Radiation vs Surgery

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JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 2/19/2009 10:13 AM (GMT -6)   
All right gang. There is a wealth of knowledge in this forum. In your OPINION which do you believe has the best cure / long time survival rate radiation or surgery? Just curious because I was just reading an article on Tiger Wood's dad who was dx with PC and received radiation treatment in 1998 (which they thought was successful at the time) but the PC came back in 2004. He died from PC in 2006 at age 74.

Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/19/2009 10:56 AM (GMT -6)   
Thats one of those debates that even the doctors mull over. The best treatment is the one that the individual chooses. They all seem to be the same when it comes to cure / long time survival rates. But...as with any cancer...cure comes from early diagnosis more so than the treatment plan for the disease. Almost any cancer detected early enough can have very long term survival.

Now...about my own opinion...early stage, low grade cancer...hmmm...I go with surgery if watchful waiting is not an option.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/19/2009 11:04 AM (GMT -6)   
my personal choice, if early and presumed contained: would be either open or robotic surgery, and then save radiation if it came back.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 2/19/2009 11:21 AM (GMT -6)   
When I was first diagnosed I was told that my case was advanced and that surgery was not an option. I did a lot of research on the issue. Here is a brief summary.
 
Organ confined disease.  Surgery
 
Locally advanced disease. Surgery + radiation
 
Metastatic to lymph nodes in pelvic area.  Radiation + Hormone (knowing what I know now I would add surgery)
 
Metastatic to lymphatic system, lungs, and bones. Hormone
 
I would probably also try chemotherapy if the other approaches did not yield results.
 
Don
 
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
 
 
 
 


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 2/19/2009 12:13 PM (GMT -6)   
I chose neither. There are other options you know. Especially in early stage PCa. Now there's an equivalent to a breast cancer lumpectomy for PCa. I know I've had it done. Yesterdays gold standard was yesterdays not the futures.

I also agree with the head of the Urologic Oncology Dept at the University of Colorado that better detection has brought an over treatment of PCa. Years from now people will look back and be some what shocked.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/19/2009 12:19 PM (GMT -6)   
well ziggy, that last statement can be said about almost anything related to the medical field. in mental health treatments, there use to be good arguments for frontal lobe lobotamy's and old school ECT, but they know different now.

the gold standard in PC treatment still has a sound and long foundation to it, especially with the improvements in both open/robotic surgeries, nerve sparing operations, many more available aids to ED after affects, etc.

in my opinion, i don't think its fair to refer to it as "yesterdays". still works today, still being improved upon, and has probably saved countless thousands of lives

david in sc
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 2/19/2009 12:29 PM (GMT -6)   
The same can be said of a mastectomy a few years ago too. You must factor in the likely incontinence and ed problems too. I have none of the former and only a little of the latter which after kick starting my ED with the little blue pills has greatly improved. There's also the lifestyle vs possible longevity issues also to be factored in. Plus I'm only referring to early stage organ confined PCa of course.

As been said there's no correct answer in choosing treatments. You choose what you think is best for you, that said a knee jerk reaction in opting for major surgery I think happens too much with men in these days of earlier detection. Chalk it up as a result of psa testing. Also in my case unlike radiation if PCa were to return I still have all options available.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 


JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 2/19/2009 12:31 PM (GMT -6)   

Gentlemen, I choose the comparison between these two treatments because they are the most frequently used to treat PC. I am not discounting other treatment options.

After my dx and researching PC, I learned that radiation and surgery have similar cure rates initially. However, after ten years surgery cure rates appear to become superior to radiation.

I was just curious as what the men on this forum thought about the two.


Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 2/19/2009 12:34 PM (GMT -6)   
JerseyG said...
Gentlemen, I choose the comparison between these two treatments because they are the most frequently used to treat PC. I am not discounting other treatment options.

After my dx and researching PC, I learned that radiation and surgery have similar cure rates initially. However, after ten years surgery cure rates appear to become superior to radiation.

I was just curious as what the men on this forum thought about the two.


I admit for your age I would recommend surgery over radiation. If you were 25 years older I'd recommend maybe the opposite.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study 
 
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 2/19/2009 12:45 PM (GMT -6)   
There has never been a clinical trial that evaluated all treatment options on level playing field.
The best evidence we have is that the survival rate of all options are remarkable similar in early stage PC. Everyone has their opinion, but the evidence doesn't support one treatment over another. So the question has to be which option has the least long term side affects. Just reading the posts in this forum one can see the severe complications and side affects of surgery. Sardino at Slone Kettering states that 40% of all their surgeries are considered unsuccessful( long term side affects, no cure or complications). And this is at one of the best surgical institutions in the country. Looking at the radiation sites the side affects are not as severe early on, but continue to build over the years. With ADT3 the side affects are moderatly severe for some but are reversable when treatment stops. Cryo surgery has the greatest incidence of impotance of all the options. All doctors will claim that their treatment is the most effective, but the evidence just doesn't support the claims. So in reality it boils down to a personal choice of what side affects you feel the most comfortable living with.
For advance PC I think the treatment options make a difference. Some think that surgery is effective in debulking the tumor for other treatments. Others think that removing the prostate just sets of chemical markers that make the PC cells in the rest of the body grow faster. They point to the rapid PSA doubling time after failed surgery as one indicator of this. I don't think there is any proof of either. I personally think that having to live with the side affects of multiple treatments is just too costly and the fewer treatments the better.
Until there are clinical trials that prove one option is superior to another it's still a guessing game and people will continue to push and defend the treatment option they chose.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 2/19/2009 4:26 PM (GMT -6)   
I agree with David (Purgatory). I'm choosing open surgery because, in my case, it gives me the best chance at a cure. If not, I still have radiation to fall back on. In addition, I want the bugger out of there and want to know where I stand re: progression. The only way to get that is by post surgery pathology. To top it off, my surgeon is the Chief of Surgery for Urology at MSK and he says it's the best way to go.

As someone on this site likes to say..."Do your homework, find a doctor you trust, make a decision and don't look back". Good advice.

Tony
Age at diagnosis 61  5'10" 260 lbs.
Resides in SW Florida
12/07 PSA 2.6  12/08 PSA 4.0
Biopsy 1/09 - 6 of 8 nodes positive 
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason
Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineual invasion is present 
DRE positive for nodule on right - Prostate 22.6 cc's
Scheduled for open RRP @ MSK 3/10/09
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/19/2009 4:35 PM (GMT -6)   
Tony, you are doing your homework, you have found a doctor you trust, sounds like you are locked into your decision, and now.....don't look back. I am not interested because you happened to have chosen my route, I am happy if you feel right inside about what you are deciding here, and do it, and can live with it come what may. I respect the path that all the men here choose for themselves. As you have learned in a short time, so many ways, so many variables, so few guarantees, and side affects and quality of life things that vary and jump all over the place. From my vantage, that absolute trust in your surgeon is critical to the path you are choosing. I for one, wish only the best and most positive results from your pending surgery. I will be happier when I know you are safely through it, and on the other side as we like to say. Then, you will be on the recovery side of PC. My best to you brother.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


strawberry man
Regular Member


Date Joined Dec 2008
Total Posts : 23
   Posted 2/19/2009 5:04 PM (GMT -6)   
JerseyG - I chose the DiVInci robotic surgery but I know some that chose the rediation and are fine.
take care

Dx 4/21/08 psa 9.7  Age 58 OMG

Biopsy results  3 areas of  3+3=6 gleason

Di Vinci surgery 6/3/08

Post op 3 months and 6 months -  all clear

0 psa TYG  (thank you God)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/19/2009 5:51 PM (GMT -6)   
Frankly, I am confused as to the intent of your post.

You have had surgery, can't go back there.

It appears that the surgery was successful. Thats very good.

Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07 robotic
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/19/2009 5:55 PM (GMT -6)   
Godfather said...
I agree with David (Purgatory). I'm choosing open surgery because, in my case, it gives me the best chance at a cure. If not, I still have radiation to fall back on. In addition, I want the bugger out of there and want to know where I stand re: progression. The only way to get that is by post surgery pathology. To top it off, my surgeon is the Chief of Surgery for Urology at MSK and he says it's the best way to go.

As someone on this site likes to say..."Do your homework, find a doctor you trust, make a decision and don't look back". Good advice.

Tony


Tony I have just noticed that our stats are remarkably similar. Myself, now 61, no symptoms, nothing felt DRE (that's because it turned out the tumour was to the front of the gland, top to bottom) , PSA 05....2.8, 06....3.2 07....3.9, 4 of 10 positive, Gleason 4+3, both lobes involved. Gland volume about 32cc. I chose surgery because (1) I wanted it out and if it was I would know the true extent. (2) Should surgery eventually not effect a cure then I could attack again with radiation. (3) Should the salvage radiation fail then ADT was available followed by chemotherapy if required. The more that time passes the more is discovered about the disease and the more advances are made. Hopefully I (along with all of you) should still be around when and if the ultimate breakthrough (gene therapy?) is made.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01

Post Edited (BillyMac) : 2/19/2009 4:59:38 PM (GMT-7)


JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 2/19/2009 5:58 PM (GMT -6)   
Gpg you should have read my first post. I'm just curious as to what different people think about the two treatments. I am extremely satisfied with my treatment choice. 

Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 203
   Posted 2/19/2009 6:04 PM (GMT -6)   
realziggy said...
The same can be said of a mastectomy a few years ago too. You must factor in the likely incontinence and ed problems too. I have none of the former and only a little of the latter which after kick starting my ED with the little blue pills has greatly improved. There's also the lifestyle vs possible longevity issues also to be factored in. Plus I'm only referring to early stage organ confined PCa of course.

As been said there's no correct answer in choosing treatments. You choose what you think is best for you, that said a knee jerk reaction in opting for major surgery I think happens too much with men in these days of earlier detection. Chalk it up as a result of psa testing. Also in my case unlike radiation if PCa were to return I still have all options available.



I must agre with most of this forum ... in early stages once the capsule out of your body with the cancer you can be clean for life by simply maintaining a healthy life style (and that is as per many long years studies ) and Surgery improved so much today that quality of life is back almost to normal ... the medical field nvested so much in improving these proven method that i am sure is for a good reason "THEY WORK BEST" with a great track record ... with all due respect your method above is a new one and yet to be proven as effective ... so in contrary to you i would have gone that route only if i had at least 10 years statistics as surgery and radiation... but again it is a personal choice at the end...

please keep us posted i wpuld be intersted to hear how that treatment turn out to be

GB
April 2007 PSA 8.4 for last 6 months biopsy shows PC 3+3=6
June 13 2007 Nerve Sparing open RP / Dr. Christopher Johnson at St. Francis Hospital NY.
4 days later home for Fathers Day, and Catheter.
Removal of catheter 10 days later , incontinence not an issue, no pads used from the get go.
1 month PSA next to not detected

ED is a longer battle:
1 month out start using occasionally Cialis and 50MG Viagra to promote blood flow with no response. 3 months and 6 months PSA not detected
ED 6 months mark starting with VED therapy and being more aggressive with meds , in addition taking Folgard supplement daily.
April 2008 : 10 month out and start seeing some serious improvements with ED while using Meds and VED , can achieve erections, Mid nights erections almost on a regular basis , and uncontrolled 90 % erections spontaneously.

UPDATE 1 YAER FOLLOW UP
ED: With Viagra Usable erection for intercourse , AND AT 80% without any medications !!
Fully continent since removal of catheter.
PSA one year : 0.0 as of 6/13/ 2008 BIG Wooohoooooooooo!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
PSA  still Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/19/2009 6:53 PM (GMT -6)   
JerseyG said...
Gpg you should have read my first post. I'm just curious as to what different people think about the two treatments. I am extremely satisfied with my treatment choice. 

My name is Scott and this thread is without merit.
 
Scott

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/19/2009 7:20 PM (GMT -6)   
gpg said...
JerseyG said...

Gpg you should have read my first post. I'm just curious as to what different people think about the two treatments. I am extremely satisfied with my treatment choice.



My name is Scott and this thread is without merit.


Scott


Gee Scott, all threads have merit and the posters are doing what is known as musing and reflecting.
Bill

Tony1951
Regular Member


Date Joined Jul 2008
Total Posts : 50
   Posted 2/19/2009 7:55 PM (GMT -6)   

My first oncology urologist recommended that I chose surgery, but added that surgery and radiation both are about equal when the disease is caught early.  The second  oncology urologist I saw suggested radiation.  He said that the side effects were different but the long term outcome are "probably" the same.  The first urologist was a surgeon, the second one was radiologist.  I chose radiation and though it is very early, I am very pleased with the side effects - or lack of side effects.  Then again, time will tell the tale.

 

Psst, regarding Scotts post questioning the merits of this post.  Scott, though I chose radiation I still read posts about surgery and any other procedure.  The two most common treatments are surgery and radiation and as such, tossing this thread around every so often is a good idea.  New members of the forum are able to see both sides of the treatment divide.

 

Tony 2


Name: Tony  Born: 1951
Diagnosed PCA 7/23/2008;  Prostate Volume 19 grams
Cancer Location: Right Mid and Right Apex 2 of 12 cores positive
Percentage of tissue involves 14%  Gleason 3+4=7 4+4=8
PSA levels  6/08/08 7.7;  6/30/08 6.8
Began HT Zoladex 8/26/2008
As of 9/11/08 I am waiting to start IMRT IGRT
September 23, 2008 after one month of Zoladex PSA 2.83
Testosterone 16.
 
October 22, 2008: First day of IMRT.  I am receiving 1.8 grays per day over a period of 43 days.
 
December 24th, 2008 Completed my Radiation treatment


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 2/19/2009 9:17 PM (GMT -6)   
To Scott (gpg): Not sure why you reacted the way you did to Jersey in the manner you did. I view all posts and threads of equal merit and value here. Didn't matter if he had surgery or not, he was just curious and asking opinions. I am still learning daily about all the other treatment methods even though I am 3 month out of surgery. I want to know more, and I want to be able to help others, better in the future.

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 2/19/2009 10:06 PM (GMT -6)   

The purpose of my post was to learn what different people thought about the two treatments. I'm not second guessing anyone's decisions here. We all made the treatment choice we felt was best for us and god bless us all with that decision. 

In making our treatment choice we also had to discount other treatment options. I know why I choose surgery. Just wondering or musing as to the reason why some of you made whatever treatment choice you made.  

I've see that a lot of younger guys choose surgery and a lot of older guys choose some type of radiation. I know all the obvious reasons (complications,  recovery after surgery, etc) just wondering if there's something deeper that I'm missing. 

Tony1951, BillyMac and Purgatory thanks for the imput but we don't know what gpg (Scott) is going through I have very tough skin but thanks for posting.


Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1


smilinjack
New Member


Date Joined Jan 2009
Total Posts : 15
   Posted 2/19/2009 11:47 PM (GMT -6)   
What kind of radiation are we talking about? If it is regular radiation, from what I understand, is like carpet bombing. It will damage everything around the prostate. If it is Proton Beam it is like a smart bomb. It only hits what it is aiming at.
Jack
age 67
DX 7 Jan. 09
psa 4.1
prostate size 61cc
free psa 17%
Gleason 3+3=6
14 cores 1 had cancer 5%
Going to do Proton Beam Therapy

Post Edited (smilinjack) : 2/20/2009 4:48:00 PM (GMT-7)


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 2/20/2009 8:46 AM (GMT -6)   
Well, YES, it is important to do your homework, find your doctor, make your decision, and then don't look back. We all try to do that, but it is almost humanly impossible, that once in a while, in your quiet moments, not to rethink things.....especially when you have the SECOND SALVAGE option looking at you. After radiation, brachy, lupron, and then salvage surgery, fistula operation, AUS operation....all by MSK.....(a good place to go), Pete's PSA seems to be rising quite fast again.
Every post has something to say I believe....and the friends that are here are helping newcomers try to figure out their way in a mire of overwhelming information that hits them when they are most vulnerable. Looking back eight years, the one thing I really wish, is that there would have been a forum like this to hear it like it really is....That is what would have helped us.... In the meantime we just keep forging ahead....

Learn everything you can, anytime you can, from anyone you can -- there will always come a time when you will be grateful you did.

Diane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and 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 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 2/20/2009 10:04 AM (GMT -6)   
Smilinjack,
 
I had IMRT and I would beg to disagree with your comment that it is like "carpet bombing". If one has the image guided (IGRT) utilizing the gold fiducials the accuracy of the beam is quite good. The beam is modulated to administer a lower dose to the surrounding area and a higher dose to the diseased area. The dosage is contoured to treat the prostate while minimizing damage to surrounding organs. The patient lays on the treatment table and prior to treatment the rad techs locate the fiducials and align the beam for the day's treatment. The machine then makes a circle around the patient stopping at precisely defined intervals to administer the radiation. In my case there were seven stations. By administering the radiation at seven points the dosage to surrounding tissue is further reduced.
 
I have had no lingering side effects from my treatment and only experienced a week of urinary and bowel discomfort due to receiving a "full pelvic" dose. My research prior to treatment indicated that the results for proton and photon were essentially the same in the situation of localized disease. Just that one was more widely avaliable and less expensive than the other. The primary advantage to proton was the point of release of the energy. As I understood it the primary release of the energy was inside the targeted zone. (Bragg Peak) If one were so unfortunate as to have a locally advanced case then the proton would be combined with IMRT.
 
I am very grateful that the medical community has an arsenal of relatively effective tools to treat this disease and the knowledge to use them on a case by case basis.
 
Best of luck to you.
 
Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
 
 
 
 

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