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David Price and Clare live in Leeds, United Kingdom. He was 56 when he was diagnosed on 30 June, 2009. His initial PSA was 4.1 ng/ml, his Gleason Score was 3+4 = 7 and he was staged T2c. He is undecided as to his choice of treatment. Here is his story.

I've had a PSA of around 3.7. for the past 3 years, rising over the past 12 months to 4.1. After a routine DRE (Digital Rectal Examination) a nodule was felt (later deemed benign). Biopsy showed 8 out of 12 samples with cancer (average of 13% volume).
Cancer found in both lobes, but, because of Gleason, it's been deemed low-to-moderately aggressive.

Only one tumour was visible on the MRI and no spread to nodes or seminal vesicles, so completely contained (as far as MRIs can be trusted!). Cancer couldn't be felt, but biopsy shows it in both lobes, so I guess that explains the T2c staging.

I'm now going to weigh up the pros and cons of the treatment options available to me, do more research, and take my time coming to a decision.

I feel as though the worst part (at least of this phase of the journey) is now over. Not knowing is definitely the worst, and we can get on with our lives again!

 

UPDATED

September 2009

 

 

In response to a reminder to let us know what he was doing, David replied:

I'll be talking to Leeds about Brachytherapy this week, and having HIFU snazzy MRI next week - so there'll be more to tell. But there's loads more on the blog!

 

UPDATED

October 2009

 

 

Had MRI scan at UCLH in London. Report shows 'large volume' of tumour on left gland, with some cancer on right side too.Possible microscopic escape on left, so I now have a 'possible' staging of T3a (I don't know how reliable a 'possible' staging is....) Still no seminal vesicle involvement, but with possible escape they say I should have bone scan.

I was told today that I'm still a candidate for HIFU, but for whole gland treatment. This is a bit of a blow, as the impotence rates - which are very good for hemi-ablation or index lesion, aren't quite so good for full gland. It also may mean that I may not qualify for the clinical trial.

I have meetings next week and a template mapping procedure due at the end of November.

 

UPDATED

January 2010

 

 

Well, my decision (6 months after initial diagnosis) has been made. My first choice (HIFU) was discarded after a frank and productive consultation with Mark Emberton at UCLH in London. I'm glad I initially pursued UCLH for treatment, not least because their high-def MRI showed a much sharper picture than my initial scan. (Why we continue to scan after a biopsy is beyond me, but there is now government support to trial pre-biopsy MRIs.)

It was clear that the location of the largest tumour (close to the sphincter) makes the risk of side effects with full-gland HIFU, no better than radiation.

My hometown oncology centre, (in Leeds) is about to follow the Canadian model of single-dose HDR (High Dosage Radiation Therapy), followed by IMRT (Intensity Modulated Radiation Therapy) 'lite'. My oncologist (Dr Bottomley) recommended this to 'mop up' any possible extra-capsular spread (MRI showed possibility of microscopic escape). This consists of 15 low dose beams about 2-3 weeks after the initial HDR treatment. I'm currently on low-dose Casodex, prescribed as both a holding-mechanism (my tumour is close to the capsule edge) and to shrink the tumour pre-treatment. I'm not experiencing any side-effects other than sore and lumpy nipples (I'm told both are not uncommon).

I feel happy with my choice. I realise that there have been risks with waiting 8 months between diagnosis and treatment, but there are (in my opinion) bigger risks in rushing into an inappropriate treatment choice.

I will update after treatment. In the meantime, I keep a PCa blog, if anyone is interested in my story.

 

UPDATED

March 2010

 

 

March 2010 I'm a few days away from the second leg of my 'triple threat' treatment.

I've been on Casodex for the past 3 months. During this period my PSA has dropped from 3.7 to 0.85. I can't say I like it though. I've had breast enlargement and tenderness and noticed my skin has been very sensitive. But it's a small price to pay. I could've taken Tamoxifen for the breast tenderness, but my specialist advised against it.

After the HDR Brachytherapy, I have 2 weeks break, and then I'm due for 15 EBRT sessions, with probably 3 months more of Casodex.

I'll update after Brachy.

 

UPDATED

April 2010

 

 

I'm now one week on from a single High Dose Radiation Brachytherapy treatment at St James, Leeds, performed by Dr David Bottomley. This has come after 3 months of Casodex which has seen my PSA fall from 3.7 to its current 0.85.

In one week I will start a course of 15 EBRT sessions, to be followed by a further 2-3 months of Casodex, and then I'll be free! I have had quite bad breast enlargement and tenderness but no other symptoms from the hormones. I can live with the tenderness.

My brachy treatment was uneventful (apart from violent up-chucking as a result of the anesthetic). I have currently some rectal irritation, but I had hemorrhoids before the treatment, so this is to be expected. I will update further once my EBRT sessions are underway.

David's e-mail address is: pricedav@gmail.com