Treatment without general anaesthetic?

Yes thanks Lyn as I wouldn't have guessed it was that way round ( as to the layman, open RP sounds like a bigger op than keyhole.)

Thanks also Microcolei, and further info is as follows.  'Intermediate' risk was what I was told,  based I gather on analysis of those 4 positive cores in the one side lobe of my prostate. Overall size of prostate is about 50cc which I think counts as big-ish but not enormous.  I'm told I have a large median lobe, not cancerous but it might have something to do with the urinary symptoms I get.  Hesitancy/occasional difficulty starting to urinate; slight after-dribble; having to get up to wee 3 or 4 times a night.  The last symptom, unlike the first, has not been helped at all by tamsulosin.  However  I do tend to drink more fluid than most people, especially decaf coffee/tea, weak and in large mugs as a 'long drink'.  

I had a fairly detailed consultation with one of the present hospital's consultant oncologists a few months ago. He wasn't against brachy at all but said that if I chose it they'd need to refer me on to Mount Vernon.  His offer was EBRT preceded & followed by a few months of HT.   In the equivalent conversation with his urologist colleague, the main offer was RP.  I asked about focal therapy and was told that my cancer (being so localised)  was suitable  but the size and shape of my prostate might be a practical difficulty for HIFU.  However when the proposition was put to the actual focal team they were content to proceed............until the anaesthesia problem arose. 

As you rightly point out there are other things, not just focal HIFU, which are ruled out if my current care team can't find a workaround for the anaesthesia issue.  

Another point is the risk of urine retention problems from swelling/inflammation of irradiated prostate tissue. This is another motive for trying to keep the radiation (or for that matter the high frequency ultrasound or cryo or electro or whatever) focused within the cancerous lobe if possible. 

Yes thanks Lyn as I wouldn't have guessed it was that way round ( as to the layman, open RP sounds like a bigger op than keyhole.)

Open RP is a bigger op with a longer recovery period and possibly a couple of extra nights in hospital. However, open is kinder to the heart. For keyhole surgery, the patient is tipped head down for a number of hours which a) puts huge pressure on the heart and b) would be impossible if the patient was awake. In open surgery, the patient is just flat on the operating table so a better option for men with heart conditions.

Edited by member 21 Apr 2023 at 15:37  | Reason: Not specified

Given that brachytherapy can be done with a spinal block (indeed, that's the default at Mount Vernon since COVID), I don't see why HIFU can't. It may be the team has simply never done it that way.

Do you think the short course, 5 day, SBRT might work for you?

Australian report

UCLA report

I know there's people on this forum who've had short RT treatment though I don't know if it's SBRT or how available it might be.

Jules

The international differences are beyond my comprehension and I'm unable to read the UK link you posted. I'm pretty sure that the Varian device used in the stereotactic RT referred to in the reference I posted does the 360 degree rotation thing. Unfortunately the ABC report I posted was short on critical the sort of critical detail that matters when you're deciding what sort of treatment might be best.

Jules

There is an alternative that has not been mentioned which might be an option for you. You are right that EBRT deposits some of it's radiation on the way to the tumour and indeed past it. However, Proton Beam though being fired through the body at different angles deposits very little dose on the way to the tumour on which it unloads and virtually nothing after because the tumor is in the 'Bragg Peak'. The Christie at Manchester and UCLH in London each have a Cyclotron with which they have the capability to treat with Proton Beam but may wish to reserve it's use for other cancers where it's use has greater benefit. (There is some conflicting information as to how well it compares with EBRT for PCa but is generally thought not to be more successful). There was a facility that administered Proton Beam in Wales but I think this has now closed. It is available in Prague although somebody reported a bad experience there. Longer established facilities are in the USA but eye wateringly expensive. There are several centres in Germany. I believe one of our members had this in Munich. See graph curve for Protons and Photons .......  https://physics.stackexchange.com/questions/169665/dose-depth-curve-of-photons-vs-protons

Edited by member 26 Apr 2023 at 16:48  | Reason: to highlight link

Mark Emberton mentioned in passing in one of his talks that at UCLH they were able to use their cyclotron to treat PCa. He did not say to what extent it's being used for PCa. I don't know what the attitude of the Christie is in this respect. Apart from possibly these facilities, I think it would be necessary that anybody wanting Proton Beam therapy would need to have it outside the UK, most probably privately, unless they can find and be accepted into a trial.

I am not recommending Proton Beam, I don't recommend any particular form of treatment. I only mention it as the OP was asking about what other possibilities there were that avoided GA.