I guess one could say that this journey started about a year or so ago when I had my gall bladder removed on an emergency basis under general anesthesia. I couldn't pee for about a day and a half and required catheterization. The surgeon, probably suspecting prostate problems from experience with similar circumstances (with old guys), suggested that I see a urologist. Bless him, for that led to a urologist who at a PSA of just (8.2) offered the option of waiting for 6 months or having a biopsy now and you know the option that I took - yep - let's wait for 6 months! About 8 months later, after some procrastination, I showed up again at the urologist's office and with the collection of another PSA, this time at a lofty (9.4) it was determined that maybe I really should have a biopsy - the dreaded TRUS ! Actually, I found the biopsy not nearly as bad as I had though or had heard, with some minor discomfort and a little blood in the urine for about a day, but no infection which was one of my main concerns. The results though (see the text addition below-Biopsy results), after some discussion with the urologist as to my preferences led me to a radiation oncologist whom I just saw yesterday. Anyway, to make a short story long, I now have been offered the privileged opportunity of taking part in a group of 20 men in a clinical study on "Focal Therapy". If you are not familiar with this term (and by the way, it's surprising just how much more interest one takes in all things prostate when you first here the diagnosis - YOU'VE GOT PROSTATE CANCER ! - kind of makes you sit up and take notice!) as I wasn't until very recently, the concept is to destroy the tumor ONLY leaving the surrounding soft tissue largely intact and undamaged thus sparing the bulk of the prostate and attempting to lessen the side effects which which sometimes occur to a greater of lesser degree with some of the "whole gland" therapy approaches such as surgery and various radiation therapies. We shall see. Seems logical though. In any case, this site may enlighten on the salient points of this therapy:
Check it out. I am scheduled to have some more tests possibly in early September to wit : Endorectal coil MRI and MR Elastography, PET/CT, Ultrasound Elastography, and last but certainly not least a "Three-dimensional perineal mapping biopsy" (whew!) in which 24 core samples (wow-will anything be left!) will be taken on just the so-called "good" side of the prostate if there is such a thing which I'm convinced there's not these days, the one with no cancer showing to date to "prove" unilateral cancer before just the tumor will be "removed" so to speak via low dose brachytherapy applied to the tumor and some surrounding tissue. This is the plan anyway. Enough said already. I will update when I have some more material to add. Good luck to all of you and many thanks to all who have provided this wonderful site. Bye for now.
It showed adenocarcinoma (95% of all cancers found in the prostate are adenocarcinoma to the best of my knowledge) and I quote directly from the biopsy : "Prostate Biopsy, Left base x 2 = moderately differentiated prostatic adenocarcinoma, gleason grade 3 + 4 = 7 seen in the two
core biopsies. Tumor measures 1.5mm occupying 20% of the core biopsy and 1mm occupying 10% respectively. Scant extraprostatic soft tissue is present, which is clear of malignant involvement. There is no evidence of perineural invasion or high grade PIN. Comment : Some of the atypical glands seem to be fused, indicating Gleason grade 4 growth pattern which accounts for approximately 10% of the tumor". The balance of the other 8 out of the 10 cores showed "Benign prostatic tissues identified".
Since this biopsy I have had the prerequisite lymph node CT scan, and a bone scan both of which were negative.
I personally, certainly at the ripe old age of 68 yet, should have realized earlier though that at least something was wrong as I had been experiencing urinary "problems" for a few years, mostly of a minor nature and really just annoyances I thought and chocked it up to just "getting older", but none the less such things as getting up 3+ times a night to pee, extra urgency to pee, etc. - and I guess most of the standard symptoms should raise some alarm bells. Some of the symptoms have actually and strangely subsided somewhat from what they were at their peak maybe a couple of years ago. Strange isn't it? And I wouldn't have any explanation for it. Maybe I'm just getting used to some of the symptoms!
For what it's worth, the rationale for the Focal Therapy from my personal point of view is along these lines - even though the prostate is not a "vital" organ, and could be removed with radical prostatectomy or EBRT etc., it sure would be nice to have as much of one's normal function intact if this were possible and perhaps not suffer some of the various side effects of what one might find in a more radical approach. This is not to say that Focal Therapy doesn't come with some side effects but the goal is to lessen these side effects and I'm all for that! They wouldn't remove your liver if you had a tumor in it, they would treat just the tumor wouldn't they? (in that case I guess out of necessity!). Sure, your taking the risk that they might not get all of the cancer but I figure if the tumor I have now took say 10 years? to develop, even if there is a nucleus of another tumor on the so-called other lobe of the prostate that is undetectable now, it would most likely take a like amount of time to develop and by that time this procedure may be a generally accepted protocol and done as a day surgery (well almost!?) Bear in mind, these are my own personal thoughts and keeping in mind that I am not trained in medicine and certainly not a doctor. I've only tried to reason this thing through to the best of my ability and general knowledge. Some of the knowledge and insights of which I have gleaned from this site!
Hello. It's been quite a while since I've been here. And it's been quite a journey along the way! I did participate in a "Focal Brachytherapy" clinical Study. On January the 9th of this year I ventured off the Vancouver, B.C.'s University of British Columbia Research Facility to get a very thorough 2 hour MRI combined with a "vibrational study" in the same crotch vicinity (which I never did completely get an understanding of !). On April 16th I proceeded to have a 38 core prostate biopsy of which 2 cores of less than 10 % cancer were found, and last but not least, after I had been eliminated from the clinical study, on June 25th I received "whole gland" therapy by the installation of (are you sitting down) no less than 146 Iodine-125 "seeds" implanted in my large but poor prostate! The proceedure was uneventful (they gave me a spinal anesthesia as I aspirated into one lung (due to pre-existing acid reflux problems) when I had the biopsy but did not develop "aspiration pneumonia" and they were somewhat concerned that I would) and pain in the area was almost non existent. Everything just fine until - Now comes the interesting part: I haven't been able to pee without a catheter since the operation more than 2 -1/2 months ago! There have been 5 unfruitful attempts or "trials" with no success. In fact I just started another one today as I write this. I have a theory - The prostate was about 80 grams and I am now told that I probably have had BPH + cancer + Prostatitis and that I most likely have had a chronic case of Prostatitis for quite some time. Question : Perhaps the old prostate should have been shrunk before the procedure AND an extended course (which I now getting - 6 weeks of Cipro in an attempt to "normalize" the prostate) of antibiotics given BEFORE the procedure. This might have made it more likely that I didn't have a burning sensation in my rectum quite often (very close to that huge prostate that was just filled with those seeds) and I just might be able to pee on my own! I have been told by at least one source that my case is quite rare because most people can pee right after the procedure, which I find very strange myself what with the proximity between the rectal wall and the urethra! I would have thought it not so rare. I should have put on the brakes so to speak after I had been ejected from the Focal experiment and said whoa, maybe I should consider carefully other therapies if the Focal approach is not available to me; maybe surgery would be better for me or something else altogether.
I must say though that I can still get the occasional erection but it doesn't do one much good with the devices attached to me! But enough of the complaining and whining, I still have hope that I CAN pee without the accoutrements and If so life would be perfect again. I would like to add this before I go - This is just me. I'm sure that many people receive brachytherapy and do just fine with very little or no real side effects. In fact, if it had not been for the ongoing peeing issue I would say it was a "piece of cake". Other remedies can present their own problems too. Well, so long for now. If I actually get to the point of peeing for myself, I will let you all know. Best wishes and stay strong!. Rick
P.S. My latest (6 weeks after) = 4.6 (it was 9.1 two days before)
P.S. The urologist say's he will ream me out after a year if I still can't pee without a catheter. Is this a good thing - if anyone has had a TURP I guess they call it, please advise me on this!
I said I would update my story. I did. But I want to add an "addendum" to that story. These are comments that I was not inclined to share with others for fear that they would consider me "just sour grapes" and that I was feeling sorry for myself because the therapy didn't go as well as I or anyone else involved had anticipated (apparently even the doctors). You see, I was originally supposed to be treated as a "Focal Therapy" candidate in a clinical trial. This would mean that I would have had a significantly reduced amount of radioactive "seeds" implanted in my prostate - just where a lone, single tumor was located. The goal was supposed to be less "side effects". This was not to be the case though, as it was later found in contrast to the small sample rectal biopsy, that I had a tumor crossing both lobes of the prostate. Since this was not within the guidelines of the study, I would then require 142 seed implants constituting "whole gland therapy" instead of maybe the 65 or so seeds in the Focal Therapy program. Now, my dear prostate, of whom I had never even heard of a year ago and which has helped me many times in my life, was a whopping 80 grams and not the 50 grams or less it probably should have been to do ANY kind of radiation therapy, which it turns out has caused me very much distress - 1. urinary retention over 3 months to date 2. a possible "burnt" rectal wall 3. and much mental anguish trying to figure out whether I made an extremely bad life decision having this procedure done at all and what I'm going to do next. In retrospect, I should probably have thought much more deeply about the outcome of any therapy including prostatectomy once I was told I was out of the Focal study. I'm pretty sure that we can't look back on our decisions, except to accept them, but if I had it to do over again and know what I know now, I would put a hell of a lot more thought into this than I did. On the other hand, it wouldn't have hurt though if some doctors, who have the experience factor that we as laymen don't have, would have cautioned me. After all, these are the people that we are supposed to rely on for this information are we not?
Anyway, what's done is done and one has to make the best of it no matter what. Best Wishes - Rick
Hi. I thought it would be a good time to update my story, so here goes. I just got back the results of my latest PSA test. I had a PSA of 9.8 when I left for the operation/procedure, a PSA reading of 4.6 at the 6-week point, and now the latest one at 4.5 months of 0.65! The radiation oncologist told me that it usually takes anywhere from 1 year to 2 years to reach this point (a PSA level below 1) so I am both amazed and grateful for this. I would have to say that whole gland brachytherapy worked for me then. It would appear that the cancer is gone! I certainly hope so! The only thing remaining now is to get the previously mentioned urinary problem solved. This is the problem with urinary retention. I have had about 7-8 (lost count) Foley catheters inserted and withdrawn over the past almost 5 months in an unfruitful attempt to once again get me to pee "normally" and believe me, this is no fun! At first it's OK I guess but after about the 4th one it get to be more and more painful. The last one was a "killer" and they are getting much more uncomfortable just to wear as time passes in any case, so much so that I have requested a Suprapubic Catheter of the Urologist. He says he will call me with an appointment soon. That's the last I have heard. This is not the ideal solution, but may give me some improved degree of comfort and movement. I hope so. So we shall see; I will update my story when I get the new catheter in place. In the mean time stay strong and good luck to all. Rick
Being that this is exactly the 1 year anniversary of having brachytherapy (June 25,2015 - June 25, 2016) I feel it is appropriate to update my story (I didn't really have anything better to do anyway). I have been doing well on this therapy. My latest PSA reading was 0.52 and it was really as high as 9.8 just before the Brachytherapy. I went through a little bit of hell dealing with the fact that I could no longer pee without the aid of an indwelling urethral catheter and had the pleasure of having everything from a #12 catheter to a rather large #18 which was jammed into the whizzer by two lovely nurses at about 3am in the morning (in the hospital of course) one night or day as you please. This apparently did some damage having it in and out, in and out every 2 weeks it seemed (just to give me a "trial" to see if I really could have pee'd all along) and it also was getting very painful. So I thought, gee Doc. do you think we could do something to rectify this situation?? The Doc thought a little bit and said yes, Rick we could put in a "Suprapubic Catheter"!! Well, that was what I wanted to hear! What a difference! I can do almost anything now that I used to do, and believe me, that is definitely a relief! There is nothing more limiting or uncomfortable than having a urethral indwelling catheter for 6 months. Unfortunately, the suprapubic catheter is still in there after another 6 months. I get it changed about every 3 months and have not had an infection yet. I probably shouldn't say that as I'm pretty sure I'll probably get one now. I have a shower every morning and before bed and wear tight fitting briefs to keep the catheter from moving around too much while say walking or whatever. The doc says he will "ream me out" (the urethra that is) maybe in another 6 months or so. So I'm looking forward to that (yeah, I'll bet!). He said I will be able to pee like I was 18 again. Not very likely but we'll see. Would be good though. Well, I better leave now and try to find something to do. Maybe I'll go out for a walk. Until next time - good bye and good luck. Rick
Rick's e-mail address is: firstname.lastname@example.org