As mentioned in my last post, further good news, was received concerning my ongoing treatment and came in the form of a 'green light' to commence radiotherapy ASAP. Originally, it was planned that I would have two consecutive implants (duration of 6 months) and then, providing the PSA level was at an appropriate level, we would the consider radiotherapy.
The upshot of the visit was, that we now move into a new phase of treatment - 'Radiotherapy' (RT) as an adjunct to the Hormone Therapy (HT). The latter will most likely continue for approximately 18 to 24 months. However, there is a possiblity that I could be on HT for the remainder of my life; dependent upon the success of the radiation treatment.
[It has also been decided at this stage, to rule out surgery; because of the likely complications; both during and after the operation].
Radiation Therapy will entail daily radiation treatment, 5 days a week for approximately 6 weeks; (with Saturday and Sunday ... 'off for good behaviour').
Unfortunately this will also involve short stays in hospital for each subsequent treatment; thus further complicating my desire to lead as normal a life as possible e.g. juggling work committments, cancer therapies and home and social life etc.
Hormone Therapy
It has long been known that once prostate cancer develops, the male hormone testosterone, produced by the testicles, is closely involved in stimulating the cancer’s growth and spread. Earlier treatments for the disease often involved removing the testicles surgically to reduce testosterone production by the body. Now products are available that can be taken in the form of tablets or injections to suppress testosterone even more effectively. The process is known as hormone therapy.
Hormone therapy is often used to shrink the prostate and the tumour before commencing radiotherapy. It is now quite common for a course of hormone therapy to be administered after primary treatment by radiation or surgery, particularly if there is evidence that the tumour may have spread beyond the capsule (tissue immediately surrounding the prostate). There is emerging evidence that better outcomes are being achieved from these combined techniques.
If the prostate cancer has already spread to other organs or to bone at the time of diagnosis, hormone therapy becomes the primary method of treatment. Monthly or three monthly injections, possibly also accompanied by tablets, are used to try to reduce the PSA reading as close as possible to zero. Most advanced cancers respond well to hormone therapy for several years. Some doctors apply the therapy intermittently - six or twelve months on treatment then some months off - known as "pulsing". This gives the patient some respite from side effects and may extend the period of effective treatment, although this has not been proved.
The advantages of hormone therapy are that it is simple to administer. The disadvantages are the side effects, which can be distressing. They include hot flushes, loss of libido and erections, sweating, mood swings, disturbed sleep, loss of energy and personal motivation, body hair loss, bone loss, weight gain and breast development or tenderness. Unfortunately, most advanced cancers eventually become resistant to hormone therapy, after which the disease resumes its progress.
Radiation
Radiotherapy involves the use of various types of X-rays to treat cancer.
External beam radiotherapy (EBRT) has been the traditional method of delivering the radiation. Short pulses of tightly focused beams of X-rays are delivered from outside the body into the prostate for a few minutes each day. Treatment continues five days a week for seven weeks. Conformal Radiotherapy, allows the X-rays to be directed very accurately to the prostate in three dimensions. EBRT has a track-record of success in "curing" cancers confined to the prostate that is very close to that of surgery.
From a patient’s perspective, the advantages of EBRT are that it is less intrusive and stressful than surgery, with no risk of infection. It particularly suits older men or those with fitness or other health problems that make the risk of surgery greater. The disadvantages are that time for treatment is much longer and may involve travel and accommodation problems, particularly for country patients. Radiation can damage other organs, particularly the bowel and bladder.
Irritation of the bowel is a common side effect that can trouble patients for six months or longer after treatment. Rates of occurrence of incontinence and impotence are similar to surgery, but tend to occur later. With radiotherapy up to 50% of men develop erection problems and many develop mild to moderate inflammation of the bowel, although only approximately 3% of men develop severe, ongoing bowel problems. It is also important to mention that it is not uncommon after radiotherapy to develop a change in bowel habit, with looser and more frequent bowel movements, increased flatus and possible bleeding.
Once again, the skill, experience and result record of the radiotherapist and standard of the treating equipment are paramount to the outcome. Intending patients should enquire carefully into these matters before making a selection.
After treatment you will have further PSA tests to monitor developments. Your PSA should gradually reduce over about 12 months to between 1 and 2. If it fails to reduce to these levels, your doctor may recommend further treatment, probably by hormone therapy. However, regardless of the post-treatment movement of the PSA reading, it is quite common for doctors to recommend hormone therapy immediately after radiation as part of the total treatment.
The upshot of the visit was, that we now move into a new phase of treatment - 'Radiotherapy' (RT) as an adjunct to the Hormone Therapy (HT). The latter will most likely continue for approximately 18 to 24 months. However, there is a possiblity that I could be on HT for the remainder of my life; dependent upon the success of the radiation treatment.
[It has also been decided at this stage, to rule out surgery; because of the likely complications; both during and after the operation].
Radiation Therapy will entail daily radiation treatment, 5 days a week for approximately 6 weeks; (with Saturday and Sunday ... 'off for good behaviour').
Unfortunately this will also involve short stays in hospital for each subsequent treatment; thus further complicating my desire to lead as normal a life as possible e.g. juggling work committments, cancer therapies and home and social life etc.
Hormone Therapy
It has long been known that once prostate cancer develops, the male hormone testosterone, produced by the testicles, is closely involved in stimulating the cancer’s growth and spread. Earlier treatments for the disease often involved removing the testicles surgically to reduce testosterone production by the body. Now products are available that can be taken in the form of tablets or injections to suppress testosterone even more effectively. The process is known as hormone therapy.
Hormone therapy is often used to shrink the prostate and the tumour before commencing radiotherapy. It is now quite common for a course of hormone therapy to be administered after primary treatment by radiation or surgery, particularly if there is evidence that the tumour may have spread beyond the capsule (tissue immediately surrounding the prostate). There is emerging evidence that better outcomes are being achieved from these combined techniques.
If the prostate cancer has already spread to other organs or to bone at the time of diagnosis, hormone therapy becomes the primary method of treatment. Monthly or three monthly injections, possibly also accompanied by tablets, are used to try to reduce the PSA reading as close as possible to zero. Most advanced cancers respond well to hormone therapy for several years. Some doctors apply the therapy intermittently - six or twelve months on treatment then some months off - known as "pulsing". This gives the patient some respite from side effects and may extend the period of effective treatment, although this has not been proved.
The advantages of hormone therapy are that it is simple to administer. The disadvantages are the side effects, which can be distressing. They include hot flushes, loss of libido and erections, sweating, mood swings, disturbed sleep, loss of energy and personal motivation, body hair loss, bone loss, weight gain and breast development or tenderness. Unfortunately, most advanced cancers eventually become resistant to hormone therapy, after which the disease resumes its progress.
Radiation
Radiotherapy involves the use of various types of X-rays to treat cancer.
External beam radiotherapy (EBRT) has been the traditional method of delivering the radiation. Short pulses of tightly focused beams of X-rays are delivered from outside the body into the prostate for a few minutes each day. Treatment continues five days a week for seven weeks. Conformal Radiotherapy, allows the X-rays to be directed very accurately to the prostate in three dimensions. EBRT has a track-record of success in "curing" cancers confined to the prostate that is very close to that of surgery.
From a patient’s perspective, the advantages of EBRT are that it is less intrusive and stressful than surgery, with no risk of infection. It particularly suits older men or those with fitness or other health problems that make the risk of surgery greater. The disadvantages are that time for treatment is much longer and may involve travel and accommodation problems, particularly for country patients. Radiation can damage other organs, particularly the bowel and bladder.
Irritation of the bowel is a common side effect that can trouble patients for six months or longer after treatment. Rates of occurrence of incontinence and impotence are similar to surgery, but tend to occur later. With radiotherapy up to 50% of men develop erection problems and many develop mild to moderate inflammation of the bowel, although only approximately 3% of men develop severe, ongoing bowel problems. It is also important to mention that it is not uncommon after radiotherapy to develop a change in bowel habit, with looser and more frequent bowel movements, increased flatus and possible bleeding.
Once again, the skill, experience and result record of the radiotherapist and standard of the treating equipment are paramount to the outcome. Intending patients should enquire carefully into these matters before making a selection.
After treatment you will have further PSA tests to monitor developments. Your PSA should gradually reduce over about 12 months to between 1 and 2. If it fails to reduce to these levels, your doctor may recommend further treatment, probably by hormone therapy. However, regardless of the post-treatment movement of the PSA reading, it is quite common for doctors to recommend hormone therapy immediately after radiation as part of the total treatment.
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