Prostate cancer (en anglais)

Témoignage

02.04.2003

Resumé and Conclusion

As the possibilities to cure a prostate cancer are very much dependent on how far the cancer has progressed and that the statistics become difficult to understand if all cases are included, I have limited this resumé to what is known as “low risk patients”.

This is a patient with a PSA value of less than 10, a Gleason Sum of 2-6 and a Tumour Clinical Stage of T1 - T2b.

The treatment was performed in September 2001. I was born in 1942.

Treatment Possibilities

  • Surgery
  • External Beam Radiation
  • Brachytheraphy:
    • High Dose. A mixure of external radiation and seed implants (mostly for T3 tumour).
    • Low Dose. A 1-2 hours single session. Radioactive seeds are placed in the prostate under ultrasound guidance. Isotopes used are Palladium 103 with half-life of 17 days or Iodine 125 with half -life of 60 days. Depending on the isotope used the radiation will stop after 3 to 10 months.
  • Testosterone-suppressing hormones. Makes the tumour shrink. A positive help whether by surgery or radiation. Kills sex-life as long as used.
  • (Cryosurgery. A method where the tumour is frozen to death by liquid nitrogen. Very little data available. Excluded)
  • (Three dimensional conformal radiation therapy -3D-CRT-.Very little data. Almost no side effects but 40% recurrence after 4 years. Excluded.)

I have set as my first priority to be cured from the cancer. As the second priority the quality of life. That is to give me the best possible bet as to any side effects from the treatment. And as the last priority the treatment procedure as such.

My first priority

It seems to be quite clear that, for a low risk patient, the chances to get rid of the cancer are equal good with any of the three treatments (Surgery, external radiation or brachytheraphy).
Second priority

Incontinence and Impotence

It has been very difficult to create an opinion on side effects as to incontinence and impotence after surgery. The answers you get, whether verbal or from statistics, depend so much on where the tumour(s) is placed and if it has perforated the prostate capsule or not and on the urologist performing the surgery. Also on the patient's personal design and general health. Some statistics show urine leak up to 15% and stress incontinence up to 50%. Impotence seems to be a 50/50 chance. For early stage T1 tumours a nerve-sparing procedure can be used in order to minimise the risk for incontinence and impotence. The multitudes of variables make you hesitate.

The radiation treatments all list these two side effects as possible but from the low dose brachytheraphy incontinence is rare and only 5% have more frequent and urgent urination permanently. In the age group of 60-70, 15% have become impotent and 40% with partial loss only.

Rectal bleeding

This is a typical radiation problem, as the intestinal walls will take a beating from the radiation. This is mostly temporary and painless but quite impressive. By low dose brachytherapy 2% and by external 7% or more.

Recurrence

This is obviously an important question. Surgery is a one-chance treatment and by recurrence hormones or maybe half dose radiation can be used. The 10-year recurrence seems to be some 25-30%. If nerve-sparing procedure has been used by a T2 tumour or higher the risk of recurrence will increase. Here again, much depends on the urologist performing the surgery. By external radiation the relapse percentage after 10 years is some 14%. And by seed implant less than 10%. Here it must be stressed, however, that there is only a 12-year follow-up period.

The 3rd priority

  • Surgery normally requires 10 days of hospitalisation and involves all inherited risk therewith.
  • External radiation is given in very small daily doses for a month or two.
  • Brachytheraphy High Dose means first a few weeks of external radiation then the seed implants and followed by another two weeks of external radiation.
  • Low Dose seed insert is a 30-minute job as such but as it is done under anesthesia a day will pass by before it is over. The next day x-ray and CT scan in order to check that the implants are correctly placed.

Conclusion

To follow my priorities I have chosen the Low Dose Seed Implant at the Seattle Prostate Institute. Good chances to cure the disease; good chances for little if any side effects and a short and comparable easy treatment even though it is far away from Geneva.

Feedback

19 April 2003 - I went out for dinner with my wife the same evening after the treatment. I have no side effects at all. My PSA is 1.34.

Lars Enström
September 2001