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Return of PC after brachytherapy

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helen33824
helen33824

10 yrs ago my husband had brachytherapy at age 57, since when PSA gradually began to creep up again and last year jumped to 7.5.  PET scan & biopsy confirmed aggressive cancer in prostate & SVs (Gleason 9), probably due to cancer cells being missed in brachytherapy. 

Prostatectomy & further brachytherapy ruled out by oncologist, who said only option is containment for as long as poss by HT (Prostap).  PSA first reduced to 0.4 but now risen to 2.6.  In absence of pain and peeing problems, doctor seemed unconcerned, mentioned ‘PSA bounce’ & changed parameters in path lab (whatever they are!).  Further review in 3 mths.  Obviously not the result we were hoping for.  With all the other treatments mentioned on this forum, we don’t know why he said HT was only option. 

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  • n-mac
    n-mac helen33824

    Posted

    Maybe take a good look into High Intensity Focused Ultrasound (HIFU) as a way to ablate the re-emerge cancer.  IMO, Memorial Sloan Kettering  (MSKCC) or MD Anderson are the best centers to be evuated for, and explore other leading edge options.  Also, you may want to look into clinical studies that involve various immune system enabling treatments.  Both institutions have excellent websites with information on all of the above.

    Best wishes, thoughts, and prayers.

  • miss_sue
    miss_sue helen33824

    Posted

    Helen

    I am so very sorry to hear the Gleason score of 9 . After things like radiation or in his case the bracytherapie it may not be possible to do a prostectomy or radiation. But treatments are all in how one person treats the cancer. I hope you have access to a medical oncologist . Also if you can seek a second opinion .There are stronger drugs like zitiga or Xtandi . I think the prostvac or other immune therapies work better at the start of prostate cancer but ask about them . 💙💙💙

  • aksns61
    aksns61 helen33824

    Posted

    I can only  assume that HT means Hormone therapies, but you did not identify which product or for duration. Its common, ( In the US) that failed BT leads to many options, depending, of course, to the health and particular findings. Perhaps a second opinion would help provide a clear path for you- at the very least giving you some clear choices. If you have access to the internet, please  look at the NCCN guidelines ( 2015, V3) for recommendations for therapies when a failure has occured.
  • jerald1234
    jerald1234 helen33824

    Posted

    Hi,

    Did you ask why salvage prostatectomy is ruled out? You mentioned HT to keep contained, is it contained now or has it metastasized? Where do you live?

    Best,

    G

  • aksns61
    aksns61 helen33824

    Posted

    Hi Again-

    Please see this online publication.

    Harvard Medical School, harvardprostateknowledge.org has an excellent publication called "Harmone Therapy for Prostate Cancer" and it provides excellent information about using ADT when previous therapies have failed.

    Best of Luck

    Alan

     

  • helen33824
    helen33824

    Posted

    Thanks to everyone for your advice and sympathy.  Forgot to say we’re in G.B.  I have to say that what my husband’s been told so far isn’t reassuring.  The oncologist explained that an operation wasn’t possible as some of the cells could be missed and start to spread (at this point he actually shrugged and said that may already have happened, although the scan last January showed they hadn’t at that point.)  He also said that salvage brachytherapy would destroy both the urinary system and bowel.

    It was decided at his latest review that my husband continues on 3 monthly injections of Prostap3 (Leuprorelin) until his next review in June.  He tried to ask the doctor again about alternatives but she went vague and just said she’d have to ask the oncologist. So far he’s only had the occasional hip pain, which is a side effect of the Prostap, so she wasn’t concerned.  

    Since then I’ve found another forum where people with increased PSA were given several other options, including more frequent injections, and their testosterone levels were being tested as well, which hasn’t happened yet in my husband’s case.  We’ll see what happens in June and maybe put a bit of pressure on if necessary.   

     

    • n-mac
      n-mac helen33824

      Posted

      As I said before, if you can make it happen, to maximize his chances for the best outcome get to MSKCC or MD Anderson for futher analysis and opinion.  They have the best, and they are the best. Although I live about as far away from NYC as you do, I personally have had terrific experience so far at MSKCC.
    • alfred5
      alfred5 helen33824

      Posted

      Hello. My OH also had brachytherapy aged 57 here in the uk. That was 2 years ago. So far he's doing well. I didn't find out until after he had brachytherapy that there are not many other treatments you can have if the brachy fails. Unless you go privately it's difficult. I hope you find a solution. Have you asked on the other uk prostate cancer forum? (I thinks it's Macmillan) I've found everyone quite helpful on there with a wealth of knowledge. Most are from the U.K. too.

    • miss_sue
      miss_sue helen33824

      Posted

      Helen you really have to insist on care . The attitude of medical has to change on PC . I live In Canada and the attitude here is not to screen for PC because to many men suffer from mis diagnosis . But it leaves men like my husband Dave to a cancer that was so aggressive and relentless he died at 64 after a diagnosis just 27 months before. I fought tooth and nail to access every treatment I could get for him .I think health care In England is much the same as Canada it's supposed to be free or government sponsored .But when dollars and cents are involved in cancer there defiantly is a cut off line as to what treatments you are going to receive . Here we live in basically a communist idea that you are only alloted what the government decides you should have . Yearly physicals are no more and are now every 3 yrs . I guess they figure cancer will take a 36 month holiday between exams . Be assertive in requesting care ....Damm well demand care Make sure you write down all the questions you want awnser to and go there as well .

    • helen33824
      helen33824 alfred5

      Posted

      Thanks Alfred, yes, I looked on it yesterday and apart from HT the only other options mentioned were cryotherapy and HIFU which I’m not sure are available at our hospital.  Would probably have to go private.  We were hoping for radiotherapy as a back-up if the Prostap failed but there are other types and combinations of HT available so are crossing our fingers that an alternative could work.  I've been reading all the forums - you're right, one can certainly learn a lot from them.

      Hope it works for your OH.  My brother-in-law also had brachytherapy 12 years ago and has been signed off as clear of PC.  We've been told 2 out of 3 men are okay afterwards.

    • helen33824
      helen33824 miss_sue

      Posted

      So sorry to hear about your husband, Sue.   That’s really awful!   We’ve read criticism that a lot of treatment and operations are carried out needlessly and the first doctor my hubby saw didn’t believe in PSA tests.  However, his father and brother both had PC so he was forewarned and insisted on it, which was just as well as he was also found to have it.  His first treatment was under the urologist who was great, both supportive and positive, but the oncology team now seem quite the opposite.

      We’re in much the same position as you with our NHS, which is slowly going under, although I have to say we’ve both had excellent treatment up to now through it.  Anyway, we’re trying to remain positive and are currently compiling a list of questions for his next review.

      We’ve been planning to revisit Canada & do Alaska cruise this year but are expecting travel insurance to be sky-high.

      Best wishes. 

    • alfred5
      alfred5 helen33824

      Posted

      The chap that did the brachy said if psa was still low at 3 years after treatment then it was only 5% chance of it returning. But I have read the same figure as you said above. I hope it works too. It was suggested to OH that he went on active surveillance. But as he farms and has busy times of the year he decided to have treatment at a quiet time on the farm. If he suddenly needed treatment at harvest time t would have been difficult. I am younger than him and our youngest son was only 5 when he was diagnosed. So choosing a treatment was difficult.

      I hope your husband finds something that helps. All the best.

  • alfred5
    alfred5 helen33824

    Posted

    Hello. No the other forum is just called prostate cancer U.K.
  • aksns61
    aksns61 helen33824

    Posted

    When I had biopsy done, 12 were taken and each core measured for level of cancer. You did not mention how many samples showed cancer and where they were found. In my case, 9 had cancer, 7 were 4+3, all others were 3 + 3. In the US, this is stage 2 cancer, T2C. Your doctors should have provided you with the same type of information which would at least let you know how aggressive this is.  Please ask them WHY they prescribed ADT, what they hope to accomplish.
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