Treatment Options

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

jack moss
New Member


Date Joined Nov 2009
Total Posts : 5
   Posted 11/14/2009 10:28 AM (GMT -6)   
Having been diagnosed with PC, with a Gleason of 7 (4:3), 1 core positive 47% of core. I've opted for IMRT (5 Weeks), followed by the implantation of sees. My PSA was 4.1. I'm 51, and DiVinci was suggested but my wife was diagnosed with anal cancer one week before I and will undergo radiation and chemo followed by surgery. So needless to say I can't be "down for the count" and care for her at the same time.

Onocologist told me that with the treatment I chose, and because my PSA was 4.1, my chances of reocurrence is about 85 percent. I'll take that considering I drive I-95 everyday!!

Question is for anyone who followed a similar course of treatment. Pros, Cons, etc.

Thanks!

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 11/14/2009 10:40 AM (GMT -6)   
Jack,

Welcome to the forum. There are a bunch of guys that will be along shortly and be able to address your questions better than I. I opted for surgery (9/17) and only recently found that my PSA is not undetectable and will be scheduling IMRT in the next week.

I just wanted to welcome you. My personal experience has been that this is an extremely knowledgeable and supportive group of folks and I am sure that your questions will be answered.

Good luck and welcome to the brotherhood,


Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 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

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


jack moss
New Member


Date Joined Nov 2009
Total Posts : 5
   Posted 11/14/2009 10:55 AM (GMT -6)   
Thanks Sonny! Looking forward to the info.

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 11/14/2009 11:12 AM (GMT -6)   
Jack, welcome to the most caring PCa site you'll find!

Your original post confuses me a bit since it says you have an 85% chance of a recurrence down the road ... is it possible the doctor meant that your treatment option has an 85% chance of success?

I am sorry about your wife's diagnosis ... sounds like she has a long, hard road ahead of her. You will hear from many going through IMRT right now, including Purgatory (David) who had surgery and is now going through salvage radiation. For him, this process has been a long, hard one and he has 9 more treatments to go.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/14/2009 12:08 PM (GMT -6)   
Nothing wrong with your choice, many roads lead to Rome (lol so to speak). Has a decent track record as a modality on PCa, you can talk to patients on www.yananow.net whom have done this and see there journey records/results, etc. See more at www.prostate-help.org and other sites. Of course the leading establishments on this have websites: www.dattoli.com (Florida) and www.rcog.com (Radio Therapy Clinics of Georgia-have a mailer video too) and other centers doing similar or same protocols. Surgery and other treatments all have a place in choices for us patients. ALot of ways to fight this beast.

The plus side you likely will remain continent and could have possible cure or long term remission, your stats are not looking all that ominous. David may comment on his radiation (salvage therapy), his does not seem to be the typical patient scenario, it is more of the atypical version side effects(except for fatigue that is very common and goes away). So, just because one person weighs in with maybe a bad 'trip' does not mean this is weighed more than perhaps no response, herein. Same applies to surgery one 'bad trip or two' does not mean all patients get the same side effects. (being fair minded here). It is possible to get a lousy doc in any modality of PCa and some horror stories exist on any treatment.

Good luck to you, if you want to drop me an email I could discuss something directly on this.

Post Edited (zufus) : 11/14/2009 11:35:51 AM (GMT-7)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4080
   Posted 11/14/2009 12:30 PM (GMT -6)   
Dear Jack:
 
Sorry for your diagnosis and that of your wife...but you have found a good forum for both advice and support.
 
Your choice of treatment is a reasonable one and one that is highly likely to result in curing your cancer.  I believe you may have misspoken or misunderstood the "85%"...surely that is the chance of cure rather than reocurrance.
 
Personally, I had the seeds only and have done quite well.  You can read my journey by clicking the link at the bottom of my signature.  We have another member, JohnT, who is not only very knowledgeable but also was treated with a combination of seeds and IMRT.  I trust John will be along shortly with his comments.
 
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"!

jetguy
Veteran Member


Date Joined Sep 2006
Total Posts : 741
   Posted 11/14/2009 12:57 PM (GMT -6)   
Jack, I am sorry for both you and your wife and wish the best for both of you.
 
Two and a half years ago I underwent 43 Image Guided IMRT treatments and had no unpleasant experiences.  There was a bit of fatigue toward the end that went away in about three weeks.  At the end of it I had lost one pound.
 
I'll get back to you later with more details.
 
Regards,
 
Bill
August of 2006, PSA up to 4.2 from 2.7 one year ago. 
October free and total PSA 12% free and 5.0 total.
A month, or so later, 4.7.
Late in the year decide on Image Guided IMRT.
Begin 43 treatments on January 23, 2007 and finish on March 23.
 
Wow, almost two years behind.  I had a typical radiation bounce that
scared me, but it seems to be ok.  PSA is about 1.0 which is ok for
a rad guy at this stage of the game.
 
Got my FAA medical certificate back four months after starting my
treatment.  It's still a First Class, just jumping through a few hoops.
 
October, 2009.  Latest PSA is still 1.0 - that would make you surgery guys nuts, but it's just fine for a rad guy.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/14/2009 3:19 PM (GMT -6)   
I agree with what the others say about the 85%. With only one core positive (out of 12?) you are a very good candidate for seeds. I suspect that it is the Gleason 7 that makes your doc want to add radiation. Looking at the surgery nomograms I don't think that the surgical option would have a much different success rate.

Since you want to be there for your wife, be sure to talk to your doctor about side effects during the radiation treatment (mostly fatigue) and how you can be ready for them. Oddly, exercise can help fight fatigue.

Anyway, we are here hoping for the best for both you and your wife.
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/15/2009 7:00 AM (GMT -6)   
One drug that is said to be a fatigue fighter is dexamethasone 1-mg (think I spelled it correctly). I don't know first hand, never tried it, did also do radiations via Cyclotron(neutron) & later IMRT (photon) rare combo with max exposures(which I asked for), no complications thus far 7yrs.+ since done, did have fatigue set in and it went away, too. Not saying you or anyone else could not have any complications, alot has to be said for the expertise of whom does whatever proceedure one chooses in PCa treatments or any proceedure. The patients own body-presentation(condition) type variables  could also make a big difference in this mix and healing times, yada...yada..yada.
 
With a patient doing only radiation as a treatment your psa's afterwards are a different threshold to monitor, because you still have a prostate and it will heal, thus a working prostate will give off psa values. So psa value of 1.0 and such is not bad or worrisome.
 
Radiation bounce can occur many months after doing radiations, and sometimes as far out as 26 months, psa will raise quickly, followed by a drop (this is why you get further psa tests not real long afterwards to confirm), only happens in maybe 33% of rad patients. When it happens naturally the patient freaks out (thinking psa failure), monitor afterwards.
 
Also, psa numbers do not drop  as soon thereafer as it does with surgery, you might take 3-12 months(possibly longer maybe) to reach nadir psa level (the lowest number you would or can achieve) followed either by holding steady thereafter or rises.
 
Zap those little _____    (hey your futures so bright you gotta wear shades)

Post Edited (zufus) : 11/15/2009 6:20:47 AM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4185
   Posted 11/15/2009 12:30 PM (GMT -6)   
Jack,
I don't know where your oncologist got his numbers but they sure don't match anything I've ever seen. If you don't have evidence of capsular penetration or lymph node involvement your chances of cure are over 70%. If the tumor is completely contained your cure chances are about 90%. Ths would be exactly the same if you had surgery. I would ask your oncologist why he thinks an 85% reocccurance rate, is there something he saw that makes him suspect that it is not contained?
If he says it because of the treatment you chose then you need to get a new doctor because he obviously doesn't know what he is talking about or is trying to sell you something.
 
I had both seeds and IMRT and the only side affects I had was urinary frequency and urgency for about 4 weeks that was very tolorable. I have no side affects whatsoever in fact my urinary stream and bowel movements are better than before treatment, never a problem with ED.
Do your research and find a good radiolgist and a good brachytherapist. Skill does matter and the better doctors have less complictons and side affects.
 
The dose given by a combination of seeds and IMRT will kill any PC cells within the prostate and 10mm to 15mm in the surrounding bed.
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


Nebraska Guy
New Member


Date Joined Aug 2009
Total Posts : 11
   Posted 11/15/2009 2:01 PM (GMT -6)   
Jack,

I choose a similar treatment (4D IG-IMRT followed by Pd seeds) at the Dattoli Cancer Center. I start my IMRT treatments tomorrow. Who will do your treament?
05/06: PSA Test PSA 6.0
07/06: PSA Test PSA 6.7
02/07: PSA Test PSA 5.8
??/07: First Biopsy No PCa found. Atypia found in right lobe. Prostate size 53cc. Put on Avodart
08/07: PSA Test PSA 2.6 (affected by Avodart)
08/07: PSA Test PSA 4.11 (affected by Avodart)
08/07: PSA Test PSA 3.27 (affected by Avodart)
03/09: PSA Test PSA 4.5 (affected by Avodart, Dr doubles it & calls it 9.0)
05/09: Diagnosed (age 53) second biopsy T1c stage, Gleason 6 (3+3), 3 of 12 cores all in right lobe. No perineural invasion. 7% cancerous, Cat Scan Negative. Prostate size 40cc. Went off Avodart.
09/09: PSA Test PSA 7.66
10/10: Second opinion of 5/09 biopsy Gleason 7 (3+4)
09/11: Start Treatment at Dattoli Cancer Center Endo-rectal Coil Dynamic MRI spots tumor in right lobe. Color Doppler Ultrasound spots concer in both lobes and possible sign of capsular penetration. Stage changed to T2c. Prostate size over 60cc (Dr thinks earlier mesurements incorrect due to simplistic calculations). Put on double dose of Avodart.


jack moss
New Member


Date Joined Nov 2009
Total Posts : 5
   Posted 11/15/2009 9:29 PM (GMT -6)   
Hi Everyone,

Thanks for the replies! I'm sorry for the confusion, the 85% referred to the cure rate not reoccurrence (phew!) Doc said that mine was very small, "microscopic" and my cure chance was the same at 10 years as it would be for surgery. Sounds good to me.

I'm getting treatment (2 down so far) here in South Florida at One-Oncology. Great place and very methodical on getting the "aim" right. I'm feeling good about my chances.

This is good because I want to be there for my wife. Her anal cancer is early "mild infiltration", but no spread yet. We go together, she gets six weeks, I get five. She's got a chemo port and the "cassette". But after 26 years we've always did everything together and so here we go!

Thanks for being there! I'll surely check in from time to time with questions and also to share my experience, hope and strength.

God bless.

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4088
   Posted 11/15/2009 9:34 PM (GMT -6)   
Jack What a great loving attitude. Best of luck to the both of you. Please keep us posted.

Jeff T
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.


jack moss
New Member


Date Joined Nov 2009
Total Posts : 5
   Posted 1/2/2010 5:44 PM (GMT -6)   
UPDATE: Radiation finished on 12/15, going for the seed implant (60 seeds) this Wed, January 6th. Getting a little apprehensive (never been through any surgical procedure). Would love to hear from those who had the seeds implanted, about the side effects etc.

Wife is done with radiation and chemo, has surgery scheduled for January 29th.

Thanks so much in advance.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/2/2010 5:56 PM (GMT -6)   
Jack,

Glad you are done with your radiation portion. The men here that have been through seeding report very few side effects, I am sure they will be happy to share their experiences with you.

I will be thinking about you and your wife's situation in the weeks ahead. Wishing only the best results for the both of you.

Please keep us posted of your situations.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA:
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4185
   Posted 1/2/2010 9:00 PM (GMT -6)   
Jack,
No problems, procedure is much better than a biopsy, no pain. Done in about an hour. You will have urinary frequency and urgency for 4 to 8 weeks. Stay close to bathrooms because as soon as you feel you have to go you only have a few minuits. On long drives take a bottle you can pee in. Stay off all caffine and alcohol. Take Ibupropine to keep the swelling down and take FlowMax. Side affects are very tolorable and shouldn't keep you from doing anything you want to do.
Good luck with your procedure and keep us posted.
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


JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 1/3/2010 11:36 AM (GMT -6)   
Jack,
 
Had seed implants on 12/11/09 to be followed by 25 IGRT treatments in Feb. Procedure was done at 7:30 AM and I was home by 12:30 PM. No serious problems. You will have blood in the urine for about a week. I am also experiencing urinary frequency, urgency, and burning that was mentioned by John T. above. I'm told by my radiologist that this will subside after a month or so. Other than that, I have been back on my normal routines. I would imagine that you will tolerate the procedure very well. Best wishes to both you and your wife.
 
Joe67
 
__________________________
 
 

Age -67 PSA - 4.5

Biopsy  (9/4/09) - Positive in 5 of 8 cores. In those 5 cores, 5 of 11 samples were positive. Gleason 3+3=6. Stage – T1C  Ct and Bone scans negative

 

BT performed on 12/11/09. 84 seeds of Palladium 103. Surgery at 7:30 - Home at 12:30 same day with no catheter. Side effects as expected -  some burning, frequency, urgency, blood in urine which has subsided.  Resumed daily  1 ½ mile walk after 3 days.

 

BT will be followed in 2 months with 25 IGRT treatments. 

 
 

jack moss
New Member


Date Joined Nov 2009
Total Posts : 5
   Posted 1/4/2010 4:07 PM (GMT -6)   
Thanks so much for the replies. Sounds nothing worse than what I experienced with the biopsy. Old Army type, will comply! Besides have to get 'er done and get back on me feet for the missus, she's got the longer road!

Cheers and again thanks, let you know how it goes.
New Topic Post Reply Printable Version
Forum Information
Currently it is Thursday, April 19, 2018 7:17 AM (GMT -6)
There are a total of 2,953,071 posts in 323,966 threads.
View Active Threads


Who's Online
This forum has 162049 registered members. Please welcome our newest member, Wienie.
374 Guest(s), 12 Registered Member(s) are currently online.  Details
Wienie, JJO, Injector, C_G_K, Pratoman, WalkingbyFaith, KYLEb23, Herophilus, xlyzd, Imbeccak, RobLee, garyi