Thanks for all your input....definitely some great feedback! It just goes to show what a nightmare this disease is as far as having to make decisions. My husband had been leaning strongly toward having surgery, but is now seeming to heavily favor brachy as his treatment of choice. He's repeating his PSA on the 28th, and we're meeting again with the Rad. Onc. on the 29th.
Initially, I didn't feel that Brachy was a good option for him at his young age. I work in the field, but admittedly, I hadn't kept up with all the research for the last few years after going from full-time to casual, and after being off with knee operations for a couple of years. After doing some reading, and discussing brachy with the Rad. Onc., my thinking has changed. Here are some points that seem to be coming through in the most current literature that are making me feel that Brachy is a valid option. I encourage and welcome any comments (pro or con)!
- There is virtually NO increased risk of developing secondary cancers post-brachy (one study quoted 1 in 300). The dose fall-off from the seeds is very short, and improved treatment planning and intraoperative seed placement has greatly decreased the dose to the bladder and rectum (the two main areas for concern), while increasing the dose to the prostate with improved accuracy in seed distribution.
-If the 10 year survival is similar as that for surgery, it stands to reason that any PSA recurrence after that time is likely to be caused from disease that was already beyond the prostate and in the blood stream initially (as with surgery). Also, they are able to implant seeds around the capsule for a margin of approx. 5mm, thus treating ECE that may already be present.
- The risk of local, persistent disease or local recurrent disease is extremely low, so the argument from the uros that you can't have surgery after brachy is a bit of a moot point. Of course there are exceptions, but the risk is small.
- The side effects (especially ED) seem to be less disturbing for brachy....at least initially. It also seems that ED that develops over the course of time with brachy responds better to meds (Viagra, Levitra) than in some patients who undergo surgery.
As I've said, no decision has been made yet with regard to treatment, but I can't help but feel that the BIGGEST advantage of surgery over brachy in some instances is psychological (i.e. "get it out of there!"). The other obvious advantages are that you can rely on your PSA readings to monitor your treatment immediately after surgery, and you also get a full post-op path. report.
With brachy, you have to be emotionally strong enough to deal with potential PSA "bounces", and a slower reduction of PSA to a point where it is once again a valuable monitoring too. I can't really see any long-term risk associated with leaving an essentially "dead", non-functioning organ in place.
Again, I welcome any discussion!!
-Husband's 1st PSA done (age 45) at routine physical PSA 3.8
-DRE at physical indicated no abnormality other than slightly enlarged
-Consult with urologist Jan. 2010---DRE negative, PSA 3.89
-Biopsy Feb. 10, 2010: T1c, Gleason 3 + 3, 2/10 cores pos. (5% in one core, <5% on other core) 1% of core volume positive, gland size 38.84
-consult with "open" prostatectomy uro March 2010
-2 consults with rad. onc. for Brachy March, Apr. 2010....also discussed AS
-latest PSA reading April 8 4.63
-consult with "robotic" uro Apr. 12....tentative surgery date booked July 8
-Have also booked tentative Brachy date of July 20th.
-undecided as yet