As Tudpuck warned me it was a breeze. Left home at 9am and was back in the house at 12:15. Most of the time was spent in preop.
63 Paladium seeds were placed. I have a cathether that will come out tommorrow morning; it's a precaution for any urinary blockage.
In two week I have to have a CT scan to check seed placement and plan for my 5 weeks of IMRT. I'll take off to Idaho for 4 weeks and be back for 5 weeks of IMRT.
WHY I CHOSE BRACHYTHERAPY AND IMRT
I’m one of the few people on this site that chose an alternative other than surgery, and this was the thought process that I used to come to this decision.
I was misdiagnosed with BPH for 10 years when every stat indicated I had PC. When they finally found some on my 12 biopsy a 2nd opinion proved it to be indolent and a Color Doppler biopsy found the real cancer, a large transition zone tumor that over 150 biopsy cores and an MRIS had missed. With PSA of 40, lymph node mets were suspected.
At that point I realized that I would have to take my treatment into my own hands and question everything my doctors told me. I read about 20 books on PC and over a hundred published papers (most of them twice) and lurked on a number of PC sites. The most valuable thing I learned was from Strum: “To have a successful outcome you must understand the biology of your individual cancer, choose the treatment option that provides the best outcome for your individual PC and get the most experienced doctors.”
I first concentrated on understanding the biology of my PC. A Combidex MRI eliminated lymph node involvement. But I still had 3 high risk factors, psa of 40, G 4+3, and a large tumor. This indicated I should be going on ADT.
To offset these high risks my PAP was low, my PSA doubling time was slowing (from 2 in 2000 to 4.5 currently), PCA3 was low, change in diet affected my psa velocity (reduced from 40 to 30), Combidex was negative, scans showed tumor was contained. I added this to the fact that I probably had this tumor for at least 12 or 15 years and what I read about transition zone tumors, usually non aggressive, usually contained and throw off a lot of PSA. I concluded that the probability of having a non aggressive PC was very high even though I had three high risk factors.
With this information I got 4 opinions on treatment options. Drs Sholtz, Bahn and Barantsz, all highly respected in the PC world recommended radiation because of the tumor location and the low probability of a clear margin. My Onco Urologist still recommended surgery without looking at any of the scans.
In my readings I came to the conclusion that the short and long term side affects and complications from surgery were not worth the small increase in cure rates that may or may not occur. This was a personal judgment and certainly does not pertain to all. The high probability of positive margins, the difficulty in transition zone surgery ruled out surgery. I considered surgery followed by radiation to get the positive margins unacceptable because of the stacking of side affects.
So now it was ADT3 or IMRT or a combination of both. In my research I discovered that a combination of Brachtherapy and IMRT would give more greys than either treatment alone with about the same side affects as IMRT. Since I had a large tumor I felt that I needed the largest dose possible. I didn’t want to take Lupron because of the side affects and took Casodex and Proscar to reduce the prostate and tumor volume before seed implants. In three weeks my prostate went from 60mm to 32mm and PSA from 30 to 0.6. This was another indication that my tumor was non aggressive.
I’m a pragmatist and realize that my chance for cure is about 70% and if I do have a reoccurrence I will go on ADT3. I hope that day never comes, but I feel I made the best decision for me with the best data available to give me the best shot at a cure.
64 years old.
I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.
In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.
I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.
A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.
Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,
I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.
The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.
As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive
Awaiting schedule for seed impants