Considering IMRT and DaVinci

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NewspaperLover
Regular Member


Date Joined Sep 2009
Total Posts : 311
   Posted 10/24/2009 11:00 PM (GMT -6)   
I am weighing IMRT therapy and DaVinci surgery, and have a series of consultations scheduled at Dana Farber this week.  I probably am not a candidate for brachytherapy because my prostate at 57 cc is too large for that approach.  In meetings already with two surgeons, both indicated they would have to take the right nerve bundle, and at my age (66) I have a pretty good idea what that means for ED.  The track record data are not as extensive for IMRT as opposed to surgery, so (other than the risks of radiation, which are not inconsiderable if things go wrong), the 5 - 10 year recurrence and survival outlook is less clear for IMRT.  My Primary Care physician told me that an arbitrary cut off sometimes used is age 65;  that is < 65 calls for surgery because of a longer life expectancy.  My urologist said that if I were 70, he would recommend radiation, but at 66 would still go for surgery.  (Not incidentally, the median life expectancy of a 66 year old American male is 12 years.)
 
Any of your thoughts, as always are appreciated.
 
Age 66
PSA:  6.0  on 07/31/09 having risen from 4.2 on 12/02/08.  Free PSA 23.5%.
Other PSA History: 4.3 on 05/01/08; 3.3 on 11/15/07; 3.1 on 05/20/07; 4.0 on 11/30/06; 3.40 on 09/01/05.
 
Biopsy:  09/04/09  13 snips;  two positive.  Right Mid  3+4 = 7 and 15% of the total volume.   Right Lateral Mid 4+3 = 7 and 20% of the total volume.
 
 
 

Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 10/25/2009 6:36 AM (GMT -6)   
There are at least 2 people on here that have lost a nerve bundle and have had no problem with ED straight after the operation and I am one of them I do not know how many others are OK after time So if you are thinking that you always get a problem after losing a bundle it is not so
 
 
Age 64 From UK now in Thailand Baby boy born 2/14/2009
 First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/0924 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear 
Open surgery 7/27/09
Prostate Gland weighting 34 grms
Gleason upgraded to 3+3 Tumour not closeto prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 10/25/2009 10:28 AM (GMT -6)   
Newspaper lover,
Like it or not at your age surgery is risky, us old guys just don't heal like we used to, and when something goes wrong it tends to be a lot worse and more often. Whoever told you that your prostate is too big for seeds doesn't know what he is talking about. The cutoff is 60cc, but smaller is better and more effective. You can easily reduce your prostate size to about 50% by taking 3 months of Casodex and Proscar; this will also kill any stray cells that may have escaped. My prostate went from 60cc to 32cc. With a G7 a more effective approach would be a combination of seeds and IMRT. The advantages are a much higher dose, about 20% to 25% with the same side affects of either treatment alone. Also two different types of radiation makes it better if your PC builds a resistance to one of them.
Do some more research on both surgery and radiation; combination therapy may be more effective than surgery with your stats and will certainly result in fewer side affects and pain.
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


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 10/25/2009 2:44 PM (GMT -6)   
As an old guy of 63 at the time of surgery, in good shape, I came through it without problems -- except ED, expected with non-nerve-sparing.

NewspaperLover, you are 66, and if you are also in good shape, then surgery is a valid option. If your health is not so good, then a non-surgical option will likely be better for you.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.


NewspaperLover
Regular Member


Date Joined Sep 2009
Total Posts : 311
   Posted 10/25/2009 5:56 PM (GMT -6)   
Thanks for the input Colin45, JohnT, and Piano  --  this is the toughest choice I have ever had to make, and I appreciate the information and support you provide.  Except for PC, I am in very good health, and quite physically active.  I'll let you know how it goes at  Dana Farber.
 
 

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 10/25/2009 5:56 PM (GMT -6)   
I did surgery at 66 because I felt that it gave me radiation options for later on. By the way, I survived. The surgery issue is your overall health, as judged by your surgeon (and in my case by my internist who saw no problem with surgery) Your biopsy shows a moderately aggressive cancer, but not a lot of it so you have a number of options.

My brother did brachy at age 55 and now at 60 reports PSA of 0.0 and no ED that is not handled by 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
6 mo. PSA 0.00 -- 1 light pad/day


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 10/25/2009 8:26 PM (GMT -6)   
Hi,
I had my Robotic surgery at the age of 67 and had no problems at all. I was walking 3 miles one week after my surgery. It really depends on how good a physical condition you are in prior to surgery.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1


Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 10/26/2009 3:37 PM (GMT -6)   
Talk to doctors you know..ask point blank what they would do....read everything...read old threads on this site...there
a world of research and common sense..

for me with lots of risk factors, I never considered radiation all nine 9 physicians including 4 uroologists recommended surgery, preferably daVinci.....the director of a unit of Johns Hopkins recommended Memorial Sloan Kettering as did 7 others.....do your homework and readh Dr Scardino's terrific book.

good luck
mbshine
AGE 62
DX 7/08
psa HAD GONE FROM 1.7 TO 4.3 IN THREE YEARS...DIGITAL AND ULTRA SOUND EXAM SHOWED NO ENLARGEMENT.
BIOPSY SHOWED 2 OF 12 CORES POSITIVE.
TWO TUMORS SHOWED GLEASON 4+3 AND 3+4
NO INDICATION OF ESCAPE FROM CAPSULE OR METASTASIS
STARTED CONSULTATIONS AT SLOAN KETTERING 8/09
DR GUILLONNEAU SAID NO SURGERY UNLESS MASSIVE WEIGHT LOSS.
AT DX 333 LBS, SLEEP APNEA, AND HIGH BP
BARIATRIC SURGERY RECOMMENDED.
LAP BAND SURGERY IN EL PASO, TX 1/23/09
10/1/09 276 LBS, TRIGLYC AND CHOL NORMAL, NO SIGNS OF SLEEP APNEA, ONE BP RX REMOVED AND OTHERS CUT DOSAGE IN HALF;

STARTED QUARTERLY ZOLODEX BY TAOS,NM UROLOGIST, WHO TRAINED AT MSKCC, INJECTIONS AND CASODEX 50MG DAILY 9/08

davinci done 10/19/09
Jackson pratt drain removed surgery plus 1 day.

pa69
Regular Member


Date Joined Mar 2009
Total Posts : 260
   Posted 10/26/2009 6:49 PM (GMT -6)   
I had my surgery at age 69. Today, almost 11 months after surgery I feel great. Still 100% ED but at my age I don't really care. Still have mild incontinence, just enough to use a pad if I go out for long periods where I might not have access to a restroom.

Right now my daughter and I are training for a 5K run on Thanksgiving day. I feel that my qol is much better now than before surgery. My only problem is dealing with the ever present possibility that my PSA level will start to rise.

Wishing good health to all,
Bob
Age 70, First ever PSA 7.8 taken June 2008, Biopsy July 2008, 10 of 12 cores positive, Gleason 3+3=6
da Vinci surgery December 10, 2008, catheter removed December 29 2008
St. Lukes Hospital, Bethlehem, Pa.
Dr. Frank Tamarkin
Prostate weight 73.0 grams, Gleason 3+3=6, stage pT3a
Tumor locations: right anterior apex, right posterior apex to mid
left anterior mid to base, left posterior apex to mid
extensive perineural invasion in right anterior apex, right and left posterior apex to mid
seminal vesicles negative
Three PSA tests undetectable, latest July 18

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