First PSA since seed implants

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Klaats
New Member


Date Joined Sep 2009
Total Posts : 15
   Posted 1/27/2010 1:52 PM (GMT -6)   
First PSA since BT on 11/10/09 at 1.3. Good numbers, I think, but will confer with Dr. to make sure. I was at 11.4 in July of '09 and at 4.3 in Oct. before the procedure. Still no big side effects with incontinence or impotence. Would venture to say that sex may be even better than before but would not recommend BT as a treatment for erectile dysfunction. I know, it's early, and time will tell. Would continue to highly recommend Chicago Prostate Center and Dr. Moran. At least consider as one of the viable options. Peace to all in their journeys.
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 Oct. '09 4.3
Biopsy - 12 core. 08/12/09 - 10 % of one core, Gleason (3+3)6,
Second analysis same biopsy - 14% of one core, Gleason (3+4)7
Aureon Score 19 out of 100 (see aureon.com)
Volume 10/13/09 - 38 Grams
Brachytherapy 11/10/09 with Dr. Brian Moran at Chicago Prostate. 82 palladium seeds.
1/27/10 First PSA since implants at 1.3


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/27/2010 3:15 PM (GMT -6)   
klaats,

go going, sounds like a good number for this point in your seed journey, glad you aren't getting slammed with side effects at this point. please keep us well posted.

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: 1/10 .12
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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 1/27/2010 3:34 PM (GMT -6)   

Hi Klaats:

Your numbers are indeed great..congratulations.  The PSA will continue to drop until you find your nadir but you are off to a good start.  Glad to hear about the SE's...that is what you should expect.  I'm now 1 year+ post-seeding with everything totally normal.  Maybe something down the road, but so far...so great!

Drop in from time to time and keep us posted.

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 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Klaats
New Member


Date Joined Sep 2009
Total Posts : 15
   Posted 1/28/2010 7:45 AM (GMT -6)   
Thanks Tudpock. I know the trip has just begun. Always skeptical of something that seems too good to be true but all I can do is take it as it comes.
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 Oct. '09 4.3
Biopsy - 12 core. 08/12/09 - 10 % of one core, Gleason (3+3)6,
Second analysis same biopsy - 14% of one core, Gleason (3+4)7
Aureon Score 19 out of 100 (see aureon.com)
Volume 10/13/09 - 38 Grams
Brachytherapy 11/10/09 with Dr. Brian Moran at Chicago Prostate. 82 palladium seeds. Uraxotrol 10mg once daily and Alleve 2-3 times daily.
1/27/10 First PSA since implants at 1.3


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 1/28/2010 11:28 AM (GMT -6)   
Klatz,
I'm about 9 months post seeding and 7 months post IMRT. I have no side affects either and my doctor said that since I have never experienced any SE it would be improbable for them to appear later. Hope he is right.
Hope your psa continues it's downward trend.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/28/2010 1:15 PM (GMT -6)   
JohnT, Tud, and Klaats, I am so glad that you guys were able to be on that path, and I know a few more have joined you too since I first came to HW. Seeding always has that special place in my mind/heart, as it was my original choice of treatment until my numbers shot them down. All of you have done well with it, and I think you guys make a good sampling of how good a treatment choice that can be.

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: 1/10 .12
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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 1/28/2010 2:03 PM (GMT -6)   

David, thanks.  Actually I feel so badly for you sometimes knowing that your situation prevented you from making your original selection...especially in light of the ongoing problems you have faced.  Frankly, you are one of the few surgery guys on this forum with the open mindedness to recognize brachytherapy and AS as legiimate treatments.  You have the "street cred" as a post-surgery patient to help people understand that they have choices and I personally appreciate your approach.

Hope you are feeling ok today and I continue to pray for this never-ending saga of yours to conclude with a VERY favorable outcome.

Best wishes,

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 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/28/2010 3:37 PM (GMT -6)   
Tud, it does seem never ending, I know it does to all of your guys, probably to the point of nausea, but I only tell it like it is. You can imagine how I feel on the receiving end. Today has been hell day, been in a lot of severe pain, all cath related, probably had 3 dozen or more severe spasms alone, plus lots of deep penile and rectal pain. I did a lot more the past 3 days, and now I am paying for it. Had to take pain meds at 2 pm today, very unusual, as I try to wait as late in the day or evening as possible. Right now my body is saying rest and heal, but my mind is 100% trying to be busy. This particular episode with the SP caths and the SRT, has been going on non-stop since October 1, that's a long time to be hurting every day. End of vent.

I was open minded on treatment before my own surgery. The only two I had issues with, and still do, HIFU - only because I don't agree with non FDA treatments out of the country as an American, just my personal take, and the Cybro-freezing method, which I understand is rarely used and rarely works, could be wrong on that.

I see AS, Seeding, straight RT, Seeding with SRT, and both robotic and open Surgery as our main choices. Each has its place, and each depends a lot on the patient, his stats, his family history, his appearent agressiveness with PC, a lot of things.

While I wanted seeding, and interestingly, my own beloved uro/surgeon never tried to trash it when we went through the whole thinking about treatment processes, I found out that is is widely used in my immediate area for those that don't merit or want full blown surgery.

I am not judging or critisizing any brother here, I stand by any man's choice, but with all that has been learned here and elsewhere, I often wonder if some of my surgery brothers that had low grade pc, low core, low %, low velocity have had 2nd thoughts in t heir heart of hearts?

The side effects from surgery are just too undpredictible, and looking at charts/numbers on them does little good if one has long term incontinence or ED.

My numbers/velocity narrowed me into a small window of true choice, nothing I can or could do about that, but I wonder what it would have been like if I had really had some choices in the matter. I only wish that each new friend/brother here, really deeply thinks about what they want to do for treatment, if at all, if their number allow them the full palatte of choices. It does make me nervous when someone is dx with pc, and already had surgery all within 2 months or less. Their choice of course, but is it really due diliigence about a drastic life changing event? Again, not judging ,just asking.

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: 1/10 .12
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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 1/29/2010 5:38 PM (GMT -6)   
Hey Klaats,

Quite a coincidence, your mentioning Dr. Moran. Just yesterday I had my biopsy/pathology report sent up to Dr. Brian Moran at the Chicago Prostate Center to see if he believes I may be a good candidate for the seeding procedure. My head is chuck full of all the options/possible side effects etc etc. I am very lucky to have a daughter and family live in Naperville, IL which would sure make the 20 minute trips to Westmont much easier -- if I decide on regular radiation or the seeding at his facility. If you feel you have some advice on that facility and their staff, please let me know as I'm constantly looking for advice and reassurance. Thanks in advance.
Bob, down in Southern Colorado


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/29/2010 6:04 PM (GMT -6)   
Good going, Bob, perhaps you will join the Brotherhood of the Seeded here, and you will be one more case on that particular journey that we can follow. Please keep us posted.

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: 1/10 .12
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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


scully66
New Member


Date Joined Jan 2010
Total Posts : 8
   Posted 1/30/2010 7:09 PM (GMT -6)   
Hi - This is my first post as I was just diagnosed last week with PC (psa 3.7, T2a, Gleason 3+3 in 1 of 12 cores).
 
I've been compiling info like a madman, naturally, but because I'm only 43, I'm having trouble finding many guys my age who were faced with treatment decisions. My urologist wants to take it out to "be sure" but logic tells me to go with seeds and, if levels don't go down, then I can always have the prostatecomy later.
 
Obviously, I want to minimize SE and it just seems to me that you should try BT before jumping in with both feet.
 
Is this a foolish approach?
 
I'd love any opinions and especially if anyone faced this dilemma in the early 40s. Thanks.

Scott
43 years old
Diagnosed 1-10 and studying options
psa 3.7 at diagnosis
T2a, cancer found in 1 of 12 cores. Gleason 3+3
To remove or radiate...that is the question


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/30/2010 7:18 PM (GMT -6)   
Hello and welcome to HW, Scott.

There are several men in your age range here that can give you some age specific advice. With only one core being positive, you very well could be a good candidate for Seeding, and it may give you the least amount of bad side effects, in comparison to surgery.

However, most would agree, that surgery after Seeding and/or Radiation in general is not a good option, and can lead to severe complications and perm side effects. Many surgeons will not even do one. so that is something to think about.

There are secondary treatments you could do, if you underwent seeding and it failed later aside from the risk of surgery.

Hopefully, some of our Seed Brothers will check in with you here and give you some direct advice.

Please stick with us and keep us posted.

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: 1/10 .12
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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 1/30/2010 8:27 PM (GMT -6)   
Scott, The following was published in the New Prostate Cancer Info Link (I heard you Tony)

Gómez-Iturriaga Piña et al. have reported on the effectiveness and safety of iodine-125-based brachytherapy (125I-BT) when used alone (without adjuvant hormone therapy or external beam radiotherapy) as first-line therapy for men with T1-2 prostate cancer who are ≤ 55 years of age at their institution. This is a retrospective analysis of data from 96 men treated between May 1999 and November 2005. The median age of the patients at treatment was 53 years (range, 45-55 years). All patients were followed for at least 30 months and the median follow-up was 63 months. Only 1 patient experienced a biochemical failure, and the actuarial 7-year of biochemical relapse-free survival is 98.9 percent. Grade 2 acute and late genitourinary (GU) toxicity rates were 9.8%and 10.6 percent, respectively. Grade 3 GU toxicity (urethral stricture) was observed in 3 men and was corrected with urethral dilatation or transurethral resection. Two patients (2.2 percent) developed grade 2 gastrointestinal toxicity (proctitis). Erectile function was preserved in 85/91 men with prior good function (93.4% percent); 41/91 patients (45 percent) used phosphodiesterase-5 inhibitors. The authors conclude that, this group of younger men “experienced excellent bNED rates with low toxicity” and that “Men in this age group should be offered low dose rate prostate BT as an option to consider.” As usual, what we don’t know is what percentage of these men might have done just fine on some type of expectant management regimen.

The data for seeding goes out to 15 years and is excellent for low grade PC control. The data is not as long as surgery, but I think it is unresonable to believe that after 15 years we are suddenly going to see a rise in reoccurrances. Cancers just don't work this way, the longer you go the more likely you are cured. I have never seen any data that suggests that Brachtherapy is not suitable for younger men.
Surgery is a poor option for salvage after seeds, but you can be reseeded, have cryosurgery or HIFU
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

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