Posted on the New Prostate Cancer Info Link:
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.
Brachytherapy now has a lot of 15 year data and control for low risk PC is very good long term. I think it is unreasonable to expect that there will be significant reoccurance rate after 15 years as cancer just doesn't work that way. The longer you go without a reoccurrance the less chance you will have of ever having one.
Brachy is just as safe for younger men as for older men.
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.