What to do next??

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Regular Member

Date Joined Sep 2008
Total Posts : 30
   Posted 11/15/2008 12:25 PM (GMT -6)   
HRD2: thanks for asking about my doc's appt. 
After Wed's appts with two different docs I drove home, parked my car, reclined the seat, and went to sleep.  I was completely exhausted from all of the activity.
Here's the upshot:  Had meetings with radiation oncologist and surgeon; the cancer is contained in prostate; bone scan was negative for cancer activity; PCa appears to be caught early (only one in 12 cores was positive for cancer). Placement and amount of cancer make me eligible for the full menu of treatment options.  Now I have the hard job of figuring out which of the options is the right one for me.  I have two more appts scheduled: another radiation oncologist and a surgeon that specializes in robotic method. 
My urologist is not a fan of the robotic method; He is not an early adopter of the method. He believes that the robotic technique is not able to discern nuances as when the surgeon uses his hands.  He says this is particularly important  regarding nerve sparing.
Not surprizingly, the radiation guy likes radiation treatment; the surgeon like surgical treatment.
I havn't the slighest idea what I will do.  At this point am leaning toward seeds.  This technique has shorter recovery time; less interruption of sexual performance; less (in many instances) urinary problems; no catheter (unless there is problem voiding); same cure rate as surgery; there is potential for recurrence.
The only thing the doc aked me to do was decide a date by when I will make a decision.  He says that men have tendency to postpone decisions and then not make a decision at all. I completely understand.
Question: what is experience of folks with seed implantation?
born 1952
diagnosed with HIV 2001
PSA--ranged from 2-7
2 previous biopsies-all negative 2005 and 2007
diagnosed with prostate cancer:Sept 30, 2008
Gleason Score 3+4=7
bone scan 10-9-08--appears to be negative
trans rectal MRI 10-27-08
appts w/docs to review tests scheduled 11-12-08

chris nz
Regular Member

Date Joined Sep 2007
Total Posts : 33
   Posted 11/15/2008 1:33 PM (GMT -6)   
Hi Banker, I took 5 years to come to a decision on the treatment options. I had seed implant in August, I was at work 2 days later. Early days yet to evaluate how successful, but I've had no problems, stopped the Flomax and pain pills after 2-3 weeks, no voiding problems except an urgency to p when I hear running water, sometimes I get a retention sensation but not often. Yes I am satisfied with my decision as long as it is successful and I don't have to have back-up procedures.
Dx Nov '03, age 61, 1 of 8 +, 3 + 3, PSA before biopsy 6.5.
after biopsy PSA went 10.5 and stayed there.
Tried a lot of the can't fail 'cures'. Found 'Prostasol' a version of PC Specs.
PSA dropped to less than 1.
Still tried other supplements but reverted back to 'P'. [ a herbal estrogen.] Had problems with hereditary Deep Vein Thrombosis, now on blood thinner.
March '08, second biopsy, 3 of 10 + [10-50%], 3 + 4, PSA 1.0. T2A.
Bone scan didn't show much, bone density showed early osteo in places.
Had Brachytherapy Aug 23 08. 75 seeds, started work again 2 days later.

Forum Moderator

Date Joined Sep 2008
Total Posts : 4243
   Posted 11/15/2008 1:56 PM (GMT -6)   

Hello Banker:

I'm just slightly ahead of you in the process so can clearly identify with your current feelings and anxieties.

First of all, in my opinion you are doing the right thing by consulting several docs.  I did the same thing and felt better about my decision because of it.  I see you are leaning toward the seeds...that is the decision I have made also but I think most men in this forum have opted for surgery.  It's an individual choice, of course, and all of the research I did showed similar cure rates.  Then it becomes a matter of evaluating the side effects plus how much you psychologically want to "have it out".  That's a big deal with many patients...not so much with me.

There is a lot of reading I could recommend, but three particular things come to mind:

1.  JustJulie's thread on this forum shares her and her husband's brachytherapy experiences.  I found her comments very helpful as were the comments of others on the thread.

2.  There was an excellent article in the New England Journal of Medicine, March 20, 2008, entitled "Quality of LIfe and Satisfaction with Outcome among Prostate-Cancer Survivors".  This provides up to date data comparing different treatments and I found this very useful.

3.  I posted a recent topic that I called "Experience Counts".  It cites info from Hopkins re the need to use experienced surgeons if you want the best outcome.  I'm sure this is true for radiation practitioners as well.  The guy who is doing my seeding has well over 500 procedures under his belt (so to speak) and I spoke to a number of his patients who were very pleased with him as a doc.  I think this experience thing is especially true when it comes to robotic as there are tons of urologists who are now "learning" it.  This was my second option and the surgeon I had chosen had 1000+ procdures.

Anyway, good luck in your decision making and please come back here and tell us what you decide.

Age 62
Gleason 4 +3 = 7
PSA 4.2
Brachytheraply volume study done on 11/14/08
Brachytherapy scheduled in early December

Veteran Member

Date Joined Apr 2007
Total Posts : 823
   Posted 11/15/2008 6:46 PM (GMT -6)   
Hi Banker

Nice to meet another 1952 baby. We were all in your same position when we found out about this disease. Get several opinions from several doctors. Better hospitals have a multidiciplinary approach to treating PC. They have the patients meet with Doctors from several diciplines and talk to the patients about the various treatments so you can make an informed decision. Make that decision and don't look back. Good luck to you and let us know how your journey is going.

age at dx 54 now 56
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
Tossed the pads this spring
ED still a problem
first year PSA less than zero

Veteran Member

Date Joined Jul 2008
Total Posts : 637
   Posted 11/15/2008 9:03 PM (GMT -6)   
Hi Banker..... My husband had brachy (seeds), and conformal external radiation and lupron for one year in 2001...It went well for four years, and we thought things would be fine. No incontinence, but problems with ED, that were just beginning to get better (after four years)....well, PSA began to rise.....at that point the only thing to do was go back on Lupron or have Salvage Surgery. The doctors at Sloan Kettering gave a chance of 50% total cure with salvage surgery citing probable side effects. The other option was Lupron. He decided on the salvage surgery. The SEs have been horrible for my husband. Surgery at first would have taken the cancer out, and then if it did return, he could have the the radiation at that point. But, you have to do what you think is best for YOU....and dont look back.. (I am trying not to) D
Husband Pete
dx Jan 2001 age 67 gleason 4 + 3 PSA 16.5
seed implant and conformal radiation Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06
Fistula operation 2/07 MSK
Many cystoscopies and ER visits with strictures
catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/07
AUS Operation at MSK Sept 8. Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008

Regular Member

Date Joined Sep 2008
Total Posts : 72
   Posted 11/15/2008 9:44 PM (GMT -6)   
Just a quick thought. Tudpock18 made the statement that there are many "learners" out there. My local urologist was extremely concerned with where I would have the surgery done for this reason. At a Prostate Cancer Seminar I attended in Los Angeles with some of the nations best prostate cancer docs representing all types of treatments, it was stressed that one should be cauious with the places that say it can be done in 2 hours and they do a large number a day.
So I am a believer in daVinci Robotic, but keep all your options open. I wanted seeds but was not a candidate for that.
Don't get discouraged!!
Diagnosed Feb 2008  54 years old
3+4=7 gleason
7.5 PSA
4 out of 20 biopsies were cancerous
daVinci Robotic surgery July 24, 2008
Univ of Calif San Francisco Med Center  Dr Peter Carroll
In hospital 2 nights altho I had option of leaving the next day but stayed due to distance home.
Contained in prostate, not spread
Six weeks post surgery PSA less than .01

Regular Member

Date Joined Sep 2008
Total Posts : 30
   Posted 11/16/2008 9:15 PM (GMT -6)   
All of these posts are very helpful. Thanks.

Regarding"learners," I am particularly concerned. My surgeon has many surgeries under his belt, but i am still concerned about residents versus attendings conducting the surgery. IF I opted for regular surgery, I will have it done at a commmunity hospital instead of our big spiffy teaching hospitals. At the community hospital, i won't have to deal with residents...just my surgeon.

The idea of the cancer returning is the one that bothers me the most when it comes to the seeds. The cure rate between surgery and seed implantation is the same, but cancer can potentially come back with the seeds. I am not certainly I completely understand this. How can the cure rates be the same?

The recovery from surgery makes me quite squeamish...but the seeds have problems too with potential for urgency or catherization.

Everytime i think i KNOW what I want to do, I get another rash of questions and doubts. I completely understand the comment to make the decsion and don't look back.
born 1952
diagnosed with HIV 2001
PSA--ranged from 2-7
2 previous biopsies-all negative 2005 and 2007
diagnosed with prostate cancer:Sept 30, 2008
Gleason Score 3+4=7
bone scan 10-9-08--appears to be negative
trans rectal MRI 10-27-08
appts w/docs to review tests scheduled 11-12-08

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