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Jersey Joe
New Member

Date Joined Sep 2009
Total Posts : 5
   Posted 9/13/2009 8:10 PM (GMT -6)   
Here's my story -  67  PSA 3.1   DRE normal   Gleeson 3 +4   T1C   11 negative, 1 positive
core - involving 5% of the specimen and pattern 4 compromising 10% of the cancer.  Prostate size 24.   Considering seed therapy, but I'm not sure with the second Gleeson number being 4.  Any input would be appreciated.  Thanks

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 9/13/2009 8:30 PM (GMT -6)   
Hello and welcome, Joe. Sorry you need to be here, but glad you found us.

We have several guys that have done seeding. On the surface, you very well might be a good candidate. Your prostate size is small, you only had one positive core, low PSA, and low amount of cancer in the one positive core. Hopefully one of the seed guys will come along soon and give you some more information.

When was your biopsy done?

Hope we can help you as your deal with your case of PC.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 9/13/2009 8:59 PM (GMT -6)   


With your intermediate risk PC you have the option of surgery, external radiation, seeds, or a combination of seeds and external. All have approximately the same cure rate for localized PC, but all have different side affects. Research all your options and choose the one best suited to you.

I chose a combinaton of seeds and external (IMRT) because I wanted the highest dose of radiation with the least side affects. The only side affects I have had were 4 weeks of urinary frequency and urgency that didn't affect my normal activities. When sitting or driving I had to go about every hour; when active it was about every 2 or three hours. The procedure was about 45 min and painless, much less than a biopsy and I was golfing the next day.

The downside to radiation is that you have to wait up to a year to see if you have a reoccurance, in surgery it can be 6 to 9 months. Also you can get a better pathology from surgery as they have the prostate tissue to work with. Radiation does a better job in killing the PC cells in the prostate bed and other hard to get at places in the prostate.


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.


Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 9/13/2009 9:05 PM (GMT -6)   
It sounds like you have already done a lot of homework -- we don't have all the answers but this group is big on learning. As David said, you are a possible candidate for seeds and so should talk to a radiation doc. Perhaps you should look for a doc who places seeds using color doppler to target the worst areas.

My brother had seeds 5 years ago and was back to work the next day, he is currently zero PSA, no incontinence, ED easily overcome with Viagra
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads

Regular Member

Date Joined Apr 2009
Total Posts : 133
   Posted 9/13/2009 9:36 PM (GMT -6)   
You might consider sending patholgy info. for second opinion as you consider your situation. I had 2/12 positive results with low volume. Original pathologist said 3-4 Gleason, John-Hopkins said 3-3 which was a bit of relief as I considered situation. 
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 9/13/2009 10:10 PM (GMT -6)   
Jersy Joe, I second the motion to have your biopsy slides reread. If the second reading is different, as it was in my case, it doesn't mean the second pathologist is right and the first not. It just means pathology is a judgement call sometimes and you may be one or the other. I had one pathologist say I was "6" another "7" so I figured I was a "6.5." The second read made a difference to my treatment decision. I'm glad I had it done.

I wish you well and I'm looking forward to reading your next report.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 9/14/2009 10:20 AM (GMT -6)   
Joe, Welcome to the Forum. Hate to meet you under the circumstances, but I hope you find a home here.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: ED- 50 mg Viagra 3X week, pump daily,
Bimix-30/1/20-.20ml 2X most weeks continues using plump and ring technique
PSA's: .04 each test since surgery

Forum Moderator

Date Joined Sep 2008
Total Posts : 4274
   Posted 9/14/2009 6:05 PM (GMT -6)   

Hi Joe:

As you can read from my signature and journey (if you want to click my link), my situation was not too different from yours.  Brachytherapy is certainly an option for you and will likely provide a cure rate as high as the surgical alternatives.  A common approach for G7 patients is to add a course of external beam therapy to the brachytherapy treatments.  However, it is also common to do brachytherapy alone IF the G7 is accompanied by small prostate size, low number of cancerous cores and small percentage cancer noted.  That was my situation and I chose brachytherapy alone and you probably will also have that option.

While you say that you are considering seeds, it is not exactly clear what you have done in the research process.  So, I will take the liberty of using up some of our band width and pasting in a reply I gave recently to another new patient who was considering the options.  I hope this is helpful and please let us know how your progress, what you decide and if we can be of further help.



First of all, with early stage cancer you have time to research the heck out of your alternatives so you can feel comfortable that you are making an informed decision.  If you haven’t bought it yet, I advise you read “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”.  It’s not perfect, by any means, but is an excellent primer.  (JohnT also recommend Dr. Strum's book that you might consider) Secondly, all of the usual treatment options will most likely cure you.  There are multiple long term studies for surgery and brachytherapy that indicate they provide basically the same cure rate for early stage cancer patients.  Of course, each man is different and I suggest you plug your stats into some of the predictors available to see where you fall.

You should also make sure you consult at least three EXPERIENCED doctors to gather your options.  They are your uro-doc surgeon, a radiation oncologist and a prostate oncologist.  Many of the major cancer centers, e.g. Johns Hopkins, Duke, MSK, M.D. Anderson, etc., can provide those three in a multi-disciplinary team setting.  Otherwise, you can and should still do it on your own.  I highlighted “experienced” because there are definitive studies that demonstrate better outcomes if your practitioner has done 250+ procedures…let them learn on someone else. 

You also might consider getting a color doppler biopsy to assist with your baseline.  I didn’t even know such a thing existed but would have gotten one if I had known about them.  The bottom line is to make sure you are totally comfortable with the decision.  This is huge and they are messing with pretty important real estate!


You will likely get lots of advice here from the experienced surgery guys if you are interested in that approach.  The two choices I looked at were robotic and open.  Robotic is newer but there are plenty of experienced guys now who can do it.  I would have chosen robotic if I had chosen surgery.  With surgery you get the aforementioned likelihood of cure, the immediate post-procedure knowledge of the pathology of your cancer and the psychological advantage of “having it out”, that is very important to some men (it was not to me). 

But surgery is invasive, even the robotic kind.  You have the inherent risks of major surgery, a catheter for some period of time (a week to months) and some time needed to recover from the operation.  You also almost certainly will experience incontinence – typically improving over a period of months.  You will most likely experience ED.  That improves over time for most men, especially with the help of Viagra, Levitra or Cialis.  There is some clear evidence that ED is psychological as well as physical.  In other words, once you lose the ability to have erections, it’s tough to get them back because you are trying so hard to make it happen.

The things that some surgery docs don’t tell you are that you lose your ejaculate, your penis make get shorter and many men ejaculate urine.

One advantage of surgery that many surgery patients cite is the fact that, if the cancer recurs, you have salvage radiation as an option for further treatment.  I personally find this a rather specious argument, since the cure rate from this "broad beam" radiation treatment is quite low and further treatment is likely to be required anyway.


This was my choice and, 10 months out, I’m glad I made it.  I’ll let you know in 20 years if I’m still glad!  You can read my “story” if you click the link at the bottom of my signature.

A typical poster-boy candidate for brachytherapy will have Gleason 6 or less, a prostate size of 50cc or smaller, Stage T1-T2, and PSA less than 10.  With G-7, brachytherapy alone may also be used if all of the other criteria are met plus cancer found in only a few cores and with a small %.  Otherwise, the doc will typically use HT to lower the prostate size and/or supplement the brachytherapy with a 4-5 week course of external beam radiation therapy.

Brachytherapy as a procedure is pretty non-invasive and is typically done on an outpatient basis.  There is very little pain involved and the patient pretty much returns to normal activities within 48 hours.  Besides the aforementioned curative power of seeds, the urinary effects are much different than surgery.  There is rarely any incontinence, but a patient may experience some frequency and/or urgency during the first couple of months.  Most docs put men on Flomax for 3 months to assure normal urinary activity.  Pre-procedure, most patients take a written test about their urinary activities.  If things are pretty normal pre-procedure, they are more likely to be normal post. 

The same can be said for ED in brachytherapy patients.  A patient performing well before seeding is more likely to perform well afterward.  In any case, most of the “performing” patients return to sexual activity within a couple of weeks of the procedure.  However, if and when ED occurs in brachytherapy patients, it is likely to be a couple of years down the road.  If that happens, the same little blue pills that help surgery guys will likely do the trick for seed guys.  In general, brachytherapy patients show somewhat less ED than do surgery patients when normalized for age, diagnosis, etc. There are also a small percentage of brachy patients who experience bowel issue; that seems to vary with the expertise of the doctor.

While “radiation after surgery” is generally available (but not highly successful) if the cancer returns for surgery patients, “surgery after radiation” is not usually an option for brachy patients.  There are only a few docs who will do salvage surgery after radiation and personally, I would not recommend it.  So, if cancer returns to a brachytherapy patient, the options are likely to be hormone therapy, cryosurgery, re-seeding or maybe even HIFU.



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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

Regular Member

Date Joined Jul 2009
Total Posts : 384
   Posted 9/14/2009 6:58 PM (GMT -6)   
Welcome to our club and forum. I second what some of the other men have stated and would recommend talking to someone about radiation with seeds. I had the Davinci robotic 32 days ago and doing great. I know of one man here local in our town that is 72 and had the DaVinci. Either one will give you good results I believe.

Father treated for Prostate Cancer in 1997 with Proton Beam - Still doing well.
My Stats
Age at diagnosis 54, PSA 5.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7, 2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
Post Surgery - Dr. Spared 100% of Nerves on the left side.
Estimated that 50 - 70% of the nerves were spared on the right side.
Final Path report
20% of the prostate Invovled
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear
Positive Margin 1.8 cm in length Noted in Right Apex

Jersey Joe
New Member

Date Joined Sep 2009
Total Posts : 5
   Posted 9/15/2009 8:47 PM (GMT -6)   
Thanks for the warm welcome.  It's a Club no one wants to belong
to, but glad it exists when you need it.
Thanks to all who replied.  I appreciate all the information provided.
My biopsy was in August 09.  I am in the process of getting a second
opinion on the slides. I have an appointment with a radiation oncologist
next week. I will ask him about color doppler.
I have been doing a lot of research online, reading everything I can find.
Looking forward to hearing from some more of the seed guys.  Thanks Joe

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 9/15/2009 9:30 PM (GMT -6)   
Jersey, with your small prostate size, low core number and per cent of cancer, etc., you would make a good candidate for seeding. Your reasonably lower PSA number works in your favor. Even though you are a Gleason 7 at this point, I think you would make the criteria for seeding. I wanted to, but my numbers were way off the scale for that.

As you probably know by now, don't have many here that took that path, but those that did are passionate about their choice, and the rest of the brothers here back their choice, myself included.

Sounds like you are doing all the right things, in researching and preparing for your primary treatment choice. Good luck, and keep us posted.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, does not rec. HT at this time, mapping on 9/21/9

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 9/16/2009 6:39 AM (GMT -6)   
Greetings, Jersey.  Looks like you have a good plan of attack.  Glad you are here - not glad you have cancer but that you found this board.  I have found it a big help along the way.  Look forward to hearing from you soon.  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

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