending, of course, to the health and particular findings. Perhaps a second opinion would help provide a clear path for you- at the very least giving you some clear choices. If you have access to the internet, please look at the NCCN guidelines ( 2015, V3) for recommendations for therapies when a failure has occured.
Hi,
Did you ask why salvage prostatectomy is ruled out? You mentioned HT to keep contained, is it contained now or has it metastasized? Where do you live?
Best,
G
Hi Again-
Please see this online publication.
Harvard Medical School, harvardprostateknowledge.org has an excellent publication called "Harmone Therapy for Prostate Cancer" and it provides excellent information about using ADT when previous therapies have failed.
Best of Luck
Alan
Thanks to everyone for your advice and sympathy. Forgot to say we’re in G.B. I have to say that what my husband’s been told so far isn’t reassuring. The oncologist explained that an operation wasn’t possible as some of the cells could be missed and start to spread (at this point he actually shrugged and said that may already have happened, although the scan last January showed they hadn’t at that point.) He also said that salvage brachytherapy would destroy both the urinary system and bowel.
It was decided at his latest review that my husband continues on 3 monthly injections of Prostap3 (Leuprorelin) until his next review in June. He tried to ask the doctor again about alternatives but she went vague and just said she’d have to ask the oncologist. So far he’s only had the occasional hip pain, which is a side effect of the Prostap, so she wasn’t concerned.
Since then I’ve found another forum where people with increased PSA were given several other options, including more frequent injections, and their testosterone levels were being tested as well, which hasn’t happened yet in my husband’s case. We’ll see what happens in June and maybe put a bit of pressure on if necessary.
As I said before, if you can make it happen, to maximize his chances for the best outcome get to MSKCC or MD Anderson for futher analysis and opinion. They have the best, and they are the best. Although I live about as far away from NYC as you do, I personally have had terrific experience so far at MSKCC.
Hello. My OH also had brachytherapy aged 57 here in the uk. That was 2 years ago. So far he's doing well. I didn't find out until after he had brachytherapy that there are not many other treatments you can have if the brachy fails. Unless you go privately it's difficult. I hope you find a solution. Have you asked on the other uk prostate cancer forum? (I thinks it's Macmillan) I've found everyone quite helpful on there with a wealth of knowledge. Most are from the U.K. too.
Hello. No the other forum is just called prostate cancer U.K.
Helen you really have to insist on care . The attitude of medical has to change on PC . I live In Canada and the attitude here is not to screen for PC because to many men suffer from mis diagnosis . But it leaves men like my husband Dave to a cancer that was so aggressive and relentless he died at 64 after a diagnosis just 27 months before. I fought tooth and nail to access every treatment I could get for him .I think health care In England is much the same as Canada it's supposed to be free or government sponsored .But when dollars and cents are involved in cancer there defiantly is a cut off line as to what treatments you are going to receive . Here we live in basically a communist idea that you are only alloted what the government decides you should have . Yearly physicals are no more and are now every 3 yrs . I guess they figure cancer will take a 36 month holiday between exams . Be assertive in requesting care ....Damm well demand care Make sure you write down all the questions you want awnser to and go there as well .
Thanks Alfred, yes, I looked on it yesterday and apart from HT the only other options mentioned were cryotherapy and HIFU which I’m not sure are available at our hospital. Would probably have to go private. We were hoping for radiotherapy as a back-up if the Prostap failed but there are other types and combinations of HT available so are crossing our fingers that an alternative could work. I've been reading all the forums - you're right, one can certainly learn a lot from them.
Hope it works for your OH. My brother-in-law also had brachytherapy 12 years ago and has been signed off as clear of PC. We've been told 2 out of 3 men are okay afterwards.
So sorry to hear about your husband, Sue. That’s really awful! We’ve read criticism that a lot of treatment and operations are carried out needlessly and the first doctor my hubby saw didn’t believe in PSA tests. However, his father and brother both had PC so he was forewarned and insisted on it, which was just as well as he was also found to have it. His first treatment was under the urologist who was great, both supportive and positive, but the oncology team now seem quite the opposite.
We’re in much the same position as you with our NHS, which is slowly going under, although I have to say we’ve both had excellent treatment up to now through it. Anyway, we’re trying to remain positive and are currently compiling a list of questions for his next review.
We’ve been planning to revisit Canada & do Alaska cruise this year but are expecting travel insurance to be sky-high.
Best wishes.
The chap that did the brachy said if psa was still low at 3 years after treatment then it was only 5% chance of it returning. But I have read the same figure as you said above. I hope it works too. It was suggested to OH that he went on active surveillance. But as he farms and has busy times of the year he decided to have treatment at a quiet time on the farm. If he suddenly needed treatment at harvest time t would have been difficult. I am younger than him and our youngest son was only 5 when he was diagnosed. So choosing a treatment was difficult.
I hope your husband finds something that helps. All the best.
Thank you. All the best to you and OH too.
When I had biopsy done, 12 were taken and each core measured for level of cancer. You did not mention how many samples showed cancer and where they were found. In my case, 9 had cancer, 7 were 4+3, all others were 3 + 3. In the US, this is stage 2 cancer, T2C. Your doctors should have provided you with the same type of information which would at least let you know how aggressive this is. Please ask them WHY they prescribed ADT, what they hope to accomplish.
Hi Helen,
I am sorry for your and your husband's health situation.
As I understand, you are not well served by your urologist. Perhaps you should find another one who will be able to:
1. Determine the extent of the cancer. This is best done by undergoing a PSMA PET CT scan; and
2. Provide your husband with ALL the options available. This is a longer list than the options the urologist can offer or the options available at the hospital he works in.
I agree with your sense that there must be other options besides hormone therapy. This is not to say other options are better, but at least you should be made aware of them.
Barney you are probably not in the uk. It isn't always easy to just find another urologist in the uk. Ww often just get what we are given. Unless we have private insurance, which not many people do. Sometimes we can ask for a second opinion but it's not always available. We could only have the standard MRI too. There's no choice of a better machine.
I hear what you are saying.
My point is that for those that don't have private insurance, they should weigh up their choices carefully:
either follow the treatment plan of a urologist you don't really trust OR
find a high volume urologist attached to a hospital who through different scans can identify the extent if any of the cancer AND whose experience will enable him to offer the best options available. And the best option may mean a shorter treatment period or a very different type of treatment to that being offered by the urologist Helen's husband has been seeing .
Sure this option may be costly in dollar terms, but a lower cost, in dollar terms treatment could be costly in affecting quality of life unnecessarily.
Just my 2c
Sorry for delay in replying – we’ve been away.
He did have a PET scan in Jan 16 which showed slow growing cancer in prostate with more aggressive type in seminal vesicles. Gleason: 5+4. No further spread at that time.We are indeed in the U.K. I suppose he could ask for a transfer to another local hospital but we don’t know how good their oncology departments are. The one he’s currently attending is supposed to be a good one, although we haven’t seen much evidence of that yet. The doctors have given him various information leaflets about the hormone treatment (and one on salvage brachytherapy before telling him that he couldn’t have it) but seem vague and uncaring, and reluctant to answer any questions. So far we’ve learnt more from the Cancer Research UK and Macmillan websites.