After a couple of postponements I will now be seeing Mr Singh on Wednesday 26th of this month, October, at 11.30 and Dr Owen, the radiotherapist who is conducting the trial I’ve been invited to join, at 4.00 pm on the 3rd November. (The Radiotherapy and Androgen Deprivation in Combination After Local Surgery trial, conducted by the Medical Research Council, and the Radiotherapy—Adjuvant Versus Early Salvage (RAVES) trial)?
Questions for Mr Singh:
What was the result of the tissue tests on the prostate and surrounding margin where the tumour was poking through the capsule? I have been told the stage was confirmed as T3a.
In that area the prostate was stuck to the surrounding tissue. Was this because of the tumour or because of damage done by the targeted biopsies in that area?
The tissue margin tested positive so there are cancer cells present. These are presumably still prostate tissue and cause or contribute to the residual PSA level I have of 0.02. Is that correct? What does a positive margin mean? How deep a margin was taken? Cancer to edge or not quite so far? Artefact of surgery (iatrogenic intraprostatic incision) or already there before the operation? Was the positive margin adjacent to the prostate apex?
Could these cells produce tumours and if so how long might that take? I was told that it could take years for tumours to be detectable by scans or not happen at all. Can any of these cells move into the blood stream or lead to tumours in other organs or bones?
General prognosis I was offered is that 50% on PSA monitoring would not develop further cancer. Of the other 50% half would respond successfully to further treatment, radiotherapy e.g. and half would not. I didn’t make a note of these figures so I may have mis-remembered. Are these figures correct?
What do the statistics show in terms of the likely time period before radiotherapy is recommended? Are the majority 1 or 2 years or is 3 to 5 more typical? The issue here is that the older a patient gets the more likely the recovery will be affected and suffering from side effects.
If I stay on observation and PSA monitoring how often would this happen and what would trigger concern and a recommendation of further treatment? What would the monitoring be looking for in order to trigger radiotherapy and how quickly would this be commenced.
Is there any expert nutritional advice available for my condition?
Questions for Dr Owen:
What of the new more accurate and targeted therapies? I’ll get a name for these.
Do they take a scan to identify where in the pocket where the prostate used to be (the bed?) to identify sites that need targeting? I understand that once the prostate is removed and the radiotherapy is targeted at the prostate bed it is difficult to measure up and reliably direct radiation and that there is a danger of over dosing the bladder and bowel. Is this correct?
I’ve more time to think about this but would be mostly concerned with the actual procedure and possible side effects, what they could be and how probable. The main ones seem to be incontinence, erectile dysfunction and damage to the bowel. I would need to know how long these tend to last or if they can lead to permanent conditions.
Look at
http://www.harvardprostateknowledge.org/positive-surgical-margins-following-radical-prostatectomy