Patients' experiences

Paddy Kelly, 52, Nottingham
Graham Robson, 53, Aberdeen
Max Stinchcombe, 54, Southampton
Chris, 61, Devon
Chris, 58, London

Men from all walks of life may suffer from prostate cancer. Here, you can read the stories of five men who decided that LDR brachytherapy (seed implantation) was the best treatment for their cancer.

Paddy Kelly is an airline pilot with a leading airline. He had never even heard of the prostate until a routine medical check and blood test by his GP in December 2005 revealed high PSA (prostate specific antigen) levels. Paddy's PSA was 27 ng/mL. The normal range is between 0–4 ng/mL. A high PSA level such as this is often caused by prostate cancer.

Paddy was referred to a urologist in Ireland who took eight biopsies (samples of tissue from the prostate). "Not a pleasant procedure", Paddy remembers. The results, however, came back clear and Paddy was put on a "wait and see" policy even though he had other urinary symptoms. Not reassured by this diagnosis Paddy requested a second opinion in the UK and, in February 2006, 14 more biopsies were taken, this time under general anaesthetic. Once again they came back clear, but his PSA score was still too high. Paddy also had a bone scan, which came back negative. His doctor gave him a course of antibiotics in case it was just a urinary infection.

"I was becoming increasingly concerned", said Paddy. "My mother had died of cancer and my sister had breast cancer, so I decided to go online and do my own research."

Luckily, Paddy came across the St Luke's Cancer Centre in Guildford run by Professor Stephen Langley, a urologist specialising in prostate cancer. "I read that Stephen performed a different type of biopsy which was more accurate and so I made an appointment to see him. This time the results of the biopsy were all too clear - I had bilateral prostate cancer with a Gleason of 6/7 and needed to make a decision about treatment without much delay. This was now June 2006, 6 months since my initial PSA check."

Paddy was given hormone treatment and external beam radiation before receiving LDR brachytherapy in December 2006, a treatment which places radioactive seeds in the prostate to destroy the tumour. "The short term side effects from the hormone treatment and EBRT were not great but apart from feeling a little uncomfortable from the brachytherapy I had no other long term side effects from this treatment. It was so convenient - I was back at work almost immediately."

Paddy was advised not to have surgery to remove the prostate as incontinence is a common side effect; "That is something I simply cannot afford to suffer from as a pilot. My career is very important to me".

Paddy now has a PSA level of 0.08 and is optimistic that he is clear of prostate cancer.

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As CEO of V.People, a successful man management company in Aberdeen, and with four demanding children, Graham really did not have the time to be ill, so when he got the results from a routine medical check-up that he had a PSA level of 6.5 ng/mL he was shocked.

"I had booked in for a BUPA medical check last May just to make sure everything was in working order before I embarked on a 120 mile charity bike ride" said Graham. "I had trained hard for the ride and was feeling fit and healthy so when the doctor said I had prostate cancer, I was totally taken aback."

"My initial reaction was to have surgery and just cut it out, but when I was told that it could take 3 months to fully recover and that there was a strong possibility that I would get erectile and urinary problems after surgery, I realised that my life may never be the same again."

Deciding that surgery was not an option, Graham was given the alternative choice of external beam radiation, which has a high success rate, but still has the same side effects as surgery. A friend, however, mentioned that he had read about the St Luke's Cancer Centre in Guildford which was pioneering research into prostate cancer.

"I looked them up on the web and read about LDR brachytherapy, a non-invasive treatment which injects radioactive seeds into the tumour", said Graham. "I had not heard of this treatment before but it sounded a good option to me."

Graham went to see Professor Stephen Langley at the Centre. "I was worried how successful the treatment would be and what would happen if it did not work and the centre was, of course, a long way from home." However, Professor Stephen Langley reassured Graham that LDR brachytherapy had a high success rate with fewer side effects than surgery and that he could be back home and at work again very soon.

"I went in for the brachytherapy procedure in the morning and was out of bed in the afternoon and home the next day. It was that quick and painless", said Graham.

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Max is a happily married man with two children. He has a rewarding career as a bank manager in Southampton and likes to spend his weekends on the golf course. In fact, it was on the golf course 4 years ago that he first learnt he had prostate cancer.

"I had just had a routine company medical which showed a slightly elevated PSA (prostate specific antigen) score which I was told could be indicative of the early stages of prostate cancer. My wife was very concerned and insisted that I go to the GP to get it checked out. My GP immediately referred me to a urologist who took a rather painful biopsy."

The results of the biopsy were due back on the day of an important golf match, so Max left his wife to take the call convinced nothing was wrong. "I will always remember my wife calling me on the first hole with the momentous words - Max, you have cancer", said Max. "I immediately went into the stereotypic man's response by denying anything was wrong and carried on playing golf as usual. I even stayed for the prize giving ceremony in the evening."

When Max got home he found his wife in tears and he realised the potential severity of his condition. "I decided to take control of this disease and went online to research possible treatment options", said Max. "I also contacted the Prostate Cancer Charity which had fantastic patient information and were extremely helpful. The treatment I decided I wanted was brachytherapy, a convenient `one-stop shop` which uses radioactive seeds to destroy the cancer cells. Results showed that the side effects from brachytherapy were less severe in terms of incontinence and impotence than traditional surgery and that was very important to me as I was only 50 at the time."

Max had his brachytherapy at the St Luke's Cancer Centre in Guildford performed by Professor Stephen Langley. "I was slightly sore and uncomfortable afterwards, but had no side effects and was back at work in 2 days. So far there is no sign of the cancer returning."

Max actually had to go to the USA 4 months after his treatment. "It was rather amusing", he said, "as the radioactive seeds were still active and I had to have a letter from Professor Stephen Langley at St Luke's Cancer Centre to get me through airport security - there was no way I wanted another body search!!"

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Chris and his wife Ivy were enjoying early retirement and had just bought a second home in Florida when his GP diagnosed a borderline PSA score in January 2005 during a routine medical. Chris was referred to a urologist who reassured Chris that at this stage no treatment was needed and that he would be actively monitored with his PSA taken every 6 months to record any changes. “I was so unconcerned with the results”, said Chris, “that my wife and I went off to Florida to enjoy our new home and the sunshine and I completely forgot about my next 6 month blood test.”

It was later in September 2005, when he was back in the UK, that Chris had a second PSA test and his urologist was concerned as his PSA level had risen to 10.9. A biopsy was taken which confirmed that Chris had localised prostate cancer and the urologist recommended that he underwent an immediate radical prostatectomy. However, Chris was not keen on the side effects from radical surgery and also the long post-operative recovery period.

Luckily, Chris has American relatives and he decided to ask them for advice. They suggested that Chris enquired about brachytherapy (or seed implantation as it is called), a procedure routinely carried out in the USA. Chris mentioned this to his urologist who agreed that he was a suitable candidate, but that this treatment option was not available in Devon. Having researched brachytherapy on the internet, Chris and his wife Ivy decided that this was definitely the treatment they both wanted as the risk of impotence was minimal compared to surgery and their physical relationship was very important to them.

Chris eventually decided to pay privately for brachytherapy and his treatment was carried out at Guy’s Hospital in London in November 2005. “I decided to stay in for a couple of nights as it is a long way back to Devon, but I could have gone back the same day as the procedure if I had wanted. Although I was uncomfortable for a few days after the procedure, I have no physical side effects and my wife and I can just go on with enjoying our lives.

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Chris, a web site developer and composer from London, was diagnosed with prostate cancer in October 2007 after he consulted his GP following some urinary problems. "My father has a benign enlarged prostate and suffered similar symptoms, so I assumed that was what I had," said Chris.

However, an above normal PSA score and resulting biopsy confirmed that he had prostate cancer. Unfortunately, Chris suffered an adverse reaction to the biopsy and was poorly for six weeks. "Not only was it a shock to hear I had cancer," said Chris, "but I was fit and well when I went to see my GP and to be so ill after the biopsy was not pleasant, although I understand it is a very rare occurrence".

More worryingly, Chris's consultant decided to do an MRI scan to make sure the cancer had not spread. The results came back showing a slight shadow in one seminal vesicle and, more alarmingly, in the bones, although they could not be absolutely certain the shadow was cancer. Mercifully, a nuclear bone scan came back clear within a few days, but the question remained over the seminal vesicle.

Chris was, therefore, told that his only options were radical surgery or external beam radiation (EBRT) and warned of the possible side effects of impotence and incontinence. "You can imagine how I felt," explained Chris, "Things just seemed to be going from bad to worse."

However, a friend who had had brachytherapy suggested that he seek a second opinion and Chris's GP referred him to a London brachytherapy centre where a more sensitive transrectal ultrasound scan showed that his cancer was confined to the prostate and Chris was told that he was a suitable patient for LDR brachytherapy.

In April 2008, Chris underwent the brachytherapy procedure and was home the next day. "I'm experiencing some urinary symptoms, but they are only what I was led to expect and I'm confident they will improve. In general, I can just get on with enjoying my life and work," said Chris.

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