Let's take your points one by one:
Brachy Cure rate for low risk factors: Prostate Cancer Foundation of Chicago, 11 years; 96%
Cleveland Clinic, 11 years; 96%
MSK; " 5 year reoccurrance rates similar for surgery, Brachy and IMRT"
Seattle Prostate Institute; 10 years, 97%
Who says surgery is the "gold standard"? Urologists that are trained as surgeons. How can surgery be 5% better when the cure rate for seeds is 96+%. Your Uro is pulling numbers out of his hat.
Salvage radiation only works because of two reasons: 1, the surgeon didn't remove all of the prostate tissue (they can never get it all) and that tissue contains pc cells. 2. the PC has escaped the gland and is in the prostate bed. In both of these cases radiation does a better job at the margins. The typical radiation margin is 10mm to 15 mm to the bed and also gets all the PC at the difficult ureatha margin. What most people don't know is that a 2nd application of seeds of a different isotope for a salvage procedure can be performed if PC is still local. (Dattoli).
There is no 20 year data on Brachy; there is also no 20 year data on Robotic. Only
open has 20 year data.
There are some experts that believe that surgery is more effective for younger patients, but no evidence to support it. The slight advantage, if any, is more than offset by quality of life issues.
Some other facts:
There has never been a recorded instance of hospitalization required for complications during the brachytherapy procedure. (Grimm)
For patients with no ED issues before procedures; Boston Study 36 months after (Normal, Intermediate, Poor).
Non Nerve sparing surgery: 6% 31% 63%
Nerve sparing surgery: 8% 28% 64%
Brachytherapy: 46% 35% 19%
There is a lot of information out there on Brachytherapy if one searches. Hope this helps in giving you more information. If you need the source data feel free to e mail me.
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.