RADIATION VS. RP

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Temenos
New Member


Date Joined Jul 2010
Total Posts : 2
   Posted 8/16/2010 8:15 PM (GMT -6)   
Hello Everyone... this is my first posting. I am trying to decide between radiation with hormone therapy (6 months of hormones with radiation for the middle 2 months) versus an RP. I have traveled to Boston and met with a number of doctors. They are all optimistic. A very experienced surgeon (over 3 thousand prostatectomies!) says that he can get this done. A very experienced radiation oncologist says the same thing. I am wondering if anyone has been in the same dilemma. I am wondering what your experiences are with the side effects from either one. Thank you.

age: 68 - 5' 6" - 137 pounds
very athletic - still play basketball, tennis and running.
biopsy June 25; Gleason 3+ 4 = 7
PSA's are all under 4 - there was some concern about acceleration which led to biopsy
Perineural Invasion; some evidence of extracapsular invasion

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/16/2010 8:41 PM (GMT -6)   
Welcome to the site.

Because I have an advanced case I have had both therapies with low morbidity. Have you had a second opinion as yet on the biopsy. You can have your slides sent to Bostwick Laboratories or to Johns Hopkins' Jon Epstein and get a another opinion. This might be very helpful in deciding a therapy...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3893
   Posted 8/16/2010 8:50 PM (GMT -6)   
Sorry you are here Temenos, but welcome to the board..

This is the age-old question..Your stats point to a cure either way..You left out some key information, how many cores, how many positive cores, percentage of cancer in each positive core...DRE result? "Stage"?

Both the surgeon and the R-doc can back up their claims as far as curing you, so it's basically a choice of side effects..Your small stature and athleticism should help mitigate them but the combo of radiation and HT is not a cake-walk by any means. With a PSA under 4, you can take your time and research your decision carefully. This board is FULL of threads that deal with this subject. Of course, everyone favors the treatment that worked for THEM and the guys who had treatment that did not work, well, they don't write much anymore...

If you don't already have one, get a copy of "Guide to surviving prostate cancer" by Dr. Patrick Walsh. 2007 edition. Read it cover to cover. Knowledge is power..

I too am in the same situation as you, my prognosis is somewhat worse, but so far I'm going with surgery (robotic) because, well, I think it's as good a place to start as any..But I'm not 100% committed.. With surgery, 3 days later, (when the complete biopsy comes back) you pretty much KNOW where you stand...

Good luck to you, read and learn and then make an informed decision..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/16/2010 8:52 PM (GMT -6)   
I agree with TC-LV. I think that you need to be as certain as you can be about your gleason score. My initial biopsy was a 3+4. Final pathology showed that I nwas actually a G8. If you find that it is very likely that the tumor is aggressive and not capsile contained you may want to strongly consider radiation therapy as opposed to RP.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/16/2010 9:10 PM (GMT -6)   
Hey,

Some more info on your biopsy would help us to understand your case. Arguements can be made pro/con both methods you mentioned. I agree too, that a second opinion from a higher source of your biopsy slides could be useful. Do you have any family history with PC? What kind of velocity issues did you have? Velocity has been the most darning thing in my own case so far. Sounds like you are doing the right stuff by getting opinions out there, and not racing for a decision. That's a good start.

I agree to, the Walsh book is a good primer, and of course its biased toward surgery, but its still a bible of good general information. With have men here experienced with almost any kind of complications and side effects you can imagine, my own case included. We also have men that just breeze right through the process.

Be leary of any doctor guaranteeing anything, doesn't work that way in reality. Please keep us posted on your case. This is a great place to be if you are dealing with PC, we got a good group of brothers and sisters, more like family most time.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/16/2010 9:31 PM (GMT -6)   
BB_Fan I was thinking the opposite...

The new guy is 68, he might even be better suited for active surveillance if he is just Gleason 6.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 8/16/2010 9:41 PM (GMT -6)   
I wish there was a magic formula that made it very plain.

It is a complex decsion cycle. You will find men on this site who have selected most the standard treatment choices and have failed to some degree. Not necessarily because they chose the wrong treatment, but because the PC is such a nasty bugger.

If you look at the nomograms, and the various studies, you will also find that the outcomes are all comparable in success and failure rates.

It really will come down to what you feel comfortable with. The more you can learn about each treatment and how it may affect you, and the diagnosed PC, the more you will find yourself becoming more comfortable with a choice over another.

Good luck on your journey.
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
1 year psa (364 days) .01
15 month PSA <.01

April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 8/16/2010 9:46 PM (GMT -6)   
Maybe one of the more knowledgeable guys can explain this to me or correct my assertion. I thought if someone was going to get HT (either by itself or with one of the forms of radiation), they were pretty certain the PCa is not confined to the prostate.

So a RP by itself would not be a wise choice (unless accompanied by an adjuvant or salvage radiation), but Temenos's surgeon thinks just the RP can (probably) cure him, but the Onco's treatment indicates PCa has already escaped the prostate??????

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean
PSA tested on 7/15/10: Zero Club membership card issued (trial membership with 90 day renewal)

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 8/16/2010 9:59 PM (GMT -6)   
Escaping the prostate capsule and escaping the prostate margin are 2 different things. We can have an EPE, but a skillful surgeon can cut around it and leave it inside the cutting margin.

Sometimes HT is used prior to surgery, to shrink the prostate, or to arrest the cancer until the surgery is performed.
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
1 year psa (364 days) .01
15 month PSA <.01

a777
Regular Member


Date Joined Aug 2010
Total Posts : 22
   Posted 8/16/2010 10:25 PM (GMT -6)   
Hi.
I'm also pretty new here.
It is a great place.
Please see my post from a few weeks ago...some great info in there.
http://www.healingwell.com/community/default.aspx?f=35&m=1872147
Age-64
PSA- 9.9
G7 (3+4)
6 of 10 positive (two were 2% at 3+3 so nothing to worry about)
The part to worry about-
left base (conventional type seen in 2/2 cores, involving 50% of submitted tissue, G7 (3+4-pattern 4 accounting for 40% of tumor)
left mid (conventional type seen in 2/2 cores, involving 50% of submitted tissue, G7 (3+4-pattern 4 accounting for 40% of tumor)

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/16/2010 10:37 PM (GMT -6)   
The location of the tumor is of primary importance in whether surgery would work or not. If there was any question of extra capsular extension than radiation certaintly would have the advantage as radiation can get a good 15mm of margin compared to the 5mm or so of surgery. Also if there is ECE there is a probability that cells at the margin will not be seen by the surgeon or patholigist. Radiation does a very good job on these.
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


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3893
   Posted 8/16/2010 10:38 PM (GMT -6)   
"I thought if someone was going to get HT (either by itself or with one of the forms of radiation), they were pretty certain the PCa is not confined to the prostate. " <April6>

HT is frequently combined with radiation not because the cancer has spread but because the HT makes the radiation more effective..Radiations cure rate is better if it's combined with HT..

With seed implants, they sometimes use HT to shrink the prostate and the cancer it contains so fewer seeds will be needed to get the desired coverage..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

Post Edited (Fairwind) : 8/17/2010 7:59:14 AM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/16/2010 10:53 PM (GMT -6)   
@April 6th
The debate as to whether to use HT alone or not is relatively shot down in several studies unless there is confirmed metastatic disease. If there isn't confirmed mets, the use of HT alone is not a good idea. Here is a link in today's Prostate Cancer InfoLink news feed:

tinyurl.com/394us88

There is consistent mounting data that HT is a bad idea for local prostate cancer, and that RP consistently outperforms radiation therapy in all risk groups. I can probably site a dozen retrospective studies that agree with this post at the InfoLink. But the Sitemaster at the InfoLink asks a valid question: Is it necessary to do the more invasive procedure to get those results. I posted a reply to his post that will show up tomorrow. I think that it is important to look at age and life expectancy and also the aggressiveness and stage of the disease. In this post, Temenos is 68 years old. If he is genetically tied to a family that lives into the 90's, and he is otherwise healthy, then he should take the prostate cancer specific mortality rates more seriously. If not then it is possible that will do well with radiation therapy of any kind, or possibly even not treating the disease if his health is poor. I'll let Temenos clarify that. But combination therapies have more side effects, and adding HT is going to be the potentially worst one.

I do not know of any circumstance where HT alone is a best procedure except in stage 4 disease or where life expectancy is very short.

John T, you and I will debate that forever. EPE or positive margins alone are not a basis for eliminating a surgical intervention as an effective therapy. In the link above Michael Zelefsky is the Editor in Cheif of Brachytherapy magazine and even he acknowledges that.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 8/16/2010 9:57:34 PM (GMT-6)


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 8/17/2010 7:56 AM (GMT -6)   
Thanks guys for filling me in and shedding some light on the HT aspect. Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean
PSA tested on 7/15/10: Zero Club membership card issued (trial membership with 90 day renewal)

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 8/17/2010 9:58 AM (GMT -6)   
TC-LasVegas said...
BB_Fan I was thinking the opposite...

The new guy is 68, he might even be better suited for active surveillance if he is just Gleason 6.

Tony


I believe it was stated that his Gleason was 7, not 6.

It would seem to me that Temenos, or perhaps that is "tememos" at age 68 might consider brachytherapy, or brachytherapy in combination with IMRT in place of either radiation alone or RP. At age 68 with his situation I am a bit surprised that RT was even recommended. Many surgeons would not even consider RP in a man over 70 years of age, and Temenos is very close to that.

Sancarlos
Age 66
PC diagnosed 7/2009
Stage: T2c
Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11.15.2010 + hormone therapy (Lupron) + IMRT on Novalis (February-March, 2010), 45 gy.
Casodex added 8/9/2010.

PSA at time of diagnosis: 11.9
PSA 10/2009, 5.0
PSA 12/2009, 0.56
PSA 5/2010, 0.15
PSA, 8/9/2010, 0.066

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/17/2010 11:06 AM (GMT -6)   
Sancarlos,
I was responding to BB_fan's post suggesting that he should get a second opinion from a reputable pathologist. If the Gleason is downgraded then perhaps he can be in no hurry to do an intervention. If it is still G7 then his overall health is a factor as to whether to do anything. The determination as to whether to do surgery should never be placed on age alone but rather overall health and life expectancy. We have had many members treated at 70 or above and doing quite well.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/17/2010 11:18 AM (GMT -6)   
The age 70 bit is not a hard line in the sand, would depend whether the patient is a "young" 70 or an "old" 70, factoring in their general medical history and current ailments if any.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39

Temenos
New Member


Date Joined Jul 2010
Total Posts : 2
   Posted 8/22/2010 7:41 PM (GMT -6)   
Hi All... thank you so much for your quick responses. I am new to this site and did not post my PSA ratings which are: 2.1 (July '07); 2.0 (Dec. '07); 1.9 (Feb.'09); 2.9 (March '10); 3.4 (April '10).
Biopsy results this past June: Gleason 7 (3+4 according to Jonathan Epstein) 12 cores taken; four involving 5%,5%,20% and 80%. All rest were negative. There is clear evidence of extracapsular extension and perineural invasion. One reading of my endorectal MRI suggests seminal vesicle involvement. Clare Tempany and others say no to this seminal ves. finding. Although a leading surgeon was quite confident that he could be successful with an RP and spare one of the nerves...I am strongly leaning toward 6 months of hormone therapy with 2 months of radiation in the 3rd and 4th months. Thanks again for your thoughts about this.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3893
   Posted 8/22/2010 8:30 PM (GMT -6)   
Perhaps you should look at combining brachytherapy (seeds) and IGRT.. If its already outside the capsule and you are thinking radiation, you might as well do the Full Monty, take the heavy dose that only the combined treatment can provide (150 Gr) and hope for the best..The side effects for this are no worse than EBRT radiation alone if done properly..There is no reason to go through surgery and then have to endure radiation treatment too...

You and I are standing in exactly the same place..

I put your numbers in the Han table and you have a 94% chance of having an undetectable PSA after 10 years with surgery...You have a 73% chance your cancer is organ confined..But don't take my word for it, read the Han and Partin tables yourself!
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

Post Edited (Fairwind) : 8/22/2010 8:24:07 PM (GMT-6)


F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3997
   Posted 8/22/2010 8:56 PM (GMT -6)   
Temenos -- your numbers are similar to mine.  i think the combo treatment is wise.  i think you hit PC as hard as you can and don't hold anything back especially if there's a good chance it's out of the capsule. there's an old guy at the radiation clinic who's 75 with a PSA of 20 who's undergoing the same exact treatment as me.  he's spry and very sharp and has a brother in his 90s.
he's a couple of weeks behind me in IGRT but he's had the brachy and has been on lupron for months.
 
he comes from out of town for treatment and his only complaint is urinary urgency and a little tiredness.  his libido is also non-existent.
 
F8


age: 55
PSA on 10/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
ADT, brachy and IMRT

Post Edited (F8) : 8/22/2010 8:28:58 PM (GMT-6)


AnotherDisplayName
Regular Member


Date Joined Aug 2010
Total Posts : 54
   Posted 8/23/2010 5:36 AM (GMT -6)   
Not only do you have to decide between RP or RT, you need to investigate the different flavors of RT. I was lucky to hear about proton beam therapy soon enough to look at it pretty thoroughly, and once I did the decision was a no-brainer. Buy Bob Marckini's book ("You Can Beat Prostate Cancer", $18 from Amazon). It's the best $18 you'll ever spend. Go to his website (www.protonbob.org) and contact some of the survivors. Take your time -- you've probably got plenty of it -- and make your decision.

The interesting thing I found when doing this was that if you talk to anyone who has survived any treatment with a decent overall experience, he'll recommend whatever treatment he had. He is, after all, alive, in spite of minor difficulties, perhaps, like incontinence, impotence, recurrence, etc. But the average proton patient is positively enthusiastic about it. He is not only alive, but the treatment itself was a genuinely enjoyable experience, he's living a normal life now, and has joined a growing social fraternity. I'm planning for my 6-month checkup now, and the hardest part is arranging the social schedule at the treatment center (UFPTI in Jacksonville). My 1-hour checkup has become a small part of a 3-day vacation.
Mike

Tracked PSA over last 19 years
Diagnosed 9/2009 at sudden PSA rise to 4.6; Biopsy Gleason 6, Clinical T1c
Proton Beam Therapy March-April 2010
Now back to normal, everything works, no side effects.
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