Side effects from Seed Therapy and IMRT

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Jersey Joe
New Member


Date Joined Sep 2009
Total Posts : 5
   Posted 10/5/2009 10:43 PM (GMT -6)   
I am considering seed theryapy or IMRT.  I have been told
either treatment would be 90 -95% effective for my PC.  I am weighing the
possible side effects at this point.  Does anyone know which treatment
would have the least side effects? 
 
 
 
Diagnosed PC 7/09.  PSA 3.1 DRE normal -  biopsy 1 of 12   .5% of core.
3 + 4   Gland size 24
 
9/09 second opinion on biopsy changed to 3 + 3.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 10/6/2009 5:44 AM (GMT -6)   

Joe:

With your stats, either treatment should provide success.  The literature is mixed re which of these techniques would provide fewer side effects when done by a highly experienced doc.  I think the bulk of the evidence would favor BT but not by an overwhelming margin.  In either case, the only likely SE is the possibility of ED some years down the road (but less likely than with surgery).  With your prostate size you are certainly a good candidate for BT; BT is the less invasive and more convenient of the two and was my choice.

I don't know your age but, with your stats, it would seem that you might seriously consider AS as you might never need ANY treatment.

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"!

Jersey Joe
New Member


Date Joined Sep 2009
Total Posts : 5
   Posted 10/6/2009 9:19 AM (GMT -6)   
Thanks for your imput.  I'm 67 years young.  Would appreciate hearing from anyone else
regarding the side effects Seed therapy vs IMRT.  Thanks again

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 681
   Posted 10/6/2009 9:59 AM (GMT -6)   

Brachytherapy (seed implant) seems to have a lower immediate incidence of ED than surgery.  By that,I understand that people who choose BT do not usually suffer erectile problems until a few years later.  I have always been uncomfortable with the fact that with BT you will always have  higher PSA numbers because you still have a prostate. I chose surgery because of my higher Gleason score.

If I were you, with the numbers in your diagnoses, I would consult with a urologist about AS or watchful waiting.  At least in the short term, you might be able to put off decision making for 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


Jersey Joe
New Member


Date Joined Sep 2009
Total Posts : 5
   Posted 10/6/2009 10:40 AM (GMT -6)   
Correction - Biopsy 1 of  12 cores  -  1 core 5%.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 10/6/2009 11:38 AM (GMT -6)   
I had both seeds and IMRT for a large G7 tumor. Had seeds in May and IMRT, 35 treatments, in July. The only side affects I had were frequency and urgency for about 4 weeks after seed implants. Both were very controllable and did not affect any of my daily activities. I palyed golf the day after seeds and about twice weekly during IMRT. Either treatment will work with few side affects. Seeds are convenient, with radiation you have to go about 8 or 9 weeks for 20 min every day. Seeds are a one time 45 min procedure.
Your prostate size of 24 grams is perfect for either procedure.
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


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 10/6/2009 12:41 PM (GMT -6)   

JT..based on Joe's stats, would you agree that he should at least consider AS?

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"!

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 10/6/2009 1:40 PM (GMT -6)   
Tud,
If it were a 3+4 then definately no. I would get a third opinion from Bostwich or Epstien on the path just to be sure. A 5% G6 is an excellent candidate for AS. Two doctors I saw for a 2nd opinion said they would never treat a G6 with 5% core as it is most likely indolant.
Joe, in any case you have a lot of time to make a decision.
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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 10/6/2009 5:06 PM (GMT -6)   
As some would suggest. this may be an ideal candidate for Color Doppler. There is a chance they missed the tumor location with the standard needle biopsy.

Then I would agree that AS could give him several years of normalcy, before entering into the world of side effects.
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)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/6/2009 5:47 PM (GMT -6)   
John, if all his cancer really is, is a 5% core Gleason 6, and assuming he doesn't have a family history of PC, sounds like a really good candidate for AS, one of the better ones I have seen here. With the right criteria like his, sounds like it might make perfect sense.

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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 10/6/2009 5:49 PM (GMT -6)   
I had 44 rounds of IMRT and for the most part the side effects were tolerable. One of the side effects for me was bowel bleeding which was easily controlled. Fatigue was a concern however I was also on Lupron and Casodex so not sure that is concern. I am still impotent two years later and that is due to the IMRT or so I am told.
Based on your stats has the doctor considered watchful waiting?

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%


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 10/6/2009 5:52 PM (GMT -6)   
With your stats there is a reasonable case to be made for watchfull waiting. As you can see, I am a surgery guy, but my younger brother had seeds at age 55. Now, 5 years later he reports that his only issue is ED and that Viagra deals with that very well.

Your problem is too many good choices and lots of time. You may want a consult with a prostate oncologist to help layout options.
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


JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 10/7/2009 1:43 PM (GMT -6)   
"We" are Brachytherapy patients - no side effects to speak of other than some fatigue - and no sign of ED at this point.
 
 
Husband diagnosed in December 2005
PSA of 3.74
Gleason 6
Brachytherapy (91 stranded seeds) April 2006
PSA of 0.39 - November 2008 - whoo hooo!
PSA of 0.31 - May, 2009 - whoo hoo again!
PSA of 0.22 - July, 2009!
 
 


chris nz
Regular Member


Date Joined Sep 2007
Total Posts : 33
   Posted 10/7/2009 2:38 PM (GMT -6)   
Hi JJ, I was DX in 2003, 3+3, was on AS till 2008 when I had BT, no SE's, nothing, everything still works.
Make an informed choice and don't be panicked
Dx Nov '03, age 61, 1 of 8 +, 3 + 3, PSA before biopsy 6.5.
after biopsy PSA went 10.5 and stayed there.
Tried a lot of the can't fail 'cures'. Found 'Prostasol' a version of PC Specs.
PSA dropped to less than 1.
Still tried other supplements but reverted back to 'P'. [ a herbal estrogen.] Had problems with hereditary Deep Vein Thrombosis, now on blood thinner.
March '08, second biopsy, 3 of 10 + [10-50%], 3 + 4, PSA 1.0. T2A.
Bone scan didn't show much, bone density showed early osteo in places.
Had Brachytherapy Aug 23 08. 75 seeds, started work again 2 days later
PSA after 6 weeks 7.8
PSA after 3 months 4.2, everything still working well, absolutely no problems. next check in May '09

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