Prostates over 60mm are not candidates for seeds, although a large prostate can be shrunk up to 50% with a combination of Casodex and Proscar for a period of a couple of months. Patients with urinary issues may not be candidates for seeds as the radiation will make the issue worse.
Seek a Brachytherapist that has done at least 500 procedures. Like surgery this is a skilled and experienced based procedure and better doctors get better results. The Dattoli Cancer Center, Chicago Prostate Center, Seattle Prostate Center and RCOG all have long term reliable data on both cure rates and side affects.
A combination of seeds and IMRT is very effective for high grade gleason, higher cure rates than surgery alone. The advantage of a combination therapy is that two different types of radiation are used, so if a pc cell is resitant to one form the other will kill it. Also dead spots are reduced and margins can be targeted up to 15mm. The higher dose about
140 to 150 gy is far higher than radiation alone at 81gy with no increase in side affects. A combination of Surgery and salvage radiation will approach these cure rates, but with much higher side affects and complications.
There are many 15 to 20 year studies comparing brachytherapy and combination therapy to surgeryacross all Gleason grades.. The Prostate Cancer Study Group details all theses studies and was composed of well known doctors from all fields, pathology, surgery, oncology and radiation.
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.