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Prostate cancer

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Old 30th Nov 2017, 19:49
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Prostate cancer

So all,

My brother in law just had his PSA results back; 55 (yes, i did not skip a ", " or a "." .

Of course he is "in the system" with all kinds of researches and looking into possible treatment. (they are still investigating if the cancer has spread over the rest of his body/organs).

Any one of you have ever heard/experienced of this high value of PSA and what to expect?
I know there are some medical experts reading PPRuNe, maybe they can point me to some new treatments or any info.

This case is in (western) Europe.

Any info is welcome (also via p.m.)

Thanks for any help.
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Old 30th Nov 2017, 22:20
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I stand ready to be corrected on this because my medical knowledge is mediocre, gained by experience at the sharp end.
I wouldn't get too wound up about the PSA number. As you know, the important thing is going to be whether there's been a metastasis form the prostatic capsule.
I should have thought that his urologist would do CT scan of the prostate, a lung X ray and a nuclear bone scan,
His urologist might well take a biopsy sample, perhaps a transperineal or targeted biopsy rather than the cruder anal biopsy. This will produce the well known Gleason score.
All of these results will be put into the melting pot and a determination as to treatment will be made depending on the likelihood or actually determinable escape of not of cancer cells from the prostatic capsule.
Good luck to your brother in law. It's all a most terrifying journey he's embarking on.
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Old 2nd Dec 2017, 21:22
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There is an existing thread "Bugger I´ve Got Cancer" which contains much information from people in various stages of diagnosis and treatment of various different forms of cáncer including Prostate.
Best wishes to your BiL
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Old 2nd Dec 2017, 21:35
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I think that's in Jet Blast and not in Medical. There's masses of good information in there.
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Old 7th Dec 2017, 17:35
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There is a urologist on here who may be able to give exacting advice (?obsgraham)

Difficult to go off just an isolated reading. They can be sometimes raised after examination of the prostate, or sometimes in a UTI.

Such a raised level shouldn't be ignored however.
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Old 7th Dec 2017, 19:34
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Wrong gender, gingernut -- none of my patients even had a prostate!
Sounds to me like the person under consideration has access to good quality care. We all wish him well.
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Old 11th Dec 2017, 19:08
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Apologies Obgraham.

I take it you are the guy/lass who can paper the hall and stairs through the letter box :-)

Back to the OP, the result needs following up.
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Old 17th Dec 2017, 15:35
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I am a bit late into this thread but being a subject close to my own heart, here's the CAA's protocol on the subject.

Basically, once on the road to recovery from radical treatment the prospect of returning to flying is good.

CAA Prostate Cancer protocol
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Old 12th Jan 2018, 12:53
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High-Intensity Focused Ultrasound

High-Intensity Focused Ultrasound (HIFU) gets mixed reviews as to its effectiveness. We don't hear all that much about it here in the USA but a local urology practice is mentioning it in their literature.

As usual, Google offers a confusing variety of opinions, professional and otherwise.

Anyone have experience with it ? Radgirl ?

[No, I don't need it but know a growing number of men who have to make treatment choices, from a bewildering menu, upon diagnosis. And at my age, every PSA is another potential chance to join them.]
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Old 12th Jan 2018, 14:34
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HIFU is being used in a number of centres in the UK and those I know of involve excellent mainstream urologists. It consists of placing a probe in the rectum and using a guidance system from a previous MRI to direct the beam. Takes 40 to 120 minutes, normally under anaesthesia. They used to catheterise patients for a few days, but this is now less common and patient goes home 30 minutes later.

The great benefit is the non invasive nature of the treatment compared to radical prostatectomy. There have been a couple of papers suggesting this is a good option for some patients. Hashim Ahmed at Imperial Hospital London reported 172 day case procedures noting low complication rates and good results as follows:

0.7% of patients had incontinence (requiring pads), 30% erectile dysfunction and none developed a rectourethral fistula or bowel dysfunction. Overall, there was no evidence of disease in 92.4% after one HIFU session, at a mean follow-up of 12 months. Focal therapy using HIFU might offer the greatest potential in reducing morbidity further

My understanding is that the machines were nor FDA approved and so could not be used in the US - they were bringing US patients to the UK for HIFU not long ago.

The issue seems to be that the treatment recommended depends to a degree on the interests of the individual urologist - some urologists only do robotic prostatectomy, others only do HIFU. The advice must be early diagnosis with MRI and template biopsy followed by cross examination of your urologist as to the risks and benefits of the various treatments, but if my tumour were suitable I would prefer HIFU to surgery or brachytherapy, if I had a prostate !
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Old 12th Jan 2018, 15:56
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Radgirl,

Thanks for the info. They must have some machine they can now use in the US cuz our local urology practice is advertising they use HIFU but only mention one doc in the group who does it.

Considering how noninvasive it is, it likely couldn't hurt to use that as an opening treatment and see how it goes ? You can always ramp up from there if it doesn't ?

It's the biopsy process that would keep me up at night. Here they use some sort of mild oral medication to fuzz you out a bit vs a colonoscopy-level "knock-out".

A friend had three rounds of biopsy as they kept getting only questionable cells. Three biopsies...86 snips !! That's like pullin' yer brain outta yer nose !

Hit pay dirt on round 3 so he had a long series of conventional radiation and, for now, is fine.

Makes a 70 y/o guy start looking over his shoulder to be sure the Fickle Finger of Fate isn't catching up with him (punt intended).
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Old 12th Jan 2018, 16:35
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It is now six weeks since the original post. Even in a slow old world there should be some update. It is not particularly kind to speculate based upon a six week old blood test, even if one might be a patient surgeon.
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Old 12th Jan 2018, 16:35
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Thanks for the update Bafanguy - it was only a question of time before the FDA approved one of the devices

The template biopsy involves a navigation system to target the biopsies from the imaging obtained at MRI. It is a large number of large needles and it is essential the patient is completely still

In the UK this is done under a GA not the IV sedation used for colonoscopy and certainly not oral tranquillisers. The US has historically done quite horrendous procedures awake, in part due to a lack of anesthesiologists but also because Americans had a real fear of anesthesia having been told the army staff sergeants who administered the newly introduced pentothal on US casualties at Pearl Harbor killed more GIs than the Japanese.

However that was yesterday. Today I would tell anyone having this procedure to have a general anaesthetic both for their own comfort and for accuracy. No ifs. No buts.
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Old 13th Jan 2018, 02:58
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Originally Posted by cavortingcheetah View Post
I think that's in Jet Blast and not in Medical. There's masses of good information in there.
Or, you might say, ‘theres good information on masses in there....’!

As a 3 year pancreatic cancer survivor then I guess that I am entitled to joke about it!
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Old 13th Jan 2018, 11:43
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Gallows humour gets one through many tribulations!
May your fortitude continue!
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Old 14th Jan 2018, 02:21
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Spot on....! (Pun intended for cavortingcheetah.....)
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Old 14th Jan 2018, 10:05
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Be positive!

A sense of humour certainly does help and I was fortunate to get the all clear from a biopsy.

I found my GP and the urologists, with one exception, very positive and reassuring.
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Old 14th Jan 2018, 18:19
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I thought Canada was big on HIFU, but my encounter with Prostate cancer was at least 8 years ago.

I got a Gleeson 4 + 3, the worst way around and was on the borderline for Brachytherepy. But just scrapped in.

The biopsy was 12 stings, the only anaesthetic being local via the same route.

They said it was like being stung by an elastic band. And that was about it.

The "Volume studies" needed a general, as did the insertion of the seeds. (made in Canada.) I had no real after-care. Isn't that strange? Just let them know the PSA a couple of time.

Bad things. I did get some tendancy towards 'Bowl hurry.' All normal, except I don't get very long warning times. Long flights and I zap myself with Piccolax and time it so I've stopped pooing by the time I'm on the aircraft.

Brachytherapy is big down under I'm told. In NZ, anyway.

Radgirl.

I'm very concerned about the use of anaesthetic. Given people don't seem to know exactly how it works, I wonder where the boardline is between people of my age who should not have it if possible, and folk that are going to be unaffected. I had a long briefing from my son about new drugs and the way they work, and the way they affect the synapses. Quite astonishing what they're learning now, but I just have a niggling doubt we get away with things Scott free.

An interesting subject.

In haste.

Oh, just a mention about my viewpoint (no pun) I had back of the eye surgery with local, also two carpal tunnel ops. I was allowed to look into my hand,.
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Old 14th Jan 2018, 20:50
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Thanks Loose Rivets

They make you tough in Canada! I take my hat off to you. Suffice it to say that I have heard from many men how painful it was. We can anaesthetise the eye with various local anaesthetic blocks so we rarely give a general anaesthetic, and limb blocks do the same for the hand, but in the case of this biopsy it is usually just infiltration and not as effective

You are absolutely right that we have been ignorant about how anaesthetics work, but we are now learning fast. However the general anaesthetic you would receive for this is very very safe and the expected outcome is no effect of more than a few hours. I really dont want people to go through distressing and painful procedures out of a fear of longlasting affects that dont exist for most cases. And 78 is not old nowadays. We dont stop people having anaesthetics on the basis of age.

Brachytherapy is another treatment as is Cyberknife. Radiotherapy does have side effects. That is why it is important to ask which treatment can be used, the risks and the benefits.
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Old 14th Jan 2018, 21:47
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Here's a little light hearted reading on brachytherapy. It's quite popular in South Africa although you'd need to make sure that the man who does it knows what he's doing. A radiation damaged bowel is a possible consequence of a less experienced surgeon and that can lead to permanent anal leakage.
I would draw the attention of those considering this treatment to the tests that are commonly carried out down there before embarking on this course of action.
I wonder if they are standard practice everywhere?
It is, of course, a relatively expensive treatment, radio active pellets are not cheap and have to be transported too.


Brachytherapy - I have cancer now what?


Here is a little blurb from a brachytherāpic patient. Peter Harden practises at the Donald Gordon Hospital, a teaching hospital, while Van Niekerk practises at the Sunninghill.

https://sites.google.com/site/ianbra.../home/my-story

A little digression used as a means of bringing an excellent surgeon's name to the attention of anyone who is interested.

https://www.netcare.co.za/News-Hub/A...arged-prostate

Last edited by cavortingcheetah; 14th Jan 2018 at 22:08.
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