Apologize if this has been posted before but it is quite encourging for younger guys that have made

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 8/19/2009 10:02 AM (GMT -6)   
the surgery decision.
 
 
Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03
 
PSA August 18th 2008 = .01 or less, test only goes down to .01


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/19/2009 10:43 AM (GMT -6)   
This was posted back in June I believe. But it is worth noting again. Clearly, surgery has an advantage in the younger guys, but here's the kicker ~ Men in their forties were not encouraged to be screened until 50/45 with high risk. So this group of guys was outside of screening protocol...

Also note, that delivery of radiation has been improved. Seeds/IMRT is much better than 16 years ago. But we don't have twenty year data on it yet, and I personally would not gamble with cancer. I chose surgery because it was and still is the gold standard. At least until we see actual proof otherwise. By that I would like to see numbers equal to or better than surgery at the twenty year mark...

Also note the descrepancy in the no treatment catagory compared to radiation...Study data here does not clearly define why NDT had better numbers than radiation. RTOG states that it is because the radiation arm had more aggressive cancer and that NDT was not an option. Thus the higher mortality rate.

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!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/19/2009 1:38 PM (GMT -6)   
TOny, I agree with your post fully.
Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 8/19/2009 2:43 PM (GMT -6)   

Tony, as much as I love you as a mod and respect your opinion, I'll offer a different take re your second paragraph.

Your implication is that treating PCa with radiation is "gambling with cancer".  I understand that many uro-docs feel that way and, obviously so do you.  However, my research would indicate that many, many, many studies have been done that demonstrate the effectiveness of radiation as being as equally curative of PCa as surgery.  I understand that you just stated this as your opinion and I respect that.  However, my opinion reflects that of those radomized stuides of 15+ years that show fairly equal results when normalized for patient diagnosis.

Anyway, you are certainly entitled to your opinion, I just disagree with you on this point.

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"!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/19/2009 4:57 PM (GMT -6)   
I fully understand tud,
But it is my opinion. The results you reference are not in the same light as the article. This article suggests that surgery is better for younger men. The RTOG study I think you reference does not include them, as many studies don't include men under 50. But I left the door open to newer techniques such as the therapy you chose. We just don't have 20 year data on it yet. We have 40 year data on surgery, 30 using RRP, and it still shows better results than current 10 year studies.

I have always said, 10 year studies are seriously lacking when you talk of a tweenty year disease like prostate cancer. The advocacy network and most doctors agree...

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!


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 8/19/2009 5:21 PM (GMT -6)   
Tony, I was not commenting in the context of the article (I did that in June when it was originally posted).  I was simply responding to what I took as your blanket comment that treating cancer with radiation was more of a gamble than surgery.  Perhaps that was not what you meant and, if not, perhaps I took it wrong. 
 
Also, I was not quoting RTOG or any other study specifically, just stating what many studies have concluded, i.e. that both protocols are equally likely to cure the cancer...assuming a patient is eligible for both options.  For that reason, IMHO, neither proctocol is more of a gamble than the other...
 
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"!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/19/2009 6:28 PM (GMT -6)   
No blanket statement intended. Just that we lack long term study information from the latest techniques available in delivering radiation. But using EBRT twenty years ago was clearly inferior to surgery, and studies show that. My second part of the statement, cleary my own opinion, that says until I see twenty year studies showing comparable or better statistics, it does constitute a risk to be taken on by the elector of that option. But I would like to clarify if I may. I can fully understand if a person at the median age range of 55-70 years old at time of diagnosis choosing a current radiation option. They will have less side effects in the near run and sufficient results on the cancer to keep it at bay for the duration of that persons life. I have told this to people, including my own father. I would not be against him chosing radiation at all.

The article above is correct. Unfortunately we lack sufficient data today, and that is where I have taken my advocacy work. We need to stop eliminating age groups from studies. Clearly we could have so much better data if researchers and institutionss in the 80's and 90's did not eliminate patients under the age of 50. These results could show us so much more today a more favorable path to choose. We saw recently in the New England Journal of Medcicine two contraversial studies that elimated anyone under the age of 50. Makes no sense to me...

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!


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 8/19/2009 8:01 PM (GMT -6)   

Tony, thanks for the clarification.  I certainly agree with you re the inclusion of men under 50 in the studies and I believe that is very important.  I'll just assume I took your "gamble" comments out of context; your comments in your last post made it clear that you believe in the efficacy of radiation in the 55-70 age group and on that opinion we are in violent agreement...

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"!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/19/2009 8:15 PM (GMT -6)   
Amen, Tud,
I am living with advanced prostate cancer and cannot find meaningful study data for my condition because I was 44 when diagnosed. Grrrr. That does upset me, too. I understand why that is though. Before PSA we seldom found guys like me until it was too late. As contraversial as PSA is, it may have saved or extended my life. I will be my own study...And that's just wrong. But I know that long term studies take time. May they all produce good results.

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!

New Topic Post Reply Printable Version
Forum Information
Currently it is Monday, June 18, 2018 3:01 PM (GMT -6)
There are a total of 2,972,911 posts in 326,035 threads.
View Active Threads


Who's Online
This forum has 160867 registered members. Please welcome our newest member, RAbid.
426 Guest(s), 17 Registered Member(s) are currently online.  Details
eliramon, clocknut, xxxa5200, spouse21, xpeetzax, sandyfeet, B waverly, redskinsfan, myilah, Garion, Fairwind, RAbid, FamilyGuy, cppoly, U.C.Me?, straydog, huneri