Brachytherapy today

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 5/19/2009 5:43 PM (GMT -6)   
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.
There was absolutely no pain that I usually have for about 4 hour after a biopsy. I had a burning and sense of urgency, but that lasted for about 1 hour. Just had lunch and will probably do a little work this afternoon.
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.  

 

JohnT

 

 


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

 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4181
   Posted 5/19/2009 6:05 PM (GMT -6)   

JohnT...I'm glad you didn't make a liar out of me!!!

Congrats on a successful day.  I'm glad that all went well and that you're feeling ok.  Pop a vicodin before night-night and tomorrow will be like this never happened.

I'm also glad you took the time to explain some of your "journey".  Every man's story is different - don't we all know that! - and I'm sure you made the right choice.  I hope you will add chapters to your journey as time goes on so folks can read a continous story...and I trust a successful one!

Best wishes,

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 5/1/09.

chris nz
Regular Member


Date Joined Sep 2007
Total Posts : 33
   Posted 5/19/2009 6:11 PM (GMT -6)   
JohnT, I am pleased you had no more degree of 'difficulty' that I had.
regards c
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
PSA after 6 weeks 7.8
PSA after 3 months 4.2, everything still working well, absolutely no problems. next check in May '09


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 5/19/2009 6:47 PM (GMT -6)   
John,
 
Congratulations - the treatment process has started, I am sure you must be relieved. I really appreciate your tought out and informed approach to battling the beast. My best wishes on the treatment process and hope you can soon report back lower PSA results.  
 
I fully agree with you that if the chances of positive margins are higher, we dont need to stack up the side effects of surgery and then radiation. I was myself on the fence between seeds + radiation (at RCOG) and surgery. Opted for the surgery because I could get Dr Walsh to perform, and my PSA was a tad lower with a GS 6 (my chances for positive margins were 30%) but could have been the other way around.
 
Best wishes
 
Age at DX: 43
PSA: 11/08:15.6, 01/09:16.6, 02/09:17.1
Biopsy 12/08 at USF Tampa
8/12 cores positive, GS 3+3,
perineural invasion in 2 cores
Staged T1c
CT, Bone, XRay negative
03/04/09 - Open Surgery at Johns Hopkins by Dr Patrick Walsh
Path Report: GS 6, Tumor Contained, margin clears, nodes+vesicles clean
Both nerves spared,
Catheter Out: 03/18/09
Incontinence : Resolved from day one, cant believe it
ED : some signs of life
Diet : Vegetarian, No-meat, no dairy diet since 01/09


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/19/2009 8:56 PM (GMT -6)   

John always impressed with your tenacity and journey. I wish you the best.

Z-Bob


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 5/19/2009 9:51 PM (GMT -6)   
John,
I'm glad every thing went well for you with no pain. I hope all goes well in the future when you get your first zero to be followed by zeroes for ever.
Age: 67
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09
Surgeon: Dr. Randy Fagin, Austin TX.
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
seminal vesicles clean
Lymph nodes: not dissected
1st PSA test 4/7/09 result <0.1


JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 5/20/2009 8:06 AM (GMT -6)   
Welcome to the "seeded" side - I'm glad all went well for you.
Husband diagnosed in December 2005
PSA of 3.74
Gleason 6
Brachytherapy (91 stranded seeds) April 2006
PSA of 0.39 - November 2008 - whoo hooo!
PSA of 0.31 - May, 2009 - whoo hoo again!
 


mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 5/20/2009 1:48 PM (GMT -6)   

I'm glad everything went well. Best wishes and thanks for showing me your decision path.

Mike


Lower left groin hernia: mesh and large scar: surgery early 2006
Nov/Dec 07 and March 08 and now Dec 08: Severe perineal pain (between scrotum and rectum). Septra/Bactrim for 8 months (Nov 07-Jun 08) for diagnosed prostatitis.
PSA start of 2008: 5.3..... PSA June of 2008: 7.3
14 DRE all benign or nothing felt
TRUS Biopsy Nov 08: Got copy of pathology (see below). Prostate about 40 cm sq.
General Health: pretty good, 5' 10", 180 lbs, slim.
Bone scan Dec 08: Negative
Barium enema X-ray (March 09 due to several days of blood in stool)
MRI with endorectal coil (April 09 as part of a study)
3D advanced TRUS (April 09 as part of a study)
CT (April 09 as part of a study)
Biopsy Pathology: 5 of 8 cores positive, adenocarinoma in both lobes. 30%-65%. One core perineural invasion. 2 cores "foamy" and suspicious. All +ve cores, 3+3 GS 6.
Open RP surgery: May 5/09 Surgeon spoke to my wife and was very positive. Said both nerve bundles spared and not damaged. Bilateral lymph node dissection performed. Discharged 48 hours after surgery. Staples out, catheter out and pathology sheduled for May 21.
Physical State: Home office in basement. Up and down 10-20 times a day. Walking lots of circles around inside of house and back patio. Bit sore but coping very well so far.
Mental State: Pre-surgery anxiety gone. Now waiting for path report, cath removal and staples out. 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/20/2009 2:28 PM (GMT -6)   
Hey John,
Congrats on the treatment. Now for the healing and low PSA's. My very best to you and prayers for many great years ahead.

Tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

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