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Prostate cancer

Old 14th Mar 2018, 21:40
  #41 (permalink)  
 
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BoeingBoy, the problem with complete removal is the complication rate is relatively high. Which is one reason I'm comfortable with my Urologist recommendation to do hormone and radiation which have a low risk of complication (another is that both my Urologist and my Radiation Oncologist come very highly recommended by other doctor types).
Right now, everything that has happened has been pretty much what I was told would happen. I go in later today to get my prostate 'mapped' for the focused beam treatment that should start later this month (I got gold 'markers' inserted in my prostate about a month ago - which along with the mapping will be used to target the beams).
For now I'm remaining optimistic of a good outcome - and the doctors keep using the 'cure' word which helps greatly.
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Old 15th Mar 2018, 04:34
  #42 (permalink)  
 
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I had mine removed 5 years ago in France using robotic surgery . The Da Vinci robot to be precise . 3 days in Hospital . All back to normal within a couple of weeks except I now only shoot blanks . The top tip when considering this route is that the surgeon needs to be experienced . I cannot stress enough the need for annual PSA Check over the age of 50 or 40 with family history . Best wishes to all .
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Old 15th Mar 2018, 09:36
  #43 (permalink)  
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Rusty. Don't worry about the finger. It's not that bad, and if you need a biopsy ask for a transperrienial one which is much more comfortable, if only for the fact that you're out for the whole procedure. It's also a lot more accurate.

tdracer: I think we are working on the same lines. I have one positive core close to the periphery which the surgeon said would increase the chance of me having a positive margin (and therefore a higher chance of failure) so I figure zapping with a little extra spread to pick anything lurking outside the capsule seems more sensible.

Good luck to you both with your treatment.
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Old 22nd Mar 2018, 19:29
  #44 (permalink)  
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Just to answer my own question posed on the previous page....does a lifetime of long haul prevent or jeopardise your treatment with RT? The answer is no. The Oncologist looked at my intake and likened it to living in Cornwall versus Scotland for most of my life.

I have now started the HT/RT route and am researching the use of SABR radio applications and also the use of rectal spacers.

Finally someone will get to do to me what a lot of FO's could only dream of....
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Old 22nd Mar 2018, 20:30
  #45 (permalink)  
 
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Originally Posted by BoeingBoy View Post
Rusty. Don't worry about the finger. It's not that bad, and if you need a biopsy ask for a transperrienial one which is much more comfortable, if only for the fact that you're out for the whole procedure. It's also a lot more accurate.

<snip>.
Quick and simple, while I talked to the doctor about religious cults! No problems, but as a friend died in months from prostate cancer a few months ago, it's worth that physical check.

The blood test seems to be worthless - provides false negatives and positives.
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Old 22nd Mar 2018, 21:12
  #46 (permalink)  
 
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The blood test seems to be worthless - provides false negatives and positives.
Not my experience - the finger check didn't reveal anything unusual, it was the elevated PSA that sent me to the Urologist for a closer look.
Agree that the finger check is no big deal - some of the other stuff that's gone up my butt since is far worse. I mentioned to the Urologist that he kept doing things unpleasant things to me - he responded that he'd be a little worried about me if I didn't find them unpleasant...
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Old 23rd Mar 2018, 01:49
  #47 (permalink)  
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The finger thing brings back a memory. I was getting worried about flow and had a wellness check in a Texas clinic. PSA ~8.5 I went to another clinic and paid for a digital which included pressing first the left side and then the right. Ejected fluid was gathered for analysis.

Left side. Done. Right side, press, press, "Oh. No need to carry on."

So obvious was the bulge that the doctor simply abandoned his routine. I was then blessed with a doctor in San Antonio who did the biopsy for only the cost of the lab work. It was in a Christian hospital, and the doctor upon being told I was uninsured said, 'when you have been blessed as I have, I believe in spreading the joy/good luck' something like that.

He offered me the DaVinci machine at reasonable cost $22k IIRC, but by then I was again entitled to British medicine but it was more the long term issues that influenced me to head west. As I've often mentioned, in the event I elected to have Brachytherapy, being on the borderline at a Gleason of 4+3.

I would never try to influence anyone on which path to take. It is after all a matter of life and death. The decision has to be made on a combination of statistics and technical specifics for the individual. Not the easiest of choices.
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Old 23rd Mar 2018, 17:13
  #48 (permalink)  
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If it can be determined without a reasonable doubt that the cancer is contained within the prostatic capsule then the decision seems to turn on the possible retention of some sort of sexual function.
As between Brachytherapy and Prostatectomies, in general you've more chance of performing sexually following the former than the latter.
As between Prostatectomies, you've got more chance of performing sexually following a nerve sparing (Da Vinci) procedure than a radical procedure.
Problems can arise with the Da Vinci procedure should there be previous scar tissue as from an appendectomy or a nephrectomy/nephro-ureterectomy. Scar tissue makes fine surgery tough work. In such cases it is possible that the surgeon will have to make a theatre decision to convert the nerve sparing procedure into a radical one. An example of this, by his own account, is Andrew Lloyd Webber, who went into a Da Vinci procedure intending to retain sexual function after a nerve sparing operation only on awakening to discover that the finest team in Britain at the London Prostate Centre under the direction of Professor Richard Kirby, had been unable to spare his sexual function.
There is one final small but significant point. The end of a man's capability for sex will often affect his partner's psychological well being and sex life, depending on concepts of old fashioned virtues of faithfulness. To embark upon a course of action that will likely deprive one's partner of fulsome sexual gratification makes a treatment decision, insofar as is possible, a two person one. Involvement of one's partner is an important part of the road to successful recovery from prostate cancer and this is true no matter what the actual physical outcome.
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Old 23rd Mar 2018, 20:31
  #49 (permalink)  
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Every professional I've consulted so far, from Urologist, Surgeon, Oncologist and specialist Nurses have all said the same thing.....decide what treatment you want with you heart and nothing else.

I have a friend who is going towards surgery whilst I am now on the HT/RT route. He wants his treatment up front and done in one go. He is happy to take the next twelve months getting over it and hopefully regaining continence and sexual function.

For me the research I've done seems to indicate a large percentage of complications are common during and post surgery, with infections, bleeding and urethra clip movement or failures. Of course most are successful and I am only reading about the abnormal cases, but having spoken to, and read about people who had surgery a lot said they might have not gone for it had they taken longer to think things through.

A lot of men rush into surgery because they are keen to lose the cancer and get things over with quickly. Choosing surgery for emotional reasons seems common. However what many are not told about is the chance that whilst the cancer cells may not have metastasised into the lymph nodes or bones some cells may have escaped into the surrounding tissues of the bladder, rectum or pelvic floor. Unless visible to the surgeon these will not be dealt with by surgery and will cause a 'Biochemical Failure' (or recurrence) in the following two to five years. That will mean returning for the HT/RT treatment that the candidate tried to avoid in the first place. My Oncologist puts that risk at about 25% for men with intermediate cancer (G7 4+3).

For me it just seems more scientific and logical to first starve the cancer cells by depriving them of the testosterone they are feeding on and the zap the little sods with RT or Brachytherapy which should also include a small spread to take care of any 'positive margin' that might be lying around the surrounding tissues. It's not fool proof and there is a similar chance that a recurrence could occur but it does seem that the chances are a little smaller.

One thing pushed to surgery candidates is that post RT salvage surgery won't be possible. Whilst that has been true in the past it's now becoming a little more common as RT becomes more accurate. So it's one more myth to debunk.

Post RT you also have Cryotherapy and High Intensity Focused Ultrasound technologies available along with good progress being made on the genetic research front especially using RNA. I believe only the delivery method is holding that up.

I would not urge anyone to go for my choice, or to go for surgery. It must be what appeals to you as an individual but the one thing I would say is to do your research and find out as much as possible about the path you favour before you choose. Too many are pushed towards surgery as a quick fix and as a one stop solution but it's not that simple.

The one thing I have found is that I can locate plenty of posts on forums saying 'I wish I hadn't rushed into surgery' but I can't find one that said 'I wish I'd never had Radio'.
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Old 24th Mar 2018, 09:39
  #50 (permalink)  
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I enjoyed that post. Research is a key element. I have met men whose brachytherapy surgeons have left much to be desired. The consequence of that for the brachytherapy patient has sometimes been permanent anal incontinence. The selection of the man who irradiates you is just as important as your choice of scalpel operator. If your biopsy is a butcher job, you are not going to permit that same happy hacker to deprostatize you, are you?
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Old 24th Mar 2018, 11:15
  #51 (permalink)  

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Google prostate cancer UK and there's a very good website run by a charity.Tried posting link but it wouldn't work!

DON'T be shy, everyone I've met in the course of investigations has been incredible, putting me at ease and explaining everything clearly as I'm only a retired pilot.

MP

Last edited by MaximumPete; 31st Mar 2018 at 10:36.
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Old 24th Mar 2018, 14:53
  #52 (permalink)  
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Prostate Cancer UK Web site

I can vouch for the good support this charity gives. An excellent help and chat line along with personal contact if you want it and a forum (You'll find me under the same username there).
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Old 30th Mar 2018, 15:33
  #53 (permalink)  
 
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I've had a PSA up to 17 (it's 8.6 at the moment) and have had MRI and biopsy with nothing found so a high number isn't a death sentance. Regarding the biopsy it really is nothing to worry about. I had the local up the rectum and as already mentioned by a previous poster, it is just like having a rubber band thwacked against your skin. They do ask you to pass urine before you go home to see if everything works but I was home mowing the lawn an hour after having it done.

The finger up the rear reminds me of the old joke about the guy who goes for a rectal examination.

'Where shall I put my underpants doctor?'

'Just pop them over there next to mine.'
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Old 31st Mar 2018, 19:46
  #54 (permalink)  
 
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When I was still working, I used to find that on nightstops, I would be going to the loo on multiple occasions through the night - not a problem during the day. Add to that a few dribbles and a lack of libido ( or was it opportunity !!! ) and the mass of information regarding PC in all forms of the media, well lets just say it set a few alarm bells ringing.

A trip to my GP surgery resulted in a blood test which resulted in a low PSA reading (1.6) and a recommendation to come back in 12-18 months. Second time around the reading was fractionally higher - nightime frequency generally 0-1, maybe 1-2 if I had been drinking until late in the evening. Third time around ( last week ) a reading of 2.2 but with no apparent prostate abnormality from the finger up the bum test. At the docs suggestion, I am now on one tablet a day (Contiflo XL) which is designed to 'relax' the prostate which may in time reduce any enlargement - we await the side effects which may include tiredness, dizzyness and reduction in a certain bodily fluid ! Of course all these drugs come with the standard warnings associated with corporate liability paranoia; I well remember the ads on US television which promoted the likes of Viagra only to be followed by a terrifying list of possible consequences !!!

The simple point is this...its a bit like de-icing, if there is any doubt then there is no doubt - get it checked.
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Old 31st Mar 2018, 21:05
  #55 (permalink)  
 
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The one thing I have found is that I can locate plenty of posts on forums saying 'I wish I hadn't rushed into surgery' but I can't find one that said 'I wish I'd never had Radio'
.
I think one thing that gives people pause about radiation treatment is the long term consequences of exposing your body to high doses of radiation (at least that was the case for me). So I asked the Radiation Oncologist about the long term threat that the radiation cancer treatment might give me cancer in the future. His response was interesting and not something I'd heard before.
Basically (and this is simplified from what I'm sure was a dumbed down answer), while there is a risk that radiation treatment can cause cancer in the future, it's low. The reason is that when hit with high dose radiation, the cell knows it's damaged and will try to repair the DNA. When hit by low dose radiation (e.g. radioactive fallout), the cell damage is subtle enough that the cell doesn't know the DNA is damaged - hence a significantly higher risk of future cancer developing.
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Old 31st Mar 2018, 22:11
  #56 (permalink)  
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One of the common side effects of the drug Tamsulosin, the main ingredient in Conti Flo, Flomax etc, is retrograde ejaculation. This occurs when the bladder sphincter muscle does not contract before ejaculation thus leading to a discharge of seminal fluid into the bladder instead of its wending a merry way down the urethra.
Try not to think about that when engaged in bedroom activities. It's somewhat disruptive to man vibes. It might help to regard the process as a primitive form of birth control known in the appropriate parlance as coitus saxonicus. This was possibly invented by the inhabitants of Wessex shortly before the Norman conquest and the introduction of french letters into the UK.
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Old 1st Apr 2018, 08:54
  #57 (permalink)  
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So I asked the Radiation Oncologist about the long term threat that the radiation cancer treatment might give me cancer in the future. His response was interesting and not something I'd heard before.
Basically (and this is simplified from what I'm sure was a dumbed down answer), while there is a risk that radiation treatment can cause cancer in the future, it's low.
The general opinion is that there's about a 5% chance of consequent bowel or bladder cancer within about five years post RT. It seems to be linked to the amount of spread outside the prostate capsule that the machine is set to give. The less accurate the focus, the more collateral damage done to surrounding tissue. Some spread is desirable in top end intermediate or high risk cancer to mop up any positive margin of cells that may have leaked out. To put it in context the best machines usually operate up to 5mm of spread with stereotactic machines like Cyberknife operating down to 0.5mm. That's great if you know all the cancer is in one place and in the centre of the prostate but if (like me) there's some lurking near the edge it's best to have a general blast around.

This equals the same 5% chance of never regaining continence post surgery.

The one thing all my research has shown so far is that there is no easy ride through prostate treatment. You have a choice of two lousy journeys. You just choose which is most palatable to you.

I had to use Tamsulosin prior to the transperrenial biopsy. Apart from making me feel lousy and aiding flow rate it didn't seem to have any effect on frequency or sexual activity. Despite the side effects in the leaflets, every man is different.
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Old 1st Apr 2018, 10:23
  #58 (permalink)  
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Is it usual in Britain to have a prostate MRI, bone scan and chest Xray between a positive biopsy result and treatment?
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Old 1st Apr 2018, 12:58
  #59 (permalink)  
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The usual route in the UK has for many years been DRE. PSA. TRUSS Biopsy. MRI. Bone scan (if PSA is over 10) and then treatment.

This has resulted in a lot of men being rodded and radiated unnecessarily (both in the UK and USA) so there is a move now to do the MRI before the biopsy and to use the Targeted Transperrenial method of biospy to provide greater accuracy.

One thing to beware of is that some hospitals insist on using a trace agent to enhance the MRI. This invariably contains a toxic heavy metal called Gadolineum which is supposed to be flushed out through the kidneys. (Kidney function is checked first) However there is growing evidence that it doesn't all come out and that some remains lodged in muscles and the brain. The consequences of that are unknown at present although a lot of patients complain of multiple problems. The medical profession is burying its head about it but certain types of agent have now been banned in Europe and the FDA is moving toward accepting that they can have serious consequences. If you are offered a 'Trace MRI' ask if you can avoid it until further evidence comes to light.
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Old 3rd Apr 2018, 14:56
  #60 (permalink)  
 
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Some good info here . 100 % agree best biopsy for accuracy and no pain is Transperrenial. Assuming the MRI scan indicated the cancer is contained within the capsule , 7 + Gleason score , good overall health etc removal should be seriously considered .Bracotherapy means for practical purposes surgery is not an option in the future .
As far as Surgery is concerned Robotic is a no brainer . The best . However the Surgeon ideally needs to have done a minimum of 200 + operations / procedures .
From personal experience I had a 3 day stay in hospital after surgery in France . With a course of physiotherapy post op when the catheter came out after 8 days pissing near normal along with erectile function the same time ( Ciallis had been prescribed) . This is for info only and I am in no way medically qualified to give advice . Best of luck to all .
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