History: (living in another EU country since 2005, treatment in UK)
1982 Right orchidectomy and external radiation therapy for testicular cancer
August 2004 (aged 60): Prostate (PSA 4.2) ultrasound – 30% enlarged
May 2007: PSA 6.85 (same UK clinic)
26-July-2007: DRE = No irregularities but prostate “raised” so biopsy needed
11-August-2007: TRUS biopsy of prostate followed by 3 days of antibiotic Ciprofloxacin. No obvious blood in urine, plenty in sperm.
24-August-2007: Urologist (surgeon) confirmed prostate cancer, Gleason 7 (3+4)
Research led me to decide I would prefer to be treated by brachytherapy (recalling the awfulness of previous surgery/external radiotherapy)
5-September-2007: Urologist referred me to Oncologist (physician) stating that surgery was not really an option for me as the area had been irradiated previously.
12-September-2007: Oncologist referred me to Professor Langley (brachytherapist) after offering me HIFU which he was experimenting with - I didn't want to be a guinea pig.
23-October-2007: DRE + ultrasound – prostate of 55 cc. Prof Langley said I was suitable for Brachytherapy, maybe after 3 months hormone treatment to reduce too large prostate first.
5-November-2007 - PSA test at clinic near home – 8.26
10-January-2008 medication to clear bowel + no food and plenty of water.
11-January-2008 Brachytherapy Stage 1 (planning) - prostate size / access OK
12-January-2008 Painful urination until I started drinking cranberry juice (maybe a coincidence).
25-January-2008 - Started taking one Flomax in evening
5-February-2008 medication to clear bowel + no food and plenty of water.
6-February-2008: Into hospital 15:00, 100 seeds implanted under General anaesthetic 16:30, catheter overnight. 10:00 following morning: CT scan (to confirm placement), catheter removed, kept in until 250 ml of urine passed and less than 250 ml left in bladder. Discharged 17:00 with 5 days supply of antibiotic, 1 month supply of Flomax, a card to show anyone if I have problems in that area (or die in the next 3 years!) and a letter to explain to airport security why I have set the radiation alarm off (apparently titanium does not trigger metal detectors).
Urinating at 15 minute intervals throughout night.
8-February-2008 18:00: urination intervals up to 2 - 3 hours.
No pain at any point so far - though sitting on a hard chair is slightly uncomfortable.
13th February 2008: last day of drinking 3 litres a day. Faint pink (blood) flush in urine once, now needing to go about every 3.5 hours (hopefully better when I get back to 1.5 litres a day). Still slightly uncomfortable sitting on hard seats. So far this therapy is much less uncomfortable than I had anticipated (and not at all painful).
23rd February 2008: (17 days post-implant). Catheter training (insertion, use and removal) was straightforward and bordered on not being unpleasant. As things were going so well and the catheter didn’t seem to be a problem, I was given clearance to fly home – as long as I doubled up on Flomax for 3 days before and after the flight. All going well still, flew back from UK without incident and without triggering any security alarms. Now going 4 to 6 hours during the day without needing to urinate (but still only 3 to 4 hours at night – why the difference? I would have thought that the body slow down while asleep would reduce urine production, though the booklet they gave me specifies that things are worse at night!). Standing up urinating is virtually painless but not so easy sitting down. No leakage or dripping. The very slight irritation in urethra/prostate seems to be stimulating erotic dreams! though I have not yet seen anything of an erection. I feel that the double dose of Flomax is leaving me feeling quite washed out. Overall I feel that I am currently better off than I was before the implant – but with 4 weeks of worsening symptoms to come.
1st March 2008: (24 days post implant). Don’t know if it was cutting Flomax back to 1 a day (in the evening) or change of water, or unavailability of cranberry juice here, or normal progress, but stream has gone very slow and thin now and no longer completely painless. Frequency still the same and no problems with drips / incontenence. Sitting is no longer uncomfortable – guess that was just the aftermath of the needle assault. Only 18 days of getting worse left I hope.
19th March 2008: (42 days post implant). Well this is as bad as it is supposed to get. Stream is still weak but frequency still the same (4-6 hours during the day, 3-4 hours at night), pain has diminished standing up, but urine comes in 2 distinct phases – about 2/3 and then 1/3 separated by a few seconds. Occasional urgency – but this seems to be because of hanging on when first signs occur. No ED as at implant + 25 (though very low volume of ejaculate). Forecast is for a plateauing of symptoms for the next 2 weeks and then a gradual return to pre-implant state by implant + 6 months. My first post treatment PSA test is scheduled for the middle of May.
31st March 2008: First clinical review after implant - team well satisfied with my progress (everything at least as good as pre-implant except for night time frequency), they gave some suggestions for reducing the 4 times a night need for urination:
1. Stop drinking large amounts earlier (interpreted by me as only whiskey after 18:00!)
2. After first urination of night, walk around for a few minutes and try again.
3. In extremis use a catheter to make sure bladder is empty before going to bed.
My nights being worse than days could be down to the bladder relaxing and not exerting as much pressure as during the day
They expect my night time frequency to reduce over the next 6 weeks.
13th April 2008 - night time stream improved
14th April 2008 - stayed in bed all night!
21st April 2008 - The bowel problems I was "promised" after 6 months appear to have arrived after 2.5 months. Much research seems to indicate that 6 to 8 weeks after radiation is the expected time of onset and that things do not get markedly worse (or better). The promised correction by diet and Imodium have little effect and it is difficult to get any information on how to manage the problems. Serves me right for having it so easy so far I suppose. I'm worried that my earlier radiation treatment may be contributing to present problems.
14th May 2008 - first post implant PSA test = 1.43 ng/ml. Ano-rectal problems continue, they are much the same but I'm learning to live with the discomfort. I'm going to ask the team at my next review if they can find other patients who have had brachytherapy implants some time after having had external beam therapy of the pelvis and how they turned out.
18th July 2008 - Ano rectal situation not perfectly back to pre-implant state, but getting there slowly. I researched the actual functioning of the lower end of the intestinal tract and have more or less "potty trained" myself again - the automaticness is not back yet but I do have a reasonable level of control and convenience. The main components of my self devised treatment (my health team contact was not really interested) are raw garlic (to stimulate the surfaces) and half strength Kegel type exercises to manipulate the muscles. Happy to provide more details to anyone interested.
18th September 2008 (implant + 7 months) PSA 0.805 ng/ml. Bowel function about on a par with the UK House of Lords and Money Bills (they can delay them but cannot initiate them). Urinary convenience fell off a bit when I stopped Flomax (after 6 months), but careful attention to drinking schedule means I get through the night about half the time now without having to get up. Medical team seem pleased with my progress, as am I. Everything working satisfactorily.
12th December 2008 - 10 months after implant my PSA is 0.481. I'm not intending to post any more (unless things go bad), but I'll update my story for as long as I am allowed to. Thanks for all your help and encouragement while I needed it and good luck to you all.
4th March 2009 - 13 months since implant, PSA now 0.422, I was hoping for a bigger drop, but at least it is still in the right direction.
peter (aka Tumbleweed).
Linear Mode
