Study of Quality of life issues across all treatment options.

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 8/29/2009 10:24 AM (GMT -6)   
This study was done 8 or 9 years ago so new protocals and meds like Flowmax could now make the results better.
Comparison of quality of life after treatments
 
Among questions faced by men upon diagnosis of prostate cancer is "How might treatment affect my subsequent quality of life?"
The answer, like so many answers to our questions, is 'It depends....'
Among the factors affecting treatment outcomes is one's physical health at the time of treatment.
 
Below is an abstract of a study comparing the quality of life for prostate cancer patients 36 months after various treatments for their localized prostate cancer. Unfortunately free copies of the paper are not available from the journal. A brief summary of the actual results includes:
 
438 patients in the Boston Mass. area were treated between 1994 and 2001 as
follows:
 
NNRP: Radical Prosectomy, non-nerve sparing: 53 patients
NSRP: Radical Prosectomy, nerve sparing: 74
RP: both types
EBRT: EBRT radiation: 190
BT: Brachytherapy: 92
 
RP and EBRT patients were fairly evenly distributed between low-
intermediate-
and high-risk cancer diagnoses. 57% of the BT patients were low-risk and 22% each intermediate- and high-risk.
 
Results were stratified by pre-treatment functional levels (Normal, Intermediate, Poor) for:
Sexual Disfunction
Bowel Problems
Urinary Incontinence
Urinary Obsstruction/Irritation
 
Quality of life outcomes 36 months after treatment were:
 
A. Sexual Disfunction
For those with normal function before treatment:
After: Normal Intermediate Poor
NNSRP  6% 31% 63%
NSRP   8% 28% 64%
EBRT   26% 26% 48%
BT       46% 35% 19%
 
For those with intermediate function before treatment:
After: Normal Intermediate Poor
NNSRP   0% 9% 91%
NSRP     0% 7% 93%
EBRT     3% 26% 72%
BT         7% 31% 62%
 
For those with poor function before treatment:
After: Normal Intermediate Poor
NNSRP   0% 14% 86%
NSRP     0% 0% 100%
EBRT     1% 4% 95%
BT          0% 15% 85%
 
B. Bowel Problems
For those with normal function before treatment:
After: Normal Intermediate Poor
RP       73% 25% 2%
EBRT   34% 52% 14%
BT        38% 52% 10%
 
For those with intermediate function before treatment:
After: Normal Intermediate Poor
RP       32% 61% 7%
EBRT   17% 63% 20%
BT       23% 57% 20%
 
C. Urinary Incontinence
For those with normal function before treatment:
After: Normal Intermediate Poor
NNSRP   43% 49% 9%
NSRP     58% 41% 2%
EBRT      83% 17% 1%
BT           83% 16% 1%
 
For those with intermediate function before treatment:
After: Normal Intermediate Poor
NNSRP   11% 78% 11%
NSRP      22% 67% 11%
EBRT       26% 68% 6%
BT           50% 50% 0%
 
D. Urinary Obstruction/Irritation
For those with normal function before treatment:
After: Normal Intermediate Poor
RP       58% 34% 8%
EBRT   59% 37% 4%
BT        58% 31% 11%
 
For those with intermediate function before treatment:
After: Normal Intermediate Poor
RP       56% 37% 8%
EBRT   24% 60% 16%
BT        15% 73% 12%
 
For those with poor function before treatment:
After: Normal Intermediate Poor
RP        35% 25% 39%
EBRT    16% 37% 47%
BT           8% 54% 38%
 
The results can provide patients reviewing treatment options some indications of how treatment side effects may differ depending upon their status prior to treatment. In general, the better the pre-treatment health for a specific functional area, the greater the relative loss in function after treatment.
 
The paper did not address the issue of relative treatment effectiveness for cancer recurrence.
 
The Best to You and Yours!
 
Jon in Nevada
 
----------------
ABSTRACT
J Clin Oncol. 2009 Aug 20;27(24):3916-22. Epub 2009 Jul 20.
 
Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function.
Chen RC, Clark JA, Talcott JA.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/29/2009 11:39 AM (GMT -6)   
The 8-15 years ago data concerns me, would love to see an updated version of the same thing, but still interesting.
 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/29/2009 1:07 PM (GMT -6)   
This information is posted on the website for the Vattikuti Urology Institute at the Henry Ford Medical Center. I realize that sometimes the scoring methodologies are skewed toward the facility, however I think that even these numbers show marked improvement over the surgical methods in place even as little as 5 years ago.

Scorecard: open Surgery vs. VIP Robotic Surgery

Measure open Surgery Robotic Surgery (VIP)
at Henry Ford at Henry Ford

Cancer Removal No detect-able PSA at 5 years 86 percent 97 percent


Continence at 6 mos. No pads needed 60 percent 96 percent

Potency at 12 months Erections firm
enough for intercourse 66 percent 97 percent*

Safety No complications 85 percent 98 percent


Pain (1-10)scale Patient response to Pain Score 7 3

Blood loss No transfusion in surgery 89 percent 100 percent

SCORE (Perfect=600) 600 406 (67 percent) 552 (92 percent)


* In patients with no pre-operative ED, undergoing Veil of Aphrodite robotic prostatectomy.[/b This is their version of the Nerve Sparing Surgery.

Additionally I was given the latest findings from their ongoing follow up of surgeries performed over their last 4500 cases.

Complications Minor =4% Major=1%

Cancer Control up to 8 years

Death from Prostate Cancer = 4/4500
Metasis to Bone = 8/4500
PSA recurrence at 6 years =4%
Negative Margins (last 1000 cases) =80%
Negative Margins if tumor confined to prostate = 93%

Urinary Continence at 12 Months

No pad = 85%
Occasional Leak = 13%
2-3 Pads = 2%
Total Incontinence = <1%

Erectile Function at 12 mos. in men with no ED before surgery (undergoing Veil Of Aphrodite) Nerve Sparing Surgery

Normal without medication = 50%
Sexually active with meds = 30%
Impotent = 10%
No interest in sexual function = 10%

Erectile Function at 12 mos. in men with no ED before surgery (undergoing Conventional Nerve Sparing Surgery)

Normal without medication = 20%
Sexually active with meds = 50%
Impotent = 20%
No Interest in sexual function = 10%

As I said this is information provided from a single institution. As of yet I have not found a population wide survey that was participated in by multiple organizations. I'll keep looking.

As my surgery is only 3+ weeks away I have a keen interest in understanding the Quality of Life aspects following surgery. Like many of you I probably have a keener interest in these issues over just getting rid of the cancer. Technological advances in removal of a cancer confined prostate seem to make getting rid of it fairly routine these days. I hope I am not being too optimistic, I just prefer to dwell on the more positive side of things.

Remember, "EVERY DAY IS A BONUS".

Hope this is helpful to someone. I gives me some sense of comfort, anyway.

Sonny
60 years old
PSA November 2007 3.0
PSA May 2009 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

Surgery set for September 2009 with Dr. Mani Menon at the Henry Ford Medical Center in Detroit.


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/29/2009 1:10 PM (GMT -6)   
Guys I am sorry about the way the first part of my stats lined up. I thought I had it all straight from the cut and paste but something occurred when I hit the submit button that changed the alignment.

I'll try to do a better job next time.

Sonny
60 years old
PSA November 2007 3.0
PSA May 2009 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

Surgery set for September 2009 with Dr. Mani Menon at the Henry Ford Medical Center in Detroit.


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 8/29/2009 1:23 PM (GMT -6)   
This is good information even if it is a bit outdated. Thanks for posting it.
Sonny thanks for correcting your stats sometimes we get excited and take up a page. You did great.

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

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
PSA July 28th 2009 is .01

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%


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 8/29/2009 1:27 PM (GMT -6)   

David, I don't think there is any doubt that there have been improvements in all of the major treatment options over the past 20 years so these comparisons should probably be looked at as relative rather than absolute.  And, it is certainly clear to me that the radiation protocols generally yield less side effects than surgery.  We can argue 'til the cows come home about which treatment is "better" for any specific patient, but the SE's of surgery ARE generally more severe.

Sonny, Henry Ford is certainly an excellent choice for surgery but there has been some discussion on this forum about whether or not their numbers are hyped up a bit.  There was a thread on this a while back and you might want to search it out.  One of the things that one member suggested was that he would not believe anything that was put up on a web site that was not published in a respectable journal.  I did find that HF had published their results and the published results were NOT as good as those on the web site.  It may be that the web site stuff is more recent and has not been published yet...or not.  Anyway, FYI.

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"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/29/2009 2:13 PM (GMT -6)   
I don't disagree at all, Tud. Prostate surgery is a major, complex, formerly dangerous procedure (years ago), and it is life changing with its unpredictable range and scope of side effects. I feel just as strongly, that men dx. with low grade PC, Gleason 6, few positive cores, low pecentage cancer in cores, should, really take the time to think through the myriad of choices he faces with either possibly watching and waiting, or choosing a primary treatment. With a more agressive dx, there is still time to think and choose carefully, but with the higher gleasons, psa, and/or staging, a man shouldn't be lured into either doing nothing, or wasting a lot of time allowing a contained situation into cancer outside the capsule.

David in SC
 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 677
   Posted 8/29/2009 11:31 PM (GMT -6)   
If I read the results from the older study correctly, they seem to reflect what we are seeing in other studies.  The most interesting to me was the figures that showed "normal" sexual functioning  to be the same with or without nerve sparing surgery.  It is quite likely that newer procedures are trying to do a better job, but in fact I have been told it is more about the patient than the procedure.
 
As we discussed some urology mills overstate their success.  As I have said before, unless pills, shots or none of the above are listed separately then the claims are meaningless.  I suspect that the figures have changed little over the past 10 years.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/30/2009 8:23 AM (GMT -6)   
lifeguyd,
I think if the real statisitic were known about ED and incontinence after prostate surgery, and included in large studies, with detailed questions breaking it down to types of ED therapy, and the quality of sex within those, including both nerve sparing and non nerve-sparing operations, both open and robotic, then many men with a PC dx would never consider surgery. The radiation clinics would probably all have long waiting lists, and for some men, the ones's with more agressive or spread cancers would end up dying earlier than need be and many more would be dealing with reaccurances.

For the most part, surgery is a two edged sword literally. For many men, it can be a good solution as far as the cancer is concerned as their primary, and hopefully only treatment. But when you weigh in the side effects, it comes back to the old conversations about quality of life issues vs. length of life issues.

My heart goes out to our brothers that are still dealing with incontinence months or even more than a year from surgery. Each of us knows how frustrating and degrading that can make us feel. The same for those with long term ED problems, all they hear is "be patient". For the guys that had nerve sparing operations, and still have no natural actvity 2 years later, where's the justice? Where's the refund on their surgeons chargess?  For those who view sex as a physical act between a man and a woman, its needs no explanation when ED changes the playing field.  You learn to become creative, you learn new ways of intamacy.  And one would have to suffer just a week or month of ED to understand what it means when you just "cant" do it anymore.  Not because you are some dope head or drunk all the time, and you run off to the ER to get some free viagra  (happens all the time), but because you had cancer (no choice of yours) and you had surgery.  That would even make it harder for an outsider to understand the frustration and depression that comes along with longterm ED.

My heart reaches further for our advance brothers, who despite making the right choices, and willingness to try all possible means, the PC just keeps hanging around like an unwanted and uninvited guest.

This is the one part of PC that I hate the most: no easy answers, no easy solutions, no set path to eradicate it, no steps 1-2-3 to recovery, and tough and conflicting choices at each stage of the game. I hate to admit it, but in the end, each of us makes our best educated guess at what to do to try to save ourselves, and hope and/or pray that we have made the right choice(s). I guess it is all any of us can do.

But we all get one shot at the game of life, and for the most part, we do what we are doing right now. Fighting, learning, trying, learning patience, learning things about our minds and emotions that some of us never had to deal with before. Learning to adjust to new realities. What we could do a year ago doesn't matter, what we can do now and in the future is all that counts. We even have to learn how to view ourselves as men, and how we define ourselves as men, how we love our women. There's a lot going on here, that anyone outside our world would never see or understand unless they were one of us too.

There is strength in numbers, and that's why I support our brother hood of men and the sisters that are part of it too so strongly here. We do have each other to draw upon. Let the strong among us help the weak, let the happy among us help the sad.  At one point or the other, we have walked in each other's shoes in a manner of speaking.  We know the problems, we ponder the solutions, we attempt for the best solutions.  We are the brotherhood of the PC.  May God bless us and keep us, each and every one, and to those that help us along the way.

Sorry for so long, end of this Sunday's sermon.

David in SC


 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Post Edited (Purgatory) : 8/30/2009 8:31:55 AM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 8/30/2009 10:35 AM (GMT -6)   
David,
I agree with most of your post except your asseration that radiation is not as effective on agressive PC and causes more reoccurrances. This just isn't supported by the data, although it is a common opinion.
There may be a case made for patients in their 40's or early 50's having surgery, but it cairtainly isn't for those in their 60s. I haven't seen any data that the reoccurrance rate from radiation is greated than than of surgery. This idea may come from those patients with agressive disease that are recommended for radiation because surgeons won't take them. These have a higher risk of systemic desease that can't be cured by either.
Also a younger patient will have to live with the side affects for a longer period of time.
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 DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 8/30/2009 10:54 AM (GMT -6)   

Greetings, everyone.  John, I agree with you - I think.  My urologist (not my surgeon) when he gave us the news that I had cancer told us that in his opinion there was only one option and that was surgery and the primary reason was because of my age (relatively young having just had my 55th birthday).  My surgeon says I am doing better than most all of his patients and once again, he says it is probably because I am 10 to 15 years younger than many of those other patients.  I realize I am fortunate that I have not had to deal with many of the side effects and I am grateful for that.  I am aware that it is fairly rare not to have side effects after surgery and I am truly blessed.

One thing I would say is that I don't think it is good to manipulate statistics to get them to say what we want them to say.  While I agree that there are those who take radiation because they couldn't have surgery and therefore those cases may skew the stats, those cases are a part of the groups.  I'll be the first to say that the side effects of surgery are greater than those of radiation or other options, but there are reasons guys choose to have surgery. 

As I have said many times and will continue to say, different options are right for different situations and for different people.  We are all individuals.  I'm happy with my choice and I know others who chose different options, John T and Tudpock included, are happy with their options and decisions they made.  Can we not all agree that the cancer is our enemy and we are all in the battle together?  I personally am glad that there are many treatment options and I pray that someday there will just be one and that is a cure that will be available to all our brothers out there who won't have to face this disease.  David


Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/30/2009 11:27 AM (GMT -6)   
JohnT - I wasnt trying to make that assertion, at least not on purpose. My discourse was at the emotionaly level, wasn't trying to make any technical statement. The point was there would be a lot less surgeries if many men really knew the reality of open/robotic surgeries, what it really means to live with the side effects. I have said this before, not anti radiation/seeds at all. My stats were deemed too agressive for that as a primary treatment. My original choice was for seeding. I was told that I wouldn't have been a good candidate for it, and now that I have talked to two radaiton oncologists, they both agreed with my surgeon, that surgery was my best shot as a primary treatment.

So honestly, wasn't making a case that surgery is better than radiation in terms of cure, was not my intention, so I'm sorry if you read it that way.

David in SC
 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


webstergl
Regular Member


Date Joined Mar 2009
Total Posts : 25
   Posted 8/30/2009 1:50 PM (GMT -6)   
I have to say that when I was DX'ed I knew nothing of prostate cancer, hell I really didn't know much about what the prostate did. The urology group I used took the time to go over many of the details actually set me up with an oncologist for a consult. It did not take me long to know that I just wanted it out of me, my surgeon told me up front that until the prostate was removed and pathology done that there was really no way to tell if the cancer had breached the capsule. I was 52 when DX'ed and even when I talked to the oncologist he recommended that for my age surgery would probably be my best option. I did a lot of research on my own as well I knew several guys that had prostate cancer one had open RP another had radiation they told me there journey's I did know that chances were good that ED and incontinence was very likely possibilities, however I would much prefer to have the post operative problems than have cancer.

So having said that, I have had all the side affects from RP, ED, leaking like a faucet that needs new washers, scare tissue and my recent AUS surgery but at this point I don't have cancer!!!! I think it is hard to get true statistics that are not a bit tainted toward those who are collecting the statistics

Don't get me wrong I think all the posts are good and contain good information for those who are newly DX'ed, that day has come and gone for me and I am dealing with the side affects of my decision but I am doing so with a smile on my face because my PSA is ZERO and that is one statistic that I know is accurate

Thanks for letting me share

Gary
<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Age 54 (Dx age 52) <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">11/06 severe prostate infection PSA was at 52<o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">2/07 <SPAN style="mso-spacerun: yes"> 4th PSA still at 6.2<o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">3/07 Biopsy <o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">4/07 5 of 12 core samples positive with Gleason at 6 -7 <o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">6/07 Robotic Radical Prostatectomy<o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Pathology showed Cancer was organ contained<o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Last 4 PSA’s 0 <o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">11/08 Dx with BNC (Bladder Neck Contracture) due to scare tissue<o:p></o:p>

<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">3/08 balloon dilation
8/09 AUS implant now waiting 6 weeks for activation


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/30/2009 3:47 PM (GMT -6)   
Gary,

I'm in with you ! I can live with any side effect, as long as I can live. I feel fortunate at this point to have the zero's, but expect that won't always be the case.

This radiation vs surgery does get old on here. I know if a person who had radiation posts, there is some assumption that they are touting radiation, and there are some who make no bones about it. Same goes for some surgery guys.

None will ever be able to prove we were right or wrong. It is the end result that is important. I don't think the ED or incontinence is the end result either, Even re-occurence is not an indicator of right or wrong.

This disease is too variable, too multi-faceted, too complex to prove right or wrong. Let's just concentrate on awareness and helping each other.
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
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/30/2009 3:57 PM (GMT -6)   
I am skeptical about this research. It is at least counter intuitive. The nerve sparing surgery delivers worse sexual side effects than nerve sparing?

To my knowledge, there are no scientific studies to compare the outcome of different treatments. All these studies are retrospective and do not use uniform evaluation rules.

IMHO, each treatment has pros and cons and those need to be applied to individual situation to arrive at the treatment choice. There is no single best treatment, but there are best treatments in a specific situation.

John - thanks for interesting post.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/30/2009 4:19 PM (GMT -6)   
goodlife, sure we are on the same forum? I don't pick up that people here are trying to prove which is better, surgery or radiation, each person's experience is told in its own way. There are way more surgery stories here at HW, but partly due to the fact that the highest percentage of primary treatment for prostate cancer is surgery. Not saying that is good or bad, black or white, just a fact.

I also don't believe that most posters (can't think of even one to be honest) here are looking at this is right or wrong, or you are wrong and I am right kind of thinking. At best, each man makes his own treatment(s) decisions, and we all hope we are right in our own cases.

Only been here since last October, well actually lurked for months before that, but I am not seeing the negative here that you must be perceiving. If anything, this place has evolved much for the good in past 6 months or so to the positive.

Like all forums and on-line type rooms, where you don't have to face anyone in person, there have been troublemakers that have come and gone, scammers that are caught and blinked away by our great moderators, but dollar for dollar, we have a great group of men, and some women too.

Those that have taken different paths, i.e. JohnT, gets plenty of respect here. Tudpock, who often speaks for our "seeded" brethren, is well respected. I find no bias toward any one treatment path here, you are right, too many variables, too many different results, too many different stories.

When it's all said and done, and speaking for myself only, I am no different. I was faced with a tough situation, had to learn fast, make decisions that can affect the rest of my life, and I am hoping and praying that I have made some correct decisions along the way. Ultimately, its out of my hands, the final outcome, and I have to find some solace with that.

David in SC
 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 8/30/2009 5:08 PM (GMT -6)   

Gotta agree with David on this one...with the exception of a few HIFU spammers, I can't recall much much serious touting going on.  What I have seen over my months here is an excellent exchange of ideas that has proven extremely educational to me and, I think, to a lot of other survivors.  There is also a ton of support that has benefited most all of us.  Finally, I think the fact that we take the time with newcomers to share the good and the bad of various protocols is helpful to those who are facing the tough choices that we all had to make.

Having said that, do I believe that I made the right decison in my particular case to go with brachytherapy rather than surgery...yes.  Who know, maybe I'll change my mind if Jr. falls off somewhere down the line or if I get the dreaded PSA rise.  But for now it seems right for me.  I do recognize that other men, for medical and/or psychological reasons, need to make other choices.  I respect that and would not dare to second guess after the fact.

Respectfully,

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"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/30/2009 5:34 PM (GMT -6)   
Well said, Brother Tudpock, I think you clearly saw my point and intention. No secret agendas with me, I wear what I am thinking and feeling emotionally on my sleeve, as if someone couldn't tell.

David in SC

Looking forward to talking to my doctor tommorow, last appt of his day, so hoping to get some good face time.
 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/30/2009 9:13 PM (GMT -6)   
David,

Yes we are on the same forum. Your response to John T. above is indicative of what I was trying to say. I wasn't trying to throw stones at anyone, but I am a little surprised if I am the only one who sees strong pro-surgery biases, and strong pro-radiation biases, with a touch of HIFU, ice-balls, and a few other biases. Usually the inference in these biases is that the other approaches are mis-guided, and their way is superior.

All I am saying is, let's keep away from that wasted motion, and concentrate on helping each other and new members with the questions at hand.

goodlife
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
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/30/2009 9:45 PM (GMT -6)   
goodlife, you would have to give specific examples before convincing me of this. I don't read into any posts that someone thinks their way or method is superior or better in anyway. People communicate differently, writing one's thoughts and feelings isn't everyone's best shot to express themselves. And again, surgery is #1 treatment method in general, followed by radiation, so of course most of the experiences will be along those general lines.

david in sc
 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/31/2009 9:52 AM (GMT -6)   
Interesting document. I am seeing it on the PPML as well. My criticism on studies is always timeline. A year 3 study on patients from 1994 to 2001 is not going to provide a lot of useful information to guys dealing with todays' therapies. It kinda sucks that no matter what comes out that's new, it will be the result ten to fifteen years later than truly define it effectiveness against prostate cancer. In addition, how the body functions later is important data as well. Most rounds of radiation do not have many affects at year 3. Rather at year ten or even later.

I don't think an argument about which treatment is better is useful because everybody is different. What might be good for one can be bad for another. I don't think anybody can look at this study and accurately predict how they would be affected by any of the treatment modalities represented.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 8/31/2009 11:14 AM (GMT -6)   
Goodlife,
It is not unusual for patients having a particular treatment to tout that treatment. If they didn't think it was the best they wouldn't have had it. It doesn't mean that they don't think other treatments are also effective. I think it it useful to have these discussions so new patients can get additional information and make decisions on the factors that are important to them. Smart people looking at the same information will come to different conclusions; just look at the Supreme Court, the smartest people in our country usually come to a 4-5 decision when looking at the exact same info.
I think these type of studies are important in that it helps a patient ask valid questions of his doctor and have him explain exacty why he will get better outcomes.They also set realistic expectations for cure rates and quality of life issues and get rid of some of the hype that some centers promote.
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 DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/31/2009 3:01 PM (GMT -6)   
Well said,
I think the best way to set expectations is to look at each question, look at the possible answers. No matter your choice of treatment, you can fall into any of these catagories. For the most part there is predictability with these stats, but, it would be sad to set an expectation not knowing the possibilities as well.

Thanks for the post. You are very right about new patients seeing this BEFORE getting treated. Most patients won't however. That is a sad testimony about the state of treating prostate cancer.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/31/2009 4:35 PM (GMT -6)   
Sorry, I was wrong. There obviously is no strong bias here. What was I thinking ?
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
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/31/2009 5:03 PM (GMT -6)   
Goodlife, why does everything have to be right or wrong with you? The sarcasm at the end your above post shows that you still are having an issue. One thing good about HW, is that we can always agree to disagree. Perhaps that is where the real lesson is. And yes, with the newly dx, I think the dialogues we have here from the different camps is useful, needed, and critical to one's education in order to help the newly dx with them making their own primary treatment decisions.

And who do you know, whether you are talking about Fords vs. Chevy, this or that, politics ,religion, music, art, etc, doesn't have some kind of builting "bias" toward what one chooses or likes. I don't think its a bias as much as a preference. Two differnt things in my book.

We are all brothers here, we don't have to agree on every point of the compass.

David in SC
 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, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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