Quality of life comparision study between treatment options

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 4/5/2010 1:52 PM (GMT -6)   
A study was posted on the New Prostate Cancer Infolink comparing quaility of life issues after Robotic, open surgery, Brachytherapy and Cryosurgery.
Summary of results:
Urinary functions: Brachytherapy patients had significantly better functions than robotic or open patients.
Sexual functions; Brachytherapy patients had significantly better return to sexual function. There was no difference in Robotic vs open.
Bowel funtions. No difference between any of the treatments.
 
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/5/2010 2:43 PM (GMT -6)   
Interesting numbers, for sure, but the majority of those in the study have what we here at HW call low-grade PC cases, T1 and or Gleason 6 or less - that was the vast majority of those making up these numbers. I wonder what it would look like if it were mostly Gleason 7 or higher and T2 or higher.
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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 4/5/2010 3:11 PM (GMT -6)   
David,
The only thing that might change is the rate of biochemical reoccurance. There would be no change in the QOL as all procedures are done exactly the same whether it is a G6 or a G8. As to biochemical reoccurrance some studes show Brachy as superior in the higher gleason grades and others show surgery. From what I have researched the differences are not worth splitting hairs about and just about as good as a coin flip as to which is superior in the higher grades. In the lower grades there is absolutely no question that all treatment options have the same cure rate.
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 4/5/2010 4:15 PM (GMT -6)   
I think we are agreeing to agree, I think that in the low-grade, non-agressive PCa cases/strands, all the listed primary treatment methods are all but equal in dealing with the cancer. The slight advantages with seeding with ED and incontinence was something that interested me originally when I first found out I had PCa, and of course, a big selling point to men should be that it is not a major invasive procedure like open or robotic surgeries. Even as a surgery guy, from my times here at HW, studying many, many cases we present, it is all but a crap shoot as to quality of life side effects, regardless of surgical method, nerve saving vs. non nerve saving, etc. I'm still sure that a great surgeon in a great hospital may have better numbers if there were really a way to know this, but then we have our cases, where some of our guys had the best of the best, and still have terrible situations they are dealing with, either in side effects or rapid recurrance.

Do you happen to have any studies or stats showing sucess rates of "seeding" with Gleason 7 cases? I would love to see some numbers, as I was told pretty firmly in the fall of 2008, that with my numbers, I couldn't have seeding, and even the radiaton doctor made it clear that surgery was my best first shot at a treatment.

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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4184
   Posted 4/5/2010 6:23 PM (GMT -6)   

John, thanks for sharing.  Of course this is not surprising to me given my personal experience as well as the depth of study on brachytherapy that I did pre-procedure.  Hopefully this will add perspective to the new guys who are contemplating their choices.

David, I think your commentary on side effects is extremely helpful...not only from your personal experience but from your constant observaions of the many patients who roll through here.  It's a lot easier to say "get it out" pre-procedure than from a post-procedure perspective of incontinence, ED, stricutures, etc, etc, etc.  I'm sure the new guys think John and I are biased because we have made a non-surgical choice.  But I think they find it hard to fault you when you encourage people to look at non-invasive/low SE options. 

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"!

erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 4/5/2010 7:19 PM (GMT -6)   
David said, "Do you happen to have any studies or stats showing sucess rates of "seeding" with Gleason 7 cases? I would love to see some numbers, as I was told pretty firmly in the fall of 2008, that with my numbers, I couldn't have seeding, and even the radiaton doctor made it clear that surgery was my best first shot at a treatment"

My first biopsy path report came back Gleason 3+4 and had a second path report from another pathology place which came back 4+3 so now, I don't really know which is the correct one. I handed both path reports to the Doc who will be the seed implanting at the Chicago Prostate Cancer Center, Westmont, IL. After a volume study, he told me that I'd be on Lupron and Bicalutamide for a couple months to shrink the prostate. So, by the end of May, I'll know what the outcome of Brachy on a Gleason 7 will do for ME.
I'm going on 74 years of age and taking those two drugs makes my aches and pains rather questionable. I don't know if those aches and pains are normal for an old codger of 73 or if they are caused in part by those two drugs. Finally, I'd sure like to hear from any of you guys who have had Brachy, just what type anesthetic was used on you. I'm hoping for the "twilight" type as I'd rather not be awake for the procedure as with the spinal method would provide. Just recently received the hospital bill for the 12 core biopsy that was performed in an OR and noted that there were three nurses, the Urolo Doc, Anestheologist and the chap with his ultrasound machine. Kinda pricey but I was unaware of what was going on and had no associated pains during the entire procedure. Anyone care to help me out with some answers of my concerns listed above?
erbob

i .
Bob, down in Southern Colorado


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/5/2010 7:36 PM (GMT -6)   
Tud, I try to portray that neutrality with an open mind and heart. For any of the new brothers that come through our doors, I think its real important to be treatment neutral on our ends. Especially since it seems like lately, the bulk of the new guys have lower grade, Gleason 6 cases. For all of us that have been through the wringer with surgery and salvage radiation, I only wished I had been fortunate enough to have had real choices. Of course, there are those, whereby surgery is the best first hope without question.

It's hard to change the mentality of the 'I have to get it out of me immediately' line of thinking. A person would have to come to an understanding, that even with an agressive cancer indicated out of a biopsy, there is still plenty of time to go through the due diligence process of going through all the options, gathering professional opinions, and weighing it all out. It makes me feel a little sad for the guys that get the PC dx, and have a full treatment plan sceduled in a week or less. I realize that some may have done their due dillergence prior to their dx. Kind of my situation, as I had 3 biopsies spread over 18 months, and spent a lot of time reading/researching on the assumption that I would eventually be dx.

I may get shot for this one, but I still feel inside that some of the robotic "selling points" are being oversold. I know the hospitals have to drum up biz for the cost of the machines, but just doing a non-scientific review of our robotic guys, I am still not convinced they have any advantage in side effects or quality of life issues. And I have noticed that a lot of the new guys, still don't see or understand that robotic or open, it is a major complex surgery. Of course, less invasive with the actual operation with robotics, but still a very complicated surgery, and a whole lot can go wrong.

You ,and JohnT, and the other few that are on your seed path to me play an important role here, to give good working examples of how seeding with and without RT can be a good treatment. I am pleased on HW that we have at least you guys being in a position of giving an alternative to surgery.

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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 4/5/2010 8:00 PM (GMT -6)   
David,
Chicago Prostate Center: 96% low, 84% intermediate, 75% high.
Cleveland Clinic: 95% low, 89% intermediate, 71% high.
I think these results for intermediate are higher than surgery.
The largest study, The Prostate Cancer Study Group 2009, found that Brachy had superior cure rates in all risk catagories.
There are some studies at Hopkins that show surgery to be more effective in the high risk cases.
I think as these studies and updated ones that will come out in the future they will continue to challange the old way of thinking that surgery is the best cure for intermediate and high risk cases in much the same way that Active Survielance is gaining confidence among doctors as more data becomes available. It takes a lot of time to change, and most of the old data definately favored surgery. There is now good 15 year data on Brachy and a lot of 10 year data where there was very little 4 or 5 years ago. The recent developments in both external radiation and Brachy have outstripped surgery which is basically the same as it was 20 years ago. Robotic has been able to reduce the immediate after affects of open surgery, but has not improved QOL issues or cure rates over open.
There are a couple of situations in which surgery has an advantage: when a patient has urinary issues before treatment and for very young patients with high risk disease, and for overweight patients and those that have a very large prostate.
All of these studies are retrospecive studies and I don't ever see the time when we will have head to head studies with patients randomly assigned to various treatment options.
I think what we have seen this year is that the urological community is now beginning to realize that the side affects of surgery are much greater than most have been led to believe.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/5/2010 8:13 PM (GMT -6)   
John, I fully agree with your very last statement there. I don't think it's so much that surgeons are lying or misleading on purpose, but they can't predict with any certainty what kind of side effects and/or quality of life issues their surgery patients will have to endure and/or suffer through after the fact. My chronic stricture saga, certainly wasnt' discussed or compensated for ahead of time. It's a combination of having a body that loves to over-scar, an unsually complicated bladder neck to urethra connection, and a more intensely bad reaction to the salvage radiation. The dr's that make me nervous, are some of the one's that are all but guaranteeing little or no side effects from their push for surgery. I don't see how anyone could do that with a clear conscious.

I too, am glad that at least now, that AS is being viewed as a credible alternative to those meeting the criteria. If I had been a low grade case on day one, I would love to know that I could buy some normalcy of life while monitoring smartly my PC situation, and safely too. The guys that just blow that off without a thought, that qualify, may wish one day that they had thought through more on that choice.

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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 4/5/2010 8:27 PM (GMT -6)   
What's really terrific is that PCa survivors have been shown to be happier and more content than the general population.

Prostate cancer survivors 'have positive outlook' (2006)
www.medwire-news.md/news/article.aspx?k=46&id=56696

Barry
Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/'07 <0.04; 12/'07 <0.04; 03/'08 <0.04;
06/'08 <0.04; 12/'08 <0.04; 06/'09 =0.06; 09/'09 <0.04; 12/'09 =0.05;
Latest PSA 3/'10 <0.04


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/6/2010 6:45 AM (GMT -6)   
David,
 
I think that many more men who qualify for AS, would consider AS, if they realize that we all do watchful waiting in one way or another from the time of diagnosis to the time we die. AS, done with proper medical monitoring, should be strongly considered by anyone who has what appears to be non-aggresseive cancer. 
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4184
   Posted 4/6/2010 8:54 AM (GMT -6)   

Dear erbob:

RE your question on anesthesia...I was "out" on IV anesthetic (similar to colonoscopy).  I can understand not wanting just a spinal.  Talk to your doc ahead of time and he/she should comply with your 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"!

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 4/6/2010 10:01 AM (GMT -6)   
It wasn't too long ago that this thread and it's originator wouldn't met the fury of the get it out of me asap crowds inquisition. That said there are still those who appear a few days after dx already having their surgery scheduled. Or those who schedule it as casually as a dentist appointment not really grasping the possible SEs that could adversely affect their quality of life issues. In fact bringing up or giving some priority QOL issues alone would bring the wrath of some here down on ones head not too long ago, I remember from personal experience. The fact that over treatment has been shown in quite a few recent articles have finally had an effect. Although many still think it's a cost cutting conspiracy or that the doctors motives or competence are in question be it from what are normally before then respected sources and individuals. Next needed is to better explain local and systemic PCa to those newly dx.

The times they are achangin
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy
 
2/16/10 12 of 12 Negative Biopsy 
 
 
 


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 4/6/2010 11:05 AM (GMT -6)   
It wasn't too long ago that this thread and it's originator would've met the fury of the get it out of me asap crowds inquisition. That said there are still those who appear a few days after dx already having their surgery scheduled. Or those who schedule it as casually as a dentist appointment not really grasping the possible SEs that could adversely affect their quality of life. In fact bringing up or giving some priority QOL issues alone would bring the wrath of some here down on ones head not too long ago, I remember from personal experience. The fact that over treatment has been shown in quite a few recent articles have finally had an effect. Although many still think it's a cost cutting conspiracy or that the doctors motives or competence are in question be it from what are normally before then respected sources and individuals. Next needed is to better explain local and systemic PCa to those newly dx.

The times they are achangin
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy
 
2/16/10 12 of 12 Negative Biopsy 
 
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 4/6/2010 10:03 PM (GMT -6)   

You know, I think most of the surgery guys accept other treatment options.  And with great tolerance for the inferences that many surgery guys have been misinformed, made hasty decisions, and are now leading miserable lives with the horiible side effects.

It does get a little tiring tho.  Why can't all of us just accept the treatments we have chosen, without either in a backhand way or a more direct lob, throw stones at the other treatment options ?  In spite of opinions of some, the "get it out of me" syndrome is not as prominent as it may seem.  There is sound logic to the risk of surgery, there is good reason statistically to choosing surgery, just as there is to choosing brachy, radiation, cryo, Hufu, etc.etc.

And we all get opinions for our uro's, radiation docs, and pc oncologist.  Some of those arguments are influenced by doctor personality, strength of argument, and geographic location.  I happen tobe fortunate to reside within close driving distance of 4 major cancer centers here in Ohio and Michigan.  Insurance also becomes a factor for many.

I am a satisfied surgery patient, who made an informed decision, and have had as good a result as I can expect so far.  I try not to be a surgery misisonary, trying to convert the lost.  I will share my experience willingly to those who ask.  Likewise, I encourage folks to get multiple opinions and seek education, and make informed decsions.  I will never be quoted on here trying to tell someone they made a mistake, or would be making a mistake following a certain protocol.  Hopefully we can all do the same.

God bless all you guys.

 


Goodlife
 
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


Drums
Regular Member


Date Joined Mar 2010
Total Posts : 134
   Posted 4/7/2010 9:28 AM (GMT -6)   
I had a consult with a radiation oncologist yesterday and he raised an interesting point regarding AS, which was "If that's the route you want to take consider what would be your trigger point for taking action." I think it would be a reasonable question to consider when determining courses of action. Individual circumstances and preferences should be the governing factors, but his point, as logical as it seems, was just not one I had considered. Anyway, it was interesting to me and I thought I'd share.
Bill
Age 52, father died of PCa, PSA: 10/16/09 - 2.8; 1/11/10 - 3.8
Biopsy 11/25/09, 11 core samples - HG PIN on right side
Biopsy 2/17/10, 11 core samples - left side, adenocarcinoma, Gleason 6, one core at 5%
Notified of dx on 3/12/10 (27th wedding anniversary)
MRI 3/17/10 and bone scan, 3/23/10, indicate: gland volume is 27mL, PCa is confined to prostate, seminal vesicles and vas deferens are unremarkable.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/7/2010 9:32 AM (GMT -6)   
Realziggy, that can be a good thing. We don't want things to be standing still or stagnant. Education and research should keep things alive and well. Progress is measured by a willingness to accept new facts and to accept change when needed. That includes opinions. No one should be ashamed to change their mind or opinion about anything, when faced with new facts. That's how things get better.

Even though we represent a micro group of PC men and families, perhaps we are seeing the results even here in the past year of education, research, and knowledge with PC. Even the medical family is changing their views on some aspects of treatment, overtreatment, the value of AS, etc.

The hardest part to work on next, is the general fear factor of having cancer. All our adult lives, we are exposed to and taught to fear cancer, so when it hits us, or one of our brothers, its most human and normal to be paralyzed by fear, either inside or out, or both. Its also a normal part of processing the knowldege of having cancer, one of the normal steps in dealing with it. Except a person isn't suppose to get stuck at the fear stage, and that is the worse stage to make a major treatment decision. Just something to think about.

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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 4/7/2010 10:07 AM (GMT -6)   
Erbob,
 
Not sure exactly what anesthetic was used on me....just know that I was "out" and did not feel a thing (I would not want a spinal either). The only real discomfort I had when I woke up was a sore throat from the breathing tube that was inserted.  I had bruising of the scrotum (but no soreness) that went away after a couple of weeks.
 
Other readers,
 
Despite the fact that I chose BT, I would never question anyone's treatment decision.....unless that decision was made too quickly to allow for exploring all the options available. This from a "get it out now" guy who changed his mind with more research and spending some time on HW.
 
Regards to all,
 
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. Blood in urine for a week. Side effects as expected -  some burning, frequency, urgency.   Resumed daily  1 ½ mile walk after 3 days. 

 

BT followed with 25 IGRT treatments beginning Feb 15 (4500 Gy's). After third week, experienced some fatigue.

 


erbob
Regular Member


Date Joined Jan 2010
Total Posts : 281
   Posted 4/7/2010 10:07 AM (GMT -6)   
When I was first presented with the diagnosis of PC, the only thing on my mind was "get rid of it immediately". My wife (Janet) and I had a consultation with a daVinci expert who has done somewhere around a thousand of these procedures. He, of course, would NOT recommend any one treatment over another. My wife finally threw her two cents into the pot and asked him that if HIS dad had my diagnosis (at 73 years of age) what would he recommend for his own dad. He did say that he thought he'd tell his dad to seriously look into radiation of some type. This daVinci Doc sure didn't push his services at all and we really appreciated that. Then after reading the many many posts here on HealingWell.com and communicating with others who went the Brachy route, we checked into the Brachy procedure for ourselves and that's what we have now decided on. Now just have to go in for another volume study towards the end of May and hopefully, a few days later get the seeds implanted and then get on with my life. This is my second bout with C and I beat it once so sure expect to beat the beast again. :-)
Bob, down in Southern Colorado


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/7/2010 11:18 AM (GMT -6)   
Bob , I think you have chosen a good path for your self. The other seeded brethren can help you through any ofthe before ,during, and after questions you may have. At 73, either surgery method would be a big strain. I had open surgery at age 56 and I know how hard it has been on me. Look forward to following your Seed Journey in the future. Good luck, and may some peace come to your heart about having PC. You have a plan in place.

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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 4/7/2010 12:09 PM (GMT -6)   
Goodlife,
I went back and read all the posts and just don't see any attack on anyone's choices. Choices are made with information given and everyone has different criteria in making that choice and we have always supported that concept on this board.
This board is also about providing information and there is a belief system among doctors and patients that influences their decisions. That belief system is being challanged with new data and slowly patients and doctors are slowly changing their ideas about PC and treatments, When any established belief is challanged, whether medicine, politics, or religion people feel attacked.
I'm going to sart a new thread on PC beliefs that are being challanged.
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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 4/7/2010 12:44 PM (GMT -6)   
John,
 
I never used the word attack, nor did I feel I was being attacked.  Sorry if I gave that impression.
 
Some of Realziggy's comments about the "get it out of me asap crowds inquisition", and other comments here and there on various threads by some just eventually starts to wear on me.  Sorry, I'm sensitive I guess. 
 
I hate to second guess myself or others.  It is just such a personal issue, that many times an inference can be innocently made that can be taken as a backhand slap.
 
I have no quarrel with anyone, and I encourage education, myself included.  Brachy is a very promising tx, but it is still comparable to surgery in effectiveness, and we are still gatherimg data on side effects, which appear to be better in many cases than surgery, but it is still a case by case basis with PC.  No two cases are alike.
 
 
Goodlife
 
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4184
   Posted 4/7/2010 12:56 PM (GMT -6)   
Goodlife:
 
In defense of realziggy's comments, he took a real beating (before your time) from "surgery guys" who ridiculed his choice of TFT.  So if he is a bit sensitive on this it is well placed sensitivity, IMHO.  Beyond that, while it is true that not two cases are alike, etc, etc, brachy is hardly still a "promising" treatment.  There is a ton of long term evidence re its' cure rates as well as QOL and this study that John shared is reasonably powerful...beyond the "gathering data" stage...
 
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 4/7/2010 3:12 PM (GMT -6)   
I agree strongly and fully, for those with the right criteria, Brachyatherapy is a sound and serious choice to be considered as a primary treatment for PCa. Just as valid as surgery, and should be on the "considered" list of anyone with a PC dx that meets the criteria.
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, no problem post SRT
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, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 4/7/2010 3:14 PM (GMT -6)   
No disagreement from me.
Goodlife
 
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01

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