RP v SI (or PBT)

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Gleason 6
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Date Joined Mar 2011
Total Posts : 876
   Posted 4/1/2011 11:35 AM (GMT -6)   
I'm still (and I guess I will always be) coming to terms with having cancer.  I've had some good and bad days and the comments here have helped.  I have a CT scan scheduled for next week and a meeting with the doc to discuss the results of the biopsy and CT a couple of days after the CT.  IF the cancer is confined to the prostate, I'm trying to think of the options.  I don't think I could  deal with the ED and incontinence (but who knows).  If I thought I might have a couple of good years without doing anything, I may choose that.  I'm sure that there are those who are happy with their choice of whatever form of treatment they have had.  My question is are there any who regret their choice?  Thanks for your input.

Gleason 6
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Date Joined Mar 2011
Total Posts : 876
   Posted 4/1/2011 11:39 AM (GMT -6)   
I added this to my profile, but it does not display...maybe it takes some time to populate.

Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6
Kids 12/16
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6
Kids 12/16

Veteran Member

Date Joined Dec 2010
Total Posts : 3886
   Posted 4/1/2011 12:12 PM (GMT -6)   
Welcome, but sorry you had to meets us here.
Based on the information you provide you should have several options.   Surgery, permanent seed brachytherapy, and HDR temporary brachytherapy all have similar long term effects at controlling and potentially curing the cancer.  
The side effects from surgery are generally more common and sever compared to the radiation choicews.
Listen to your doctor, I assume he is an urologist.   Generally there bias is surgery.  Meet also with two different radiation oncologists, one that does HDR temporary brachytherapy and one that does permanent seeds.
Also ther are many websites and books available.   I am sure some other posters will fill you in with books to read.
Best wishes, you will do well. 

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 4/1/2011 12:33 PM (GMT -6)   
meet them all.

my only regret is getting cancer.

my personal belief, no matter what anyone told me, was that I wanted the organ containing the cancer out of me. my instincts told me that was the most prudent way to go.

Bias is towards surgery with most people, true. But all surgeons I spoke with told me radiation would also work for me. They also told me that radiation can also caused ED and incontinence.

My boss did HT followed by the seeds and he would wet himself all the time.

I had surgery and never leaked a drop. No ED really, just different experience with sex including different ( better ) orgasms.

Many do have side effects from the surgery, many don't.

The skill of the surgeon and your fitness level and age going into it seem to be factors that determine outcome to a large extent.

Also, you'll hear that once you have radiation yo cannot have surgery. That was another reason I steered towards surgery. But since then I've read a few articles that point out that very skilled surgeons can operate after radiation.

Also was told that radiation can cause other problems down the line.

Best bet to to talk to specialists in as many areas as possible and ask them the pros and cons of their method vis-a-vis the other.

Keep in mind that a lot of older surgeons and doctors didn't have robotic surgery during their 20-30 year experience and never got into it. My urologist flat out told me that he recommended robotic surgery in my case but that he couldn't help because at 45 he was too lazy to start all over again and learn a new technique.

The guy who did the seed son my boss is called Stock. From Mt. Sinai. If you're in NYC you could see him.

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Date Joined Jul 2010
Total Posts : 3887
   Posted 4/1/2011 12:38 PM (GMT -6)   
Your PSA velocity is rather high so postponing treatment for very long might not be a wise choice.. Your CAT, MRI and bone scans can be clean but that's no guarantee the PC is still 100% contained in the capsule..The scans seldom show anything until the cancer is well-advanced..Gleason 6 however usually stays in the barn for quite a while..The doctors all promote what they are selling and the members of this forum tend to promote what worked for them...With G-6, all the treatments seem to work equally well.. With PC, it's the skill of the doctor you choose, not the particular treatment you choose, the determines the outcome..

I chose surgery mainly because I am high-risk (G-9) and should it fail (it did fail) I could fall back on radiation for a second chance. If you start with radiation, it better work, because there is no second chance...When you are fighting for your life, the side-effects you must endure become a minor issue..But G-6 and G-9 are two completely different things...Knowing what I know now (hindsight is always 20-20) I would have chosen seeds plus IGRT which probably offers the highest cure rate of all the PC treatments. But in my case, there were major insurance issues and travel issues which could not be ignored...

Proton beam has not proven itself to be any more effective on PC than IGRT.. They claim reduced side effects..Radiation treatment is very expensive. Proton treatment is even MORE expensive and insurance companies sometimes balk..You might have to travel to get it, and for 40 treatments, that's a major added cost..The latest and greatest photon (X-ray) machines (Varian Novalis RapidArc) can deliver a finely controlled beam that pretty much avoids the side-effects endured by patients on the older machines..But even so, that 10year old equipment did a pretty good job and is still being used today..
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd 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. 2-15-'11 PSA 0.0

Post Edited (Fairwind) : 4/1/2011 11:50:31 AM (GMT-6)

Veteran Member

Date Joined Sep 2010
Total Posts : 2680
   Posted 4/1/2011 1:09 PM (GMT -6)   

Gleason6:  You are asking if anyone regrets their particular treatment choice, and you seem particularly concerned about incontinence and ED issues.  I guess those are the two biggest worries for most men.

My signature tells my personal experience in those two areas after DavCinci surgery, but of course everyone is different and the results vary.

I don't regret my choice, but I did want to point out something I didn't know until after surgery:  you can have an active sex life including orgasm without an erection, and the orgasm is generally just as good or better than before.  How soon (or whether) the erections return is an individual thing and seems to depend on a lot of factors:  overall health, age, situation prior to surgery, and so forth.

I would suggest that you discuss your concerns with the doctors you're dealing with and evaluate their responses.  They know your individual situation. 

Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays negative.
DaVinci 8/20/10
Negative margins; negative seminal vesicles
5 brothers, ages 52-67 ; I'm the only one with PCa
Continence OK after 7 weeks. ED continues.
PSA 1/3/10: 0.01

Veteran Member

Date Joined Sep 2008
Total Posts : 744
   Posted 4/1/2011 7:49 PM (GMT -6)   
I'm not sure I understand how proton beam was suppose to be more effective than photon beam. I never thought it was billed that way. It's still ionized radiation. From what I understand proton may have less side effects...I tend to believe that just by observation at the yana site, comparing the listed side effects of those with photon and those with proton. But I never heard or read proton advocates claim it's superior to photon in terms of effectiveness.

Gleason 6
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Date Joined Mar 2011
Total Posts : 876
   Posted 4/1/2011 9:50 PM (GMT -6)   
I did not know that you can have an orgasm without an erection. I never really thought about it. I just assumed that ED meant no more orgasm and no more sex. Must seem silly to be faced with dying too soon and be thinking about sex.
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6
Kids 12/16

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 4/1/2011 9:56 PM (GMT -6)   
you're not dying and we can't help it, we're always thinking about sex.

After surgery you will have different levels of erections. Sometimes 100%, sometimes 10%. You can have the same orgasm regardless. And in my case and that of some others here the orgasms are far more intense than pre-surgery. That was a big surprise.

Regular Member

Date Joined Nov 2010
Total Posts : 264
   Posted 4/2/2011 7:09 AM (GMT -6)   
Gleason 6,

In my case I had seed implants and have no regrets about the method of treatment I chose.
Like you I did think about dying. I think it's a natural reaction. However, at over a year later since
my diagnosis I have gotten beyond that thinking for now. At the time I couldn't sleep and had
night terrors when I did. That phase has passed. Once the treatment is done there is no going back
so that relieves some of the mental stress. Once my PSA numbers showed a downward trend that was
a relief.

Hang in there. Study your options carefully. Make a decision and get it taken care of. You'll be OK.
age 57 2/2010
PSA Feb 8.2
biopsy 2/2010 - 2 of 8 left & 2 of 8 right positive, Gleason 3+4=7
attended support group - advised to get a second opinion
second opinion on pathology from Johns Hopkins 4+4=8
PSA 15 4/2010
5 weeks IMRT 4/2010-6/2010 at Copley Hospital in Aurora, IL
91 palladium 103 seeds 7/2010 at Chicago Prostate Center, Westmont, IL
PSA Oct 3.97, Dec 2.78, 3/9/11 2.42

Veteran Member

Date Joined Jan 2011
Total Posts : 929
   Posted 4/4/2011 3:06 AM (GMT -6)   

Gleason 6 – Once you do make the treatment decision, I think you will find that you will be at peace with it.  At least that’s what happened to me.  After getting my 3rd opinion, I had three recommendations: AS, surgery, or seeds.  My wife and I did a lot of research, a lot of reading, and I talked with other men who have gone through treatment.  There was much deliberation, anxiety, and angst.  I went back and forth on which was best for me, but once the decision was made … I was at peace with my choice. 


Age 53
Diagnosed Dec 2010
PSA 5.3
Biopsy: 50% in 1 of 12 cores, Gleason 6
PSA 5.6
RRP scheduled for 6/6/2011

Regular Member

Date Joined Sep 2010
Total Posts : 225
   Posted 4/4/2011 1:33 PM (GMT -6)   
No regrets. Urologist gave me the standard three options: AS, Surgery & Radiation. I asked him if it were him what would he do. His answer: surgery.

I decided not to do radiation because of my bias (see my new post). It is probably wrong and radiation is OK but I will never know. I did not want to do AS for I wanted to "take action" right away.
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Organ confined, negative margins, Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason 4+. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 no incontinence, no ED. 3/2011 PSA: <.1

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 4/4/2011 1:53 PM (GMT -6)   
Gleason 6 said...
...My question is are there any who regret their choice?  Thanks for your input.
Gleason 6,
You have posed an interesting question, but hopefully without even reading any of the answers you realize that you would be hard-pressed to find any individual who would confess that he regrets his choice.  (Interesting consumer behaviour studies in this area regarding new car purchases...the car someone selects suddenly becomes the best car anywhere.)
There have been several related studies regarding prostate cancer treatment.  Here's the link to an abstract of one I can easily put my hands on regarding a measure of the quality of life.  For "low risk" PC patients, active surveillance had the highest QALY (quality adjusted life years).  LINK

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 4/4/2011 2:11 PM (GMT -6)   

Here is good summary of the available treatments. I had RT almost 30 months ago and in the last three or four months have started getting erections. Nothing to brag about but they are without chemical enhancement. I do not have a partner so I do not worry too much about this aspect. But I realise it is important to some.


Best to you,
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10
09/10 1.00
03/11 2.38

Regular Member

Date Joined Jun 2010
Total Posts : 118
   Posted 4/4/2011 2:26 PM (GMT -6)   
I always play coulda woulda shoulda after everything I do. It keeps my ego in check. There isn't anything major I do that I can't over analyze to see what I could have done differently. Next time I take my prostate out....

Do your research, make a decision, go with it.
PSA 2.1 on Avodart
Biopsy: 1 of 12 cores positive >5%, Gleason 8
open RP: 05/10/2010 Dr. Gary Steinhoff, Victoria BC
Pathology: pT2c Gleason 3 (80%) 4(20%)=7, no lymph invasion, no extraprostatic extension, negative margins, tumor 5% of tissue.
Nerve bundles removed (based on original Gleason 8 biopsy)

Gleason 6
Veteran Member

Date Joined Mar 2011
Total Posts : 876
   Posted 4/4/2011 2:31 PM (GMT -6)   
Thanks for all the good input and relating your exeriences. I'll check out the link. Casey59, I think you have a good point of people being happy with what they select (and hey, they really can't say how they would be if they had selected an alternative and you can't look back once the decision is made), but I just thought tthat some people may have regrets. Maybe it was a silly question. Along those lines for some of us (and I don't know what my options will be right now, but I want to be thinking and learning in case I do have options) the good news is there are several totally different options and the bad news is that there are several totally different options.
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 4/4/2011 2:56 PM (GMT -6)   
it's not a silly question at all. I bet the AS guys who find out it's progressed to far regret it, I bet the RT guys who lose potency anyway or have other damage from radiation regret it or at least ask themselves if other treatments would have been better. I'm sure some surgery guys who have to have radiation anyway and/or lose potency might regret it.

I think it's all about the results we get. And the point is that with your numbers, pretty much any treatment will do the trick.

I remember an interview I saw with Frank Zappa where he talked about regretting the fact that he hadn't caught it earlier so that he could operate. That was his biggest regret.

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Date Joined Sep 2008
Total Posts : 4271
   Posted 4/4/2011 3:01 PM (GMT -6)   
G6, over the 2 1/2 years I have been coming to HW I can recall several surgery patients who had bad outcomes who regretted their choices.  I can also recall at least one failed seed patient who chose a disastrous follow up treatment and was therefore unhappy with his choice of seeds.  Of course, since surgery is more prevalent and there are more surgery patients who visit this site, it's not unexpected that we would see more disappointment in that area.
As for myself, I am absolutely delighted with my choice however...if I had known then what I know now, I would have insisted on a color dopple scan.  My seeding was borderline as to whether or not to add IMRT...I did not.  However, it would have been nice to have the CD assurance before I made the final choice.
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
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