One Brachytherapy story.

This starts in what is probably quite a common manner. I went to the doctor in 2006 and asked for a PSA test. My father had died from prostate cancer so I knew, vaguely, that I might be at some risk. I was questioned as to symptoms – there were none – and was treated to a lecture on false positives and on an industry which rendered men impotent and incontinent because the PSA test was so inaccurate. I was dissuaded.

5 years later, now aged 65, I went back. Same surgery, different doctor – who said yes, of course. It was 6.4 – some 50% higher than the 4 acceptable for men in their 60s. Although the (young) doctor could not feel anything abnormal on DRE he sent me to Broomfield for a check, given my history. The consultant could feel abnormalities and at this point the care pathway swung into action effectively.

The biopsy followed promptly and went normally, I believe, with some pink pee for about 72 hours but no great discomfort then or later – only some odd sensations. Cancer was found on both sides, with Gleason score 3+4. It’s at this moment when it’s good to have someone with you to remember all that gets said. However ready one may be for bad news it’s difficult to be completely dispassionate and be able to hear and understand all that’s said. 6 weeks has to elapse before the MRI scan to allow the damage done by the biopsy to heal so that the MRI image is clear. I suspect that it is the availability of these scans which changed the attitude of the GP – they were not so readily available 5 years earlier.

The MRI scan confirmed that the cancer was confined to the capsule, with the Multi-Disciplinary Team (MDT) meeting with 3 days of the scan and this encouraging information – a considerable relief – being given to me within a day of the meeting. I’d done a lot of internet research in the meantime so was aware that this meant that a cure was possible. It was also confirmed that all the 3 methods of treatment normally available on the NHS – surgery, external beam radiotherapy (EBRT) and brachytherapy –would be available to me. Although there was a short delay – a week or two – before I could meet the specialists to determine which of the 3 methods of treatment would be preferable, I already had a fairly clear idea which I preferred from the researches I’d done. I didn’t fancy surgery – the incontinence incidence seemed high and no one had mentioned nerve sparing, so very probably ED as well. The incidence of collateral damage and consequent side effects with EBRT seemed higher than with brachytherapy – so I chose the latter.

This involves 2 overnight stays in hospital at Southend. The first, the Prostate Volume Study (PVS), measures up your prostate so that they know where and how many of the radioactive “seeds” – tiny canisters – will be needed. It’s done under general anaesthetic – they want you completely relaxed and not wriggling. This went well, certainly as far as the procedure itself, though the some of the details given in the leaflet were out of date. The second hospital stay for the implanting of the seeds follows exactly 2 weeks later. Again the procedure went well and the theatre staff were excellent. However, I thought poorly of some of the ward staff and of the cleanliness of the side room one was put in – I contracted an unpleasant and difficult to shift foot infection. With the procedure on the Wednesday morning I was out that evening and only a little tender for a couple of days. I could have been back at work the following Monday. The side room is used so that they can check that anything you pass does not contain a radioactive seed. The Iodine 125 in the seeds generates X-rays which only penetrate a few millimetres – and kill the cancer. There’s some gamma radiation as well, so you need to avoid getting very close to new born babies or pregnant women. But the effect halves every 2 months, so after the first 60 days all’s OK.

The immediate side effects fade quickly. Some 2 weeks later, the longer term side effects begin to appear and build to about 3 months and then fade by about 6 months. In my case this was almost entirely urinary urgency. Avoiding caffeine is the main thing (Redbush tea is really not at all bad!) and being sensible about how much you drink before some event where there are no toilets! I carried a plastic milk bottle in the car and had a couple of occasions to use it over this period.

There was a resurgence of urgency some 7 months later for which no reason could be found. One pill for this had no effect – but another did and after month if this I tried coming off them and found that the problem had gone away. There was no incontinence, no retention (I was given Tamsulosin for 6 months) no bowel problems. ED? Well it’s not as good as it was but is generally adequate for the purpose. The feeling of sex itself has changed over time and initially could be almost painful at orgasm – the agony/ecstasy ratio changed – but this has now settled. There has clearly been some nerve damage, not surprisingly really, and it’s not as quite good as it was. But satisfactory.

I feel I’ve been fortunate. The PSA levels have been   0.46 at 7 months, 0.29 at 14 months, 0.47 at 20 and 0.19 at 29 months post –op. Looks good so far!