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.

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.

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

I think that's in Jet Blast and not in Medical. There's masses of good information in there.

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.

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.

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.

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

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.]

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 !

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).

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.

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.

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!

Gallows humour gets one through many tribulations!
May your fortitude continue!

Spot on....! (Pun intended for cavortingcheetah.....)

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.

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,.

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.

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

Radgirl, in actuality, I've only been to Canada once. The family travelling from CA got stuck in snow for 11 hours, while we arrived tired from southern Texas. It was all to show the g-children what snow was like.

There was none. Christmas, and not a flake. We drove for hours before seeing ski slopes with 'God, give us snow!' emblazoned on roadside billboards. Not a good sign. :rolleyes:

When we got back to the heat, it had snowed for the first time in 109 years.

My biopsy was done in a Texas Christian hospital by a lovely doctor that waived his fees for this beleaguered Brit. I paid for the lab work. I was over 60 when this all came about so could head back to the UK for treatment. I saw the specialist about 15 hours after landing.

My GP had recommended Watchful Waiting before being told the Gleeson. My wife did the research and wheeled my bewildered state into an interview with a nice specialist nurse in an Essex hospital. I was then driven to Southend to meet Mr Lodge, one of the (then) 4 UK specialists at the teaching hospital.

I got told not to be late for the actual procedure because of the aforementioned cost. Miss the time and they have to be thrown away.

Talking of which - I wasn't allowed to cuddle my grandchildren for a while, and I could not be incinerated for a year. Good job, as I wasn't dead. Radio iodine 125.

The upshot of all this was that I was back to my bouncy self just days later . . . fully functional and eyeing the Rivetess like a rejuvenated puppy. Which is possibly one of the reasons she moved 600 yards up the road.:* Life is so strange.

Brains:

I never quote my professor son as he takes his work very seriously and I might fuzz the details, but we do talk about brains now and then and a recent discussion lead me to a post on a cosmology forum today. Quantum entanglement in brains. I muse over the fact we have c 86 Billion neurons giving multi trillions of possible interconnections, and now it's postulated that there may be some 'action at a distance between the transmitter's electrons. This would up the anti by many orders of magnitude and leave us never being able to map conciousness. I had wondered if the synapse neuro-trasmiters might be encoded, but that wouldn't be in the same league as physically unconnected messages crossing the brain.

I wouldn't have given it a second thought if it hadn't been one of Sir Roger Penrose's hobby-horses some years ago.

https://www.theatlantic.com/science/...-brain/506768/

Anyone had any experience of the success rate of HDR Brachytherapy? 71 YO Dad diagnosed with Gleason 9/PSA 45/no symptoms 3 years ago. Locally advanced. Clear bone scan. Had HDR + external RT + injected Zoladex (course finished last September) Last PSA in October 0.02 but due for a follow up PSA next week. I know he’s quite anxious in case the cancer hasn’t been subdued.

Having reread the question I'm now assuming previous treatment of a temporary Brachytherapy. I'll leave my answer as it was just for general information but I don't know if one can have seeds after HDR temporary.

A few years ago I was on the acceptance borderline with a Gleason 7, made up of 4 - 3 (the worst way round) This may of course have changed.

I'm not sure what the effects of previous treatments may be.

It's worth noting, and again some years ago, after Brachytherapy the removal of the prostate is not possible, so decision making could be based on the reduced options left after previous treatment.
Gleason readings are notorious for causing stress and even morbidity in patients. So much so that stopping that routine test was considered in the UK for a while. Personally, I thought that to be foolish, but at 71, and contained, the slowing down of the growth-rate gives some comfort, especially when closely monitored. However, I'd want advanced scans, with an MRI at minimum.

I was lucky, I had an MRI for lower back prior to back surgery. The surgeon was aware of the previous problem but perhaps always looks for cancer in older prostate patients as the back is where it seems to go.

Many thanks for your reply Loose Rivets.

Dad was told at diagnosis that even if nothing was done, it wouldn’t be an issue for 5 - 8 years which seems strange seeing it was already ‘locally advanced’

Yes, it was temporary brachytherapy and at the time, the specialist was pretty confident that it had all been zapped but recommended the Zoladex for 2 years as belt and braces. Although dad says the nocturnal visits are much reduced, he still gets up a couple of times some nights so I think he’s concerned that there might still be a problem. I’ve read online that Brachytherapy in itself can cause some long term urinary issues which I hoped should reassure him.

Interesting to know also that at 71, the growth, if it’s still there, will be slower. I had no idea so many thanks.

Unfortunately I was diagnosed with prostate cancer shortly before Christmas after they investigated a mildly high PSA (~5). Urologist had a nice quote though - "many men die with prostate cancer, but not many die from prostate cancer". Depending on what they see, treatment can be anything from "keep an eye on it and see what happens" to complete removal of the prostate.
Biopsy sounds bad, but in reality wasn't a big deal - some stings and a sore bum for a few days. Worst part was blood in my 'bodily fluids' for some time after.
They caught mine early, which is fortunate because it's fairly aggressive (8 on a scale of 2-10), two different scans found no evidence it's spread. Treatment plan is hormones for a couple months (already started), focused beam radiation for 5 weeks, then implant of radioactive 'seeds' in the prostate after a couple week break from the external radiation, then a few more months of hormones.
Obviously not something I want to deal with, but the prognosis is very positive.

That really does sound a belt a braces attack on quite a low PSA. The Gleason? 8, if it is Gleason, is made up of two figures. I don't know why my 4+3 was much worse than a 3+4, but it was that, that made my GP change his mind about 'Watchful Waiting'.


The thing about disasters is finding the light side. When I went to Southend for the Volume Studies, I needed to be Picolaxed. If you haven't been Picolaxed you don't know what you've missed.

Lovely nurse looked at me after about an hour and said, Anything happening?

Nope.

Another hour. Anything yet?

Nope

After about three hours the negative answers bought questioning looks between the staff.

Four hours and I trotted off to the single loo in the 8 bed ward. I feared this moment as I'm a fussy git, and hate loos that are below royal standard.

It was immaculate. Even to my 20/20 vision it was spotless. However, there was an abundance of loo rolls that diverted attention from my by now hurried state. Lots of loo rolls. Piled on the window sill so that very little light could enter. Piled on the top of the cistern. In piles on the floor so that one could not help kicking them asunder. Seated, one did not need armrests as one's elbows were supported by loo rolls. Somehow in this strange moment, I found this funny. Very, very funny.

There's something unique in the human psyche that lets humour soften the brickbats. Being helpless with laughter while Picolaxed is something that is beyond the sternest tests of self control, though it has to be said that one augmented the efficacy of the other. :ooh:

Yep, that is the Gleason - 4+4. I think the PSA was only used to 'get their attention' - and one reason why they think they caught it early. it was the biopsy that got the urologist's attention, along with the 8 on the Gleason - I'm reasonably sure is the reason for the relatively aggressive course of treatment. Other good news - and further evidence that it was caught early - was that he took 16 biopsy samples but only one came up positive.
At least for now, I'm more concerned about potential side effects than I am about a 'failure to cure' the cancer. The hormone treatment is already annoying - given the lack of energy and how suddenly easy it is for me to gain weight it must really suck to be female :uhoh:

Yes, I did not like the sound of the hormone treatment. I opted for just one Brachytherapy and almost literally left it at that. Just sent in the PSA's and got letters to say how delighted he was with the readings. My reading of the man who saved my life was that he never got delighted about anything, but it takes all sorts.

My burden is 'bowel hurry'. I think that's a name he made up. 1 in 500 cases he mentioned casually. Back then that would have made two of us. Tedious, it just sends signals telling me I need to find a loo a bit sharpish. All perfectly normal except for the timing of these rather demanding signals. When I was flying as SLF to Texas fairly regularly, I'd resort to the dreaded Picolax 36 hours before departure. Days, if not weeks, go by perfectly normally but I'm always mindful of loo planning which is a kind of flight planning in reverse.

Having said all this, I'm not totally sure there's not an allergic reaction issue involved since I suspect gluten/wheat of being the main cause of back pain for many years. That's pretty solid science now and the back surgeon agreed. It would take molecular levels of ?? to cause a reaction. So glad all this didn't happen when I was young.

In Australia there is an online national database of public toilets, accessible via the National Public Toilet Map website or by various smart phone apps.

Obviously this isn't terribly helpful in Texas, but I wonder if there isn't anything similar? (It is probably rather "socialist" to Texan sensibilities, but there are some things that governments can do better than anyone else!)

Well, I'm back in Essex now, and planning my midday trog takes in the wondrous new building that sits upon our Naze cliffs - a monument to lottery money that is quite simplistic in its mandate: you go into a large building with grass on its roof, that cost into seven figures, and take a deep breath. Then you look out of the windows at Walton's Naze. Something you could do before you went in. :bored:

However, having sprinted up the 72' of steps from the beach, I know, that at the top, I will have a posh new loo on my list of diversions.

Sometimes, I like humans.

mr rivets, check your pm

gs

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.

TURP vs. Other Treatments
 

Dear BoeingBoy,

I am not a physician so I am unprepared to give you professional medical advice. I have plenty of hospital experience, however, having worked as specialized technician at Crawford Long Hospital, the teaching facility of Emory University in Atlanta, Georgia, U.S.A. The oncology wing housed a number of Delta pilots who had undergone a full prostatic resection (some via TURP, others via abdominal incision), so I don't believe your exposure background radiation would preclude further targeted radiotherapy, pre- or post-surgically. As an aside, one wonders if your vocational dose levels may have been contributory to CA's development.

Funny that you mentioned "John Wayne Walking" and the human perineum. Should you need a laugh, check out my post to Fliegenmong in the thread called "A Delicate One". It's in this Forum.

I know I share the hopes of many other PPRuNers: we wish you a complete and painless cure and recovery! :ok:

- Ed :)

Thanks Cavuman.

I too wondered if after 26.5K hours my radiation was catching up with me. In one way I am glad that it is PCa that I'm dealing with rather than something more aggressive. There's always something to be positive about.

My GP says, at 73 I need a PSA test only once each year, I would have thought once every six months would be better. How do others feel on this thanks, all test results so far have been normal?

Nothing to stop you asking for a full blood MOT on an annual basis followed by PSA every six months if that is what you want for peace of mind.

I know that whatever route I follow I will be making a pest of myself at the GP's keeping up with the tests, along with the bowel cancer screening program too.

But then being a pest is something I'm rather well known for........ :ok:

BoeingBoy
 

I have just been through which I believe you might be starting,also it sounds like we have had the same career,might even know you. How do we get in touch.

I had Brachytherapy at age 56, almost 16 years ago.
My PSA was elevated and my Gleason was getting to a worrisome level, my Urologist wanted to cut everything out initially, but I got a second opinion and after waiting about 3 months for the Brachytherapy (and my PSA rising) I had the Brachy.
I have had no problems ever since, and my PSA's are at the margin of detectability.
Lots of luck.
f

Thanks everyone. I am glad to add that my bone scan has been returned as clear and I am staged at T1C which is better than I'd hoped for.

Met the surgeon yesterday to discuss that route but will be meeting the oncologist next week who I suspect will get my custom.

BUS1TER I have PM'd you.

Prostate cancer killed a friend of mine in about three months. As I'm over 60 and so many reports of it have been in the news, I've finally booked a exam next week. My fear of cancer is greater than that of a doctors finger up my ass!