hyperthermia or HDR brachytherapy?

Hi folks,

I was diagnosed with prostate cancer just before Christmas. Two out of the 14 biopsy samples had Gleason 8 cancer, 30 per cent. Another core had 3 per cent Gleason 6. My PSA is currently 3.66, although my surgical oncologist told me when I was diagnosed that my PSA is irrelevant (not sure if a PSA is ever totally irrelevant, but that's what he said).

I feel I need to make my treatment choice asap. I've basically ruled out surgery because of the side-effects and the fact that positive margins are so common.

I've been told I could do HDR brachytherapy, which would be followed by five weeks of EBRT to treat the lymph nodes, and would also include six months of hormone therapy. This might be a good choice, but there are also potential side-effects, and I do have some reservations about radiation.

A number of men in my prostate cancer support group have gone to Germany for hyperthermia treatment and hormone therapy, and they seem to be doing well. I'm seriously considering choosing this option, even though it's far from mainstream practice in North America. But the side-effects are minimal and it wouldn't close the door on any other treatment (if necessary) down the road, so I figure it might be worth a try -- although there's still a sliver of doubt because it's unconventional.

I'm just wondering if anyone could offer any thoughts on my choices here. Of course, I know that ultimately it's a personal choice and each man has to make the decision he feels is right for him.

Thanks very much,
John.

John:
Sorry to hear you have joined the club no one wants to be a member of.
With a high risk gleason, multi-approaches seem to be most effective.
May I ask what hospital is your doctor(s) associated with?
There is HIFU clinic in Toronto, and results seem to be uncertain.
Take care,
Bronson

I forgot to add that I'm now 51 years old.

no offense John but you are leaning toward the least effective treatment because you think it has it has the least side effects? 

really?

man you have over 30 more years of life left if you can beat this cancer.  NUKE IT NOW!

where is Fairwind when you need him ?

ed

 

John,

As Ed says you potentially have over 30 years to live. My belief is that you need to be aggressive with this high risk cancer and therefore need to take the conservative path of HDR brachytherapy.

Although prostate cancer is typically a slow growing cancer that doesn't usually kill, this is for a Gleason 6 cancer in someone aged sixty five and above. With someone your age, without appropriate treatment, Gleason 8 cancer has a pretty high chance of shortening your life.

Patrick Walsh, famous and respected urologist, in his book, "a guide to surviving prostate cancer" goes through why the cooling and or heating therapies are not effective. As someone one has borrowed my copy I can only go by memory and I recall it saying that during the freezing or heating process, portions of the prostate have to be kept at normal body temperature, ie portions of the prostate could not be treated with this therapy. If your cancer happens to be in those portions then it would not be killed.

The problem with Gleason 8 cancer is that unlike Gleason 6 cancer it can jump from the prostate even with negative margins. It's not the kind of cancer that you want to say, well, if option A fails I will take Option B. taking this approach means you may miss a window of opportunity where your cancer is curable.

Sorry if this is a little too direct, but you were asking for an opinion on your choices.

Regards,
An

Hi John,

Sorry to hear about your situation. In this case, I have to agree with most of the other voices. If my next biopsy (waiting for results) was to come back at Gleason 8, I wouldn't mess with a non-mainstream treatment. You likely have some of the best expertise and facilities available right in Toronto.

John,

I believe the biggest mistake most patients make is they use aggressive treatments to treat low risk cancer and less aggressive treatments for high risk cancer. It's basically a risk reward situation as low risk cancers are usually not life threatning, but high risk cancer are. Dr Strum always says fit the treatment to the biology of your cancer. You have a high risk cancer and a minimal treatment option is not appropriate. You should be using the most aggresssive approach you can and this usually means a combination treatment of surgery or radiation and at least one course of HT. A combination HDR, IMRT and HT would be a good combination treatment.
Good luck,
JohnT

The cancer you have is a far greater risk to your well being and longevity than the potential of radiation induced cancer, which is very rare and takes a long time to develop. Radiation isn't just for people in their late 60's.

Ask a urologist what he will do if surgery fails you and he will quickly say radiation. If it is so bad as a primary treatment for a 50 year old, why is it the first salvage treatment used for failed surgery no matter the age of the patient? Radiation is routinely used in very young people when it is an effective choice for cancer control.

Every treatment has its risks. The risk of a secondary cancer from radiation is about equal to dying from complications of prostate surgery. The risk of not using a treatment that is more aggressive than the cancer is that the cancer will win. Don't take a G8 lightly....or a 7 for that matter.

Just a note, hyperthermia is not the same as HIFU. Hyperthermia uses radio short waves and heats the tissue up to 45C, HIFU uses high intensity ultrasound and it destroys cells with much higher heat. The two methods are quite different. HIFU seems to have entered "mainstream" circles more than hyperthermia (as a sole treatment).

To my knowledge there are no clinical trials that confirm hyperthermia is a successful method of killing cancer, however, I know that the local hospital here uses hyperthermia IN COMBINATION with external radiation, as it has been proven that such combination has a higher success rate than radiation alone. I agree with others here that HDR+EBRT would be a way to go (or surgery). Good luck with your decision.