Trying to make a decesion

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EON
New Member


Date Joined Jan 2011
Total Posts : 3
   Posted 1/28/2011 7:57 PM (GMT -6)   
54 in Sept 2010, Random check up in April 2010 showed PSA at 7.4, Dr suggested Appt with urologist but I had no clue what PSA was or meant.  Sister in law is nurse praticioner, saw test results and highly suggested another appointment.  In Sept saw urologist and cartoligist the same day .  Had heart cath the following day and got stint placed in right decending artry.  PSA came back at 9.2
 
Dec 2010 had biospy, with multiple samples finding PC is all areas from 2%  upto 22%.  Bonescan was normal and have been presented RP surgary or IHRT with seed implants as only options.  Gleason Score was 7 T2a or b
 
Found and spoke with several guys that had surgary but none that went with the
RT. Don't like the idea of surgary and leaning towards RT with seeds.
 
Would appreciate any input on RT pros of cons. Hopefully I have all the abreviations correct.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/28/2011 8:37 PM (GMT -6)   
You will need to talk to Tudpock and John T and a few other guys whom know it best. IMRT with brachy seeds has a good track record and especially with Dattoli and maybe RCOG and a few other more reknown location centers. Go and get your copy of the pathology in your hands, tells more than you might think.

I doubt you will have to wait eon's to hear from some guys herein. I hope you like cheap humor, some say I'm full of that too.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

JNF
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Date Joined Dec 2010
Total Posts : 3745
   Posted 1/29/2011 5:54 AM (GMT -6)   
High EON,

I was similar with a Gleason of 7 and involvement in all cores. My urologist suggested against surgery as he said the probability of positive margins was significant and would probably require Salvage Radiation Therapy.

He suggested High Dose Radiation Brachytherapy and IMRT. I investigated HDR and Low Dose Permanent Seed Brachytherapy. I consulted with many practitioners including Dr. Frank Critz at RCOG (I live in Atlanta). I also researched some of the leaders in HDR including Dr. Jeffrey Demanes at UCLA and Dr. Martinez in Detroit. I found I had several HDR choices in Atlanta and spoke with them.

What I learned is that HDR is the more modern version of permenent seed implants. It is more accurate in the placement and doseage, does not leave anything in the body, solves the problems of seed migration and movement, and thus produces fewer and less significant side effects with increased effectiveness.

HDR is not new. Demanes has performed it since 1981 and it is used in many other cancers including breast cancer. The rad-onc practice I chose has been performimg it for more than 10 years and my rad-onc and urologist have done more than a thousand procedures. I found the best information to be on the website www.cetmc.com. It is very detailed and includes treatment results statistics. I would be happy to communicate with you directly to provide the details of my treatment.

Best wishes on you decision and we are all here to help.

GTOdave
Regular Member


Date Joined Oct 2010
Total Posts : 175
   Posted 1/29/2011 7:11 AM (GMT -6)   
EON, who told you that seeds were your only option?

I can certainly respect your personal decision to opt for a radiation therapy, but if the PC has not metastasized, surgery is, in my non-medical, professional opinion, at least on the table.

When you scan thru pages here of posts, the info available by fellow PC patients is staggering. There is plenty to read and learn. Buy and read the recommended books. Diet and lifestyle changes make profound differences.

Most of all, be aware that surgeons, more often than not, recommend surgery. Same is true for radiation treaters. These people believe strongly in what they do.

Most important, don't make the same mistake I made. Meet with at least 2 doc's and get a second opinion. It could save your life.

Dave
52 yr old, PSA 3.5, Gleason 6 with 3 of 4 top nodes (0%;1%;10%;1%) cancerous. Bottom 2 floors are clean.

DaVinci prostatectomy scheduled for March 4 at Yale. Lets hope attempt 2 at this goes better than my first try.

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 1/29/2011 11:34 AM (GMT -6)   
EON,
 
My first reaction was to have surgery. After doing more research, including doing a lot of reading on this site, I changed my mind and went with a BT/IGRT combo. Primary reasons were I did not want to go through major surgery at my age and wanted to minimize side effects if possible. All indications were that BT/IGRT would accomplish that with equal  cure rates vs surgery. I have been very happy with my decision. The minor SE's I experienced have all but disappeared.
 
That said, you will find guys here that had surgery and are satisfied with their results as well. You are a candidate for both. Take your time, learn as much as you can, consult with your family and then do what feels most comfortable to you. Best wishes on the journey.
 
Joe 
Age 68 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 12/9/10 - 0.1

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 1/29/2011 11:38 AM (GMT -6)   
>>What I learned is that HDR is the more modern version of permenent seed implants.<<
 
not sure that's true.  HDR was probably more common than permanent seeds before.
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3741
   Posted 1/29/2011 11:45 AM (GMT -6)   
EON, last June I was in the same boat you are in now..I chose surgery mainly because if it failed, a 50-50 chance for me, I could then move on to radiation..Well the surgery failed and I'm doing RT and HT now..The option of seeds and IMRT combined was not available to me in Denver plus there were insurance coverage issues..

So here I am, enjoying the side-effects of all three treatments (surgery, RT & HT) at the same time...(I'm tolerating it very well) At least I'm continent, a MAJOR issue with PC treatment...

Briefly, the combined seeds / IMRT treatment allows a radiation dose of around 150Gy to be administered safely. Studies have shown it to be very effective..

Most medical insurance covers surgery fairly well, but with radiation, especially radiation performed at out of area clinics, you better get pre-approval from your insurance before you agree to treatment...Costs can be staggering..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/29/2011 11:56 AM (GMT -6)   
F8- Ed do you want a correction now or later??? I better find my corregated box room(like you mentioned the ceilings before) and hide out, got to watch out for alien abuctions....it would be my 5th one. (LOL)   This twilight zone stuff is more real than you may believe. smilewinkgrin
 
Eon-  checkout info on such things   www.dattoli.com    www.rcog.com  
Dattoli used to send you a free video to watch and learn about their program, etc.
The site JNF mentioned would likely be worthy of your time.
Go to www.yananow.net   see mentors/experience and find lots of guy whom been there and done that, and you can contact them too. Same goes for surgery, cryo, hifu and kung fu (lol).
 
Education is good medicine, and yes you can O.D. on it also.!

Post Edited (zufus) : 1/29/2011 11:02:49 AM (GMT-7)


F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 1/29/2011 12:33 PM (GMT -6)   
okay i may be wrong but here's a case of HDR more than  15 years ago.
 
 
and my buddy jerry T, a neighbor of purgatory, i know had HDR seeds about eight years ago.
 
after the rectal probings and procedures i'm starting to suspect that my uro is an alien from uranus cool .
 
ed
 
 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3745
   Posted 1/29/2011 1:19 PM (GMT -6)   
Regarding insurance, radiation rtherapy is covered in the same way as surgery. My IMRT 25 sessions cost about $27,000. The two HDR sessions totalled about $12,000. So a little kess than $40,000 is what the insurance paid. I imagine that surgery would be comparable based on a two or three day stay. When my wife had breast cancer surgery last summer the hospital was paid $42,000 for four days. Her surgeons were on top of that.

As for the HDR being considered more modern it uses CT scanning in addition to the ultrasound for positioning for better accuracy. The actual radiation is administered by a robotic afterloader that can deliver different doses to different areas by changing the dwell time to meet the dose requirements. Something that isn't posisible with the permanent seeds.

Demanes at UCLA starte d doing HDR in 1981. So it has been around for several years. Critz started his permanent seed practice RCOG in Atlanta in the 1970s when permanent seed brachytherapy required an open procedure with an abdominal incision similay to open prostatectomy. With both procedures, like most procedures, technology, methodology, and skills have evolved to make things better for us.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4225
   Posted 1/29/2011 3:45 PM (GMT -6)   
EON,
Combination therapy, brachy/IMRT, is commonly used with G7 or intermediate risk cancer and when there is any indication of extra capsular extension. Your Heart issues would also place you at greater risk in having surgery.
A combination treatment can deliver much more radiation 150 gy vs 81gy which is more effective on intermediat risk cancers and will also give a wider margin to pick up any cancer in the prostate bed.
I had combination treatments about 2 years ago and now have a 0.1 psa and no ED or any other side affects. I was able to continue all normal daily activities during treatments.
If you look at data from the Seattle prostate institute and Dattoli Cancer center for combination treatments for DiAmico intermediate risk classifications; 15 year cure rates are 81 to 90%. The comparable surgical cure rates from major institutions for the similar clasifications are 50% to 64%. This data was for patients treated in the early 1990s and current advances in imaging, seed placement and accurracy of the newer IMRT, patients treated today should have better results.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

EON
New Member


Date Joined Jan 2011
Total Posts : 3
   Posted 1/29/2011 6:15 PM (GMT -6)   
Great info, thanks guys, this diffently makes me feel better about my choices. I'm about an hour out of Atlanta and plan to viste a couple Dr's there before making a final decission. I've never been big on surgary from the beginning.
I have a follow up appoitment with the heart dr on the 10th which was the earliest I could get in.  I want his input regarding the surgary before making a decession either way.

Are there any statics or studys showing % of PC returning after RT? I would think if it did return it would be in a different area but don't know.

Post Edited (EON) : 1/29/2011 5:20:25 PM (GMT-7)

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