Since I have been following this thread I thought I would share my experiences here and ask some advice at the end.
My PSA has been elevated at 7 rising to a stable 12 over the last two years but finally my GP and AME agree with me that whilst watchful waiting is all very well, leaving me until I hit 20 was too much a game of Russian Roulette.
I had a 'trace MRI' last November from which the 'Dotarem' agent nearly finished me off with highly erratic heart rates and wildly fluctuating blood pressures for the following 36 hours. I now understand that the underlying ingredient is a toxic heavy metal called Gadolinium that is rumoured to stay in the body. Many people have chronic onward problems after using it and in the States there is a growing legal case to get its use discontinued. Several varieties are already banned in Europe with Dotarem being one of the few left in use. Tip No1 : Avoid trace MRI's if you can....
The results came back as I suspected with a couple of lesions, one relatively large in the lower section and another smaller above. PiRad 5 and 4 respectively. These required biopsy so in January I was offered a targeted trans perennial one. This in simple terms is a step up from the TRUSS 'Dynorod' fishing trip normally offered but is done under a general anaesthetic with several needles placed through the area between the balls and the bum. I have to say that since a close friend called his TRUSS experience the most pain he had ever experienced in his life I count myself lucky that my discomfort was limited to imitating John Wayne walking for 24 hours, and even that was more for comfort than necessity. Tip No2: Ask for a TP biopsy if you can get one.
Sadly, again as expected the results came back as Gleason 7 (4+3) which seems the industry standard to have to do something about it. As my last PSA was 12 a bone scan has now been completed and that luckily is clear.At last some good news!
Now it's decision time between the sword or the death ray. My urologist is practically pushing me through the operating theatre doors to have surgery. So much so I presume my local health care trust must be running a BOGOF offer! I am 64 and in reasonable health so of course the preference is to recommend a one stop solution with the least risk of complications.
I am seeing the Oncologist next week to discuss HT/RT and in particular the use of SBRT in the form of Cyberknife. This replaces the normal long period of short dose radiation with five days of tightly focused high dose. The benefits seem to be slightly better success rates with lower side effects in collateral damage.
To be honest, whilst I see all the benefits of surgery, especially at my age I am viewing it as a 'lucky dip' that hopefully will clear out all the cancer but in no way can guarantee to do so. I am leaning towards the more scientific approach of starving the cells through HT before blasting them with RT. Both have equal success and failure rates (surgery maybe ten per cent better) but as post surgery all that can be offered is RT plus permanent HT I feel I might as well get on with it and hopefully try to catch all that's lurking in any positive margin outside the prostate. At least post HT/RT there is cryo and HIFU to look at before permanent HT.
My first question though is this. I have been flying for nearly fifty years and in jets for thirty five. Contacting my airline I have been sent my last years radiation record which would indicate that I have probably ingested between 2-3mSv per year over ground radiation. Has anyone any experience of an Oncologist refusing or discouraging treatment because of that? When I look at the amount of radiation planned by either traditional or SBRT routes a previous intake of around 90mSv in my life seems irrelevant.
Second question; I have done a lot of reading and study to make my choice on treatment. I have come across a lot of web sites with people who say they have had complications, infections, rectification procedures post removal. In other words I can find plenty of people online who would say they regretted having a radical prostatectomy. Apart from one bloke with itchy tits I cannot find anyone, anywhere who regrets having HT/RT even though the side effects were unpleasant. Of course one only gets to read about the cases that have gone wrong but my AME is favouring RT and frankly so am I.
However, any thoughts and advice would be welcome right now.
Best Regards.