Graeme
Wilson and Helen live in Queensland, Australia. Graeme was 66 when he was diagnosed
on 8 December 2004. His initial PSA was 6.1 ng/ml and his initial Gleason
Score was 3+3=6. He was staged T1c and his choice of treatment was Brachytherapy.
Here is his story:
In April 2004 I had a routine finger check and the GP considered the prostate
was enlarged. The PSA check showed 6.3 ng/ml, up from 3.3 ng/ml in 2002. The GP
recommended another PSA check in July which showed 5.7 ng/ml. He then referred
me to a urologist with a PSA check to be available when I succeeded in getting
an appointment.
Other
circumstances resulted in the appointment being in November 2004. The third PSA
reading was 6.1 ng/ml. The urologist recommended a biopsy be carried out. This
was done in day surgery on 8 December 2004 and 4 of the 8 biopsies showed cancer
cells. The urologist explained to me the options, these are my words not his:
surgery, external radiotherapy and internal radiotherapy. He explained the surgical
removal of the prostate to me in detail and recommended surgery as currently being
the most effective way of removing the cancer from my body, given the incomplete
statistics of other treatments. However, he also gave me a referral to a Radiation
Oncologist.
I wanted to know more about the internal radiotherapy, brachytherapy,
and saw the Radiation Oncologist on 14 January 2005. I found his explanation clear
and logical and told him I would go ahead with brachytherapy. Scans of the abdomen/pelvis
plus a bone scan were carried out the following day. These results were forwarded
to the oncologist and his urologist colleague whom I saw on 31 January 2005. The
scans had no anomalies and the urologist told me that at my age, 66, and my current
general health, good, I am an ideal candidate for brachytherapy. He ordered a
cystoscopy and volume check which was carried out in day surgery on 8 February
2005. This was my first experience of the intense "need to go" when I got out
of bed to get dressed and go home. I am not looking forward to that occurring
after the brachytherapy treatment! My volume is 26cc. Brachytherapy is scheduled
for 23 March 2005.
I had not experienced any symptons of faults with
the waterworks and as a consequence the advice that I had cancer was hard to take.
I do not think I was too easy to live with for the first few days after THAT news.
I did some research on the net and read literature on Prostate Cancer and ended
up feeling more depressed. Because I could not find as many positive comments
on the success of brachytherapy as I was hoping, for I decided to opt for surgery.
I knew the urologist was away on Christmas holidays however, I thought someone
would be in the office. There was no answer on three separate occasions over three
days.
I
then rang the oncologist's office to advise them I was cancelling the appointment
made for 14 January. When asked why I was cancelling I told the person that I
thought it would be the most effective way to remove the cancer. He quietly spoke
to me about brachytherapy and the improvements made in the technique over the
years and his confidence prompted me not to cancel the appointment. As I said
above the oncologist also convinced me of the value of brachytherapy and now that
I have made up my mind I am very pleased no one answered that telephone in the
urologist's office. I hope how I feel at the end of March will still be as positive...
The
following covers the lead up to, the brachytherapy seed implant procedure on 23
March, and the 6 days post procedure.
The
message in information supplied on brachytherapy, that a consistent intake of
fluids was necessary, reinforced personal observation of others with bladder problems.
To achieve that end, on 21 March I filled up a 2 litre jug with water with the
aim to drink the contents prior to going to bed in the evening. This is in addition
to any other fluids I may consume during the day. My intention is to continue
with this routine for the coming months. I have not found any difficulty in emptying
the jug each day. I also commenced my daily Flowmax capsule. In the past I have
been able to sleep through most nights without a trip to the toilet. Since 21
March I have been making 2 visits each night. A small price to pay if "flushing"
is essential to recovery.
I
entered hospital at 06:30 on 23 March and after covering pre-op requirements I
was in the theatre at 07:30. As an aside I mention here that I underwent laproscopic
surgery on 8 March for a unguinal hernia on my right side. I had some pain in
the lower groin area and in my right testicle and requested the urologist and
oncologist take it easy in that area. They assured me all would be OK. By the
the time I thought of a response to the anesthetist telling me I will feel a little
prick in my arm and a slight flush it was 11:30 and I was in the post-op recovery
ward.
I
felt terrific, seemingly wide awake and alert. There was a drip in my left arm
and a catheter had been inserted. I felt a need to pass water and when being checked
for blood pressure etc., I asked if I could pass water through the catheter. Sure
no worries. Communication break-down. When I tried to pass water it flowed around
the catheter not through it. I ended up with my hospital style backless gown being
wet. No sweat, after a quick gown change I was transferred to the regular ward.
When
I was wheeled into a single room in the ward I thought I was being well treated
however, the radioactivity icon, staff only, and contact the desk signs on the
door made me wonder if the low dose seeds were low enough? I was advised that
I was to have bed rest for the day. With the catheter now working OK, no food
or liquids for the previous 12 hours, plus an enema prior to the implants I was
able to lie comfortably to read and watch TV. Lunch was enjoyable and the cold
water supply was endless. I was also pleased to note that the bag from the catheter
had no discolouration from possible bleeding. A course of anti-biotics was commenced
prior to the evening meal followed by a Flowmax after the meal.
The
radiation oncologist paid me a visit in the evening and told me all went well.
My prostate volume was 30 cc and 59 seeds were implanted. I will visit him in
4 weeks and the urologist in 12 weeks. He told me to ask for pain relief when
necessary. Although I did not have any pain that I can link to the seed implants
the area between the scrotum and the rectum is sore to touch, as is the rectum
after a bowel movement. The ache from the hernia surgery was still with me so
I asked for relief before sleeping.
The
catheter was removed at 06:00. I was advised that I could leave hospital after
I had, twice, passed water successfully. I continued my water intake and had no
problem with flow, control and content three times before my discharge. Checks
of my bladder contents, using an ultrasound device showed residual amounts of
19 to 22 ml. Apparently a normal amount. At no time did I have difficulty in passing
urine. There has been no pain, no restriction of the flow and I am able to operate
the control valve to my satisfaction. I was picked up at 12:45 feeling greatly
relieved the procedure was over and I was not suffering any after effects.
During
the 6 days since the implants I have been busy with family activities. I have
not picked up the grand-children nor nursed them. However, that is because I am
following the post implant written advice. I have continued with a daily Flowmax
capsule and drinking 2 litres of water each day plus other fluids associated with
meals. Daytime toilet stops are 4 to 5 and sleeptime 2.
After
reading all the possible problems that can arise from brachytherapy seed implants
I expected much discomfort and possible pain. I have neither. I did not ask if
the radioactivity takes time to develop, which could mean swelling of the prostate
may still occur resulting in flow and control problems. I had a nocturnal erection
last night :) and am optimistic that all will continue to go well.
Am
I a supporter of low dose brachytherapy? You bet I am!!! .
It
is now 3 months since my brachytherapy/seed implants and I am pleased with my
progress.
I
am still experiencing the"urgent" need to "take a leak" however, I have learned
to control the urge until I am aware that it is the real thing ie. time to pass
water. Obviously, if I have visited a toilet in the past hour I know the "urgent"
feel triggered by the sound of running water can be controlled. I have also noticed
that I now have more flatulence than before the brachytherapy. Passing water also
triggers the flatulence and an urge for a bowel movement. This feeling also requires
control. It makes me feel like a dog checking out each electricity pole and cocking
its leg to deposit a couple of drops. Hence the need to keep control over both
the bladder and the bowel.
The
radiation oncologist told me, prior to the treatment, that after the implants
passing water can feel like passing razor blades. Some of the written information
stated that a burning sensation can be experienced during urine and bowel movements.
Both of the above possibilities did not impress me, particularly as the feelings
can last until the radioactivity is nearly exhausted. I am pleased to report that
I have never passed razor blades. I assumed the "burning" sensation would be similar
to the experiences I have had after either eating a hot curry or a hot chilli
meal. Once again I am pleased to report I have not experienced any burning sensation.
However, the sensation experienced when the urine commences to flow is difficult
to describe. In my mind I liken it to the first couple of seconds of an ejaculation,
without the pleasure. If this sensation is a bad as the effects of the brachytherapy
treatment gets I am not complaining, just thankful.
I
have found that I have limited control over the force of the urine flow. In effect,
I feel as though I just have to let gravity do the work. This can be somewhat
embarrassing standing at a urinal in a public toilet when a person come to the
urinal beside you, after you have started, and leaves before you have finished!!
My urologist said not to try and force the flow.
I
am still trying to drink plenty of water to keep the system flushed however, I
do not achieve my aim of 2 litres every day. I try to keep the urine clear to
significantly reduce the acid level. I have been taking Flomax capsules 2 days
prior to and since the treatment. When the first box of 30 finished I thought
I would try and see if I could do without them. Wrong!! The next 2 nights I was
at the toilet 4 times as against the usual once or twice. I also felt uncomfortable
during the day so after 2 days I renewed the prescription and have continued to
take 1 capsule each day since then. I have now had approximately 65% of my radioactive
dose so I assume I will need to take Flowmax until the dosage reaches 80+%.
Erections
are much the same as before the treatment.I am thankful for scientific progress
in that field.
I
visit the urologist in July and will have a PSA blood test prior to that visit.
He will also check my flow rate. I am hopeful that the PSA reading will show a
drop.
I
remain very positive about brachytherapy as a treatment for prostate cancer and
pass the word to whomever is interested to listen.
| UPDATED |
15
September 2005 |
I
am approaching 6 months since undergoing brachytherapy/seed implants. I am still
very pleased with the minimal effect of the brachytherapy treatment on my general
well being. I recently attended a seminar where the participants were of a similar
age as myself. Fifteen minutes into the seminar and men commenced taking a trip
to the toilet. I was able to sit through the 90 minutes without the need for such
a visit. I did wonder about the health of the other male attendees, and felt very
pleased with the apparent effectiveness of my treatment.
I
continue to take a daily Flomax capsule which appears to assist in bladder control.
However, I am concerned about the possibility of Flomax being addictive. Will
my body revert back to "normal" once the radioactivity drops to a lower level
and I cease taking the daily capsule? What is that level? Is it achieved after
receiving 90%, or greater, of the dosage?
I
assume my next visit to the oncologist should resolve those queries. The PSA reading
from the blood sample taken in July was 1.6 ng/ml. That is a drop from 6.1 ng/ml.
When the blood sample was taken my prostate would have received approximately
70% of the radioactive dose. My urine flow rate and volume was in the "good" field.
From
my perspective the lower PSA figure confirms that the treatment is working. My
next visit to the radiation oncologist is in November. I hope blood sample taken
for that PSA reading will show an even lower figure, but I expect the reduction
will not be as dramatic.
I
continue to be an enthusiastic supporter of the brachytherapy/seed implant treatment.
I
have had 2 blood tests since my last update in September.
A
test in November produced a reading of 0.50 ng/ml which made me very happy. During
a November visit my oncologist told me any figure under 1.00 ng/ml was good. At
that time I was not completely happy with my bladder control and so I continued
to take one Flomax each day.
By
the end of December I stopped the daily Flomax and my bladder content/control
seemed to be close to what I remember as "normal". Particularly the ability to
sleep all night with only one visit to the toilet. Currently I can sleep through
most nights without waking.
A
follow-up visit to my urologist was scheduled for 7 March and a blood test was
carried out in the last week of February. That reading is also 0.50 ng/ml and
I am still smiling. The urologist does not want to see me until March 2007. He
has ordered a blood test for September and told me to check with my GP for the
result. He told me there is no requirement for another follow-up visit to the
oncologist.
Now
that my brachytherapy seeds are approaching the end of their effectiveness I asked
him about the possibility of a PSA "bounce". He advised me it is possible but
even if my reading does bounce up it should flatten out.
Twelve
months has made a huge difference in my state of mind. I feel very fortunate that
brachytherapy has worked so very well for me.
I
had a 6 month PSA check carried out in September 2006 and my reading was 0.6 ng/ml.
That was a rise of 0.1 ng/ml from the March reading and did not worry me. The
next PSA check was carried out in February 2007 prior to my follow-up visit to
the urologist in March. He advised me the reading was 1.9 ng/ml. That startled
me a little as it was a jump of 1.3 ng/ml in only just over 5 months.
The
urologist was happy enough with the result and told me a bounce can occur between
1 and 4 years after treatment. My bounce is roughly in the middle, on 2 years.
He went on to tell me he expected the reading to subside over the next 2 years
and then flatten out. A flow check was also completed and my rate and quantity
was within the expected range. He scheduled the next PSA check for August 2007,
when my GP can tell me the reading, and his next visit March 2008.
My
overall health is good and I am happy with my waterworks. I can sleep through
most nights without getting up to go to the toilet. Except for a build up of gas,
if I go for a long period between passing water, to the best of my recollection
I am back to where I was before my treatment.
I
am still a supporter of brachytherapy.
My
PSA reading in August 2007 dropped down from 1.9 to 0.2. Naturally I was very
pleased to hear that from my general practitioner. A new PSA reading was taken
in April 2008 prior to my visit to my urologist where he confirmed the figure
remained at 0.2.
After
the "finger" check he told me the prostate felt as he expected it would as a result
of the "seeding" from the brachytherapy treatment. I was advised that he did not
want to see me again. However, he recommended continuing with the 6 monthly check
of the PSA through my GP. If the reading ever reached 2.0 I should return to him
and he would re-examine my situation to assess any future treatment.
As
you can imagine I have been smiling ever since!! I feel very fortunate that my
initial situation allowed me to be a candidate for brachytherapy. In addition,
I also feel very fortunate that the brachytherapy treatment was very easy on my
body.
Graeme's
e-mail address is: donut55@bigpond.net.au
