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IMRT vs Surgery concerns.

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Posted 9/18/2008 9:01 PM (GMT -6)
I am avoiding surgery for one reason - I'm a chicken when comes to being "put" to sleep.  A bad experience early in life seems to have left me overly concerned about surgical procedurs.  I just can't get myself to accept surgery as long as there are other options.  However, I am concerned over the vast numbers of people who are opting for surgery.  I read where people want the cancer out of them.  Won't the cancer be out of me?  I hear that once you've had radiation, you can't, later, have surgery if needed.  I also read about salvage surgery though.  Would someone please share the good bad and ugly about IMRT and surgery?

A premature thanks,

 

Posted 9/19/2008 5:16 AM (GMT -6)
No one knows the answer to this question.

Trying to compare the outcomes of various treatments is not logical: available figures are obviously based on information from some years ago when techniques and equipment used was very different to what is available today.

Often there are several treatment options that can provide similar outcomes, so it comes down to personal preference which could well depend on which side effects are most acceptable to you.

Posted 9/19/2008 5:28 AM (GMT -6)
The IMRT makes a mess of your prostate and surrounding tissue. If you later need salvage surgery, the prior IMRT makes it a lot more difficult, though not impossible.

The "cure" rates for surgery and IMRT are comparable, but I believe for higher Gleason scores, the odds favor surgery. At biopsy, I had a Gleason 9 and surgery was the standout best option for me.
Posted 9/19/2008 6:35 AM (GMT -6)
I initially was moving toward seeds because that sounded the least invasive, and I was being pushed that way by my original urologist. However, he didn't tell me everything at once. Because my biopsy was 8 or 10 cores with perineural invasion, and a gleason 7 he wanted to do harmones, IMRT, and seeds. After visiting two other urologist and weighing all the information I decided to go with surgery. I encourage you to read "between radiation and seeds" on about page 11 or 12. There is a lot of interaction about this very issue from a number of people.

Obviously, these are tough decisions that require getting all the information you can get. Sorry to hear you have a fear of being put to sleep. The funny thing about that is when I went to sleep it happened so fast that I did not know what was going on until it was over. Wishing you the best.

RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04
Posted 9/19/2008 8:21 AM (GMT -6)
I feel the 2 biggest reasons to have surgery first is #1-They take several lymph nodes out of the pelvis area at the start of the surgery and look at them for cancer cells to see if it has spread to the lymph nodes (9 were taken out of me and looked at during the pathology dissection) and #2- the total prostate and surrounding tissues removed are sliced up during the pathology examination and they can tell if it has spread outside the prostate to either the seminal vesicle or to either of the nerve bundles.  If it shows it has spread or there is positive margins, adjuvant radiation therapy or hormonal therapy can be started at a much earlier period, hopefully before it spreads to the bone or lung tissues. Give yourself the option of having as many strikes as possible available to use in the cancer fight.  3 strikes are a whole lot better than going to bat with only 2 strikes available.  Salvage surgery is possible for recurring Pc, but only in a few narrow cases.  My Pc came back after 18 months and I am currently is salvage proton radiation treatments.  The information that was obtained from my pathology report was very useful in understanding why my cancer recurred and why surgery did not get all of the cancer.   I did not have any problems with surgery, and I give that to a very experienced surgeon.  I understand why some people hate the thought of surgery, but I for one feel surgery is much less of an intrusion in your life than having to go thru 2 months of radiation treatments.  I have just finished 12 of 35 treatments and remember 12 days after surgery, I was able pretty much lead a normal life.  I still have 4 1/2 weeks of being out of town, staying in a rental condo, not having much control of my time, going thru daily treatments and having 100cc of saline solution put up my you known what.  I do not regret having surgery first in any way and would not do anything different, but everyone and every case is different.  Your Urologist, based on your biopsy numbers, will have an opinion, but do your own research. Get a second opinion from a surgeon and a radiation/oncologist. Be informed and make your own decisions.  Someone told me this is kind of like building a home and trying to decide on the exterior, a brick layer will tell you brick is best, a vinyl siding contractor will give you hundreds of reasons vinyl is best, and so will someone who does stucco.  Personal inconvenience, physical discomfort, and lack of interest in doing your homework are not reasons in making your treatment choice.  Remember 28,000 men die each year from prostate cancer.

Jerry

Posted 9/19/2008 8:29 AM (GMT -6)

Hi Tony 1951,

I am not sure what your experience was with surgery but I will say that the only time you know what is going on is after it is over. I had open heart surgery and the last thing I remember prior to the surgery was joking with the nurse about needles. Next thing was waking up in the ICU with a tube in my throat. Nurse took care of that in seconds. After that it was just a matter of time for the sternum to heal. Never had any pain or serious discomfort. Also had a hernia repair done laproscopically a few years before the heart. Again no problems and done on an out patient basis. I was sore for about two weeks and walked a bit stooped over.

There is salvage surgery available for previously radiated patients. It is hard to find a surgeon willing to do it from my research but they are out there. Cryotherapy is done as a salvage operation and apparently has been successful but comes with side effects. (So what 's new about that?)

I chose IMRT for my case based on the fact that I would have required radiation anyway due to spread and my research indicated no statistically significant difference in results for surgery vs. radiation. There was one point made in a research paper that surgery was slightly better than radiation in terms of reoccurence of the cancer. The difference was not statistically significant but you want any edge you can get. Seems that if the cancer reocurrs it is at the original site of the prostate in over 50% of the cases. Either the gland or the bed after removal of the gland. Mayo Clinic has published a number of papers regarding the relative value of the options and suggest that, in some cases, surgery and radiation combined is the best alternative to treatment of advanced PCa. In those cases there is usually a good chance that hormone therapy will be given as well.

As I understand it in radiation the gland is not completely destroyed and there is always some viable tissue. The cancer cells are completely destroyed after a time. Any where from 18 months to 36 months.

If you would like more input from IMRT types try prostatepointers.org and go to the EBRT group. I got a lot of good input there prior to making my decision.

Best of luck to you.

Don

Posted 9/19/2008 9:36 AM (GMT -6)
Tony there's another option. That being cryotherapy. That being the freezing of part or the entire prostate. Although you need to be anestitized for that like surgery. I'm just saying this not as a recommendation although it worked well for me, but to have you know of all treatments. Of course there's also HIFU but there's insurance problems there as in it won't pay for it as of now. Learn all you can, knowledge is empowerment and necessary for making this crucial decision. In my opinion you need to quickly put aside your fear of being "put to sleep" so it's not the primary factor for choosing a treatment. You very well may regret that later.
Posted 9/20/2008 7:08 PM (GMT -6)

realziggy said...
Tony there's another option. That being cryotherapy. That being the freezing of part or the entire prostate. Although you need to be anestitized for that like surgery. I'm just saying this not as a recommendation although it worked well for me, but to have you know of all treatments. Of course there's also HIFU but there's insurance problems there as in it won't pay for it as of now. Learn all you can, knowledge is empowerment and necessary for making this crucial decision. In my opinion you need to quickly put aside your fear of being "put to sleep" so it's not the primary factor for choosing a treatment. You very well may regret that later.

I live in Ohio - do you know of any centers that "do" cryotherapy in my area?

O-Tony

Posted 9/20/2008 9:16 PM (GMT -6)

Tony1951 said...

realziggy said...

Tony there's another option. That being cryotherapy. That being the freezing of part or the entire prostate. Although you need to be anestitized for that like surgery. I'm just saying this not as a recommendation although it worked well for me, but to have you know of all treatments. Of course there's also HIFU but there's insurance problems there as in it won't pay for it as of now. Learn all you can, knowledge is empowerment and necessary for making this crucial decision. In my opinion you need to quickly put aside your fear of being "put to sleep" so it's not the primary factor for choosing a treatment. You very well may regret that later.

I live in Ohio - do you know of any centers that "do" cryotherapy in my area?


O-Tony


Where in Ohio are you? I grew up in the Cleveland area. I just googled cryotherapy and Ohio and it appears it may be available at the Cleveland Clinic. It's unlikely it will be like my TFT which is still a clinical study but cryo has been available for awhile in treating the prostate in addition to radical surgery and radiation. I didn't look into it any more. But try there, the Cleveland Clinic is world renowned. Take your time in learning all options, I know it can be overwhelming at times. When that happens just take a few days off. Then after you decide take a week off or so to reflect on your choice. Then go do it without looking back or any regrets.
Posted 9/20/2008 9:35 PM (GMT -6)

Here Tony look at the videos below. It's a well done presentation about prostate cancer and the treatment options. Although the TFT study is only available here. The rest of the info is spot on.   

Each part is anywhere from 4 -7 minutes.

part 1

http://www.thedenverchannel.com/video/14776502/index.html

part 2 Options for Treatment

http://www.thedenverchannel.com/video/14776478/index.html

part 3 Deciding on Treatment

http://www.thedenverchannel.com/video/14776543/index.html

 

part 4 Getting Treatment

http://www.thedenverchannel.com/video/14776562/index.html

5/9/2008 Final update

http://www.thedenverchannel.com/reportersnotebook/16278580/detail.h

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