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Over Treatment of Prostate Cancer

Posted , 7 users are following.

Sailor_Sam
Sailor_Sam

I have just been copied in on a letter from the Consultant Urologist to my GP giving an update on the appointment I attended following an MRI.

it says:- "Mr "Sailor Sam" was reviewed today. He is a know case of prostate cancer on active surveillance. His PSA has been slowly creeping up suggesting that he is progressing on a biochemical level. In view of this , radical treatment was discussed but "Sailor Sam" is not keen on this for fear of side-effects. His preferance is to continue with active surveillance and therefore he will be seen in clinic in 3 months time"

Now on the letter it says Diagnosis:- Gleason 6 adenocarcinoma of the prostate diagnosed in 2012. Latest PSA 3.3

MRI Scan shows T2 N0 - prostate cancer in 43cc prostate gland.

Staging is small volume. A small low signal foucs at the junction of peripheral and transitional zones on the left lateral aspect at the base does show restricted diffusion and is likely to represent a small focus of prostate carcinoma. It is organ defined. No further focus suspicious for prostate carinoma. The seminal vesicles show normal appearance.

The MDT 17.9.15 concensus of opinion - OFFER RADICAL TREATMENT.

So what I would like to hear is what people think about this? My Psa resutls have been May 2013 2.4

                                Aug 2013 1.5

                                Mar 2014  1.7

                                Aug 2014 1.7

                                Jul  2015 3.2

                                Sep 201 3.3

I know there are some very knowledgable people on this site but am I missing something? Offering radical treatment to a 52 year old man with this history? Is that right? I am a Mental Health Nurse myselt and work as part of a Multi-Disciplinary Team which is why I am having trouble coming to terms with their conclusion. 

Could I ask for the MDT decision to be reviewed by a different MDT? would it make a difference?

Or are they the "experts" who arrive at this decision following a certain protocol. Not sure if there are any NICE guidelines for offering treatment for example.

I know I will need treatment and I recognise we are lucky that we live in a society that has a health service that can help us so much, but is this a case of over-treatment which I've come to hear more and more about?

Anyway I've rambled on enough. Would like to hear your thoughts about this and indeed what would you do armed with this information?

thanks for listening

Sailor Sam

1 like, 37 replies

37 Replies

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  • terryw
    terryw Sailor_Sam

    Posted

    Hi Leeniepie   I would just like to take up a point you made, about people without symptoms not having a biopsy.  You said "when cells are at grades below this the patient is usually asymptomatic, and so would not be having a biopsy."  I was picked up 6 years ago on a routine test as having a slightly raised PSA (4.6 at 66).  Since then I've had some further routine tests and over the last 3 years my PSA has been between 6 and 7.  In 6 years I have never had any symptoms, still don't have any.  So I presumably fall into your category of someone who would not be having a biopsy anyway.  But I have been referred to a NHS hospital in the past year, as a result of my PSA, and they were very keen to carry out a biopsy, though after researching the subject I declined it, because taking all my factors into account, I think I just have BPH or if I have a tumout it is slow growing.  It certainly seems unlikely to me that I could have an aggressive tumour and yet not have a single symptom in 6 years.  Yet when I saw a consultant he insisted that the fact I had no symptoms did not make any difference, and he was unhappy about my refusal to have a biopsy.  So it doesn't seem to be standard NHS practice to not carry out a biopsy where someone has no symptoms.

     

    • alfred5
      alfred5 terryw

      Posted

      Terryw my other half had no symptoms either. I have read of people on another forum with no symptoms and bone spread. So no symptoms definitely doesn't mean a biopsy is not needed. I have read of people with bone spread with a psa as low as 2. This is what prompted my other half to get treated. We have 3 young boys (youngest 6) and didn't want to risk it spreading. But I know the speed of psa rise plays a big part, called the doubling time. So if yours is staying at a similar number then that's a good sign.
    • leeniepie
      leeniepie terryw

      Posted

      I did not mean that you would not get a biopsy if you have no symptoms-as you have quite rightly stated there are other factors to consider ( such as PSA). What I meant was that Gleason 1 and 2 are not commonly seen in biopsies as they are very early stage, usually before the patient has got to the biopsy point.
  • terryw
    terryw Sailor_Sam

    Posted

    Hi Leeniepie and Alfred    Thanks for your responses.  I would hope the day might come when doctors can tell us with certainty exactly what is happening and will happen.  Sadly until then we are all just trying to make our way through the maze, and certainly our individual circumstances make a big difference.  If I was younger, married, or had a young family I'm sure I would take whatever treatment anyone suggested, regardless of the side effects, because staying alive would be top priority.  But at 71, divorced (though living in hope), still working (for myself) and living my life as I want, my top priority is to carry on doing what I'm doing for as long as I can - which I would not be able to do if I got into prostate treatment.  Having said that, if I had symptoms or there were other factors to suggest that I had a tumout requiring treatment of course I would feel I had to have it - but there aren't.

    This is Sam's thread, but I don't think I'm getting off track.  The problem right now is that we all have to decide for ourselves whether treatment is appropriate for us, taking into account our age and other personal circumstances, and the likelihood that we do or don't have a tumour that requires treatment - and according to research studies most don't.

     

    • alfred5
      alfred5 terryw

      Posted

      Hi Terryw. I just thought I'd say that my other half is a farmer, he timed his brachytherapy with a quietish time on the farm (after calving and before the hay making and harvest) but apart from a 48 hour period he continued to work throughout his treatment. He did 4 hours on the farming the morning of treatment, the same day we arrived at hospital about 1pm for his brachytherapy. I collected him at 11am the next morn. We paid someone to do the cattle work that day, but he still insisted on walking round the cattle in the afternoon and fed a few bales of silage. The next day he returned to work as normal. He had to mind he didn't lift anything very heavy for 5 days. But I am just saying that it doesn't necessarily upset your working life.

      He would have struggled having radiotherapy as it is 2 hours to the hospital, 2 hours home and I expect an hour there too. Which I think was for 6 weeks. So it would have meant very long days. But I'm sure we would have found a way. But you can can continue working. I know having the prostate removed would be very different and mean taking time off.

  • terryw
    terryw Sailor_Sam

    Posted

    Hi Alfred  Thanks for that info.   Much appreciated

     

    • alfred5
      alfred5 terryw

      Posted

      Mind you Terry had my other half been in his 70's he would not have had treatment, the consultant said at his staging if he was older it would have been just watch and wait. But at 57 we wanted it treated.
  • Sailor_Sam
    Sailor_Sam

    Posted

    So according to Cancer research Low risk is:-

    Localised prostate cancer is classified as low risk if

    Your PSA level is less than 10 ng per ml, and

    Your Gleason score is no higher than 6, and

    The T stage is between T1 and T2a

    So if I tick all these boxes why offer radical treatment? 

    Still think I must be mssing something. I will give my  link oncology nurse a ring tomorrow!

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