Firmly on the fence. Surgery vs. Brachytherapy

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Klaats
New Member


Date Joined Sep 2009
Total Posts : 15
   Posted 9/24/2009 8:27 PM (GMT -6)   
Wife and I are dancing the dance of research, opinions, warnings and success stories. 5.5 PSA in Feb. Subsequent 11.4 in July. Biopsy showed 10% in one of 12 samples 3+3=6. Re-analyzed at another lab as 14% and 3+4=7. Have seen 2 uro surgeons who both recommended Da Vinci. One is Dr. Zagaja at U of Chicago who is one of the best. Saw Dr Moran at Chicago Prostate Cancer Center last week. He did another PSA and got a 6.1. Go figure. He specializes in BT and, of course, recommends that. Very confidently predicted full cure. I'm a pretty healthy 56 year old. Smoked for years but quit a couple of years ago. Bicycle commute 10 miles year round. Swim. A bit overweight. No sex problems. The more I read, the more I can't figure out why people wouldn't do the BT. It's cheaper (but my insurance is good), far less invasive, same success rates, quicker recovery, fewer side effects. What's the catch here? Is it simply that surgery is the first choice offered since most men see a uro surgeon first? Do they hear the word CANCER and simply want to get it out in the first way they are told? Your input greatly appreciated.
Lost in Chicago
Age 56 - 6'0" 215lbs
Overall Heath Condition - Good
PSA - Feb '07-3.9, Feb '08-4.8, Feb '09-5.5, July '09-11.4, Sept. '09-6.1
Biopsy - 08/12/09 -> Gleason (3+3)6, Second analysis same biopsy (3+4)7
12 core. Cancer in 10% of one core.

Considering options

Post Edited (Klaats) : 9/25/2009 5:25:05 AM (GMT-6)


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 677
   Posted 9/24/2009 8:49 PM (GMT -6)   

How can you do a 10 mile bike commute and be overweight?  lol :-)

Seriously, your numbers might be low enough that doing nothing might be the right answer.  Check it out.

I have two friends both with Gleason 6 (slightly older than you) who had Brachytherapy the same time I had surgery.  Three years later they are both convinced they did the right thing.  One has never had a problem and claims no ED problems to this day.  The other had urinary blockage after the procedure and rectal bleeding recently, but doesn't talk about ED.  He still thinks he did the right thing.

I had an aggresive Gleason 8 and had surgery, so far no reoccurence, however I have total ED failure.  I succesfully use injections. Some urologist would consider that success, I don't.

Good luck during this decision making time.


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 9/24/2009 8:53 PM (GMT -6)   
Hello and welcome, Klaats

Sorry about your PC dx. but glad you found us on the web.

Your stats do put you right on the fence. Need our seeded brothers Tudpock and JohnT to come give their first hand experience with BT, seems to be working for them.

Your single core of cancer is encouraging, the most negative thing you report is re-classing your gleason to a 3+4 (7). Gleason 7's can be a troublesome thing, they tend to act more agressively because of the "4" cells in the mix. You didnt state your prostate size, are you in a safe size range for BT?

I ended up with open Surgery, couldn't have robotic, and now facing salvage radiation. One of the factors in your decision should be, what will you do, and what options will you have if the BT fails. Most all here, and most doctors would agree, that salvage surgery is almost always a bad move, and usually not effective. In my case, I had a lot of PSA velocity going on, and went into surgery as a 4+3 (7), which for me, made surgery the best move. At least on paper.

You are doing the right thing right now, you got plenty of time to research, ask questions, get various profesional opinions, etc. Whatever you decide, we are here for you, welcome to the brotherhood of the PC. Please keep us posted of your journey, and ask as many questions as you want. We are here for you.

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, mapping on 9/21/9, 9/24 - mtg & procedure? with uro/surg, IMRT starts 10/5/9


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/24/2009 9:24 PM (GMT -6)   
Hello Chitown,
Welcome to HealingWell. With any radiation there is a chance at secondary cancers. Albiet a small occurance, it still is enough for many to decide on surgery which does not have that residual effect.

There are a few reasons for surgery as a fist line treatment.
1> Surgery offers a definitive pathology. The gland is fully removed and evaluated, if any additional risk factors existed they are usually uncovered after the dissection.
2> Many top oncologists feel that surgery followed if necessary by radiation is the best combination therapy. This is highly subjective and brachytherapy with external beam is showing real promise. Even Proton centers have ALL recognized Proton combined with external beam radiation provides better results than protons alone. The catch here is as David points out, once you radiate, then surgery is risky and likely not an option.
3> Surgery has 20 year study results and is well established as the primary first choice. Brachytherapy has 15 year results that do not compare favorably to surgery. Now before my buddies here jump on me about this, brachytherapy has improved greatly in the last ten years. But ten year studies do not tell a whole picture when it comes to prostate cancer ~ sometimes called the 20 year disease. But the same can be said for IMRT radiation as well. Much improved, but lacking long term paper.

This decision is very personal. For many, including myself, I wanted it out. I was 44 at the time, and there are no studies except surgery that I liked with my 35 year life expectancy left in the tank...I will say that if I knew at the time that my condition was inoperable, then perhaps I would have opted for chemo and radiation early on. But I am glad that prostate is out of my body...

Which brings me to the main point. Educate yourself early on. Take your time to fully analyze your options, get second opinions on your pathology, doctors, and options.

PS: Born in Chicago myself...

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 9/24/2009 9:28 PM (GMT -6)   
Not suggesting one way or the other. My radio wouldn't seed because of my G9. I am a bit concerned with your rapid PSA doubling times, yet only one core.

Is this sugestive of a capular penetration, ie. PC has escaped the prostate ? One of the arguments that many ascribe to, and I guess i do as well is that unless you go in there and look, you'll never know. Therefore it is difficult to know the best treatment. Obviously the surgery would treat the prostate issue itself, but you may need IMRT or some other type of radiation besides seeding if it has escaped the capsule.

I don't think there is any doubt that seeding is a great technology for standard PC. It's just knowing when we have standard PC that's the issue.

I am convinced in my own case that I would be in a world of hurst had I not had surgery. I did have an EPE 0utside the capsule, and now I am watching much more closely than I would have otherwise.

Good luck. This is a hard decsion. Not there are any wrong answers, but each choise has some plusses and minuses.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
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)
5 month PSA <.03 (undetectable)


Michelangelo
New Member


Date Joined Sep 2009
Total Posts : 12
   Posted 9/24/2009 9:35 PM (GMT -6)   
Hi Klaats,
Welcome to HW.
I'm fairly new to this myself but for what it's worth I'd try and get a more accurate PSA reading
and in the meantime consider obtaining a Color Dopler Image.
You'll need that if you have a Gleason rating of 6 and choose "Watchful Waiting".
If your Gleason really is 7 then don't hang around regarding making an informed decision.
Good luck.
Age: 54 (53 at diagnosis - June, 2009)
PSA: 10.6
Biopsy tested positive: Gleeson 3+4
Surgery: DaVinci Robotic prostatectomy (31st July 2009)
Northwestern Memorial Hospital, Chicago, IL
Dr. Robert Nadler, Urologist/Surgeon
Textbook procedure.
Catheter: Removed after 10 days.
Incontinence: Currently, no. (Slight leakage for three days after Catheter removal. Wore pads for physcological boost).
ED: Intermitent. Bad reaction to Cialas. Currently experimenting with Levitra.
PSA: Currently 0.1 (25th August 2009)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 9/25/2009 4:53 AM (GMT -6)   

Dear Klaats:

Frankly, one of the reasons I continue to post on this forum is to take advantage of the opportunity to share with folks like you who are trying to make a choice.  Personally, I think you are absolutely right re your insight about uro-surgeons and men's desire to "get it out".  If you can separate fact from fiction and look at the choices dispassionately, I think you might find brachytherapy to be a reasonable option for you.  I have posted below what has become a standard post for me that I put up for guys in your position.  Hopefully, this will provide you with some insight.  Also, if quality of life is important to you, I suggest you take the time to read many of the topics on this forum to better understand the potential after effects of treatment options.

Tudpock

 

First of all, I’m sorry you have to be here but I will tell you that you have found a good place for both information and support.  I am one of the few brachytherapy patients that post on this forum.  You will get lots of good advice from the surgery guys…some of it balanced, some of it clearly pro-surgery.  And you will get what I hope will be balanced advice from me, but it probably will also be a little skewed with a pro-radiation bias.  So, I’ll try to be a little bit organized and provide you with some advice from my perspective.

General

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 on our forum has also highly recommended Stephen Strum’s Book – “A Primer on Prostate Cancer.  I have not read it but JohnT is highly knowledgeable and I trust his judgment). Secondly, many of the options will most likely cure you.  For example,  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!

Surgery

As I said, you will likely get lots of advice here from the experienced surgery guys.  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, Cialis and/or pumping devices and/or injections.  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 may 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.

Brachytherapy

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 relatively 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.

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.

This got a little long, but I hope it helps.  Best of luck to you; please let us know how you progress.

 


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"!

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 9/25/2009 5:13 AM (GMT -6)   

P.S. to Tony:

One of these days we should probably establish a "standard link" wherin we debate the pros and cons of surgery v. radiation for early stage PCa patients.  One of the most frequent questions we get on this forum is from new patients who are trying to decide between the two.  What generally happens then is that you and other pro-surgery guys post what may appear to be neutral suggestions but are clearly pro-surgery.  Then JohnT and I come in with what may appear to be neutral suggestions but are clearly pro-radiation.  We should call it like it is...I think any early stage cancer guy who has a choice between surgery and brachtherapy is nuts to choose surgery. 

Anyway, reasonable men can agree to disagree and I think that's where we are on this.  But, if you can think of a way to establish a permanent post on this subject, I'll take JohnT as my tag team partner we can have a nice, standard answer to provide...(JT, hope you don't mind me volunteering you).

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

Klaats
New Member


Date Joined Sep 2009
Total Posts : 15
   Posted 9/25/2009 5:23 AM (GMT -6)   
This is great guys! Keep 'em coming. I'm sure your helping a lot more people than just me.
Age 56 - 6'0" 215lbs
Overall Heath Condition - Good
PSA - Feb '07-3.9, Feb '08-4.8, Feb '09-5.5, July '09-11.4, Sept. '09-6.1
Biopsy - 08/12/09 -> Gleason (3+3)6, Second analysis same biopsy (3+4)7
12 core. Cancer in 10% of one core.

Considering options


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 9/25/2009 5:33 AM (GMT -6)   
Tud and Klaats,

Check out this shirt about seeds, I think you will both really enjoy it.


http://shop.cafepress.com/design/12906108

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 done on September 17th by Dr. Menon, Vattikuti Urology Institute, Henry Ford Medical Center, Detroit.


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 9/25/2009 6:47 AM (GMT -6)   
Look like implant seeds would not be a good option for us because we have a two years old. My husband said that the radiation would hurt young child. Is that true?

thanks

Jennifer
husband 55 years old
PSA July 2009 5.5
Diagnosis confirmed Sep 21, 2009
12 Needle Biopsy = 6 clear , 6 postive
<2%, 10%, 25%
Gleason Score (3+3) 6 in all positive cores
X-ray waiting for the result


Modelshipwright
Regular Member


Date Joined May 2009
Total Posts : 215
   Posted 9/25/2009 6:49 AM (GMT -6)   
As others have said, there is no right answer but rather, the answer that suits your personal needs after careful consideration of all the options. In my case, I have chosen Da Vinci surgery as I want the cancer out of my body and also want a definitive pathology of the walnut which will be done after surgery. I say this, as the results from a biopsy cannot always tell the complete story. It largely depends on where the needles were inserted and what was in that particular area. The question of whether they missed the worst area or got the worst area troubled me. My Gleason was 3+3, but it seems that many times after surgery, this can be elevated with the pathology results. I should know the whole story after my procedure next week and this will hopefully present me with the best picture to go forward with.

Read a lot, educate yourself and consider all your options. Share your concerns with this group and you will get support. Good luck with your choices.

Regards,
Bill ( getting ready for Da Vinci surgery next Tuesday)


Age 64. Diagnosed with Pca January 2009, PSA 5.6, Gleason 3+3=6, T1c, TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear. Robotic Assisted Laparoscopic Prostatectomy surgery for treatment - September 29/09.  Pre-op PSA down to 5.28 which I atribute to visualization techniques and a new vegetarian diet.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 9/25/2009 7:13 AM (GMT -6)   
Jennifer, I was told not to allow small children to sit on my lap for over 15 minutes at a time and to avoid intercourse with pregnant women...for a period of 2 months after my procedure.  You can google this and find similar advice but, honestly, this is something you should discuss with your radiation oncologist.  It is not a show-stopper re the procedure but it is something to consider and manage should you and hubby make the brachy decision.
 
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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/25/2009 7:14 AM (GMT -6)   
Tud, I must be the dumbest one here, I don't see all this alledged bias. Don't I (a surgery guy and soon to be a radiation guy) always call out for you, and now JohnT, so you guys going through BT first hand can state the case.

I would hope that someone considering open surgery would be steered toward me and a few others that went that way. Same with robotics, so many here went on that path.

And of course, lol, if anyone wants to know about catheters, I am ready to write a book.

In life in general, its hard to talk about anything you like, or have done, or experienced, without having some kind of positive pre-disposition toward that choice, that is human nature.

But I think most people are smart enough to glean the fluff from the stuff.

And as far as Active Survelience, formerly Watchful Waiting, that's a tougher choice to follow faithfully and responsibly. It doesn't mean sitting on one's ass and doing nothing, that's the beast called Denialism. If a man wants to prolong his normal lifestyle including his sex life, no incontinence, etc, and he meets the strict criteria forAS, then indeed it is a good choice.

A low positive core biopsy, with a moderately low PSA, with very slow velocity issues, and a Gleason 6 at best, gives a man the most options, unless he has underlying other medical issues that complicate things.

A man with a large prostate gland, high PSA, fast PSA velocity, and any flavor of a Gleason 7 or higher, or a man with many high grade, high per cent cancer cores, has fewer choices, and in some of our cases, time can be of the esscence.

To our new friend, we talk a lot of talk, discuss all 360 degrees of the compass, but when push comes to shove, we support each other, and we support each other's treatment choices. Definitely not a one size fit all malady.

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, mapping on 9/21/9, 9/24 - mtg & procedure? with uro/surg, IMRT starts 10/5/9

Post Edited (Purgatory) : 9/25/2009 7:19:56 AM (GMT-6)


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 9/25/2009 7:34 AM (GMT -6)   
Tudpock18

thanks for reply. Yes we will talk this with radiation oncologist for this concern. right now we are in the process of learning. I do feel we need take some class with professionals in the classroom.
husband 55 years old
PSA July 2009 5.5
Diagnosis confirmed Sep 21, 2009
12 Needle Biopsy = 5 clear , 6 postive
<2%, 10%, 25%
Gleason Score (3+3) 6 in all positive cores
X-ray for chest and blood work waiting for the result


Klaats
New Member


Date Joined Sep 2009
Total Posts : 15
   Posted 9/25/2009 9:15 AM (GMT -6)   
Any suggestions where I might get the Color Doppler in the Chicago area? Has anyone heard of Prostate PX test by Aureon (aureon.com)? I can't find it mentioned on this forum but it was recommended by my Dr. It appears they give a more detailed analysis of the biopsy slides than Gleason scores. Sounds like a variation on what Dr. Epstein at Johns Hopkins has been recommending in adding other factors to Gleason score.
Age 56 - 6'0" 215lbs
Overall Heath Condition - Good
PSA - Feb '07-3.9, Feb '08-4.8, Feb '09-5.5, July '09-11.4, Sept. '09-6.1
Biopsy - 08/12/09 -> Gleason (3+3)6, Second analysis same biopsy (3+4)7
12 core. Cancer in 10% of one core.

Considering options


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 9/25/2009 9:29 AM (GMT -6)   

Squire David:

Actually YOU are probably the most unbiased guy on this forum with a real openness to sending patients in multiple directions.  And I certainly don't think you are dumb unless you publish the book, "My Catheter, How I Love Thee".

Actually the word bias has a negative connotation and your phrasing, "positive pre-disposition" is certainly less inflamatory.  The point I was trying to make in my P.S. to Tony was not meant as a criticism of him, you, the forum or anyone who posts here.  Rather the fact is that many posters, including Tony IMHO,  have a "positive pre-disposition" for choosing surgery for early stage PCa.  I admit to having a "positive pre-disposition" for radiation for early stage PCa.  If I read JohnT's posts correctly, I interpret his pre-disposition as one of the few that mirrors mine.  Actually, JT and I both probably also have a "positive pre-disposition" for suggesting AS in appropriate cases...which some guys here would not ever advocate.

So, all I was suggesting is that we admit this advocacy and post a thread that represents the two views without distortion so that we could refer newbies to that discussion.

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

Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 9/25/2009 9:36 AM (GMT -6)   

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.

 


Is it possible to get radiation such as IMRT years down the road if brachy "fails"?

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/25/2009 9:56 AM (GMT -6)   
Tud, I understand where you are coming from, your clearification made sense to me. You know from talks with me in the past, that I originally wanted BT but couldn't have it because of my stats. I might have wanted Robotic, but was too new and untested in my area, and in the end, the open Surgery was my only real choice, because my prostate bed was not suitable for Robotics even if it had been chosen.
Sometimes, reality changes our minds and our choices.

When I first came here, didn't know much about AS or "watcful waiting", I have learned a lot here, and know that there are men with safe situations of AS, if they are responsible patients on their end of things. The over treatment of a truly indolent cancer is a sad thing, and comes with a high price no matter how good you are with side effects. I have done well with both incontinence and ED, but as good as it is, it will never be the same as it were pre-surgery. Not complaining, thankful for what I have.

I just don't like seeing AS being used as a stall, when the stats of the man tell a more dangerous situation is at hand, and with the more aggressive strands of PC, even a few months wait can put the cancer well outside the prostate, and the person playing a new and difficult game.

But if a man has, lets say, only an example, a single core positive out of 10 to 16, and that core is in the 1-10%, clearly staged T1, and clearly a normal Gleason 6 (3+3) and has no history of PC in the family, and will assume he isn't African-American, and has a slow climbing psa history with a number well below 10, then by all means, the best advice is to sit tight, and do the AS thing in the correct manner, strictly following and complying with the doctors orders for tests and biopsies when scheduled. That man might buy years of not needing treatment, and preserving the preciousness of a normal life for some time. If I had been in that scenerio, I would want to wait too.

This is all good thinking on this thread, for both the novice and the experienced. Pre-disposition is one thing, and out and out biased where the subconcious is saying "you are a fool and if you don't do it my way, you are wrong" would never work here. Every man is different, every medical history is different, too, too many variables to be dogmatic about our treatments, problems, and side effects.

We are still on the same page, Bro. Tud.
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, mapping on 9/21/9, 9/24 - mtg & procedure? with uro/surg, IMRT starts 10/5/9


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/25/2009 10:12 AM (GMT -6)   
As you can see, I had surgery, but my younger brother had BT at about your age. He is now five years out with PSAs of 0.0 and reports that any ED is handled easily by Viagra.

about seeds and small children. The most commonly used seed Iodine-125 has a half-life of about 60 days. That means that after two months the radiation emitted is only 50% of what it was when the seeds were put in. After 4 months it would be 25% and after 6 months 12.5% Also remember that radiation decreases with the square of the distance -- so whatever the radiation is measured at say 6 inches it is 1/4 of that at one foot. Clearly you should follow your radiologist's advice, but basic physics says you won't have to keep your child too far away or for too long.

Your stats do put you on the fence but you do have good choices and an excellent chance of beating this.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/25/2009 10:16 AM (GMT -6)   
I agree with Tudpock.
I do have a predisposition to surgery, though not in all cases. But generally yes it is true. Much in the same way Tud, you and others have a predisposition to your treatment of choice. But Klaats asked why would somebody choose surgery? And I don't believe I gave a false answer nor is there any misinformation there. I said clearly that for me, I wanted the cancer out, but others won't necessarily feel the same way. And I do believe that this option provides the safest and most efficient way to remove cancer. It might have adverse side effects for many, but certainly when I read folks say that "you certainly will have incontinence issues" I try to let it be known that I don't.

You have made your case for brachytherapy and I believe that there is good balance in this thread.

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!

Post Edited (TC-LasVegas) : 9/25/2009 10:26:41 AM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 9/25/2009 10:29 AM (GMT -6)   
Klatts,
You can get a color doppler from Fred Lee in Rochester MI. He's the best and it's a very good idea.
There is very little I can add to Tud's post. I origially chose surgery, but after a color doppler showed the tumor was in a location that made surgery very difficult, radiation was an easy choice. Tumor location is rarely factored into a decision, but as I have found out it is extremely important. Because of a large G7 tumor I decided to have seeds and IMRT because it gives a much higher dose without increasing any side affects. Having two different types of radiation increases the killing power to highly resistant PC cells if you have any.
I have had no side affects from either treatment; I'm about 2 months out. There is constriction but with Flowmax it is not noticable until you stop taking it for a few days. There was no pain whatsoever and I resumed all normal activities the next day. It was easier than a biopsy.
I think that people choose surgery for a number of reasons, fear, they just want the cancer out. The possibility of a 2nd chance if the surgery doesn't work and knowing the extent of the disease because the full pathology is avaiable. People choose Brachytherapy because of the limited side affects and quality of life issues. I also think that almost all Uros recommend surgery, because that's how they were trained.
All studies show no difference in long term cure rates between the options for localized PC. There is little question that surgery has many more severe complications than seeds.
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 9/25/2009 10:31 AM (GMT -6)   
Tud,
I think that is a good idea and would be more than happly to join you in putting togeter some stats on Brachytherapy. I have a lot of info on file.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/25/2009 10:46 AM (GMT -6)   
The only exception is the statement that all studies show no difference. Show me a 20 year study that says that.

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!


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 9/25/2009 11:33 AM (GMT -6)   
I did the robotic, at 3 months the only issue is ED but I am confident it will come back. Other than that it was no more difficult than a wisdom tooth extraction. My feeling was I did not want to go through life with constant checks and monitroing, get it over and done with. I think it all depends on the person, I did not like the idea of radiation, but I have a friend that did not like the idea of surgery.

From what I have read they are both fairly effective.
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.

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