Radiation Choices

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Gmike
Regular Member


Date Joined Jan 2009
Total Posts : 48
   Posted 6/11/2009 3:52 PM (GMT -7)   
My URO says I should get good results with either surgery or radiation. I've flip flopped a couple of times, but right now I'm leaning toward radiation because the data says it offers about the same cure rate with fewer side effects. My question is, should I have IGRT, seeds, or a combination?

In the small town where I live my URO says the radiation Doctor is good and has a two year old machine, but doesn't do seeds. I would have to drive 90 miles to Indianapolis for this. My other option is Florida. I live there in the winter and am 35 miles from the Dattoli Cancer Clinic. I talked with Dr. Dattoli on the phone and he seems almost too good to true. For instance, he implies that the Color Flow Dopler can pinpoint the cancer cells in my prostate. I've read some good things about the Color Flow but if it was that good I bet everyone would be using it.

It seems as though the people on this forum that have chosen radiation, went with seeds. I'd like to know why.

Mike
PSA
2004: 2.0
2006: 4.0 (40% Free)
2007: 3.1
2008: 5.03
2009: 5.2 (21% Free)

Biopsy(s)
August 2008(age 58): 1 core of 12 was "atypical"
May 21, 2009(age 59): 1 core of 12 positive (10%), Gleason 6, Stage T1c, 1 core atypical, prostate 45 grams
June 4th Bone scan (negative)


Family history: Father and Grandfather both had PCa


riverbend
Regular Member


Date Joined Mar 2009
Total Posts : 39
   Posted 6/11/2009 4:18 PM (GMT -7)   
Proton beam radiation is in Bloomington, IN and Jacksonville, FL

Dx T1c in April, 2009 at 45 years old after recent PSA tests ranged from 2.93-3.25
2 of 14 cores positive at 5% and Gleason 3+3... 2 cores taken from a "protuberance" were "ASAP"
Proton radiation at LLMC May-June 2009


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 6/11/2009 4:20 PM (GMT -7)   
Hi Mike,
I havent posted for a few weeks. I will tell you of my husbands seeds, radiation, lupron trip........He felt the same as you...(radiation would be easier etc), Well the cancer returned in four years, and the only thing then was salvage surgery....It has been devastating with the side effects: fistula, total incontinence, and total impotence, and catheter in for one year. Just remember that radiation can be very damaging, and it goes on for several years....On the other hand, if you have nerve sparing surgery first, if the cancer returns you can then have the radiation. Your numbers are small....You are still young, and the psa is rising slowly over several years. maybe you should just change your diet, and wait a bit more... only my humble opinion...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


KeyWestPirate
Regular Member


Date Joined May 2009
Total Posts : 60
   Posted 6/11/2009 4:29 PM (GMT -7)   

Mike:

With your numbers you have great treatment options.

 I would take my time making my decision.  It's an important one.

Get a second and third opinion.  Read more of the older posts on this site.  Talk to a surgeon.  Hell, talk to everybody!    Check out www.protonbob.com

Although radiation might have fewer INITIAL side effects, it does seem to catch up with you, even best case.  My RP surgeon claimed that the erectile nerves are invaribly damaged by the radiation, it just takes longer for the damage to show up, and when it does, it's irreversible.

Granted, he's biased  :)

 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/11/2009 5:06 PM (GMT -7)   
I ditto Diane's approach, and is ultimately why I chose RP first. I am saving radiation for the really big one if it occurs. It's basically a one shot deal.

My other non-professional opinion is that an "atypical" core is not enough to proceed with either choice. A Gleason 6 is relatively slow growing, so until you have a repeat biopsy, I would probably wait for a while, watching my PSA also.

I think the advice for a second opinion, where they should also review the pathology would be a good thinh also.

Good luck !
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
Living the Good Life, cancer free
6 week PSA undetectable. 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4167
   Posted 6/11/2009 5:39 PM (GMT -7)   
Any local cure will work well with a G6 small core.
The color doppler can identify the cancer; it's expensive relative to a standard biopsy, but well worth it. A color doppler spotted my cancer that 12 biopsies and an MRIS had missed. I'm a true believer.
Seed are a good choice; It was 3 hours from the time I left the house to when I got back. I played golf 2 days later. The only side affects I have are frequent urination. If I had a G7 or another high risk stat then a combination seeds and IMRT would be recommended.
I can't understand the arguement that says salvage radiation is a back up for surgery. If surgery didn't get it it was because it was already out of the prostate or there was a positive margin. Radiation does a much better job with margins than surgery, and if it out of the capsul than neither will result in a cure.
The overall side affects are much better with radiation and the side affects of seeds are much better than IMRT. The reason I chose ratiation was because of the least side afffects, similar cure rates and the ability to get a better margin than surgery.
Pick up a coy of "Brachytherapy and IMRT" by Danatolli

JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/11/2009 6:50 PM (GMT -7)   
JT

My comment on radiation as a back-up was a personal one, as a gut with a G 9. But, we see many posts here of guys who had radiation and then a recurrence.

We don't know without surgery if the cancer has spread outside the capsule. Most radiation targets the prostate. If it has spread outside the capsule, away from the prostate bed, it may grow back again, because the radiation wasn't focused on it.

Again, it was my personal choice for my own medical reasons, and am not suggesting anyone do what I did.
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
Living the Good Life, cancer free
6 week PSA undetectable. 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4014
   Posted 6/11/2009 7:52 PM (GMT -7)   

Mike:

Some thoughts on your post and others on this thread:

1.  If you can live with the fact that cancer might be growing slowly in your body, why not consider diet and active surveillance?  If you do consider this, please consult a physician experienced with the approach.

2.  In answer to your specfic question, my answer is similar to JohnT's answer, i.e. seeds in early stage PCa provide equal cure rates to surgery, other radiation or any other treatment, with fewer SE's.

3.  Diane's point re potential problems is well made and true with any treatment you choose.  However, if you choose radiation and the cancer returns you should scratch salvage surgery from your vocabulary.  It's high risk, especially for bad SE's as Diane and Pete will readily attest.

4.  Today's brachytherapy with experienced docs can yield the trifecta of cure, easy treatment and limited side effects.  I don't know about the Indy guys, but Dattoli is very experienced, uses color doppler and has a great track record.

Good luck,

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 6/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 6/12/2009 12:22 PM (GMT -7)   
Mike:
 
Everyone's choice is personal so I can only speak to the treatment my husband ultimately chose and why.  He chose Brachytherapy because (a) surgery was risky for him due to the location of the tumour - if they didn't go deep enough, the cancer would remain and if they cut too deep he could be incontient - that was a big factor for him to consider at 44; (b) the cure rates were the same as surgery; (c) the side effects were less and (d) we were within driving distance of one of the best cancer hospitals in Toronto with an experienced Brachytherapist. 
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!
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/12/2009 2:29 PM (GMT -7)   
Don't forget Geason score !
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
Living the Good Life, cancer free
6 week PSA undetectable. 


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 6/12/2009 10:13 PM (GMT -7)   
"I can't understand the arguement that says salvage radiation is a back up for surgery. If surgery didn't get it it was because it was already out of the prostate or there was a positive margin. Radiation does a much better job with margins than surgery, and if it out of the capsule than neither will result in a cure."

Yes, I haven't figured out the logic yet where radiation is used as a "backup". Why not just radiate to begin with.

Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 130
   Posted 6/12/2009 11:27 PM (GMT -7)   
With your small amount of prostate cancer I would certainly seek a second and third opinion with one of those opinions being from a doctor that believes Active Surveillance is a viable treatment choice. Your bio says your father and grandfather both had prostate cancer, but did prostate cancer ultimately kill them? Unless you know you have a rapidly growing cancer, I would proceed slowly and cautiously before making any treatment choices. It looks like time is on your side.
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