Chris, 58 - Brachytherapy

It was one of those rare visits to the doctor on that sunny day in June 2002 that led to my first meeting with Professor Stephen Langley during August that same year and the discovery that I had prostate cancer.

June is my birthday month and I was just 58 years old. My primary reason for the visit to my GP’s surgery was for what turned out to be a minor hearing problem. However, being cognisant of my age with relation to prostate cancer and getting up somewhat more frequently in the night to urinate, I decided to ask my GP to perform a digit test.

A digit test is a first line of approach in deciding if there is any unusual enlargement of the prostate gland which, along with other symptoms such as frequent urinating etc., can indicate a possibility of prostate cancer. The digit test indicated nothing too unusual but my doctor agreed that I was in the risk group and arranged for me to have both a blood and urine test. Blood in the urine (even in small amounts not visually detected) can be an indicator of problems but a PSA test of the blood is the primary first test. Although my urine tested OK, my PSA level of just over the threshold of 4 was reason for concern and further testing. A rule of thumb indicator is: PSA below 4 probability of no prostate cancer and PSA above 4 (as in my case) possibility of prostate cancer requiring further examination.

During my first appointment with Professor Stephen Langley he performed an ultrasonic scan and took a biopsy. This is a simple procedure (for the patient) where a thin probe is passed into the anal passage and using high frequency sound waves an examination of the shape and condition of the prostate is undertaken. At the same time, and using the same probe, a number of cell samples are taken for analysis. This procedure may take some 20 minutes and is painless.

Two weeks later I received a phone call from Professor Langley’s secretary asking me to attend his office at the Guildford Nuffield hospital. Professor Langley calmly told me that cancerous cells had been found in my prostate gland and that the situation could be dealt with and managed. He told me that the cancer had been discovered in the relatively early stages, that it was moderately aggressive and that it had not progressed beyond the prostate gland. He carefully explained that there was an excellent chance of me fully recovering my health. Further, he said that it is his ambition - and that of other specialist oncologists - to catch the cancer at its earliest stage wherever possible.

Regarding treatment, Professor Langley explained that I had a number of options. These options were:

• Active Surveillance - Take no action other than closely monitoring the condition regularly as prostate cancer often progresses very slowly.
• Radical Prostatectomy - Total removal of the prostate gland by surgery.
• External Beam Radiotherapy
• Brachytherapy – a less invasive treatment ideal when the cancer is diagnosed at an early stage. The treatment consists of placing by needle small controlled radioactive seeds in the prostate gland. The operation is performed without the usual invasive surgery methods. Radiation from the implanted seeds destroys the cancer cells from within and the radioactive process gradually diminishes but continues over a 12-18 month period.

Professor Langley supplied me with two booklets which were most helpful in understanding prostate cancer and the treatment options. One booklet fully detailed the Brachytherapy treatment. I was advised that Brachytherapy was very suited to my type of cancer and the stage of detection. However I fully understood that the choice was entirely mine. I was to return in ten days to discuss my decision with Professor Langley.

After careful study of the literature and discussion with my wife I felt confident that Brachytherapy was a modern treatment and ideally suited to my prostate condition and my temperament. My conclusions were fully supported by Professor Langley who took time to explain the way forward.

In October 2002 I had the first stage of my Brachytherapy operation which is essentially a mapping of the prostate gland to establish the accurate positioning of the radioactive seeds. A month later I underwent the stage 2 implant operation. Both operations were done by Professor Langley and gave me no cause for distress. I had no serious after-effects and my body functions remained normal.

Over the next year I was monitored by Professor Langley every three months and saw the PSA level steadily drop to its present level which is below 1. It is now some three years since my Brachytherapy operation and I have now progressed to six-monthly checks to ensure my blood PSA level stays low.

Prostate cancer is a very common cancer which is easily detected and if caught in the early stages has a high chance of cure. Brachytherapy was the right choice for me and has less risk than other treatments of side effects. Recovery from the operation to implant the ‘seeds’ is very rapid. If this treatment is a suitable choice for you I would recommend it.