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.