Prostate Cancer - next step

[John49]

My recent medical results while in Australia:

PSA = 8.

Prostate volume 35 ml.

mpMRI, pi-rads score = 5.

Prostate biopsy Gleason score = 7 (4+3).

 

My urologist in Australia recommends:

 

A PSMA-PET scan to determine if prostate cancer has reached any other parts of body.

(Where can I do this in Bangkok, avoiding the very expensive hospitals?

My urologist says the result will probably be negative, as a recent PET-CT scan was negative, apart from picking up this same issue with prostate.)

 

Removal of internal part of prostate using Holep laser procedure.

 (Apparently, this laser removes all internal tissue so that it will not grow back.

As I’m in my late 70’s, not sure if that is a real risk?

The reason for doing this is that flow is already restricted and will become more restricted with radiation.

There are other options like TURP, Rezum, or Aquablation?

The cost estimate for Holep is AUD 15,000 with negligible Medicare rebate; urologist said must stay in Australia for 4 to 6 weeks after procedure – a negative for me.)

 

Take hormone tablets for 6 months.

(I think that is to hold back the progress of cancer.)

 

After 6 months of hormones, start radiation treatment.

(Not sure what kind of radiation or for how long?

I see that Bumrungrad has video online that says they use hydrogel as spacer between prostate and rectum, to minimise damage to rectum. Are there other hospitals using this technique?)

 

Apparently, I should only do the PSMA-PET scan now, as my prostate needs 6 weeks to recover from the recent biopsy.

 

Any personal experiences, or suggestions on where to get treatment in Bangkok would be welcomed.

 

A looks like lots of specialist doctors available at each hospital, any recommendations on doctor’s names appreciated.

 

Also, it would be really good just to ‘sign up’ at one hospital for all treatments.

 

 

[advancebooking]

Bumrungrad has to be your best option. Probably as expensive as oz but just as good. Bring all evidence. 

 

7 years ago I watched a 70 year old south african die here from Prostate cancer. I saw him in his final days. Not a good thing...RIP Tony. Dont piss about. Get treated quickly and dont question the dr unless you have a MD. 

[Negita43]

I'm 80 my PSA was 46 had a biopsy in a Government hospital (Korat)  - Biopsy showed Cancer restricted to prostrate  only. Gleason 3+4

Finish my radiation on friday Varian Halcyon Linac Device - very few side effects - some restriction of urine flow not serious - but more frequent

But my hormone treatment started 6 weeks ago.

Total cost so far about £10K I am impressed with this hospital.

If cost is an issue maybe look for a good Government hospital

[Negita43]

Just to add to my previous post:

Most of the "Government" doctors in this  area (Korat) moonlight in the local private sector anyway so the  quality of the doctor is usually the same - and I supect the equipment is just as good also. One of my fellow patients actually started by going to a private hospital who promptly sent him the the Government hospital for the radiation treatment!

[Sheryl]

Rezum does not treat prostate cancer, it is used for benign enlargement. Ditto aquablation which in case is nto available in Thailand.

 

If you opt to remove the prostate, should go for endoscopic robotic approach rather than TURP. Substantially less blood loss and less risk of long term incontinence etc.

 

With Gleason of 7 and assuming PSMA-PET scan is negative,  and prostate not that big, either robotic prostatectomy or radiation treatment could be considered and ultimately your choice. Radiation treatment  has a number of different approaches, brachytherapy (implantation of radiactive pellets directly into the prostate) having the advantage of doing less damage to healthy tissue and also requiring less hospital visits. Main disadvantage of this over robotic prostatectomy is that after some years the cancer may recur whereas prostatectomy is definitive (assuming cancer did not already spread).

 

If at all concerned about cost (as it sounds like you are) I would recommend instead Siriraj hospital's private wing, will be around 25% less than Bumrungrad for same or better quality. I suggest this doctor there:

 

Prof. Sittiporn Srinuluad

https://www.siphhospital.com/en/medical-services/find-doctor?doctor_id=246&medical_id=&day=&startTime=&endTime=

 

Prof. Sittiporn also has hours at Thonburi hospital (just 5 minutes away from Siriraj) and MedPark and Bumrungrad (the last 2 being in heart of Bangkok). It can be often be quicker/easier to see him at those places but if you want to go to only one hospital then Siriraj would be the one as some treatments are not available at the other places. Though it will also work fine to see him at differing hospitals, he will remember your case, I did it that way with a friend recently.

 

[Denim]

19 minutes ago, Negita43 said:

Just to add to my previous post:

Most of the "Government" doctors in this  area (Korat) moonlight in the local private sector anyway so the  quality of the doctor is usually the same - and I supect the equipment is just as good also. One of my fellow patients actually started by going to a private hospital who promptly sent him the the Government hospital for the radiation treatment!

 

Thanks for sharing.  I have noticed the same thing with doctors where I live, working in own clinics as well as gov hospital.

 

Also, congratulations  on making late 70's with all your marbles. Lucky man. No male in my family has got past 70 so I feel like I'm up against it.

 

Wish you all the best for a speedy recovery. 

[CM4Me]

2 years ago, I had radiation treatment at Bumrungrad (Dr Apichart). Wonderful Dr / hospital. Expensive, in my case paid by DVA. I feel terrific.

[novanova]

Look up:

prostate cancer nanoknife

[newbee2022]

17 hours ago, John49 said:

My recent medical results while in Australia:

PSA = 8.

Prostate volume 35 ml.

mpMRI, pi-rads score = 5.

Prostate biopsy Gleason score = 7 (4+3).

 

My urologist in Australia recommends:

 

A PSMA-PET scan to determine if prostate cancer has reached any other parts of body.

(Where can I do this in Bangkok, avoiding the very expensive hospitals?

My urologist says the result will probably be negative, as a recent PET-CT scan was negative, apart from picking up this same issue with prostate.)

 

Removal of internal part of prostate using Holep laser procedure.

 (Apparently, this laser removes all internal tissue so that it will not grow back.

As I’m in my late 70’s, not sure if that is a real risk?

The reason for doing this is that flow is already restricted and will become more restricted with radiation.

There are other options like TURP, Rezum, or Aquablation?

The cost estimate for Holep is AUD 15,000 with negligible Medicare rebate; urologist said must stay in Australia for 4 to 6 weeks after procedure – a negative for me.)

 

Take hormone tablets for 6 months.

(I think that is to hold back the progress of cancer.)

 

After 6 months of hormones, start radiation treatment.

(Not sure what kind of radiation or for how long?

I see that Bumrungrad has video online that says they use hydrogel as spacer between prostate and rectum, to minimise damage to rectum. Are there other hospitals using this technique?)

 

Apparently, I should only do the PSMA-PET scan now, as my prostate needs 6 weeks to recover from the recent biopsy.

 

Any personal experiences, or suggestions on where to get treatment in Bangkok would be welcomed.

 

A looks like lots of specialist doctors available at each hospital, any recommendations on doctor’s names appreciated.

 

Also, it would be really good just to ‘sign up’ at one hospital for all treatments.

 

 

Honestly, what do you expect here??? An online diagnosis? Any online advice?? Any specific explanation? 

All responsible and conscientious doctors here should tell you to see a second opinion but not give any comments here. This is not a medical forum for medical personnel only.🙏

[Negita43]

46 minutes ago, newbee2022 said:

Honestly, what do you expect here??? An online diagnosis? Any online advice?? Any specific explanation? 

All responsible and conscientious doctors here should tell you to see a second opinion but not give any comments here. This is not a medical forum for medical personnel only.🙏

You're clearly "a hit a man when he's down" type.

The poster is clearly worried and needs help and empathy not your type of response.

[paul1804]

1 hour ago, newbee2022 said:

Honestly, what do you expect here??? An online diagnosis? Any online advice?? Any specific explanation? 

All responsible and conscientious doctors here should tell you to see a second opinion but not give any comments here. This is not a medical forum for medical personnel only.🙏

There are many of us on this forum that have personal experiences with prostate related issues so what is wrong with sharing your experiences which may help the guy. If you dont agree with it then just dont comment, keep your thoughts to yourself!

[xylophone]

Sheryl mentioned, "brachytherapy (implantation of radiactive pellets directly into the prostate) having the advantage of doing less damage to healthy tissue and also requiring less hospital visits" although it is possible that the cancer could return, but IMO I would recommend you investigate that procedure.

 

It is certainly one that I would strongly consider if I were in the same situation.......good luck whatever you decide to do.

[paul1804]

18 hours ago, John49 said:

My recent medical results while in Australia:

PSA = 8.

Prostate volume 35 ml.

mpMRI, pi-rads score = 5.

Prostate biopsy Gleason score = 7 (4+3).

 

My urologist in Australia recommends:

 

A PSMA-PET scan to determine if prostate cancer has reached any other parts of body.

(Where can I do this in Bangkok, avoiding the very expensive hospitals?

My urologist says the result will probably be negative, as a recent PET-CT scan was negative, apart from picking up this same issue with prostate.)

 

Removal of internal part of prostate using Holep laser procedure.

 (Apparently, this laser removes all internal tissue so that it will not grow back.

As I’m in my late 70’s, not sure if that is a real risk?

The reason for doing this is that flow is already restricted and will become more restricted with radiation.

There are other options like TURP, Rezum, or Aquablation?

The cost estimate for Holep is AUD 15,000 with negligible Medicare rebate; urologist said must stay in Australia for 4 to 6 weeks after procedure – a negative for me.)

 

Take hormone tablets for 6 months.

(I think that is to hold back the progress of cancer.)

 

After 6 months of hormones, start radiation treatment.

(Not sure what kind of radiation or for how long?

I see that Bumrungrad has video online that says they use hydrogel as spacer between prostate and rectum, to minimise damage to rectum. Are there other hospitals using this technique?)

 

Apparently, I should only do the PSMA-PET scan now, as my prostate needs 6 weeks to recover from the recent biopsy.

 

Any personal experiences, or suggestions on where to get treatment in Bangkok would be welcomed.

 

A looks like lots of specialist doctors available at each hospital, any recommendations on doctor’s names appreciated.

 

Also, it would be really good just to ‘sign up’ at one hospital for all treatments.

 

 

BNH is a very good government hospital on Silom Rd, I believe there is one of Thailands leading Uroligists practicing there, another option is Bangkok Christian hospital, a private hospital also on Silom road and a lot less expensive that Bumrungrad. Saint Louis Hospital is also worth considering if you are on a budget.

[Srikcir]

Samitivej Sukhumvit Hospital is also a possibility, ie., even if for a second opinion. Check their web site. Both Bumrungrad and Samitivej accept certain foreign medical insurances that substantially cut your out of pocket costs. For some foreign policies, 100% coverage for in-patient care.

[WDSmart]

I'm 78, and my PSA count is just a little above the danger zone. The doctors here (Thailand) wanted to test me for prostate cancer, but I checked with a few of my friends who are doctors in the USA, and they advised me against that. They told me prostate cancer was very slow-growing, so even if I had it, it would not interfere with my life unless I lived to be over 100. 

[newbee2022]

30 minutes ago, paul1804 said:

There are many of us on this forum that have personal experiences with prostate related issues so what is wrong with sharing your experiences which may help the guy. If you dont agree with it then just dont comment, keep your thoughts to yourself!

Is this forum only to special people like you? 

And if you think this forum is the right one for medical advice then you can post your medical records everywhere: Instagram, Tiktok, Facebook and others. 

As I said before: NO responsible Doc like me (except Quacks) is allowed or willing to give an expertise or diagnosis over internet (here on this forum). That's against any ethic values.

So you will get only statements of people who got a similar problem. But nobody knows that case in full with all details.

Take this to consider.

[DaLa]

17 hours ago, Sheryl said:

If at all concerned about cost (as it sounds like you are) I would recommend instead Siriraj hospital's private wing, will be around 25% less than Bumrungrad for same or better quality. I suggest this doctor there:

 

Prof. Sittiporn Srinuluad

Have to agree with  this and just to add, my PSA was 24 and Gleeson 9 when diagnosed. I am being treated by both the Urologist and the Radiotherapist specialists at Siriraj and the latter would not suggest the brachytherapy thus it was 28 shots on the Linac (1.5T 7MV) , which is the only one of its kind in South East Asia. I will never know whether the other options would have been more successful or create less after effects. My experience led to complications with my bowel and bladder that have since ( 2 months after completing treatment) have resolved to nearly 'normal' although the 3-4 bathroom visits a night are still required. Cost wise , all in was £10k and the level of care, equipment and surroundings although a public hospital felt like a private hospital. More importantly my PSA last measured at 0.6 although I haven't had any further scans to advise on the cancer cells, however the radiologist advised the 'shots' were accurate and were having the correct impact. I'm as strong now as I was before treatment, eating well and have put on 3 kilos, possibly due to the hormone treatments; which are fun with hot flashes in this heat. There's more if you want, but that's it in a nut shell, good luck with whatever course you choose.

[Negita43]

8 minutes ago, WDSmart said:

I'm 78, and my PSA count is just a little above the danger zone. The doctors here (Thailand) wanted to test me for prostate cancer, but I checked with a few of my friends who are doctors in the USA, and they advised me against that. They told me prostate cancer was very slow-growing, so even if I had it, it would not interfere with my life unless I lived to be over 100

From all that can be read it is true that in a large number of Prostate Cancer situations it is slow growing.

But sometimes the cancer is aggressive.

Without tests (MRI Biopsy) you cannot know how aggressive your cancer is.

For my part my PSA had been above normal for 20 years but recently an MRI showed it progessing significantly so I had a biopsy which led to treatment.

[DaLa]

30 minutes ago, Srikcir said:

Samitivej Sukhumvit Hospital is also a possibility, ie., even if for a second opinion. Check their web site. Both Bumrungrad and Samitivej accept certain foreign medical insurances that substantially cut your out of pocket costs. For some foreign policies, 100% coverage for in-patient care.

Careful with the wording on 'in' and 'out' patient. I've just had all in, 5 months of diagnosis, tests, treatments and follow ups for prostrate cancer. All but 1 night when I had a Biopsy was as an outpatient.

[Ben Zioner]

17 hours ago, Sheryl said:

Rezum does not treat prostate cancer, it is used for benign enlargement. Ditto aquablation which in case is nto available in Thailand.

As OP mentioned, his Australian Doctor wants to enucleate his prostate to prevent urinary retention during the cancer radiotherapy. 

[Ben Zioner]

24 minutes ago, WDSmart said:

I'm 78, and my PSA count is just a little above the danger zone. The doctors here (Thailand) wanted to test me for prostate cancer, but I checked with a few of my friends who are doctors in the USA, and they advised me against that. They told me prostate cancer was very slow-growing, so even if I had it, it would not interfere with my life unless I lived to be over 100. 

That's a wise decision. At your age I wouldn't bother either. BTW I have been diagnosed 6 years ago and I am under active surveillance.

[bkk6060]

My father had it at 79.

They chopped his nuts off saying without the hormones created in his testes the cancer would grow much more slowly.

He died 10 years later of a heart attack. 

[paul1804]

44 minutes ago, newbee2022 said:

Is this forum only to special people like you? 

And if you think this forum is the right one for medical advice then you can post your medical records everywhere: Instagram, Tiktok, Facebook and others. 

As I said before: NO responsible Doc like me (except Quacks) is allowed or willing to give an expertise or diagnosis over internet (here on this forum). That's against any ethic values.

So you will get only statements of people who got a similar problem. But nobody knows that case in full with all details.

Take this to consider.

Then if you are a doctor and should have good ethics then why dont you politely suggest this to the guy! 

[newbee2022]

2 minutes ago, paul1804 said:

Then if you are a doctor and should have good ethics then why dont you politely suggest this to the guy! 

As I said before: NO responsible Doc like me (except Quacks) is allowed or willing to give an expertise or diagnosis over internet (here on this forum). That's against any ethic values.

So you will get only statements of people who got a similar problem. But nobody knows that case in full with all details.

Take this to consider.

[placnx]

18 hours ago, Sheryl said:

Rezum does not treat prostate cancer, it is used for benign enlargement. Ditto aquablation which in case is nto available in Thailand.

 

If you opt to remove the prostate, should go for endoscopic robotic approach rather than TURP. Substantially less blood loss and less risk of long term incontinence etc.

 

With Gleason of 7 and assuming PSMA-PET scan is negative,  and prostate not that big, either robotic prostatectomy or radiation treatment could be considered and ultimately your choice. Radiation treatment  has a number of different approaches, brachytherapy (implantation of radiactive pellets directly into the prostate) having the advantage of doing less damage to healthy tissue and also requiring less hospital visits. Main disadvantage of this over robotic prostatectomy is that after some years the cancer may recur whereas prostatectomy is definitive (assuming cancer did not already spread).

 

If at all concerned about cost (as it sounds like you are) I would recommend instead Siriraj hospital's private wing, will be around 25% less than Bumrungrad for same or better quality. I suggest this doctor there:

 

Prof. Sittiporn Srinuluad

https://www.siphhospital.com/en/medical-services/find-doctor?doctor_id=246&medical_id=&day=&startTime=&endTime=

 

Prof. Sittiporn also has hours at Thonburi hospital (just 5 minutes away from Siriraj) and MedPark and Bumrungrad (the last 2 being in heart of Bangkok). It can be often be quicker/easier to see him at those places but if you want to go to only one hospital then Siriraj would be the one as some treatments are not available at the other places. Though it will also work fine to see him at differing hospitals, he will remember your case, I did it that way with a friend recently.

 

Regarding radiation therapy, and specifically brachytherapy, this is an excellent explanatory link:

https://www.cancer.org/cancer/types/prostate-cancer/treating/radiation-therapy.html

Brachytherapy used to be for low grade cases, but I see that now there are more options for using it.

 

Laparoscopic surgery should work if the prostate volume is 35 ml. Why TURP these days?

[Sheryl]

1 hour ago, paul1804 said:

BNH is a very good government hospital on Silom Rd, I believe there is one of Thailands leading Uroligists practicing there, another option is Bangkok Christian hospital, a private hospital also on Silom road and a lot less expensive that Bumrungrad. Saint Louis Hospital is also worth considering if you are on a budget.

BNH is a private hospital and on Convent Rd (between Silom and Sathorn). 

 

Bangkok Christian and St. Louis, while excellent hosp8tals, do not offer the full  range of relevant treatments.  Cannot do HoLEPS and robotic surgery for example.

[Sheryl]

1 hour ago, Ben Zioner said:

As OP mentioned, his Australian Doctor wants to enucleate his prostate to prevent urinary retention during the cancer radiotherapy. 

Yes I know. That is HoLEPS. Not Rezum or Aquablation. 

[Stevemercer]

1 hour ago, newbee2022 said:

As I said before: NO responsible Doc like me (except Quacks) is allowed or willing to give an expertise or diagnosis over internet (here on this forum). That's against any ethic values.

So you will get only statements of people who got a similar problem. But nobody knows that case in full with all details.

Take this to consider.

 I hope you are not implying that other doctors who take the time to respond are Quacks? I personally find recommendations about good Thai hospitals and specialists for specific ailments to be useful. Sometimes respondents have useful experience or comments that might be relevant. Ofcourse it all has to be taken with a grain of salt.

 

Unfortunately, you too frequently get other respondents who are dismissive, negative, opinionated, tactless, ignorant or otherwise not helpful. Such are public forums.

[newbee2022]

12 minutes ago, Stevemercer said:

 I hope you are not implying that other doctors who take the time to respond are Quacks? I personally find recommendations about good Thai hospitals and specialists for specific ailments to be useful. Sometimes respondents have useful experience or comments that might be relevant. Ofcourse it all has to be taken with a grain of salt.

 

Unfortunately, you too frequently get other respondents who are dismissive, negative, opinionated, tactless, ignorant or otherwise not helpful. Such are public forums.

I don't know any other docs here in this forum. 

But I'm too cautious and too responsible and conscientious to give any medical advice here because I don't know the whole case with all data and records. Also, to give diagnosis over internet is against any law here in Thailand and it is against data protection Act too. 

As you said to give advice/tips where to find specialists or hospitals might be ok.

More is careless as a doc.

[Jonnapat]

Stop listening to all these private hospitals and go to Siriraj hospital. 

Excellent urologists and oncologists.

Government teaching hospital with all the latest machines at a fraction of the cost of the hospital ""hotels "".

I have had super treatment there for the last 15 years and highly recommended it