Flawed reasoning?

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crewa2
Regular Member


Date Joined Jun 2009
Total Posts : 43
   Posted 7/3/2009 12:50 PM (GMT -6)   
Trying to decide between robotic surgery and radiation (Proton Beam Therapy)

From my (limited) research so far, it seems if the cancer is organ confined both options have a similar chance at favorable results. If the cancer is not fully contained in the prostate, then radiation would usually be the treatment of choice (in addition to other treatments).

Why not go right to the radiation (PBT) as the initial procedure and possibly get the cancer in the margins now? In addition, possibly avoid some of the side effects of surgery.

I'm still learning, so please be easy on me.
Age 43
5/6/2009 1st ever PSA 4.3
Referred to Urologist
DRE: Nodule felt on left side
6/19/2009 Biopsy done, 10 samples
6/25/2009 All 5 left side positive Gleason 3+3=6 T2b?
No % of involvement written on biopsy report
5 on right side benign
Sent slides to Johns Hopkins for 2nd opinion
In research mode....


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/3/2009 1:27 PM (GMT -6)   
Crew,

There will be similar side effects with either treatment, though they will be right away if you choose surgery, but may be on a bit of a delay with radiaton. As far as margins go, you won't know that with any certainty unless you have surgery, either open or robotic, and hopefully it will be revealed in the post surgery pathology report. With any of the radiation options as your primary treatment, you may not know with any certainty what is left or not.

Your stats appear fairly low grade at this point, but again, that is one advantage of surgery, they will have the prostate to look at, as well as any removed lymph nodes, and the seminal vessels to examine.

You are doing the right thing taking your time sorting through all this, it's a big decision, and one you will have to live with.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 7/3/2009 3:43 PM (GMT -6)   
I had an oncology friend who told me that at my age (46 at the time of diagnosis) that radiation would certainly do the trick and kill my cancer - leaving me with an intact prostate and mostly likely, few side affects. However he asked me to consider this. I now knew that I had a genetic predisposition to cancer of the prostate. Unless I radically altered my lifestyle - diet, region of habitat, etc..every aspect. Those chances would not diminish. Even if I did alter everything, I am only playing a game of odds. Let's hope my life expectancy is to my mid 80's. I now have 40 years left. I've gotten cancer in my first 40 years...I'll probably get it again - even if they kill all the current cancer (this is NOT a recurrence, but a second case). If I get a second round, my treatment options are lessened as far as today's treatment goes. I can bank on the fact that medicine will improve over the next 40 years, but radiation comes at a price. No treatment is free of drawbacks. I decided to get rid of it and live the next 40 years not worried about getting prostate cancer again.
just my thoughts in my process. I also asked every doctor I knew (not drs connected with PCa, just buddies) what they would do. They all said they would get it out.
So i did. Life is good. Life is full. We all make our own choices and most of us are happy with them.
Good luck.
Paul
46 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6 (Biopsy 3/07 just suspicious)
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at nine months.
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - Took 100mg viagra every night. for several months
Totally usable erections at 10 weeks, which disappeared over the course of a month or two.
ED bounce is what they call it. Now, at one year, ED is fine with viagra.
One year PSA - undectable!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 7/3/2009 4:07 PM (GMT -6)   
Crew,
There is nothing wrong with your reasoning; I came to the same conclusion after months of research.
There may be some benefit to surgery for a younger patient, but this is still speculation and not supported by any evidence.
If radiation is done correctly it will kill all of the cancer in the prostate and hard to get margins, such as near the ureatha and seminal vessels and achieve a better margin in the prostate bed.
If you have a local reoccurrance after surgery it is because some PC cells were either left in the margins or in the bed and these can be cured by salvage RT. Another benefit to surgery is that you know your actual gleason score and if you have positive margins.
The side affects from radiation are usually less severe than surgery and the side affects show up later, as with surgery they are immediate.
Both surgery and radiation have the same cure rate for localized PC.
I would also investigate a combination of seeds and IMRT as you get a much higher dose with the same side affects as IMRT alone.
Keep researching and good luck on whatever decision you make.
JohnT

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/3/2009 5:46 PM (GMT -6)   
Paul, that was a good post.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 7/3/2009 7:22 PM (GMT -6)   
If my husband had it to do over...(and I hear him say it almost every other day), he would have had it out to begin with. The salvage surgery is much worse than salvage radiation... The quality of life after radiation is very difficult....not right away, but afterwards....a few years.....also after the cancer returns, as it may..The salvage surgery part is devastating.....I would not advise it....that is why getting it out first may be best....Di
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/3/2009 8:56 PM (GMT -6)   
Interesting to note the Dr. Fred Lee the pioneer champion of cyro-therapy (break through proceedure in those earlier days) is a PCa patient himself. He is also considered one the best Doppler-color ultrasound- sonographers there are for PCa.  Anyway he is a most informed doc on PCa issues and knows plenty of other docs etc., did he get surgery, or cryo or others.......NO.....he went chemically....via Emcyt and has had decent quality of life and I believe he is around 10 yrs. with PCa at this time.  Interesting that some docs with PCa do things other than what they prescribe or endorse for us patients. Dr. Lee did not do Lupron and other hormone therapies that are sold to us patients like aspirin, interesting to think about. I am not endorsing emcyt it has some risks and possible side effects, but apparently works against PCa and he made it his choice probably for decent reasons.
 
 
 
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/3/2009 9:34 PM (GMT -6)   
Diane,

I was glad to see your name come up. Pete's story of the sequence of his treatments needs to be told time after time, it's very important that new people understand the risk of radiation before surgery. I hope Pete is doing well.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/5/2009 8:50 AM (GMT -6)   
from my limited medical knowledge I would be an advocate of surgery to remove the prostate. At such a young age I think if you choose radiation that you would always wonder in if the cancer would be returning. It is your choice and you will make the right one. My spiritual background and approach to things would always include prayer to make such a decision. I will say even though surgery comes with its share of side effects please do not under estimate the long term side effects of radiation.
Keep us posted as to your journey. We all do truly care

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


IKE-D
Regular Member


Date Joined Jun 2009
Total Posts : 77
   Posted 7/5/2009 1:39 PM (GMT -6)   
During my treatment decision process, I visited very top radiation oncologists at top academic institutions in the US all in an attempt to avoid surgery. Each of them told me they will go for surgery if they were me. In addition to the risk of recurrence with the prostrate still in place, there was the fact that radiation comes with some of the same feared side effects (perhaps much later with rad) in addition to the fact that your options are diminished after radiation fails God forbid. So surgery I did and I am very happy. Margins negative, cancer contained in prostrate, continence almost 100% and ED issues diminishing by the day and I don't have to wonder if my prostrate will be cancerous again. STill waiting for first post-op PSA but staying positive!
In the end, it will be your call which way you go but I hope the responses here help you navigate this 'wicked' terrain.
 
Kind Regards
ID
 
>Age 41 (At Dx-July 05) -Psa during annual physical went from previous 2.8 to 3
>Biopsy by 'primary' Urol Aug 05 - Gleason 6 low grade. 2nd opinion at  Hopkins confirmed Dx
>Chose Active Surv (AS)- modified diet etc.
>Around Oct 07 Psa moved up to 5.5. I decide to treat at Hopkins. Not sure what kind yet. My doctor decided on re-biopsy first.
>2nd Biopsy Dec 07 at Hopkins was NEGATIVE for Pca! Nothing found in 14 cores!
>'Primary' Urologist baffled. Planned a saturated biopsy (22 cores) to settle issue once and for all. I wasn't going to do 22 cores wide awake!
>July 07 - Did MRI just for comfort. Nothing significant found. No spread. I'd live! Still in AS mode.
>July 08 - Saturated Biopsy performed. Cancer confirmed again (of course, you took 22 cores)! Same Gleason score, same grade, similar numbers but Urol says treat very soon! I am thinking not so fast - numbers are same and you told me it means not aggressive! In any case I agreed with Urol that I will go the way of the Seeds. I research seeds more and I don't like it.
>July 08 - Dec 08 I re-lapse back into AS mode but seriously researching/considering treatment options beside surgery - went on to Mass Gen and Georgetown to explore proton therapy and Cyberknife respectively. Anything but Surgery! Both experts who are about my age were unanimous in strongly declaring they will chose surgery 'if they were me'. In addition, I learn that if either if these radiation methods (and seeds too!)  failed, no backup plan (or will be complicated)! I got the message!
>Jan 09. Went back to see my doc at Hopkins. I decide to put my fate in the hands  of the 'Da Vinci Robot' then!
> May 09. Had surgery. some Pain and discomfort but normal. Pathology all clear. Gleason 6 as before. Feeling very lucky. I gambled (based on my numbers and got 4 more years!) on the slow nature of the cancer and took my time. Very happy I finally did it. Hoping for a great recovery of all 'key' functions. Great wife and family helping out.


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 7/5/2009 2:05 PM (GMT -6)   
Just my thoughts but I would think as a worse case senario, surgery followed by radiation (if necessary) would be the most secure way to go, that way they get a really good look to see what the problem is. I know several people who had radiation and are good with it, but they tend to be older. From what I have read, I would not want to follow up radiation with more radiation down the road.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 7/5/2009 6:11 PM (GMT -6)   
Dear Crew:
 
Like JohnT, I think your reasoning is pretty sound.  Of course, since I chose radiation, you might expect me to answer that way!  I see that none of the PBT folks have weighed in yet....there are only a few of them who post here...but, hopefully you will hear from one or more of them.  In my research I considered PBT but, for my case, it seemed that the outcome and SE's would be similar for PBT or seeds (or surgery) so I chose the less troublesome one.  If you do have some interest in brachytherapy, feel free to read my journey with the link in my signature or ask any other questions you might have.
 
Most of your responses have been from the surgery folks and, as you might expect, they have some perspective that surgery is the right choice.  But, for a little balance, I would point out a couple of things.  First of all, several of the guys imply that if you have surgery you will not ever have to worry about PCa again.  That is simply not true.  Despite "clear margins" and knowing your pathology, there is still the possibility that you will find yourself with rising PSA and the need to re-treat the cancer.  There is no sure thing here.  Also, Diane properly points out the post-seed problems that her husband had that were exacerbated by the unfortunate choice to try salvage surgery.  For balance, unfortunately there are other surgery men on this forum to have had continuing problems with that protocol including one man who posted a couple of months back who was totally incontinent at 2 years post-surgery and was wishing he had done his homework a little better before making a choice.
 
Anyway, all I can really advise you is to seek multiple opinions...surgeon, radiation doc, PBT if you're interested and prostate oncologist.  Get yourself VERY informed and then you can make a good decision and not feel the need to look back.
 
Good luck and please let us know what you decide and update your progress,
 
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 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

crewa2
Regular Member


Date Joined Jun 2009
Total Posts : 43
   Posted 7/7/2009 11:40 AM (GMT -6)   
Thanks everyone for your stories and results. I find myself bouncing back and forth between the proton beam and surgery daily. Yesterday's catheter insertion (which was almost as much pain as I've every felt) was definitely a swing towards PBT. They were doing a urodynamics to test my bladder. Needles to say, after they filled the bladder I was to scared to let it back out anticipating the burn. I finally let it go, it wasn't too bad. I think I will wait for a while before I let them do the cystoscopy. Anyone else have that kind of pain with a catheter?
Age 43
5/6/2009 1st ever PSA 4.3
Referred to Urologist
DRE: Nodule felt on left side
6/19/2009 Biopsy done, 10 samples
6/25/2009 All 5 left side positive Gleason 3+3=6 T2b?
No % of involvement written on biopsy report
5 on right side benign
Sent slides to Johns Hopkins for 2nd opinion
In research mode....


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/7/2009 12:19 PM (GMT -6)   
crew,
i am a guy that wore a catheter, actually a total of 5, during my first 63 days after surgery. the best way to get one put in is to have it done when knocked out. i had 2 put in during emergency situations, the trick, is for them to use lots of lydocaine numbing jell, and for them to let it work for about 10 minutes or more to numb the top of your penis real good. after it is numb, it is more pain in your mind watching, if you dare, then you actually feel. no easy way with that.

i had one scope done awake, wasn't too bad, it was more the thought of what was going on, and my dr was real good on the numbing part. the second scope, i was put under completely, because they had to do some repair work, so didnt feel a think and when I was in the recovery room, the new catheter was already in place and working.

best luck to you in your upcoming decision. sometimes, i feel the choices we have to make with out pc, is like asking someone do you want to be shot or stabbed. all our treatment choices come with a risk and side effects, so keep doing your research well.

david in sc
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 7/7/2009 1:58 PM (GMT -6)   
IKE-D said...
During my treatment decision process, I visited very top radiation oncologists at top academic institutions in the US all in an attempt to avoid surgery. Each of them told me they will go for surgery if they were me. In addition to the risk of recurrence with the prostrate still in place, there was the fact that radiation comes with some of the same feared side effects (perhaps much later with rad) in addition to the fact that your options are diminished after radiation fails God forbid. So surgery I did and I am very happy. Margins negative, cancer contained in prostrate, continence almost 100% and ED issues diminishing by the day and I don't have to wonder if my prostrate will be cancerous again. STill waiting for first post-op PSA but staying positive!
In the end, it will be your call which way you go but I hope the responses here help you navigate this 'wicked' terrain.
 
Kind Regards
ID
 
 
Hey Ike:
I really don't mean to be unkind but given the fact that you have had "prostate" cancer for four years , isn't it about time you started spelling it correctly- not prostrate. Sorry, I could not resist.
 


 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
Brachytherapy- May 19, 2009 -so far, so good.
 
  "There may come a day when the courage of men will fail, but it will not be this day."


dawgfan
Regular Member


Date Joined Aug 2006
Total Posts : 148
   Posted 7/7/2009 2:44 PM (GMT -6)   
I was told that if I did radiation first it sort of 'cemented' the target area. If cancer recurred, then surgery was very difficult because of the previous radiation. I would like to hear from more informed professionals regarding this theory. I chose surgery, but it is not for everyone. You must do what your heart, family and faith lead you to. Best of luck in your search.
DX 8/24/06, Gleason 6, PSA 3.32, stage T1C
age 48 at the time, da Vinci on 10/20/06
Last PSA was ZERO
6/16/09 AdVance Sling installed
 


oldflyingfarmer
Regular Member


Date Joined Jun 2009
Total Posts : 32
   Posted 7/7/2009 3:18 PM (GMT -6)   
To answer one of the questions above about pain with the catheter. I had a TURP which required a catheter. It was painful and removing it was the most pain that I have ever experienced. After my RRP in May, I was again wearing a catheter, but it was much more comfortable and removal only hurt a little for a few seconds. I think the pain comes from whatever else was done inside. Hope this helps, and good luck with your decision.
Age 55
Diabetic on insulin pump
PSA started rising in 2007
2 negative biopsiesthru 2008
2009 PSA 31, TURP found Gleason 9 cancer
Started holistic approach while waiting for surgery
RRP on May 27, 2009
Cath out 2 weeks after surgery
Very little drip, some pain
Waiting for post-op doc visit July 09 with fingers crossed


Gmike
Regular Member


Date Joined Jan 2009
Total Posts : 48
   Posted 7/7/2009 3:21 PM (GMT -6)   
My URO described the prostate as "frozen in time" after EBRT (external beam radiation therapy). He said the spacing was reduced between the prostate and other organs, thus making salvage surgery difficult. His advice was to avoid the salvage surgery, since side effects such as incontinence were likely. He said hormone treatment is usually done if there is a relapse after EBRT.
PSA 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
Family history: Grandfather had PCa, died at 79 of other causes, Father had PCa still living at 80 cancer free (10 years)


crewa2
Regular Member


Date Joined Jun 2009
Total Posts : 43
   Posted 7/13/2009 8:18 PM (GMT -6)   
I got the 2nd opinion results (Johns Hopkins) from my biopsy slides today. The report was the same as the initial Gleason 3+3=6, but also included 40-60% of involvement of the positive cores. I guess no increase in Gleason is good news.

I have a consultation scheduled with a Dr. Pow-Sang at the Moffitt cancer center in Tampa, does anyone have any info on him or Moffit.

Thanks
Age 43
5/6/2009 1st ever PSA 4.3
Referred to Urologist
DRE: Nodule felt on left side
6/19/2009 Biopsy done, 10 samples
6/25/2009 All 5 left side positive Gleason 3+3=6 40-60%
5 on right side benign
In research mode....


crewa2
Regular Member


Date Joined Jun 2009
Total Posts : 43
   Posted 7/13/2009 8:31 PM (GMT -6)   
Well I just did a search on here for Dr. Pow-Sang and found a lot of good info.
Age 43
5/6/2009 1st ever PSA 4.3
Referred to Urologist
DRE: Nodule felt on left side
6/19/2009 Biopsy done, 10 samples
6/25/2009 All 5 left side positive Gleason 3+3=6 40-60%
5 on right side benign
In research mode....


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 7/14/2009 7:09 PM (GMT -6)   
Well, a "frozen in time" is a good description...the doctor told Pete, External radiation and seeds is like : "frying an egg"....OK, fine, if it gets all the cancer, but if it does return, and maybe even be a NEW cancer in the prostate, the salvage surgery will be almost impossible to heal...Picture sewing together the white part of a fried egg to something else...It breaks apart, and will not heal....That is what happened to Pete....That is why we say to have the surgery first, and then if it does return you have more options. No one likes to think there will be options...we certainly didnt, and ignored that line of reasoning. I wish that we had not.
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
waiting for new PSA 7/09


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2009 7:52 PM (GMT -6)   
Well,
You asked a good question. But you are really asking two questions...

1> Surgery first is the correct order if multiple therapies are required. If you do it, and it works, you are done with the cancer and can work on any side effectes. Radiation therapies try to hit the prostate as carefully as possible when done on the front end. One of the great claims to proton beam therapy is it delivers its dose precisely. Same with IMRT. But the problem is this, what if the cancer is outside the target area? Salvage radiation therapy targets more area and has higher risk of side effects. Thus, if you go with the proton or IMRT in a wider area, you have a risk of side effects in the future.

2> Surgery vs. Radiation...we can argue this point all day long. But there are studies that show that surgery still has slightly better results. Considering the immediate side effects, I can fully understand trying to avoid it. But there are other things to consider. divo points out one of them, salvage therapies are best done is a specific order. If radiation fails you may be able to find a surgeon willing to remove a prostate, it is for debulking a tumor purposes. Debulking is valuable because it can prolong life. In addition, radiation therapy can have residual psychological effects. If your PSA "bounces" you run the fear levels up higher in between PSA checks.

Feel free to ask any questions...your biopsy shows all five core positive on one side. Perhaps asking about more clear imaging techniques is a good idea. But what ever you decide to do, stay with us and let us know how you are doing...peace to you...

Tony


 Age 47 (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!

Post Edited (TC-LasVegas) : 7/15/2009 10:01:59 AM (GMT-6)

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