Posted 1/11/2009 1:30 PM (GMT -6)

Hello Confusion...sorry you are here, but this is a place with lots of good advice and compassion.  Shown below is a reply I gave to another "newbie" a couple of weeks back.  Hope this helps.

Also, one of the members, Rolerbe, I believe, posted this link which I think you will find very helpful.

http://content.nejm.org/cgi/content/full/359/24/2605?query=TOC

Tudpock (the following was posted approx. Dec. 30...post procedure quality of life continues to be normal today)

Hello and welcome.  I have observed that most of the guys on this site have elected surgery and you will get plenty of advice from them.  My stats were not far from yours and I looked at all options, narrowed them down to da vinci and brachy, and ultimately chose bracytherapy.  My procedure was recent (3 weeks ago) and, if you are interested, you can check my thread "Tudpock's Brachytherapy Journey" on this site to see my thought process re my choice -- plus you'll see my post-op situation which is remarkably good, i.e. my life is normal and all equipment is functioning great.

 
Having said that, I wouldn't necessarily recommend seeds for you, I just know it was right for me.  I'm sure you have examined both options carefully and know the stats and SE's backward and forwards so I won't go into those except to say that, with your cancer stats as I read them, the cure rate for both options is basically the same.  There are a few other things to consider, however, that may not necessarily be in all of the books, so I'll throw them in for whatever help they can be:
 
1.  There is a personal psychological issue that only you can answer.  That is, how important is "getting it out" to you?  You'll read a lot of posts on this site from men for whom that was a really big deal.  They wanted the cancer out of their bodies, wanted to see an immediate pathology report and that was that.  For me, that wasn't a big deal at all...the important thing was to do lots of research and make an informed decision as to the right cure and the quality of life issues, then move on.  There are no sure things with either choice...
 
2.  The other issue many men bring up is that "surgery after radiation" is not really a good option but that "radiation after surgery" is possible. That is true (though some docs do surgery after radiation but it is a very difficult procedure).  There are other options after seeds that are available but you should probably assume that surgery is not among them.  If this issue is important to you, then brachy may not be your best choice.
 
3.  The immediate side effects from surgery are well known...and you can read them in spades on this site.  Re brachy, the immediate urinary side effects are generally frequency and urgency and may last a couple of months.  However, IF you don't have much of an issue with this pre-procedure, you probably won't post-procedure.  My urologist gave me a test (can't remember what it is called) that scored me on such things as number of times I had to go urgently now, number of times I get up in the night, weak stream, etc.  My score was low (that's good), meaning that I did not have issues on those functions pre-procedure.  My radiation oncologist and my urologist both predicted that my post-procedure issues would be minor or non-existant with Flomax treatment and, so far, they have been correct.  Now, remember I'm only 3 weeks out, so I may yet have some of these issues but, so far - so good.
 
4.  ED issues occur in brachy patients at a slightly lower rate than in surgery patients -- but there are varying reports on this.  However, the ED with surgery occurs immediately after the surgery and generally gets better (with pills) over time.  The ED with brachy occurs later, i.e. 2 years++.  And, as in the case of urinary effects, if your equipment is working well before the procedure, the chances are better that it will work after the procedure.  Also, if ED does occur, the same little pills that surgery patients take work with brachy patients.  For me, sex started 2 weeks after the seeding, and junior responded well with no pill assistance needed.  I'm looking forward to 2 good years and then, if we need a little help, I'll pop the pills at that time.
 
5.  There are a small % of brachy patients who have bowel issues...but it's a larger % than surgery patients.  Experience of your radiation oncologist is key here as the issues seem to vary with seed placement and dosage.
 
I hope this helps a bit.  It's a BIG decision and I wish you the best.  Please come back and let us know what you decide.
 
 
Tudpock



Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/30/08.

Post Edited (Tudpock18) : 1/11/2009 3:50:15 PM (GMT-7)

Posted 1/12/2009 1:12 PM (GMT -6)
Purgatory -

I said "Just kidding." I could have put anybody's name in there. Frankly, yours was the first to pop into my mind. I thought it was freaky/hilarious that a post from you coincidentally popped up 5 minutes after mine. You were obviously writing your post while I was sending mine.

I apologize for any concern this may have caused on your part. I was absolutely not making any statement/comment/judgement/insinuation about your posts.

Be well,
kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
              Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
              cancerous and the 6th was suspect.  
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.

Posted 1/12/2009 1:37 PM (GMT -6)
Welcome to the club,
Yeah it's real confusing and i'm still absorbing all of this. I am active waiting, trying dietary changes and monitoring psa quaterly. Can't add anything new, but this site has tons of information. You are far from alone. Best to you

Check the links provided by zufus.
Age 59, very healthy
Psa 2007 3.2
Psa fall 2008 4.9 two weeks later 4.4
11/2008 biopsy, T1c, gleason 3+3=6 low-volume prostrate carcinoma
1 of 12 samples malignant
Left lateral mid .05mm (5%)
CT scan negative
Consultation 12/2008 decided active waiting (diet) while researching options.
Followup PSA in March 2009

Posted 1/12/2009 2:22 PM (GMT -6)

Confusion,

With a Gleason 6 you have a lot of options(if in fact you really have a gleason 6; I originally thought I had a gleason 6, but it was actually a gleason 7). The best adivice I got was to get a 2nd opinion from a prostate oncologist. You can find a list of oncologists on Prostate Research Institute's web site. My oncologist was far more knowlegable than any of the 5 Urologists I had seen and recommended 3 other tests that were never mentioned to me by any of my other doctors. He also said that my path reports, PSA history and recommendation for surgery didn't make any sense and that we had to get more data in order to come to a treatment recommendation.

I found that prostate oncologists have less of a vested interest in pushing a particular treatment and spend much more time in trying to stage your cancer using many more tests that a urologist would use. The more accurate the initial staging the more effective the treatment will be. In my case the initial stating was completely wrong and the treatment I was originally persuing would not have been effctive.

JohnT


Diagnosed 10-08 at 63 with PSA of 33
PSA was 4.4 in 1999 and has risen steadily.
Had 13 biopsies and an endorectal MRI, all negative until 10-08. Two cores out of 25 with a gleason 6
2nd opinion with an oncologist said cancer found was insignificant, but suspected larger tumor somewhere.
Doppler ultrasound with target biopsy indicate a large tumor in the transition zone, gleason 7.
Bone and CT scans negative.
PSA3= 43; (high normal is 35)
Scheduled for Combidex MRI in Feb. (Lymph node imaging MRI done in Holland).
Location of tumor makes positive surgical margin unlikely.
Looking at IMRT with hormone therapy as soon as staging is complete with Combidex MRI.
Changed diet, eliminated all meat and dairy. Taking the normal supplements recommended for PC.
 
JohnT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
John T

Posted 1/12/2009 3:42 PM (GMT -6)
kcragman, no foul, no offense taken.
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/9/9 - pre-op, 1/13/9 - corrective operation scheduled at St. Francis
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 

Posted 1/12/2009 4:31 PM (GMT -6)
John T, I believe has the number one thing patients and their docs need to know, the overall assessment of the patient, disease level, confinement percentages Partin tables(etc.), the patients health (might determine some methods he should not do) and blood markers...yada...yada, expert pathology is the key...uro-doc's send that out and read the report (then they might know what you have: PIN, HG PIN, Gleason scores, volume/percentages PCa found in each biopsy, perinureal invasion, benign tissue, or 18 variant possible PCa's only a maybe an expert pathologist could figure out, without the pathologists they could not assess very much at all, there are other things that can be defined by pathology too. (ploidities DNA stranding of PCA cells actually 3 types). Uro-doc can add psa history, utlra sound tests, DRE, gland size, etc. Then you have data to plug into the nomograms and Partin Tables etc. So that you can have an idea of statistical organ confinement, and nomograms for treatment efficacy to look over. Its kind of like let's do the math, once you have a subset of numbers from the real world (close as they can compile) you should know the odds for a successful treatment atleast to some degree. My uro-doc had nothing to say, I understood better little later.





The type of prostate cancer most of us probably herein have should be Acinar, the andemocarcenoma (spelling) is synonymous with 'prostate cancer' the type is: Acinar or others.

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