daVinci prostatectomy or brachtherapy

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acmd
New Member


Date Joined Jan 2008
Total Posts : 4
   Posted 1/29/2008 10:22 PM (GMT -7)   
58 y/o; very active.
PSA rose from 1.65 in 2005 to 3.6 in 2007.
10 core biopsies; 4 positive for cancer; Gleason grade 6.
I've spoken with urologist and radiation oncologist.  Both feel either robotic prostatectomy or
brachtherapy (High Dose Radiotherapy not permanent seeds) are equally effective.
I'm concerned about incontinence as well as erectile dysfunction.
Any feed back from those that have had these forms of therapy?
 
acmd 

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 1/30/2008 12:18 AM (GMT -7)   
Hi acmd,
Welcome to the best site on the internet for support for prostate cancer. In the coming days you will be greeted by our outstanding moderators. Good luck in your decision. But make no bones about it, there are good and bad things about each treatment option. i chose surgery and my parts work well.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
 
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
 
My Life is supported very well by family and friends like you all.
 
Visit my journey at:
 
STAY POSITIVE!


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 1/30/2008 4:37 AM (GMT -7)   
ACMD,

Most who have surgery regain continence by week 14 and - if they work at it - "uasable" erections by month 18.  Surgery gives a final biopsy that is extremely useful in navigating future medical options.

Radiation's effect on incontinence and E.D. are delayed but still real.  There is no biopsy and the patient is offered a different path for future treatment options.

My main point is: Don't let some idea that you will avoid incontinence and E.D. issues with one choice over the other be a part of your decision process!.  (There is another choice, Proton Beam, that you might look into.  If you are a candidate, the incontinence and E.D. side effects are usually less.)

Only you can decide what should be done in your particular situation.
For example, we don't know about any other health issues you may have.

The best surgeons are passionate about what they do as the best radiologists are passionate about what they do.  Try to filter their passion out of your decision process!

Read as many threads as you have time for - found indexed in the third post of the second thread at the top of the page. 
Personalize your signature with your informatrion and you will get more relevant responses. (While logged on, click on "Control Panel" and edit your signature at the bottom of the "Profile" tab.  Then save.)

Whatever you decide, you will find caring and informed people here on this forum that will share their experience and insight - as others shared with us.
Ask anything.  You have found friends.

CCedar
ICTHUS!
2 Years of PSA between 4 and 5.5  + Biopsy 23DEC06 
Only 5 percent cancer in one of 8 samples.  +  Gleeson 3+3=6
OPEN R P 16FEB07 at age 54. 1+" tumor - touching inside edge of gland.  + Confined:)
Pad Free @ 14 weeks.  Six Month PSA <.003  :)   Nine month PSA <.008
:)
At 9 months, ED treated with Pump Exercises & 100mg Viagra Daily

GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 1/30/2008 6:48 AM (GMT -7)   
Whoa - who says ED is not an issue for someone in their 70s or 80s? I certainly HOPE that's not the case in this day and age. Goodness! (and a big wave to Mr. Cialis, too!)

Hi, acmd - sounds like you're an excellent candidate for any type of treatment. That's what makes it tough. No treatment is simple or easy and all have their risks. In the end, you begin to narrow down the choices that are right for your particular situation and that can even include the convenience of locale.

Keep poking around and you'll find your way to the right answers.

And welcome - you're among the finest folks on the planet, here!
Husband: Age 67
PSA had doubled in 14 mos to 4.3/Gleason 6
da Vinci 8/06 in Austin with Dr. Randy Fagin
Post surgical path shows encapsular penetration; possible bladder neck involvement.
PSAs remain undetectable; no further treatment at this time.
Next PSA: April 08


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 1/30/2008 9:46 AM (GMT -7)   
You know, I think the best advice I can give is to put how the treatment is done out of your mind entirely then concentrate on the results of the treatment options both long and short term.

All the procedures have their bad parts and as you read they are all tolerable
After a short time you can laugh at some of the funny parts with the rest of the club members.

Randy
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.
Walked a lot
90% control the day the catherter removed.
pad only for a sneeze before the week was out
No pads most of the second week.


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 1/30/2008 10:03 AM (GMT -7)   
We chose surgery for the following reasons: (1) Pathological staging that determines the exact extent of the tumor(s) and the prostate margins. (2) The PSA goes immediately to zero. (3) More options are available if the cancer returns, including salvage radiation if needed (4) Not as likely to experience painful urination and diarrhea (5) Impotence and incontinence tend to get better over time. 
 
I want to emphasize that choice of treatment is a very personal decision and depends on many factors. Our choice was the right one for us. The important thing is to make an informed decision.  In choosing Door #1, Door #2, or Door #3, there is no going back and reselecting after that door is opened.
 


Age 59 PSA 2.6 PSA velocity quadrupled in 1 yr 
1 of 12 biopsy cores positive (5% involvement) Open RP 6/21/06  Gleason 5
Cancer confined to prostate  Post-op PSA's non-detectable


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 1/30/2008 1:40 PM (GMT -7)   

tongue  Hi  ~  acmd & Loved Ones,

 

Welcome   to…   ~ HealingWell ~

 

and

 

A   Special   Warm Welcome  to  You !

 

Click  on  link  below for important information that will help you ~ help us!!

 

Welcome New Members ~ to HealingWell

 

v       This is a journey best traveled with friends. 

 Welcome ~ New Friend from all the members here... on HealingWell.com

 

v      IdahoSurvivor ~  Moderator for Prostate Cancer Forum

http://farm2.static.flickr.com/1160/1313099593_9f819e3ff8.jpg

 

v      bluebird ~  Moderator for Prostate Cancer Forum

http://i206.photobucket.com/albums/bb179/mamabluebird1955/mamabluebirdWelcome.jpg 


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 1/30/2008 1:43 PM (GMT -7)   

tongue  Hi ~ acmd & Loved Ones,

 

Gentle Hugs and Warm Thoughts

 

We know ~ we can “all” make “Your Journey” smoother just by being here for you! 

This is truly a great forum!!! ~ You have joined!  You are now part our forum family ~ a group of wonderful individuals who are so willing to share...  It helps “all of us” ~ to help you ~ if we know where you are on your path. So ~ Please stay with us and take our hand when you need it!  Keep posting.... OKAY!!

  

 

KNOWLEDGE    IS    POWER  ...  and  POWER conquers  fear

 

YOU MAKE THE DECISIONS… YOU HAVE OPTIONS…

~ and ~

Your decision will be the right decision for you!!!

 

 

Thank you for letting us know the specifics… …this helps all of us to know where you are on your journey.

 

Buddy & I invite you to visit our personal thread listed in our signature below

We would like to help in making a portion of your journey a little smoother.. so pull from us what fits your needs.

 

Make sure you visit the links in your Welcome Message… there is so much information to help you through this!  This path is best traveled with friends. 

The stepping-stones ahead will be smoother if you stay close to all of us.

http://i206.photobucket.com/albums/bb179/mamabluebird1955/Stepping-StonestoHealingWell.jpg

 

Keeping you close in thoughts and prayers ~ as you travel this new path with new friends.

In Friendship ~ Lee & Buddy 


mama bluebird - Lee & Buddy… from North Carolina

 

v          We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

3rd PSA 08-07-2007 Less than 0.1 Non-Detectable :)


acmd
New Member


Date Joined Jan 2008
Total Posts : 4
   Posted 1/30/2008 7:43 PM (GMT -7)   
I'm curious if anyone can talk about their experience with HDR (High dose Radiotherapy).  This is a from of brachytherapy that doesn't leave seeds in place.  The major center that does this in my area shows a 96% diseasae free rate at 10 years.  Reportedly there is less incontinence and ED although some say it just occurs later.

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 1/31/2008 8:26 AM (GMT -7)   
My husband chose Brachytherapy as his treatment - he's doing great.  The high dose removable seed option was not available so he opted for traditional Brachytherapy with great results.  You can read all about it at the post entitled "JustJulie's Brachytherapy Journey".  If you have any other questions, please post, I'd be happy to answer what I can about that treatment option.
 
JustJulie

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 2/1/2008 10:10 AM (GMT -7)   

I can personally speak to the stranded seed Brachytherapy. 

My husband chose that option and has had no problem with seed migration - the seeds are actually stranded together like pearls and they stay together.  My understanding is that very few seeds actually migrate but stranding was an option so he took it - the man in the bed beside him did not.

If you have any questions, please don't hesitate to ask.

 


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 2/1/2008 2:19 PM (GMT -7)   
Ziggy9, a crap shot is a bit harsh way of describing the risk of incontinence associated with surgery. I noticed that your signature doesn't list a treatment. If you want to answer, have you chosen a method?
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.
Walked a lot
90% control the day the catherter removed.
pad only for a sneeze before the week was out
No pads most of the second week.


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 2/1/2008 3:24 PM (GMT -7)   
Sorry about the "crap shot", I was in a hurry and the old brain was working on something else.
I was in the same spot as you are now and thought a lot about proton method. You might look into that. Some of the biggest oncology centers like the university of Florida in Jacksonville are putting several of these new machines.
I stayed awake at nights worried about the surgery or more to the potential problems postop.

Best of luck.
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.
Walked a lot
90% control the day the catherter removed.
pad only for a sneeze before the week was out
No pads most of the second week.


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 2/1/2008 3:58 PM (GMT -7)   
What ever you choose I am sure, it will turn out great for you Ziggy9. That is what my little prayer just said. No matter which way you go, keep posting so others considering your path.

Man it is cold enough there, you should be able to step outside and freeze that thing. LOL
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.
Walked a lot
90% control the day the catherter removed.
pad only for a sneeze before the week was out
No pads most of the second week.


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 2/1/2008 5:12 PM (GMT -7)   
ziggy9 said...
One study I read predicted after 8 years a cancer free rate of 98% with surgery and 95% with brachytherapy. For an additional 3% risk is surgery and it's after affects worth it? The incontinence post surgery is a crapshoot. There's men who are never incontinent and many who are for years after. As I said before this forum is heavily weighted towards surgery so take that into account when making your decision.

We had a difficult time deciding between treatment options and seriously considered brachytherapy.  From studies I have read the long-term cancer-free rate is about same same and the side effects are about the same. 
Keep in mind that while the surgery option has immediate side effects, the effects of brachytherapy tend to accumulate over time. The studies are what are important to read in order to make an informed decision that is right for you. With surgery, you pay now, with brachytherapy you pay later.
I am glad that there is a wide variety of posters here representing many different treatments and individual variation in their experiences.  All are helpful for those here looking for help. 
While the majority here, admittedly, have chosen the surgery option, I haven't seen any prejudice against other treatments. We're all in this together, battling a disease none of us chose.


Age 59 PSA 2.6 PSA velocity quadrupled in 1 yr 
1 of 12 biopsy cores positive (5%) Open surgery June 2006  Cancer confined to one small area of the prostate Gleason 5 Post-op PSA's non-detectable


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 2/2/2008 4:20 AM (GMT -7)   
Friends,

Post-procedure statistics can be mis-leading.  The patients choose various procedures based on their personal situations.  These groups seem to have certain distinct characterisitcs. 
For example, I'm not certain if this is still status quo but, initially only patients with very robust prognoses were considered for candidacy for Proton Therapy. -- probably to keep comorbidities from skewing the data being collected from the comparatively small population of patients.

Otherwise healthy men,with low gleason scores,  are most typically advised to choose radical prostatectomy.  Proton Beam - and perhaps some day HIFU - and then perhaps that "easy, cheap, no-side-effect cure for all cancer,"  - these will surely follow in due time for this younger, healthy, low-gleason group.

Improvements in surgery & anesthesia and early detection (& the resulting ever-increasing chance of catching the cancer before capsular penetration) are some of the reasons our group seems skewed to surgery options.  (The younger patient is more likely to use electronic media, too.)

The various radiation treatments are still so very important.
As Julie has so eloquently commented, the smaller group representation here on this forum weights the importance of the "minority report" (e.g., radiation and/or HT)-related individual posts over the "radical majority."

As we each personalize and customize our treatment choice, it becomes ever-more apparent how Ms. Bluebird's work pioneering the index for this forum is such a blessing for everyone (that only those of us that did not have its benefit early-on can entirely appreciate).  (Take a bow, Ms. Lee!)

CCedar
ICTHUS!



2 Years of PSA between 4 and 5.5  + Biopsy 23DEC06 
Only 5 percent cancer in one of 8 samples.  +  Gleeson 3+3=6
OPEN R P 16FEB07 at age 54. 1+" tumor - touching inside edge of gland.  + Confined:)
Pad Free @ 14 weeks.  Six Month PSA <.003  :)   Nine month PSA <.008
:)
At 9 months, ED treated with Pump Exercises & 100mg Viagra Daily
Texas Hill Country FRESH Produce Department Manager
Have you had your 5 colors today?

Cedar Chopper's Page & Updates ~ Radical Prostatectomy ~ Feb '07
"Zen and the Art of Orchestral Erectile Function"

"Zen and the Art of Symphonic Continence"

Post Edited (Cedar Chopper) : 2/2/2008 4:31:40 AM (GMT-7)

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