People & Lifestyle story, June 2006
| COMBINING SURGERY
WITH RADIOTHERAPY
- One man’s experience By: Stephen Bradley |
It was in May 2002, when I was 52 years old, that I got the bad news. I was due for a routine medical check up with my company doctor but had postponed it until it was about 2 years overdue – no real excuse, just the not uncommon tendency to procrastinate on these matters. Expecting the usual comments about over-drinking, over-eating and under-exercising I was somewhat taken aback when the doctor seemed to be more concerned about one of the blood test results; a raised PSA level of 9.8. Until then, like many men, I had only the vaguest idea of what the prostate gland is, and no idea at all of the significance of PSA levels. The doctor started to explain the significance of the result but it was only after some dancing around the subject that I learned that there was at least a possibility that I has prostate cancer.
After being examined by a urologist I embarked on a bank of tests including further blood analysis, a biopsy, MRI scan and bone scan. As a result I learned that I did indeed have prostate cancer, with a Gleason level of 7. Fortunately the tumour appeared to be confined to the prostate gland itself, possibly touching the immediately surrounding tissue, but had not progressed to other parts of my body. It was officially categorised as T2a.
Being reluctant to rush into any treatment until I had investigated options further, I started a series of enquiries. As well as reading literature and articles on the subject I had discussions with four urologists and three radiotherapists. I learned of the possible treatments including; surgery, radiotherapy, brachytherapy, hormone therapy, watchful waiting etc. It was interesting to note, from these interviews, that different medical advisors favoured different treatments, each recommending action, perhaps understandably, based on his own knowledge and skill set. The surgeons invariably recommended surgery whilst the radiotherapists said that a course of radiotherapy would be best.
Believing that a "belt and braces" approach might give me the best chance of a cure I asked about the possibility of having more than one treatment. Surprisingly only one of the doctors I consulted actually suggested such a course and even he stressed some reservations about it, pointing out that there would likely be unpleasant and additional side effects or complications. Furthermore it turns out that the order in which sequential treatments are made is important. After a course of external beam radiotherapy it seems that surgery is not really a practical option. On the other hand, radiotherapy treatment after surgery is definitely possible though it was stressed that (at that time) there had been no scientifically controlled evaluation of the success of such a combination of treatments. In general most of the doctors I spoke to regarded the idea with some scepticism.
In the event I decided to have a radical prostatectomy and await results of the tumour analysis. The procedure was carried out rapidly and efficiently at the London Clinic by Professor Roger Kirby with, I believe, as low an impact on my well-being and lifestyle as could reasonably be expected. However, the subsequent analysis showed that the tumour had positive margins, and that there was thus a risk the cancer had spread to surrounding tissue. This prompted me seriously to consider a course of external beam radiotherapy, on the basis that it might increase the chance of eliminating the cancer completely. However, because this combination treatment was not a "normal", or fully tested, procedure, no one could give me any real idea as to by how much it might increase the probability of a full cure. Certainly the discussions focussed much more on the likely (though temporary) side effects and discomforts of the radiotherapy treatment – incontinence, cystitis, diarrhoea, fatigue, headaches and others – rather than on the potential increased chance of survival. In fact the side effects were described more in terms of certainty than possibility.
The course of external beam radiotherapy was carried out by Dr Beaney and his very professional team on Harley Street. It began by placing three small tattoos on the bonier parts of my abdomen. This allowed my body to be accurately located, and the relative position of the internal target area plotted, in 3 dimensions, using lasers. The actual treatment then involved a course of daily visits to the clinic over a period of about 6 weeks. Each session required me to lie on a movable, suspended couch whilst operatives used the lasers and tattoos to position my body precisely in preparation to receive the bursts of rays. The commitment to daily visits to the clinic did, of course, have a significant impact on my schedule over the 6 week period even though each individual dose lasted only for a matter of seconds. The overall treatment was completely painless and did not cause my hair to fall out. Most surprisingly, however, to my knowledge I didn’t suffer any of the nasty side effects which had been predicted – not even a loss of energy.
So what lessons can be learned from this?
- The first one is obvious. On no account delay your visit to routine medical check-ups or other tests. If I had stuck to my “normal” schedule of health assessments I might have discovered my condition a year or more earlier than I did
- Be prepared to take ownership of decisions on what is best for you. When something is wrong you clearly need expert advice, but get more than one opinion and be prepared to question and challenge those opinions. You may be surprised at how they vary.
- If you are considering radiotherapy as an adjunctive treatment don’t be put off by stories of the side effects. Although my own experience may not be matched by all others it does at least show that radiotherapy doesn’t always have to be a nasty experience. But in any event, focus on the positive aspect, not the problems. Even if I had suffered some or all the disagreeable symptoms which had been predicted they would all now be well in the past. I can’t imagine seriously considering that now, some 4 years later, I would have regretted going through a temporary period of discomfort or pain in order to materially improve the chances of a cure.
As I write my PSA level remains low, at <0.1. I can’t prove the point with statistics but I firmly believe the combination of surgery and radiotherapy has made a significant difference to achieving this result. Whether they will be sufficient to keep it that way indefinitely only time will tell.
Stephen Bradley
20th May 2006