A personal history of prostate cancer and its treatment

Diagnosis

In January 2003, Ian was diagnosed with prostate cancer.  He was then 66.

This diagnosis came about fortuitously.  Ian had had a haemorrhoid operation in June 2002, which was followed by a mild infection.  A blood test in July showed a raised PSA (although the GP’s DRE appeared OK).  The PSA was still raised after treatment with antibiotics, and our GP then referred Ian to the urology department at the local general hospital.  By the time of his appointment, in November 2002, his PSA was 35.  A biopsy in January 2003 showed prostate cancer with Gleason 8 (4+4).  In February, Ian had an MRI scan and bone scan, which showed the tumour to be out of the prostate but with no apparent spread to the lymph glands or pelvic bones (clinical stage T3a).  By this time, his PSA was 45.

Treatment

As is normal in the UK, the clinicians involved (urologist, oncologist, radiologist) held a case conference and decided that Ian’s case was best handled by the oncologist.  Ian started on Zoladex (3-monthly injections) immediately, with an initial three weeks of Casodex to control tumour flare.  We asked for a second opinion in order to investigate all our options, and were referred to the Royal Marsden, the leading cancer hospital in the UK.  Meanwhile, Ian had a CT scan which showed no sign of bone mets.  By the time of our visit to the Royal Marsden in March, we had lots of questions which were very competently answered.  Brachytherapy and prostatectomy were not considered viable options because the cancer was out of the prostate.

The only other possibility (in addition to the hormone therapy) was radiotherapy.  At the local general hospital, this would have been given to the prostate only, but the Royal Marsden was conducting a clinical trial for which Ian was eligible.  This gave radiation (using IMRT) to both the prostate (70 Gy over 7 weeks at 2Gy per day) and the pelvic lymph nodes (60 Gy over the same period).  The consultant said that “80% of patients won’t benefit from radiotherapy, the remaining 20% could benefit enormously”.

After considerable research and thought, we decided that Ian should take part in the clinical trial.  We felt that the risks of bad side effects were small (2-3%), and, although radiotherapy might ultimately m